Snoring occurs when airflow through the mouth and nose is partially obstructed during sleep. This causes the surrounding tissues to vibrate, producing the familiar snoring sound. Factors contributing to snoring include the anatomy of the mouth and sinuses, alcohol consumption, allergies, a cold, and body weight.

Sleep Apnoea

Sleep apnoea is a more severe condition where breathing repeatedly stops and starts during sleep. Obstructive sleep apnoea (OSA), the most common form, occurs when throat muscles intermittently relax and block the airway during sleep. This leads to a significant reduction in blood oxygen levels, causing the individual to wake up abruptly to reopen the airway. Symptoms include loud snoring, episodes of breathing cessation observed by another person, abrupt awakenings accompanied by gasping or choking, morning headache, and excessive daytime sleepiness.

Both conditions significantly impact sleep quality, leading to daytime tiredness, irritability, and increased risk of health problems such as heart disease and high blood pressure. While they share some common factors, their treatment and management strategies may differ significantly.

The Link Between Sinus Issues and Sleep Disorders

The relationship between sinus issues and sleep disorders, particularly snoring and sleep apnoea, is significant due to the impact of nasal obstructions on airflow during sleep. Sinus problems, such as chronic sinusitis, can lead to swelling and inflammation in the nasal passages, obstructing airflow and exacerbating snoring and obstructive sleep apnoea (OSA).

Conditions like deviated septum, where the nasal septum is displaced to one side, can further narrow the nasal passage, increasing the likelihood of airway obstruction during sleep. This obstruction not only contributes to the severity of snoring but can also interrupt the breathing process, leading to the repeated awakenings characteristic of sleep apnoea. Therefore, addressing sinus issues can potentially reduce the symptoms of snoring and sleep apnoea, enhancing overall sleep quality and health.

Sleep apnoea surgery for nasal obstructions

For comprehensive treatment of sleep apnea caused by nasal obstructions, several surgical options are available, each tailored to address specific issues:

• Balloon Sinuplasty: Targets mild nasal or sinus obstructions. A balloon device is inserted and inflated to open up passages, offering a quick recovery with minimal invasiveness.
• Turbinoplasty: Designed for cases where the nasal turbinates, responsible for conditioning inhaled air, become overly large, obstructing airflow. It reduces the size of the turbinates to improve breathing.
• Septoplasty: Corrects a deviated septum, ensuring the nostrils are equally open for airflow, which is especially beneficial for those with structural nasal issues.
• Functional Endoscopic Sinus Surgery (FESS): Utilizes endoscopic techniques to remove blockages and polyps in the sinuses, enhancing sinus function and breathing.

These procedures aim to restore effective nasal breathing, potentially reducing or eliminating the need for other sleep apnea treatments.

How Effective Is Sinus Surgery for Snoring and Sleep Apnoea

The effectiveness of sinus surgery in treating snoring and sleep apnoea varies depending on the individual’s specific condition and the type of surgery performed. Studies have shown that when sinus issues contribute significantly to obstructive sleep apnoea (OSA) or snoring, surgical intervention can lead to improvements in airflow, reduced snoring intensity, and decreased apnoea episodes.

Key Findings:

• Improvements in Sleep Quality: Patients often report better sleep quality and a reduction in daytime sleepiness following sinus surgery.
• Reduction in Snoring: Many individuals experience a noticeable decrease in snoring frequency and volume.
• Decrease in Apnoea Episodes: For those with OSA linked to nasal obstructions, surgeries like septoplasty and turbinate reduction can lead to a significant decrease in apnoea episodes.

Sinus surgery may not be a universal solution for all cases of snoring and sleep apnoea. Comprehensive evaluation by an ent specialist will determine if sinus issues are the primary cause of the sleep disorder and whether surgery is an appropriate treatment option. In some cases, additional treatments or lifestyle changes may be recommended in conjunction with or instead of surgery.

Alternatives to Sinus Surgery

While sinus surgery can be effective for treating snoring and sleep apnoea related to nasal blockages, there are non-surgical alternatives that can also provide relief. These alternatives are particularly valuable for individuals who may not be suitable candidates for surgery or prefer to explore other options first.

Lifestyle Changes

• Weight Loss: Reducing body weight can alleviate pressure on the airway, decreasing snoring and apnoea episodes.
• Sleep Position: Sleeping on one’s side instead of the back can prevent the tongue from blocking the throat, improving airflow.

Medical Treatments

• CPAP (Continuous Positive Airway Pressure): A machine that uses a mask to deliver air pressure into the throat to keep the airway open during sleep.
• Oral Appliances: Devices worn in the mouth during sleep to keep the airway open.

Behavioural Interventions

• Avoiding Alcohol and Sedatives: These substances can relax the throat muscles, exacerbating snoring and sleep apnoea.
• Nasal Sprays and Allergy Treatments: Can reduce nasal congestion and inflammation, improving airflow.

What Do We Tell Our Patients

When evaluating nasal surgery for snoring, the outcome may vary based on a few key points. Based on our experience, starting with nasal breathing improvements and checking progress before more treatments is a thoughtful approach. Sometimes, nasal surgery brings more benefits than expected.

• Extent of Nasal Blockage and Improvement Post-Surgery: The success of nasal surgery often hinges on how much the nasal passages are blocked before surgery and how significantly breathing is enhanced afterwards. Greater improvements in airflow can lead to a more noticeable reduction in snoring and sleep apnea symptoms.
• Severity of Snoring or Sleep Apnea: The level of snoring and sleep apnea severity before surgery plays a critical role. Individuals with mild conditions are more likely to experience a complete resolution or significant improvement in symptoms compared to those with moderate to severe cases.
• Shift from Mouth to Nose Breathing: Transitioning from breathing through the mouth, which can exacerbate snoring and sleep apnea, to breathing through the nose after surgery can have a profound impact. Nasal breathing is generally more conducive to a restful sleep and can significantly reduce the occurrence of snoring and the severity of sleep apnea.

Adopting a step-by-step approach, beginning with enhancing nasal breathing and evaluating progress before considering further treatments, can be a prudent strategy. Sometimes, the benefits of nasal surgery may exceed initial expectations, providing substantial relief from snoring and sleep apnea symptoms.

When Should You Consider Sinus Surgery For Snoring

Considering nasal surgery for snoring is beneficial for several reasons:

• Improves Nasal Breathing: Enhances breathing during both day and night, providing relief from snoring.
• Direct Snoring Treatment: Effective especially for individuals who snore primarily due to mouth breathing.
• As Part of A Combined Treatment: Works alongside other surgical or non-surgical treatments to address snoring comprehensively.

Nasal surgery addresses various issues, including nasal septum, turbinates, and sinuses, improving obstruction and facilitating the transition from mouth to nose breathing.

Functional endoscopic sinus surgery (FESS) is a minimally invasive and safe surgical procedure that is performed by ENT specialists to treat various sinus conditions such as chronic sinusitis, polyps, and other conditions that affect the sinuses.

In this guide, we’ll provide you with a comprehensive overview of FESS, explain how it’s performed, and what to expect during, before and after surgery.

What is Functional Endoscopic Sinus Surgery?

FESS is a surgical procedure that is used to treat sinus conditions by removing blockages and obstructions in the sinus passages. It’s a minimally invasive procedure that uses an endoscope, a thin, flexible tube with a camera attached to it.

The endoscope is inserted through the nostril and into the sinus passages, allowing the surgeon to see the sinus tissues and remove any obstructions or diseased tissues.

How is FESS Performed?

FESS is typically performed under general anaesthesia, although local anaesthesia may be used in rare cases.

During the procedure, your ENT surgeon will make small incisions in the nasal cavity to gain access to the sinus passages. The endoscope is then inserted into the nasal cavity, and the surgeon can view the sinus tissues on a monitor.

Using specialized surgical instruments, the surgeon will remove any obstructions, such as polyps or inflamed tissue, from the sinus passages.

The goal of FESS is to improve the drainage of the sinuses and promote the healing of your sinus tissues.

Am I A Candidate For FESS Surgery?

Functional Endoscopic Sinus Surgery (FESS) is generally recommended for individuals suffering from chronic sinusitis, polyps, or other sinus conditions that have not improved with medication or other non-surgical treatments.

Whether or not someone is a candidate for FESS will depend on their specific condition and evaluation by an ENT specialist.

What to Expect After Surgery

After surgery, you will typically be discharged the same day. You may experience some discomfort and swelling in the nasal cavity, but this can usually be managed with over-the-counter pain medications.

Your ENT specialist may prescribe saline nasal sprays or rinse your sinuses with a saline solution to help clean them and promote healing.

Most patients are able to return to work or school within a week or two after FESS surgery, although this will depend on the extent of the surgery and the nature of your work. Your surgeon will provide you with specific instructions for post-operative care, including when to resume normal activities.

Are There Any Risks or Complications?

As with any surgical procedure, there are risks associated with FESS. These may include bleeding, infection, and damage to the surrounding tissues. However, FESS is considered a safe and effective treatment for chronic sinus conditions, and the risk of complications is generally low.

Conclusion

Functional endoscopic sinus surgery is a safe and effective treatment for chronic sinusitis, polyps, and other conditions that affect the sinuses. If you are suffering from chronic sinusitis or other sinus conditions, FESS may be an appropriate treatment option for you. Speak to your ENT specialist to learn more about FESS and if it’s right for you.

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FAQ

Is FESS painful?

FESS is generally performed under general anesthesia, so you should not feel any pain during the procedure. After surgery, you may experience some discomfort and swelling in the nasal cavity, but this can usually be managed with over-the-counter pain medications.

How long does the FESS procedure take?

The length of the procedure may vary depending on the extent of the surgery, but it usually takes between 1-3 hours.

Will I be able to breathe through my nose after FESS?

You may experience some congestion and swelling in the nasal cavity after surgery, but you should be able to breathe through your nose within a few days of the procedure. In some cases, it may take several weeks for the swelling to completely subside and for you to notice an improvement in your nose breathing.

How long does it take to fully recover from FESS?

Recovery time varies depending on the extent of the surgery and the nature of your work. Most people are able to resume daily activities within a week or two after FESS, but you should avoid strenuous activity and exercise for several weeks, until your first review with your surgeon.

How do I prepare for surgery?

Your ENT specialist will provide you with specific instructions to prepare for FESS. This may include avoiding certain medications or foods, stopping smoking, and arranging for someone to drive you home after the procedure.

Is FESS Medisave Claimable and can I use my corporate insurance

In Singapore, Functional Endoscopic Sinus Surgery (FESS) is generally considered a medisave claimable procedure if it is deemed medically necessary by an ENT specialist. However, the amount of coverage depends on the specific case and your Medisave balance.

Corporate insurance coverage for FESS may vary depending on the policy and your insurance provider. Speak to our friendly clinic staff to learn more about financing options for FESS.

Will I need to stop taking any medications before or after FESS?

You may be asked to stop taking certain medications, such as blood thinners, before the procedure. After the procedure, you may need to take antibiotics or other medications to prevent infection.

Can FESS be performed on children?

Yes, FESS can be performed on children who suffer from chronic sinusitis or other sinus conditions. Our paediatric ENT specialists will determine if FESS is a suitable treatment option for your child after an examination.

What should I expect during the post-operative appointment?

During your post-operative review, your ENT specialist will examine your nasal cavity and sinuses to evaluate your healing progress. They may also remove any packing or splints that were placed during the procedure.

What are the alternative treatments to FESS?

Alternative treatments to FESS include medication, such as nasal sprays or antibiotics, or balloon sinuplasty, which is a less invasive surgical procedure. The effectiveness of these treatments may depend on how severe your condition is.

Can I drive myself home after FESS?

No, you will not be able to drive yourself home after FESS. You will need to arrange for someone to drive you home, as the effects of anesthesia will most likely impair your driving abilities.

How long will I need to use nasal sprays or rinse my sinuses with saline solution after FESS?

There is no cookie cutter answer for this. Depending on your healing progress, your ENT specialist will provide you with specific instructions for post-operative care, including how long you will need to use nasal sprays or saline rinses. This will depend on the extent of the surgery and the nature of your sinus condition.

When can I resume exercise and other strenuous activities after FESS?

You should avoid strenuous exercise and activities for several weeks after FESS, as these activities can increase your risk of bleeding and other complications. Your ENT specialist will provide you with specific instructions for when it is safe to resume these activities during your post-operative review.

What should I do if I experience complications or concerns after FESS?

If you experience complications or concerns after FESS, such as fever, severe pain, or bleeding, contact your ENT specialist right away or go to the nearest A&E if your complications are severe.

Can FESS be performed as an outpatient procedure?

Yes, FESS is typically performed as an outpatient procedure, which means you can go home the same day as the surgery.

Overview of Sinusitis

Sinusitis is the inflammation or swelling of the sinuses that surround your nose, usually caused by a viral or bacterial infection. It is a common condition that often clears up without medical treatment. However, if your symptoms last for more than 7–10 days or if you experience a fever or a bad headache, you should schedule an appointment with your general practitioner (doctor).

What are Sinuses?

Sinuses are small, air-filled spaces located in your facial bones that are connected to your nasal cavity or the inside of your nose. Since they surround the nose, they are also known as paranasal sinuses.

Everyone has 4 pairs of sinuses: behind your forehead (frontal sinuses), cheeks (maxillary sinuses), nasal bones (sphenoid sinuses) and between your eyes (ethmoid sinuses).

The main function of these sinuses is to produce mucus, a thin, watery fluid that flows freely from your sinuses into your nasal cavity. This layer of mucus acts as a trap for dust, germs, and other particles in the air. It also contains antibodies and bacteria-killing enzymes that help fight infections.

What is Sinusitis?

Sinusitis, or sinus infection, occurs when excess mucus builds up in your sinuses.

The presence of bacteria, viruses or allergens in your sinuses can cause too much mucus to form, blocking the tiny openings of your sinuses. As a result, mucus is unable to flow through these openings into the nasal cavity. The buildup of mucus in the sinuses encourages germs to grow, leading to a sinus infection.

Most sinus infections can clear up on its own without treatment. However, if your symptoms worsen after 5 days or persist longer than 10 days, a bacterial infection may be present and you should consult your doctor. Occasionally, an infected tooth or fungal infection can also cause sinusitis.

Types of Sinusitis

Sinusitis can be classified into 3 different types based on its duration.

• Acute Sinusitis.Acute sinusitis is the most common type. A viral infection can cause symptoms that last between 1-2 weeks. In the case of bacterial infection, acute sinusitis can last up to 4 weeks.
• Subacute Sinusitis.Subacute sinusitis symptoms last longer than acute sinusitis symptoms, between 4-12 weeks. This type commonly occurs with bacterial infections or seasonal allergies.
• Chronic Sinusitis.Chronic sinusitis symptoms persist for more than 12 weeks and may continually return. This type is usually caused by bacterial infections, persistent allergies or structural nasal problems. It may also require more invasive treatment such as surgery.

Symptoms of Sinusitis

Symptoms of sinusitis vary according to the length and severity of the sinus infection.

In general, if you have 2 or more of the following symptoms accompanied by thick, green or yellow nasal discharge, your doctor may diagnose you with sinusitis.

Common symptoms include:

• Blocked or runny nose
• Postnasal drip or mucus running down the back of your throat causing irritation
• Thick nasal discharge
• Reduced sense of smell and taste
• Cough or congestion
• Pain and tenderness around your cheeks, eyes or forehead

Other symptoms may include:

• Pain in the upper jaw and/or teeth
• Bad breath
• Fatigue
• Fever
• Headaches
• Nausea

When should you see your doctor?

If your symptoms are mild and improving, you don’t usually need to see your doctor and can look after yourself at home. However, see your doctor if:

• Your symptoms are severe or getting worse, e.g.,
  • Fever (above 39 degree celsius)
  • Swelling around your eyes or forehead
  • Severe headache or facial pain that does not resolve with over-the-counter (OTC) drugs
  • Confusion
  • Double vision or other visual disturbances
  • Stiff neck
• Your symptoms persist after 7-10 days
• Your symptoms continue after taking antibiotics prescribed by your doctor
• You experience episodes of sinusitis frequently

Common symptoms include:

The following may increase your risk of developing sinusitis:

• Previous respiratory tract infections such as the common cold
• Allergic reaction to substances such as dust, pollen or animal hair
• Deviated nasal septum: a crooked septum (the wall between the nostrils) may restrict or block sinus passages, making the symptoms of sinusitis worse
• Nasal polyps: small growths that can block nasal cavity or sinuses
• Asthma
• Dental infections
• Immune system disorders or autoimmune diseases such as HIV/AIDS or cystic fibrosis that can lead to nasal blockage
• Allergic rhinitis (hay fever)
• Smoking
• Regular exposure to pollutants such as carbon monoxide, nitrogen oxide, sulphur dioxide or secondhand cigarette smoke

Overview of Sinusitis

Sinusitis is the inflammation or swelling of the sinuses that surround your nose, usually caused by a viral or bacterial infection. It is a common condition that often clears up without medical treatment. However, if your symptoms last for more than 7–10 days or if you experience a fever or a bad headache, you should schedule an appointment with your general practitioner (doctor).

What are Sinuses?

Sinuses are small, air-filled spaces located in your facial bones that are connected to your nasal cavity or the inside of your nose. Since they surround the nose, they are also known as paranasal sinuses.

Everyone has 4 pairs of sinuses: behind your forehead (frontal sinuses), cheeks (maxillary sinuses), nasal bones (sphenoid sinuses) and between your eyes (ethmoid sinuses).

The main function of these sinuses is to produce mucus, a thin, watery fluid that flows freely from your sinuses into your nasal cavity. This layer of mucus acts as a trap for dust, germs, and other particles in the air. It also contains antibodies and bacteria-killing enzymes that help fight infections.

What is Sinusitis?

Sinusitis, or sinus infection, occurs when excess mucus builds up in your sinuses.

The presence of bacteria, viruses or allergens in your sinuses can cause too much mucus to form, blocking the tiny openings of your sinuses. As a result, mucus is unable to flow through these openings into the nasal cavity. The buildup of mucus in the sinuses encourages germs to grow, leading to a sinus infection.

Most sinus infections can clear up on its own without treatment. However, if your symptoms worsen after 5 days or persist longer than 10 days, a bacterial infection may be present and you should consult your doctor. Occasionally, an infected tooth or fungal infection can also cause sinusitis.

Types of Sinusitis

Sinusitis can be classified into 3 different types based on its duration.

• Acute Sinusitis.Acute sinusitis is the most common type. A viral infection can cause symptoms that last between 1-2 weeks. In the case of bacterial infection, acute sinusitis can last up to 4 weeks.
• Subacute Sinusitis.Subacute sinusitis symptoms last longer than acute sinusitis symptoms, between 4-12 weeks. This type commonly occurs with bacterial infections or seasonal allergies.
• Chronic Sinusitis.Chronic sinusitis symptoms persist for more than 12 weeks and may continually return. This type is usually caused by bacterial infections, persistent allergies or structural nasal problems. It may also require more invasive treatment such as surgery.

Symptoms of Sinusitis

Symptoms of sinusitis vary according to the length and severity of the sinus infection.

In general, if you have 2 or more of the following symptoms accompanied by thick, green or yellow nasal discharge, your doctor may diagnose you with sinusitis.

Common symptoms include:

• Blocked or runny nose
• Postnasal drip or mucus running down the back of your throat causing irritation
• Thick nasal discharge
• Reduced sense of smell and taste
• Cough or congestion
• Pain and tenderness around your cheeks, eyes or forehead

Other symptoms may include:

• Pain in the upper jaw and/or teeth
• Bad breath
• Fatigue
• Fever
• Headaches
• Nausea

experiencing Blocked or runny nose?

Consult An ENT Specialist To Get Diagnosed

book appointment

When should you see your doctor?

If your symptoms are mild and improving, you don’t usually need to see your doctor and can look after yourself at home. However, see your doctor if:

• Your symptoms are severe or getting worse, e.g.,
  • Fever (above 39 degree celsius)
  • Swelling around your eyes or forehead
  • Severe headache or facial pain that does not resolve with over-the-counter (OTC) drugs
  • Confusion
  • Double vision or other visual disturbances
  • Stiff neck
• Your symptoms persist after 7-10 days
• Your symptoms continue after taking antibiotics prescribed by your doctor
• You experience episodes of sinusitis frequently

Common symptoms include:

The following may increase your risk of developing sinusitis:

• Previous respiratory tract infections such as the common cold
• Allergic reaction to substances such as dust, pollen or animal hair
• Deviated nasal septum: a crooked septum (the wall between the nostrils) may restrict or block sinus passages, making the symptoms of sinusitis worse
• Nasal polyps: small growths that can block nasal cavity or sinuses
• Asthma
• Dental infections
• Immune system disorders or autoimmune diseases such as HIV/AIDS or cystic fibrosis that can lead to nasal blockage
• Allergic rhinitis (hay fever)
• Smoking
• Regular exposure to pollutants such as carbon monoxide, nitrogen oxide, sulphur dioxide or secondhand cigarette smoke