The ability to treat paranasal sinus disease has been revolutionized by fiberoptic endoscopes and computed tomographic (CT) scanning. Fiberoptic endoscopes have made it possible to examine the nose thoroughly from the anterior nares to the postnasal space. The endoscopic procedure requires local anesthetic and may be performed in the office. CT scanning identifies the anatomic relationships of the key structures (orbital contents, optic nerve and carotid artery) to the diseased areas, a process that is vital for surgical planning. CT also defines the extent of disease in any individual sinus, as well as any underlying anatomic abnormalities that may predispose a patient to sinusitis.

The reasoning and concepts supporting the use of FESS have recently become widely accepted. (The term "functional" was introduced to distinguish this type of endoscopic surgery from nonendoscopic, "conventional" procedures.3,4) The goal of FESS is to return the mucociliary drainage of the sinuses to normal function. The paranasal sinuses are maintained in a healthy state by ventilation through the individual ostia and by a mucociliary transport mechanism that keeps a continuous protective layer of mucus flowing out of the sinuses.

The fiberoptic endoscope enables the surgeon to examine the nose in great detail and is an essential tool for diagnosis. Patients with seasonal or perennial rhinitis should be given advice about avoidance of allergens and treatment with topical nasal steroid sprays and antihistamines. Acute infective sinusitis is treated with antibiotics and vasoconstrictor nasal sprays. If medical treatment has failed, the patient may be a suitable candidate for an endoscopic procedure.

Patient selection therefore involves a thorough history and physical examination, a trial with medical treatment and, finally, CT scanning. The result is a highly selected group of patients who can expect an improvement of up to 90 percent in their symptoms.