How safe is ESS really?
Reviewed by Joanna Stephens

Endoscopic sinus surgery (ESS) is a very frequently performed operation, both in America and worldwide. This ambitious project looked at the health data of more than 105 million patients across 60 1US HCOS. The cohort of 116,669 patients who underwent ESS showed the following rates of complications, which is extremely useful when it comes to comparing to your own complication rate and practice. The risk of an orbital complication was 0.74% which encompasses: diplopia 0.238%; optic nerve injury < 0.09%; blindness and low vision 0.262%; epiphora 0.256% and haemorrhage into the orbit 0.02% with a canthotomy rate of 0.041%. The risk of a CSF leak was 0.21% of whom 18.5% developed meningitis. The risk of a haemorrhagic complication included epistaxis at 3%, carotid artery injury at <0.09% and risk of blood transfusion of 0.232%. These are interesting findings, as the pattern of complications – bleeding being most common, followed by orbital and then cold blaze complications – aligns with English data and other studies. However, the overall complication rates, particularly for bleeding, appear lower than those reported in other UK studies. 

Complication rates following endoscopic sinus surgery for chronic sinusitis.
Dhamija R, Das N, Ding P.
AM J RHINOL ALLERGY
2025;39(3):197–204.