Chronic sinusitis that does not respond to drug therapy should be treated with surgery to remove the chronic focus of inflammation. A distinction is made between chronic sinusitis with or without polyp formation.

After imaging the paranasal sinuses using computerised tomography or magnetic resonance imaging, the operation is minimally invasive using endoscopes and special instruments through the nostril. The procedure during the operation is also minimally invasive. This means that only the sinuses that are actually affected by the disease are operated on.

In so-called "FESS" (= functional endoscopic sinus surgery), any existing constrictions inside the nose are treated, the natural openings of the sinuses are located and widened using special instruments. The procedure is performed endoscopically, i.e. with small optics (keyhole surgery) and very small surgical instruments via the inside of the nose; no external incisions are required. This means that no visible scars remain later. The aim of the endoscopic procedure is to permanently improve ventilation and the removal of secretions in the nasal and sinus area. Previous headaches, a constant flow of mucus in the throat, a reduction in smell or a general reduction in performance due to chronic inflammation can be effectively alleviated. For long-term recovery, not only the surgical procedure itself is essential, but also professional ENT aftercare: we ensure this as part of your hospitalisation. The nose and paranasal sinuses are cleaned daily by a doctor using suction, and patients are also taught how to care for their nose independently by trained specialist staff. Thanks to good co-operation with our ENT colleagues in private practice, follow-up care is also guaranteed after discharge from our clinic.

In the case of polyp disease of the paranasal sinus mucosa and simultaneous aspirin intolerance, an aspirin intolerance test can be planned in our intensive care unit following the operation. In many cases, this therapy leads to the prevention of new polyp formation (-> allergy consultation)

In the case of unilateral symptoms and corresponding signs in the imaging (CT, MRI or DVT), depending on the findings, surgery may be necessary without prior drug therapy in order to rule out a malignant disease of the paranasal sinuses. During this operation, the affected region is inspected and, depending on the findings, either surgical treatment (usually restoration of the ventilation of the affected sinus) or a tissue sample is taken.

Malignant tumours of the paranasal sinuses are rare and can become conspicuous through various symptoms: Those affected sometimes suffer from frequent nosebleeds or one-sided obstructed nasal breathing, have pain over the midface, a foul-smelling discharge from the nose or notice a change in the shape of the upper jaw or cheek region. The removal of a tissue sample to confirm the diagnosis can be offered and carried out promptly in our clinic in an uncomplicated surgical procedure. Depending on the type of tumour, an individual therapy must be planned. Depending on their location, many tumours can be treated through the nostrils (endoscopically) or by open surgery. The type of operation and approach is planned after discussing the disease in our interdisciplinary tumour conference and discussed together with the patient. In addition to endoscopic surgery, a variety of open approaches are available, which are used depending on the location and extent of the tumour. Care after a more or less extensive operation is provided in our in-house intensive care unit, among other places, and enables individualised and intensive aftercare. We are always available for a detailed discussion with patients and their relatives to clarify any questions.

Accidents can lead to tears in the base of the skull with cerebrospinal fluid (CSF) leaking into the nose. Bacteria can enter the brain through these defects and lead to meningitis and abscesses in the brain, which is why such injuries should be closed by surgery.

Benign and malignant tumours that are located at the base of the skull can lead to a variety of symptoms. Depending on the location and size of the tumour, surgery through the nose or through combined approaches may be necessary.

Tumours of the pituitary gland (hypophysis) are approached via a transnasal or combined approach through the nose and the top of the skull in cooperation with our colleagues in neurosurgery.

Due to the complicated anatomy , co-operation between several specialist disciplines is sensible and necessary. Only through precise diagnostics can an individualised treatment plan be drawn up, which is followed by patient-specific, problem-oriented, optimal treatment.

The Skull Base Centre at Ulm University Hospital therefore includes the Department of Otorhinolaryngology, Head and Neck Surgery as well as the Department of Neurosurgery, Radiology/Neuroradiology and Oral and Maxillofacial Surgery. As not all tumours can always be completely removed surgically, the radiotherapy department is also an important part of the team.

In addition to the extensive experience of the doctors involved, the integration of the latest intraoperative techniques means an additional plus in safety.

Operations on the base of the skull are generally performed using computer navigation. Intraoperative imaging (mobile DVT device or magnetic resonance imaging in the "brain suite") can be used to visualise residual tumour areas that have not yet been reached during the operation and the operation can be adjusted accordingly.

Since 2017, our clinic has had a mobile digital volume tomograph (DVT). It works by rotating an X-ray tube around the patient, the images of which are used to calculate a three-dimensional image that is similar to a CT scan. The advantage of the DVT is the relatively low radiation exposure and the small size of the device. As our CBCT is mobile, it can also be used intraoperatively, for example to check the position of CI electrodes or osteosynthesis plates before the patient wakes up from anaesthesia. As the DVT is located in the ENT clinic and we have direct access to it, we also have the option of direct imaging of the paranasal sinuses without having to wait for a radiology appointment.

Many frontobasal procedures are now performed via the nostrils using endoscopes, which involves significantly less trauma and less long-term impairment to the patient.