Recovery after sinus surgery

Contents

Life After Surgery

Sinus Surgery

THE RECOVERY PROCESS

An ethmoidectomy, maxillary antrostomy, powered septoplasty with turbinoplasty, and balloon sinus dilation surgery are different procedures, but what happens following surgery is similar.

It can take several weeks for you to fully recover. You’ll have some swelling and tenderness inside your nose after the surgery, but this is normal. You may have symptoms like a severe cold or a sinus infection. This is due to swelling, dry blood, mucus, and crusting in your nose. To help your nose and sinuses return to normal, your doctor may recommend nasal irrigation or saline sprays and antibiotic lubricants.

After surgery, it’s important to take good care of your nose and sinuses to let them heal properly and prevent scars.

Here are some suggestions for taking care of your nose and sinuses after surgery:

  • Keep your head elevated to help reduce bleeding and swelling after your operation. The first night after surgery, elevate your head with extra pillows or sleep in a recliner.
  • If you have packing material and splints in your nose, make sure they stay in place. If the packing gets clogged, breathe through your mouth. Do not remove the packing or splints.
  • Some bleeding is normal for 2 to 3 days after your operation. If you think you are bleeding a lot, be sure to call your doctor.
  • Don’t blow your nose for at least a week after surgery. Don’t do any heavy lifting, straining, or strenuous exercise. This increases the likelihood of bleeding in your nose.
  • If you have to sneeze, try doing it with your mouth open.
  • Don’t take aspirin. It slows clotting and increases bleeding.

Depending on your surgery, you’ll be asked to return for a follow-up visit about 3 to 7 days after your operation. During that visit, your doctor will remove any packing (if necessary), make sure that your surgery site is healing according to plan, and give you more instructions on caring for your nose and sinuses.

NASAL PACKING REMOVAL

In most cases, your doctor will have placed temporary nasal packing inside your nose to support the newly opened sinus passages and to absorb excess fluid while your tissues heal. Dissolvable nasal packing from Medtronic can help your sinuses heal faster after surgery1 and is gradually absorbed by your body within a few weeks. (Traditional nasal packing has to be removed at a follow-up visit and can stick to the tissue inside your nose, which can make it painful to remove.)

What to Expect During Sinus Surgery Recovery

Though sinus surgery is only recommended as a last resort, some people find no other alternative that can bring them relief from sinus pain. The fortunate thing here is that sinus surgery usually works very well. In fact, endoscopic sinus surgery, which is the most common type of sinus surgery performed today, is about 85 to 90 percent effective.

During endoscopic sinus surgery, the surgeon looks directly into your nose and sinuses through a narrow tube called an endoscope. During an endoscopy procedure, the scope may be attached to a camera, and the surgeon can open nasal and sinus passages, as well as remove any diseased tissue through the scope.

Mary Szczygiel, of Southbridge Mass., had chronic sinusitis for most of her life. At age 65, she decided to undergo sinus surgery to improve sinus drainage, remove diseased sinus tissue, and open up her nasal passages. ” I finally feel like my suffering with sinusitis is over,” says Szczygiel, “Sinus surgery has given me my life back.”

What Happens After Sinus Surgery?

“After sinus surgery, you should expect sinus congestion, mild sinus headaches, and perhaps a small amount of nasal oozing of blood, but this is usually not a significant problem. You should expect to take one to two weeks off from work depending on the physical nature of your job,” says Mark A. Zacharek, MD, residency program director for the department of otolaryngology and head and neck surgery at Henry Ford Hospital in Detroit.

Sinus surgery is one that can be done under general or local anesthesia, and usually patients are fine to go home the same day. “In most cases, packing is not needed, or absorbable packing can be used so you do not need to come back for packing removal after surgery. Sinus pain is not usually severe,” says Martin Citardi, MD, chairman of the department of otolaryngology and head and neck surgery at the University of Texas Medical School in Houston.

It can take several months for your sinuses to fully recover after sinus surgery. “I did not have much sinus pain at all,” Szczygiel recalls, “but it did take a long time to experience the complete results of the surgery. In my case, it took about one year before I really started to appreciate how much better I felt.”

Possible Complications and Risks of Sinus Surgery

“Most complications after surgery are related to issues of bleeding, infection, and anesthesia risk,” says Dr. Zacharek. “Bleeding that requires urgent return to the operating room is rare but can happen.” If bleeding is active during surgery, it can be controlled with nasal packing. “Infection of the sinuses after the surgery may happen and can be treated effectively with appropriately chosen antibiotics,” says Zacharek.

“Anesthesia risks are associated with cardiac arrest, stroke, and death. Though these are rare, proper medical clearance and evaluation by a cardiologist prior to sinus surgery is necessary if you have a history of cardiac disease, diabetes, hypertension, or hyperlipidemia,” says Zacharek.

There have also been reports of injuries to the eye and brain during sinus surgery, but they are very rare. Zacharek points out that the national quoted risk of these injuries is 1 percent. “More serious complications such as brain injury resulting in major hemorrhage or blindness are fortunately very rare when these surgeries are performed by someone experienced in these techniques,” notes Zacharek. These rare risks are due to the physical proximity of the inner sinus cavities to the brain and the eyes.

Some other possible complications include loss of smell and a change in voice quality. Change in voice may be noticed if the physical structure of the sinuses is significantly changed by the surgery, but this is not usually a problem unless you are a voice professional. Sense of smell is usually improved, but may be damaged in rare cases.

How You’ll Improve During Sinus Surgery Recovery

Dr. Citardi stresses that, after sinus surgery, post-operative care is as important as the surgery itself. During the first few weeks, you will frequently return to your doctor’s office to be examined with an endoscope, and you will have your nose and sinuses cleaned out.

“The most important post-operative care issues for patients include close follow-up with the surgeon,” stresses Zacharek. “Additionally, sinus irrigation with sterile saline solution is important. You should also sleep with your head elevated for two to three days after surgery to allow for better nasal airflow. Avoid blowing your nose for a 7 to 10 day period and avoid heavy exercise or contact sports for three to four weeks to prevent bleeding.”

“I would certainly urge anyone with chronic sinusitis to consider sinus surgery,” says Szczygiel. “Find a good, experienced surgeon that you can work with and remember to be patient. Learning how to do sinus irrigations and keeping my allergies under control was a big part of my recovery. Sinus surgery works, but keeping your sinuses healthy is an ongoing process.”

Sinus surgery can be a very effective treatment for chronic sinusitis when medical treatments, including prolonged courses of antibiotics, have failed. Remember that complete recovery can take several months, and that good post-operative care after sinus surgery, including working closely with your surgeon, is as important as the procedure itself.

Find more information in the Everyday Health Ear, Nose, and Throat Center.

How Long Is Sinus Surgery Recovery?

Functional endoscopic sinus surgery

To perform functional endoscopic sinus surgery or FESS, Dr. Yeung guides an endoscope through your nostril in your nasal passages. This thin, flexible tube has a tiny camera on the end, so Dr. Yeung can look for issues in closer detail. Once he identifies your sinus problem, Dr. Yeung uses special medical instruments that also fit through your nostrils to correct the problem by removing or fixing any structures causing a blockage.

Dr. Yeung uses FESS to address several sinus problems, including turbinate reduction and polyp removal. Your turbinates clean and humidify the air you breathe as it passes through your nose into your lungs. Nasal polyps are tear-shaped growths that can block your sinuses and interfere with mucus drainage.

Recovering from sinus surgery

Dr. Yeung introduced functional endoscopic sinus surgery to the Houston area more than 15 years ago. He performs FESS as outpatient procedures, so you can usually go home the same day as your procedure.

In addition to being a skilled ENT, Dr. Yeung’s also known for his advanced technical skills and innovative endoscopic techniques. Because of this expertise, men and women having sinus procedures at Houston Sinus Surgery often see faster recovery times than average. For minimally invasive techniques that don’t involve cutting, you can usually expect to fully recover within a day or two.

Thanks to Dr. Yeung’s skills in endoscopic surgery, you can find long-lasting symptom relief following an FESS procedure as well, resuming regular activities within 7-10 days.

Additional benefits of FESS include:

  • Minimal postoperative discomfort
  • No external scarring
  • Less tissue removed
  • Less bleeding and pain

FESS also comes with fewer risks and complications than other more invasive sinus surgery techniques.

To learn more about sinus surgery, call Houston Sinus Surgery, or schedule an appointment online today.

Post Operative Instructions

What to Expect After Endoscopic Sinus Surgery:

  • Bleeding: It is normal to have some bloody discharge for the first 3-5 days after sinus surgery, especially after you irrigate your sinuses. If steady bleeding occurs after surgery, tilt your head back slightly and breathe through your nose gently. You may dab your nose with tissue but avoid any nose blowing. If this does not stop the bleeding you may use Afrin spray. Several sprays will usually stop any bleeding. If Afrin fails to stop steady nasal bleeding then you should call our office or the on call doctor (see contact below).
  • Pain: You should expect some nasal and sinus pressure and pain for the first several days after surgery. This may feel like a sinus infection or a dull ache in your sinuses. Extra-strength Tylenol is often all that is needed for mild post-operative discomfort. You should avoid aspirin and NSAIDs such as Motrin, Advil, and Aleve (see below). If Tylenol is not sufficient to control the pain, you should use the post-operative pain medication prescribed by your doctor.
  • Fatigue: You can expect to feel very tired for the first week after surgery. This is normal and most patients plan on taking at least 1 week off of work to recover. Every patient is different and some return to work sooner.
  • Nasal congestion and discharge: You will have nasal congestion and discharge for the first few weeks after surgery. Your nasal passage and breathing should return to normal 2-3 weeks after surgery.
  • Postoperative visits: You will have a certain number of postoperative visits depending on what surgery you have. During these visits we will clean your nose and sinuses of fluid and blood left behind after surgery. These visits are very important to aid the healing process so it is essential that you attend all those scheduled for you. There is some discomfort involved with the cleaning so it is best to take a pain medication (described above) 45 minutes before your visit.

What to Avoid After Endoscopic Sinus Surgery:

  • Nose Blowing and Straining: You should avoid straining, heavy lifting (> 20 lbs) and nose blowing for at least 10 days after surgery. Straining or nose blowing soon after surgery may cause bleeding. You can resume 50% of your regular exercise regimen at 1 week after surgery and your normal routine 2 weeks after surgery.
  • Aspirin or Non-steroidal Anti-inflammatory (NSAIDs) medications: Aspirin and NSAIDs such as Motrin, Advil, and Aleve should be stopped 2 weeks prior to surgery. Aspirin and NSAIDs such may cause bleeding and should be avoided for 2 weeks after surgery.
  • Steroid Nasal Sprays: If you were taking nasal steroid sprays prior to surgery you should avoid using these for at least 2 weeks after sinus surgery to allow the lining of the nose and sinuses to heal. Your doctor will tell you when it is safe to restart this medicine.

Postoperative Care Instructions:

  • Nasal Saline Spray: Nasal saline mist spray can be used every 2-3 hours after surgery and can make your nose more comfortable after surgery. These sprays (Ayr, Ocean, Simple Saline) are over-the-counter medications and can be purchased in any pharmacy.
  • Sinus Irrigations: You will start the sinus irrigations with the sinus rinse kits (NeilMed Sinus Rinse Kit) the day after surgery. This must be performed at least twice daily. Your doctor or nurse will show you how to perform the irrigations. At first they will feel strange if you haven’t done them before. Soon, however, they will become quite soothing as they clean out the debris left behind in your sinuses after surgery. You can expect some bloody discharge with the irrigations for the first few days after surgery. These irrigations are critical for success after sinus surgery!

When to Call After Surgery:

  • Fever after the day of surgery higher than 101°F
  • Constant clear watery discharge after the first week of surgery
  • Sudden visual changes or eye swelling
  • Severe headache or neck stiffness
  • Severe diarrhea
  • Steady, brisk nose bleeding that doesn’t get better after using Afrin

Who to Call After Surgery:

During the day you should call the clinic at: 410-955-6070

After hours you should call: 410-955-6242

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Sinus Surgery Recovery

Recovery is often the biggest concern patients have when they’re thinking about having sinus surgery. A lot of our patients have heard how awful the recovery can be. Patients who had sinus surgery in the past often described a miserable experience. After hearing about these types of experiences, many patients are understandably reluctant to have any sort of nasal surgery.

Thankfully, a lot of progress has been made in the way sinus surgery is performed. These days, the recovery process is usually much smoother for a few different reasons. First, we do not routinely use nasal or sinus packing at the time of surgery. In addition, the types of procedures performed these days are much less invasive than what might have been done in the past. Of course, there is a recovery period after any surgery. But many of our patients are pleasantly surprised that recovery is nothing close to the miserable experience described by family members or friends who had surgery 10 or 20 years ago.

It is very important to take good care of your nose after surgery. This is what will allow your body to heal properly after surgery.

These are the instructions we give our patients after nasal and sinus surgery with Dr. Goyal. If you are having surgery with a different practice and surgeon, please check with your doctor to see which instructions they would like you to follow.

What to expect immediately after surgery:

  1. Bleeding: It is normal to experience some bleeding during the first few days after surgery. You may use tissues or gauze under your nose to catch the drainage. You can expect to change the gauze frequently for the first 1 – 2 days. Some patients may need to change the gauze as frequently as every 30 minutes the night of the surgery. You may dab your nose gently with tissue, but do not blow your nose. If you have persistent heavy bleeding, please call our office.
  2. Stuffiness: Your nose will feel very stuffy and obstructed during your first postoperative week.
  3. Fatigue: You will feel very fatigued, sometimes for as long as a couple of weeks after surgery. It is best to take this time to rest as much as you need.
  4. Pain: Most patients do not have severe pain after sinus surgery. But remember that everyone is different and some patients may have more significant pain. Most of our patients do not need any prescription pain medicine. Most use plain Tylenol for pain control.

What to do after surgery:

  1. Pain medicine: Most of our patients find that their pain is well controlled with over-the-counter Tylenol. Do not use aspirin or aspirin related products (Motrin, Advil, Aleve, etc.) because these medications can increase your risk of bleeding. If you have severe discomfort that is not controlled by Tylenol, please call us at 315-254-2030 so that we can find a better option for you.
  2. Other medications: Dr. Goyal will let you know if you need other prescriptions after surgery. Most of our patients do not need any prescriptions after surgery.
  3. Saline rinse: Start using the saline rinse the morning after surgery to irrigate your nose twice a day (with the NeilMed Sinus Rinse kit). You can pick up refills of the salt over the counter at local drug stores or directly from the NeilMed company itself. These irrigations will allow you to clear your nose and sinuses of clots, crusts, and other debris. Try to use the irrigations at least four times a day, but you may certainly use it more often. More information about using the rinse is available on our page about sinus rinses. You can also watch a video on using the sinus rinse.
  4. Saline nasal spray: Using saline nasal sprays throughout the day can also help keep your nose moist. Use a spray like Ocean nasal spray or Ayr nasal spray (or a generic saline spray available over the counter). You should use 2 – 3 sprays in each nostril every 1 – 2 hours throughout the day. Moisture is very important for proper healing.
  5. Activity: You should get plenty of rest after surgery. Straining, lifting, or pushing yourself too hard can increase the amount of bleeding from your nose. Please take time to rest.
  6. Returning to work or school: Most patients take 4-5 days off from work or school. It is fine to return to work or school if you are not having bleeding from your nose and your pain is well controlled. Some patients also find that they just don’t have the energy to go back for a week or more after surgery. So, a lot depends on how you feel and how much you feel like you can do. When you do return, it is important to stay on light duty at work.

The first week:

  1. Do not blow your nose. The best way to clear your nose is to use the saline rinse. If you need to sneeze, do not suppress it. Instead, sneeze with your mouth open.
  2. Do not perform any heavy activity. Avoid bending, straining, or lifting more than 15 pounds. Light walking and normal household activities are acceptable immediately after surgery. You may drive if you are not requiring narcotic medications.
  3. If you experience stomach upset from your antibiotics, active culture yogurt or acidophilus tablets (available at health food stores) on a daily basis may help. If you develop diarrhea, stop your antibiotics and contact our office. Persistent diarrhea may require further medical evaluation.

Beyond the first week:

You will have frequent return visits to our office. At each visit, we will look in your nose with the endoscope to ensure the nose and sinuses are healing properly. Often times, we will remove crusts, debris, and scar tissue during these visits. The first visit is typically 1-2 weeks after surgery. Some patients find it helpful to take a dose of pain medication about 45 minutes before their first postoperative appointment.

At any time:

Call our office if you experience any of the following:

  • Any visual changes or marked swelling of the eyes
  • Severe headache or neck stiffness
  • Severe diarrhea
  • Brisk bleeding

You can also visit our page listing Frequently Asked Questions about Nasal and Sinus Surgery.

If you have other questions about scheduling surgery, having surgery, or the recovery after surgery, please feel free to contact us. In addition to serving patients from the Syracuse, NY area, we treat patients from throughout the Upstate New York region. We treat many patients from Binghamton, Ithaca, Cortland, Utica, Rome, Auburn, Rochester, Buffalo, and Watertown. Our office is located just a few minutes from the major highways in Syracuse, making it easy for patients from all regions of Upstate New York to reach us.

If you are interested in having an evaluation at our office for your nasal and sinus issues, please contact us. You may request an appointment by calling, sending us a text message, or by requesting an appointment online. We are available by phone or text at 315-254-2030. Our office staff is available Monday – Friday, from 8:30 AM to 4:30 PM.

Endoscopic sinus surgery: A tale of overuse

By Arthur W. Curtis, MD

Overuse, or medical care that provides no benefit to the patient, is rampant in our health care system. At least 20% of the money we spend on health care is wasted – more than $700 billion dollars a year – and unnecessary care is a major contributor to this waste.

In my own specialty of otolaryngology (ear, nose, and throat conditions), there is one procedure in particular that has been done unnecessarily on millions of patients and wasted tens of billions of dollars over the past few decades, with no evidence it even works for most patients. This overused procedure is endoscopic sinus surgery (ESS).

Endoscopic sinus surgery has been done unnecessarily on millions of patients and wasted tens of billions of dollars.

As with many overused medical tests and procedures, ESS became popular due to a perfect storm of financial incentives, promising technology, and bad science. I present this example of overuse, not just to discourage this unnecessary operation, but because it so clearly demonstrates how well-meaning, highly-respected doctors and medical institutions can succumb to the perverse incentives in our broken health system, at the expense of patients.

The advent of sinus surgery

Otolaryngologists are constantly searching for ways to alleviate the pain of sinus infections, a condition that affects between 10 – 30% of Americans each year. Bacterial sinus infections happen when sinus passages become obstructed, bacteria multiply, and the sinus chambers fill up with pus under pressure (sorry for that imagery). These sinus infections usually clear up on their own or with antibiotics, but for the occasional resistant cases, sinus surgery is used to re-open the small air passages.

In 1985, when I was an otolaryngologist and faculty member at Northwestern University, endoscopic sinus surgery had just come to the US from Austria, and represented a great advance over older operations. Working through the nostrils with a surgical telescope, surgeons could avoid facial skin incisions, making the procedure much less invasive.

Endoscopic sinus surgery quickly became a big moneymaker for doctors, industry, and institutions. Physicians (and hospitals) could get reimbursed thousands of dollars for each surgery, instead of a small amount for antibiotics. Companies that sold instruments for sinus surgery gave courses and would loan instruments to surgeons to get them started. The procedure was advertised as being extremely safe, with famous surgeons making claims such as, “More than 2500 endoscopic ethmoidectomies have been carried out . . . without any serious complications.”

Creating an epidemic

Just as everything appeared to be going well for sinus surgery advocates, other medical advances were threatening to render sinus surgery rarely necessary. A few years into the ESS boom, otolaryngologists like myself learned to treat difficult sinus infections with antibiotics targeted against anaerobic bacteria. Shortly after that, we learned to open up the sinus passages pharmacologically with a short course of a high dose of an oral glucocorticosteroid such as prednisone. By 1995, with these two new tools, almost no one needed surgery for sinus infections.

Otolaryngologists proclaimed a new disease to justify using this operation on more patients.

But once a procedure has been taught and popularized, it is very difficult to curtail its growth (especially such a lucrative procedure like ESS). Rather than ceasing surgeries, otolaryngologists proclaimed a new disease called “chronic rhinosinusitis” (CRS) to justify using this operation on more patients. Medical experts defined CRS based strictly on symptoms like nasal obstruction, nasal congestion, and postnasal drip, allowing them to declare 10-15% of the population as being “sufferers” of CRS.

Before long, experts from the American Academy of Otolaryngology–Head & Neck Surgery, using modern marketing techniques, was aggressively promoting CRS. The Academy announced “2001: A Sinus-free Odyssey,” a campaign that was part of Sinus Awareness Month in March of 2001. Academy members were exhorted to inform the 37 million sinus sufferers in the U.S. that medical and surgical relief was available for their chronic condition.

Show me the evidence

Proponents of ESS claim that the procedure is effective, citing studies “on tens of thousands of patients” that show improvement in patients who have the surgery. But these studies have major flaws – the most egregious being the lack of control groups. Although advocates for surgery assume that CRS will stay the same or get worse over time, patients with CRS in control groups actually get better over time without surgery. So you can make it look like any treatment helps people with CRS as long as you don’t have a control group. The only randomized controlled trial performed, which came out in 2004, found that maximum medical therapy and maximum medical therapy plus surgery work equally well.

You can make it look like any treatment helps people with CRS as long as you don’t have a control group.

Because of this lack of evidence, specialty guidelines from 2007 and 2015 do not recommend ESS for CRS, nor does the Cochrane Collaborative recommend ESS for CRS without or with polyps. About 365,000 endoscopic sinus surgeries (1.13 per thousand) are, nevertheless, performed in America every year, mostly for CRS. It is also done, usually unnecessarily, for “sinus headache,” “suspected recurrent acute rhinosinusitis,” and various facial pains. This procedure alone costs our health system more than $3 billion a year.

Sinus surgery, like all surgeries, comes with risks. The proximity of the sinuses to the eyes and brain means that small mistakes, or even no mistake at all, can lead to grave complications such as blindness, life-threatening infections, and brain damage. This has hurt doctors as well as patients; from 1985-2005, nearly 40% of otolaryngology malpractice payouts were linked to a diagnosis of sinusitis.

A culture of overuse

Why do highly-respected doctors and medical institutions continue to promote a procedure that is ineffective, that is based on bad science, and that causes patients harm? I know many of these doctors, and they are not bad people. But thanks to groupthink, self-delusion, a bit of arrogance, pressure to generate income for their institutions, the subconscious influence of money, adulation, and fame within the specialty, isolation caused by the hierarchical nature of the medical culture, and careers focused on caring for the most difficult cases—they know not the harm they have caused.

Sinus surgery is far from the only overused medical procedure. This story plays out in every specialty, to the tune of billions of dollars each year. I believe we need big changes in our health care system to stop harmful and expensive unnecessary care, and I’m not the only one who thinks so. Hundreds of clinicians, patients, and community members have joined together in the Right Care Alliance, a grassroots social movement to bring affordable, effective, and safe medical care to all Americans.

We are fighting to stop medical overuse, to ensure that patients are informed of the risks and benefits of their treatment, to encourage evidence-based medicine, and to make people pay attention to the concerns expressed by nurses, doctors, patients and patients’ relatives about suspected unnecessary care. Join us in spreading the word about Right Care, and be a part of the solution.

Top 10 Myths About Endoscopic Sinus Surgery and Balloon Sinuplasty

1.) My nose will need to be packed and the packing removal is very uncomfortable.

In the past, many sinus doctors would pack the patients’ noses with gauze and remove the packing a day or days later. Ask anyone who has had nasal surgery with packing, and they will remark about how uncomfortable it was even years later! Fortunately, packing is not required at all. Newer technologies have obviated the need for it. Whether having traditional sinus surgery or in-office Balloon Sinuplasty, nasal packing is no longer required. It’s a good idea to seek a sinus surgeon who does not use nasal packing regularly.

2.) Sinus surgery doesn’t work very well and often needs to be repeated.

The fact is that the vast majority of patients that have sinus surgery and/or Balloon Sinuplasty have significant improvements in quality of life. In a recent analysis of 45 separate studies conducted regarding quality of life improvements after surgery, all of those studies showed significant quality of life improvements in anywhere from 77% to 97% of patients enrolled in the studies. Sinus surgery is highly effective.

Nonetheless, revision sinus surgery needs to be performed in 15-20% of cases with many of the revisions related to regrowth of nasal polyps.

3.) The recovery is very difficult and takes a long time.

Typically, after traditional sinus surgery, most patients require a few days to a couple of weeks (if doing manual labor) away from work due to some congestion and drainage. With in-office Balloon Sinuplasty, there is little to no “down time.” Most patients return to normal activity within 1-2 days after the procedure.

4.) My eyes will get black and blue.

There are usually no external changes such as getting black and blue unless someone is having cosmetic nasal work done at the same time.

5.) Sinus Surgery/Balloon Sinuplasty will not be covered by my insurance.

The fact is that both traditional sinus surgery and Balloon Sinuplasty are covered by the vast majority of insurance plans; however, there are a few plans that still do not cover Balloon Sinuplasty. Depending upon your plan, there may be pre-authorization required prior to approval of sinus surgery or in-office Balloon Sinuplasty. The office in which you are receiving care should handle this for you.

6.) I’m not sure that in-office Balloon Sinuplasty is safe.

Over 35,000 in office Balloon Sinuplasty procedures have been performed to date with an outstanding safety profile.

7.) Every patient with sinus problems is a candidate for in-office Balloon Sinuplasty.

Many patients have severe structural issues such as a deviated nasal septum or large nasal polyps. These folks are best served by traditional sinus surgery done in a hospital or ambulatory surgery facility under general anesthesia; however, many patients without such severe structural issues can benefit from in-office Balloon Sinuplasty which is done under local and topical anesthesia and has little to no “down time.”

For more information, check here.

8.) Nasal polyps always re-occur and there is no good treatment for them.

While it is true that a percentage of nasal polyps can re-occur, treatment options and technology have provided substantial advances in sinus surgery and decrease the likelihood of re-occurrence. Examples of this include intra-operative navigation which serves to function much like a navigation system for your automobile. It allows surgeons to precisely identify where they are at all times and thus provide additional safety measures.

Also, the Propel™ sinus implant is a substantial technological advance in the treatment of chronic sinusitis and nasal polyps. It is a dissolvable implant that slowly releases topical steroids and helps keep the sinuses open, prevents scar tissue formation, shrinks nasal polyps, and decreases the likelihood that polyps will come back after they are removed.

9.) I’m not sure I can tolerate the in-office Balloon Sinuplasty procedure. I’m afraid it will hurt.

Although some people may be reluctant to have an in-office procedure, a recent in-office Balloon Sinuplasty study revealed that 82% of patients found it tolerable or highly tolerable while 15% found it somewhat tolerable. With the use of local and topical anesthetics, most patients tolerate the procedure very well and describe the sensation as pressure more than pain.

10.) I’m not sure in-office Balloon Sinuplasty will be effective in relieving my symptoms.

In-office Balloon Sinuplasty is a safe and effective procedure. Studies demonstrate clinical and statistical improvement in patient quality of life and radiographic outcomes at 52+ weeks post procedure.

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NOTICE: This is only a guide and is not a guarantee of results. This article is for your entertainment only and is not being given as medical advice. Always consult your personal physician on any medical matters.

Functional Endoscopic Sinus Surgery

Sinusitis afflicts millions of people in the United States every year. It is a disease which causes thickening and swelling of the linings of the sinuses in the face and forehead region, causing symptoms of congestion, drainage, post-nasal drip, diminished sense of smell, and headaches or facial pain. Your doctor has recommended functional endoscopic sinus surgery (FESS) as a means to help reduce these chronic symptoms. But since sinusitis is a chronic disease analogous to asthma or high blood pressure, surgery alone rarely brings cure; however, the symptoms of the disease can often be helped significantly with marked improvement in overall functioning and lifestyle.

What is Functional Endoscopic Sinus Surgery?

Functional endoscopic sinus surgery was developed in Austria in the 1970’s and brought to the United States in the mid-1980’s. The procedure requires no incisions on the face but utilizes “telescopes” which are long thin rods of glass wrapped with stainless steel providing illumination and visualization in the nose and sinus pathways. Instruments that have been designed solely for the purpose of FESS are used alongside the telescopes to perform the operation. The purpose of the operation is to enlarge the drainage pathways of the sinuses thereby preventing the build-up of mucus and pus in the sinuses so common in chronic sinusitis. This can be understood as the sinuses being analogous to the rooms off of a hallway: surgery helps to remove the walls between the rooms and the hallway, resulting in one large hallway without partitions.

The operation may be performed under general anesthesia with you completely asleep and a machine supporting your breathing or under local anesthesia with sedation where you remain in a “twilight”. Your doctor’s preference may vary depending on your particular situation. You may wish to speak with him more regarding this.

The operation may take anywhere from 2 to 4 hours depending on the extent of surgery that is required. An overnight hospital stay is only rarely required. Pain tends to be of the dull achy variety and is well treated with pain medication. Packing is only rarely needed, though commonly your nose will feel stuffy and congested for several days following the operation. If your doctor has had to repair your septum at the same time as your sinus operation, splints may be required which may remain in the nose about a week. They are simply removed at the first follow-up clinic visit.

Risks of FESS

The risks of functional endoscopic sinus surgery include, but are not limited to, bleeding, infection (as with any operation), as well as risks associated with the location of the sinuses next to the eyes and the brain. Specifically, things to be concerned with here include double vision (usually lasting only a few hours at most), blindness, and brain fluid leaking into the nose and sinus cavity, with the concomitant risk of meningitis or brain abscess. The risk of blindness is extremely low while the risk of brain fluid (CSF) leaking into the nose and sinus cavity is greater. If your physician were to identify a CSF leak at the time of your operation, it would be repaired right there using similar FESS techniques.

Remember, while the techniques of FESS have been shown to provide long-lasting symptomatic relief for chronic sinusitis, it is surgery designed to address only areas that are involved with disease. If your disease should progress over time to involve additional sinus areas, additional sinus surgery may be required in the future, again utilizing FESS techniques.

What to Expect After Your Operation

When you awaken from anesthesia, you will be in the recovery room. Your nose will be stuffy and achey. You may have a dressing under your nose to collect the occasional bloody drip that is normal for the first 24-48 hours after surgery. You will experience some dull ache around your nose and sinus cavity that should be well treated with pain medication that will be prescribed for you.

You will be sent home with prescriptions for pain medication and an antibiotic pill, possibly also steroid pills. It is extremely important to take the antibiotic pill as prescribed, as serious infection could result if not taken.

You should keep your nose moist with a salt-water nasal spray (Ocean, Salinex, Ayr, etc.) or possibly an irrigation solution for the first week following your operation. Your first follow-up will be approximately one week following surgery at which time cleaning of the nose will be performed in the clinic under local anesthesia (sprays), a procedure that may need to be repeated weekly for the first 4-6 weeks following surgery. For the first couple of post-operative visits, it is recommended that you take pain medication prior to your arrival for extra comfort and have a driver with you as appropriate.

Usually at your first follow-up visit, steroid sprays will be restarted (Rhinocort, Nasocort, etc.). Antibiotics will be continued until the cavity is healed, usually about 3-4 weeks. Similarly, if steroid pills are prescribed, these will usually be slowly discontinued over three to four weeks.

Post- Operative Instructions

  1. Change the pad under your nose as needed for the first 24-48 hours following surgery. Bloody drainage is normal during that time. Call for excessive (flowing) bleeding.
  2. Keep nose moist with over-the-counter salt-water spray (e.g. Ocean, Ayr).
  3. Minimize your activities and refrain from working for about one week following your procedure, even if you feel well!
  4. Take a pain pill prior to your coming for your first post-operative visit. Bring someone with you to drive as appropriate.

Problems? Call us!

We are available to discuss any concerns that you may have at any time. If you have any concerns, please call Dr. Senior’s clinic: 919-966-6484.

After hours, call 919-966-4131, and ask for the ENT physician on-call.

Copyright 2002, Brent Senior, MD

Many people who are unhappy with the appearance of their nose look into plastic surgery and undergo rhinoplasty. Although rhinoplasty can provide you with a new and aesthetically pleasing nose, some patients may experience a loss of taste or smell after their surgery. This may sound scary, but there is no need to worry, as it is only temporary. It is actually incredibly rare for rhinoplasty to permanently affect your ability to taste or smell. But why does this happen in the first place? Well, we have the answers for you below.

What Is Rhinoplasty?

Rhinoplasty, or nose surgery, is a popular cosmetic procedure that can alter the size and shape of the nose for a more flattering appearance. Some patients find their overly large nose to be a distraction while others would like for their nose to be straighter or more symmetrical. In other instances, some people with breathing difficulties may opt for septoplasty. Candidates for rhinoplasty usually undergo this procedure because they struggle with issues such as:

  • Bumps on the bridge of the nose
  • A disproportionately large nose
  • A large or round tip
  • Nasal breathing difficulties

Dr. Baker’s philosophy is that your nose should look natural and blend well with the rest of your facial features. Using minimally invasive techniques, he will gently refine the nose rather than radically re-engineer it.

How Do Your Senses of Smell and Taste Work?

To better understand why someone can temporarily lose their senses of smell and taste following rhinoplasty, one must understand how both senses function together. When a person breathes through their nose, the nerve endings inside the nose can detect a scent as the air wafts past them.

These same air molecules then pass through the nasal cavity into the back of the throat. This is how your taste buds can detect flavor based on the scent. When you have a cold and your nose is stuffed, the nerves and air passages usually get blocked, making it difficult to smell and taste. The same thing can occur when a person has undergone rhinoplasty due to their nose being swollen and bruised.

What Happens to Your Senses After Rhinoplasty?

Because rhinoplasty is an extensive procedure that requires drastic changes to the nose, it makes sense that your body needs time to heal. Therefore, it is common for the nasal tissues to swell and for the nerves and air passages to be affected during the recovery process.

Although this can reduce your sense of smell and taste, these effects are only temporary. Your ability to smell and taste will return as soon as your nasal passages clear up or the swelling goes down. For many patients, their senses may fully return within three to six weeks. Complete healing can take six months to a year, and there should be no lasting or permanent effects on taste or smell.

To learn more about rhinoplasty and how it can help you achieve your aesthetic goals, you can contact our office at (305) 381-8837 or schedule a consultation online.

Is it typical to lose all sense of smell after endoscopic sinus surgery?

Question: Is it typical to lose all sense of smell after endoscopic sinus surgery? It’s been 3 months and I still can’t smell anything. I can only taste salt and something bitter. I have had a ten day course of steroids and antibiotics and still no results. Thoughts? Thank you!! AK

Answer:

Many of us don’t realize how important the sense of smell is. Loss of smell can interfere with every day satisfaction but also can be a health issue. We use smell to help determine what foods have spoiled, whether there is a fire as well as it being an important part of our enjoyment of food and other daily personal interactions.

The smell fibers, unfortunately, are quite exposed in the nasal cavity. They are located at the very top of the inside of the nasal cavity- and send their fibers directly into the brain by small perforations through the “cribiform plate” The sense of smell can be lost if air particles do not reach the roof of the nose, as when we have a cold, or from actual damage to these exposed fibers. The first is rather treatable, but our success in treating nerve damage is much less. When endoscopic sinus surgery is done for sinus disease or other nasal complaints, we usually try to avoid the area of the cribiform plate, as it is quite easily damaged- possibly causing a leak of brain fluid.

A wonderful article by an old friend, Dr. Charles Kimmelman, showed that about 2/3 of patients have an improvement in the sense of smell from endoscopic sinus surgery, 1/3 have some diminshed sense of smell, but in his study he found 1% may lose their sense of smell from surgery. It seems to be independent of the kind of surgery, the age, gender and anesthetic used. You can find this article in an ENT journal- Laryngoscope Volume 104, issue 8 pages 981-988. That is, we still don’t know what causes the “olfactory” or smell nerve damage in those rare instances.

After surgery, one gets some swelling in the nasal and sinus passages that can hinder flow of air to the smell fibers, by far the most common reason to have diminished smell after surgery. We would commonly treat with steroids and antibiotics for any potential infectionand to bring down swelling so that air can get to the top of the nose. Additionally, one would often treat with oral steroids to try to reverse any potential nerve damage. One can monitor smell function simply- we use the University of Pennsylvania Smell and Taste Center booklets.

It is difficult for me to tell which kind of loss you have. But don’t give up…. If the loss is from obstruction, hopefully this will resolve as post-operative swelling diminishes- and finally, there is some possibility of regeneration of nerves that may be damaged- up to a year. I would ask your surgeon about what type of loss he or she thinks you have.

We take care of many such problems here at the NY Sinus Center- but a regional center of excellence for this problem is at the University of Pennsylvania Smell and Taste Center in Philadelphia.

Robert L. Pincus MD

Ask the ENT Doctor

Associate Professor Otolaryngology

NY Otolaryngology Group/ NY Sinus Center

Sinus Surgery

What should I expect if I have sinus surgery?

For some patients with chronic or recurrent sinus infections, sinus obstruction or nasal polyps, the doctor will recommend sinus surgery. Usually these patients have been treated with multiple antibiotics and other medications and have been evaluated for allergies, but have persistent symptoms.

The goal of sinus surgery is to eliminate physical obstructions of the sinus cavities and nasal passages and to enlarge the natural sinus openings. The surgeon removes diseased bone or mucosa (skin lining), polyps or cysts, rinses the open sinuses and sometimes takes cultures. A pathologist examines the diseased tissue. The surgeon takes measures to minimize scarring and support healing structures. Surgery reduces the frequency of sinus infections by restoring natural patterns of ventilation and drainage within the nose.

Modern sinus surgery, sometimes referred to as Functional Endoscopic Sinus Surgery (FESS) is performed through the nostrils using narrow cylindrical scopes, fiberoptic illumination, magnification, video displays, and a variety of specialized instruments for removing diseased tissue. It is usually performed under general anesthesia (patient asleep) as an outpatient surgery.

The patient should stop all topical decongestant sprays four to six weeks prior to surgery. Before any sinus surgery, the patient must avoid blood thinners like aspirin or aspirin containing products such as Aggrenox, Ecotrin and Excedrin for two weeks. Other blood thinners such as Plavix, Coumadin and Warfarin should be stopped ahead of time according to your surgeon’s instructions. Non-steroidal anti-inflammatory medications (like Ibuprofen, Advil, Alleve, Naprosyn, Mobic and Celebrex) should be stopped at least a week before surgery. Surgery may be delayed or rescheduled if a patient has a respiratory illness, flare up of asthma or had any food or drink the morning of the procedure.

Risks of surgery include bleeding, formation of scar bands, recurrent sinusitis in the opened sinuses or progression of sinusitis to involve other sinuses, and recurrent growth of polyps. Rare risks include reactions to anesthesia, spinal fluid leak, decreased sense of smell, or injury to the eye socket resulting in pain or decreased vision.

Recovery typically involves nasal packing that is removed a day or more after surgery. One can expect a few days of bloody nasal drainage and post-nasal drip. Salt water (saline) sprays and irrigations are used for two weeks or more. Follow-up in the office for endoscopic cleaning is important to ensure proper healing.

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