Reasons People May Need Sinus Surgery
Sinus surgery may be necessary for people who have chronic recurring sinusitis but don't get better after trying medication or other treatments. The goal of sinus surgery is to enlarge the sinus openings to allow for better drainage.
How Sinus Surgery Is Performed
Sinus surgery has been performed using an endoscope since the 1950s. A tiny fiber optic tube is inserted through the nostrils allowing the surgeon to visualize the sinus cavities. The surgeon will then use other instruments to open up the pathways from the sinuses and allow for better drainage. No external incisions are made with this method of sinus surgery.
In some cases, image-guided (using a CT scan) sinus surgery may be necessary. This is because the sinus cavities can be very close to the eyes, brain and several major arteries. This allows the surgeon to visualize these structures and avoid them.
Before Sinus Surgery
In most cases, sinus surgery is performed on an outpatient basis. Your surgery may be in a hospital or a surgical center but in most cases you will go home the same day of your procedure. Before the surgery, your surgeon will explain the benefits and risks. Risks include but are not limited to: bleeding, infection, and allergic reactions to medication given during surgery. Risks are involved in receiving general anesthesia. If you have a family history of an adverse reaction to general anesthesia, inform your doctor.
Stop taking medications which may thin your blood 1 to 2 weeks before your sinus surgery (be sure to clarify with your surgeon which medications you should stop taking and when). These medications include aspirin (Bayer, Anacin), warfarin (Coumadin), Ibuprofen (Advil, Motrin), Plavix, Heparin, or Lovenox, and large doses of vitamin E.
In most cases, a nurse will call you the day before surgery to give you instructions and the time of your procedure. You will be given exact instructions on when to stop eating and drinking the night before your surgery. Due to the risk of vomiting and aspiration, your stomach and bowels need to be empty. You should also refrain from chewing gum, sucking on mints or smoking.
Remove all metal from your body before sinus surgery including jewelry and body piercings. You will also need to remove contact lenses, dentures, retainers, or hearing aids. Wear loose comfortable clothing the day of surgery. If you are a woman of child-bearing age (usually ages 12 to 55) and have not had a hysterectomy, you will be required to take a pregnancy test. This requires a small amount of urine. If you have additional health problems or are on prescription medications, your doctor may order blood tests.
After Sinus Surgery
A nurse will watch you for a couple of hours after surgery to make sure that you are not having a lot of pain and that you are able to eat and drink. She will also monitor your blood pressure, heart rate, oxygenation etc. When you are well enough to go home, you will be given exact instructions on how to take care of yourself. Your doctor's orders should supersede any advice given in this article. However, in general patients are instructed:
- to be in the care of another adult for 24 hours after surgery
- not to drive, sign legal papers, or participate in activities that require them to be awake and alert for 24 hours
- that there is usually a small amount of bloody drainage from the nose which should be monitored
- to keep your upper body elevated to help with pain and swelling
- to eat and drink clear liquids if they are experiencing nausea or vomiting
- if you have splints or packing in your nose it may be necessary to breathe out of your mouth
In addition to these instructions, patients are usually instructed to call their doctor if:
- they experience excessive bleeding
- they have pain or swelling that they cannot control
- they experience a fever or chills
- if they notice any green or yellow drainage from the nose, particularly if it has a foul odor
- they are unable to urinate by 8 to 12 hours after surgery
In the rare event of emergency situations such as heavy bleeding, difficulty breathing or chest pain, the patient should go to the emergency room or call 911.
Managing Pain After Sinus Surgery
You will most likely be given narcotic prescription medication after your surgery such as Percocet or Lortab. Follow your physician's directions for taking this medication. Do not drive. If this medication makes you nauseated, you may want to try taking it with a small amount of food. In some cases, surgeons may also order anti-nausea medications or antibiotics. Make sure you clarify with your nurse before discharge at what time you should start taking these prescriptions as you may have already been given doses of anti-nausea medication or antibiotics during surgery.
Many surgeons recommend using a cool mist humidifier or a saline nasal spray after sinus surgery. Your surgeon will want to see you in his office a week or two after your surgery to make sure that you are healing properly.
American Academy of Otolaryngology - Head and Neck Surgery. Fact Sheet: Sinus Surgery. Accessed: June 23, 2009 from http://www.entnet.org/HealthInformation/SinusSurgery.cfm