Sinus

  • What to expect when you are having nasal or sinus surgery

    During your office visit, we will discuss the different facilities in the area where we can do your surgery.  Once you decide on a facility and a date, our office will schedule the procedure.  Prior to the day of surgery, you will get a call from the facility.  They will ask some of yours or your child’s health history and will give you specific instructions on when to not eat or drink prior to surgery.  The day before your surgery, you will get another call from the facility telling you the specific time that you need to arrive.  We arrange the schedule by age so that younger children go first.

    Before surgery

    You should refrain from taking any over the counter NSAIDS for a couple of weeks prior to your surgery.  These include medications like Advil, Aleve, Motrin, BC Powder, etc.  Plain Tylenol is acceptable.

    The day of surgery

    • Once registered at the facility, you or your child will change into a hospital gown.
    • The anesthesiologist and anesthetist will meet with you and answer any questions you have regarding anesthesia and sedation.
    • Parents can stay with their child right up to the time that they are taken to the operating room.
    • Your child can bring along a comfort item, such as a stuffed animal, if they like.
    • Adults and older children will get an IV placed before the procedure.  There are ways we can numb the skin to lessen any discomfort.
    • You will also get some Afrin nasal spray in both sides of your nose before you go back to the operating room.
    • The surgery usually lasts less than one hour and you should expect to go home soon after the surgery is over.
    • You will not have packing in your nose after the procedure.  If you have a septoplasty done, you will have a few dissolvable sutures that you may feel for a couple of weeks.

    What to expect after surgery

    • Children are often irritable immediately after surgery.
    • It is not uncommon to have some intermittent fever immediately after the surgery.  This should be controlled with Tylenol or ibuprofen.
    • Our office will call and check on you and arrange for a follow-up appointment.
    • There will be some mild pain after the surgery.  You may also experience some bloody nasal discharge.  If this is excessive, call our office.
    • Bleeding is unusual and can usually be managed with Afrin nasal spray and squeezing the end of the nose.
    • Please avoid bending over, heavy lifting, and strenuous activity for a week after surgery.
    • One of the most important things you can do is keep the inside of your nose moist with saline irrigations.  Please see our separate instructions for how to mix this irrigation.  You should irrigate the nose several times daily.
    • We will see you back in the office within a week after your surgery.
  • Why do we have sinuses?

    There is no way to know for sure but they probably serve a couple of functions. Having these air cavities in the bones of the face and skull makes our heads lighter.  They also make the bones surrounding our brains more likely to break with trauma.  When these bones fracture, it is similar to the front end of a car crumpling in a collision.  Energy is absorbed and the brain is protected.

    What is sinusitis?

    Sinusitis is inflammation that involves any of the paranasal sinuses.  This inflammation can have multiple causes including viral, fungal, and bacterial infection, allergy, and others that we don’t completely understand yet.  Common symptoms include pain, pressure, nasal congestion, and purulent nasal drainage.  Because inflammation almost always involves both the nose and the sinuses, the term rhinosinusitis is often used.

    Uncomplicated sinusitis is diagnosed based on symptoms and examination.  X-rays and CT scans are not needed.

    How do we treat sinusitis?

    Most sinusitis is the result of viral infection and will get better without treatment within ten days.  Antibiotics are warranted if symptoms persist for more than ten days or significantly worsen.  It is estimated that only about 0.5%-2% of viral sinusitis progresses to bacterial sinusitis so antibiotics are rarely warranted and, in fact, are greatly overused.  Even when used appropriately, antibiotics decrease the duration of symptoms by only about a day.  Antibiotics given for a common cold will not prevent bacterial sinusitis.  Instead, this overuse contributes to the alarming increase in the incidence of bacteria that are resistant to antibiotics.

    Treatment of sinusitis is aimed at reducing the symptoms.  Analgesics like Tylenol or Motrin are used for pain control.  Saline nasal lavages are also very helpful at managing congestion and clearing secretions.  Topical nasal steroids are also used.  For severe nasal congestion, topical decongestants like Afrin can be used.  It is recommended, though, that these be used for no more than three consecutive days.

    Below is a link to the most recent practice guidelines from the American Academy of Otolaryngology.

    What is chronic sinusitis?

    Chronic sinusitis is defined as the persistence of at least a couple of symptoms of sinusitis (pain, pressure, nasal congestion, purulent nasal discharge, decreased smell) for greater than twelve weeks with documented inflammation.  It affects up to 10% of the population.  Some people with chronic sinusitis will also have nasal polyps.

    How is chronic sinusitis treated?

    Most chronic sinusitis will respond to medical treatment that consists of topical nasal steroids and saline lavages.  Antibiotics are occasionally needed to manage flare-ups.  Systemic steroids are often needed if polyps are present.

    When these treatments fail, surgery is an option.  Surgery is intended to create better aeration of the sinuses and allow for better, unobstructed drainage.  Another positive effect is that it allows topical treatments like steroids and saline lavages better access to the sinuses making them more effective.

    What is the surgery like?

    We do the surgery through an endoscope so there are no incisions or bruising on your face or nose.  The pain afterwards is mild and usually does not require pain medication.

    The procedure takes about 30-45 minutes and is done as an outpatient.  This means that you wake up and go home the same day.  It takes about a month for the skin in your nose and sinuses to return to normal so you will experience some congestion as things heal.  This is usually not severe.

    You are able to return to normal activity as soon as you feel like it after surgery and there is no nasal packing.

    What is balloon sinuplasty?

    We can use a small balloon to dilate the openings of some sinuses.  This is a similar process that heart doctors use to open up the blood vessels that supply the heart.  The ethmoid sinuses are not amenable to this kind of treatment, though, and they account for most sinus disease in adults.  For this reason, balloon sinuplasty will not replace endoscopic sinus surgery but will compliment it nicely.

    The frontal sinuses, for example, are very difficult to treat surgically without balloon dilation.  The maxillary sinuses are also very accessible with a balloon.  Since these sinuses are the first to develop, most childhood chronic sinusitis is located there and is treated nicely with balloon dilation.

  • Post-Operative Instructions for Sinus and Nasal Surgery

    • Our office will call you to arrange for follow-up.
    • You may experience some bloody nasal drainage for the first couple of days.  If this occurs, use Afrin nasal spray.  Be sure to use Afrin for no more than three straight days.
    • Use saline nasal spray/irrigation copiously for the first week after surgery.  Spray/irrigate your nose at least every few hours while you are awake for the first week.
    • There are no restrictions on diet.
    • Avoid heavy lifting and strenuous exercise for the first week after surgery.
    • If you need to go to an Emergency Room, please use Crestwood Medical Center so Dr. Lockette can see you.
  • Nasal Saline Irrigation

    Buy Ocean Nasal Spray or an equivalent at your drugstore.  You can continue to purchase these or you can refill the container with the following recipe.

    • 1 quart of distilled water
    • 3 tablespoons of canning/pickling salt
    • 1 tablespoon of baking soda

    Tap water has chlorine and will burn.  Table salt has iodine that will also burn when applied to the nose.  Using distilled water and canning salt is less irritating.

    Hold you face over the sink and irrigate each side of the nose with this solution at least three times daily.  If you are doing the irrigation correctly, the rinse will come out of the opposite side.