0

Fast Facts

Keep using your steroid nasal spray every day until surgery to get the best result from surgery.

Take 2 weeks off to recover. Stay within one hour of a hospital for 2 weeks after surgery in case bleeding occurs.

Rinsing with saline four times a day for 6 weeks is the most important thing to get a good outcome.

Surgery doesn’t cure rhinitis and allergy, most people still need to use medication  like a steroid nasal spray before and after surgery.

What is this for? Is it effective?

The nasal septum is a wall that runs down the middle of the nose, dividing the nose into left and right sides. The septum runs from the tip of the nose almost to the very back of the throat. A bent septum (septal deviation) can cause blocked nose. Straightening the septum can improve blocked nose. This is called septoplasty.

The turbinates are bones on the side wall of the nose, about 10cm long. They are covered by the lining of the nose (mucosa).

The turbinates swell due to rhinitis, causing congestion, blocked nose and runny nose. Rhinitis can be caused by a virus (a cold), allergy, hayfever or irritation, for example from dust, smoke, perfume, cleaning products, alcohol.

The turbinates shrink when you are exercising and with medications, like steroid nasal sprays or anti-histamines. Medication is very effective in treating rhinitis. If the turbinates have been swollen for a long time, they may not shrink back to a normal size with medication. Surgery may be needed to reduce the size of the turbinates and relieve blocked nose. This is called turbinoplasty.

Surgery doesn’t cure rhinitis due to allergy or irritation. It makes more space inside the nose. Swelling can recur and so most patients will need to start using steroid nasal spray again after surgery to prevent the turbinates swelling again.

19 of 20 people who have surgery for blocked nose have long term improvement. 1 of 20 have recurrent or persistent blocked nose due the septum moving again, the turbinates enlarging again or scar tissue (adhesions) forming.

Frequently Asked Questions

What could go wrong? Is there a chance that surgery could make me worse?

There needs to be a balance between doing enough surgery but not too much surgery.

Surgery can improve breathing, congestion and runny nose.

Too much surgery can affect the natural function of the nose. My approach is to conservative, that means making the minimum change necessary to get the outcome you want. It is better to be conservative initially, then do more surgery later if needed, rather than to do too much initially then have to reconstruct or try to repair later.

The septum is important for the way your nose looks. Changing the septum too much with surgery can weaken it and cause a change in the way your nose looks or a hole through the septum from one side of the nose to the other. A hole in the septum can cause a whistling sound or blood noses.

The turbinates warm and humidify the air you breathe in, ensuring the right temperature and humidity for the lungs to work well. If too much of the turbinate is removed, you can feel dryness and crusting and even a feeling of being blocked. This is called empty nose syndrome and is very hard to treat.

Temporary side effects: 

Blocked nose: Although this operation is designed to unblock the nose, initially the inside of the nose will swell and feel very blocked. This lasts for 1-2 weeks.

Pain is mild and often patients describe the feeling as like having a “head cold”.

The tip of the nose and front teeth can feel numb for days to months after surgery.

1:20 patients get small bands of scar tissue (adhesions) while healing. These are easily treated at the first and second post-operative visits. It is important to keep these appointments; if adhesions aren’t treated early they can require another operation later.

1:50 patients get a post-operative infection needing antibiotics. Serious infections needing readmission or surgery happen to 1:200 patients

1:100 people get chest problems like cough. After surgery, walk around every hour and breathe deeply into the bottoms of the lungs, to prevent collapse  of the lower parts of the lungs. Left untreated it can lead to infection (pneumonia).

1:200 people have bleeding after surgery. The nose has many blood vessels and during healing, bleeding can happen. It is common to have a small amount of blood stained mucus discharge for the first week. Some people have a more serious blood nose and need treatment in hospital. Bleeding is more likely if you are taking medications that promote bleeding, if you are too active or with nose blowing.

Rarely, clots in the legs can occur. There are prevention strategies that begin in hospital and continue at home including compression stockings for 5 days, early return to walking and leg exercises.

Permanent side effects:

1:100 patients have a hole or perforation in the septum. Often this causes no symptoms. Sometimes it can cause a whistling sound, bleeding or crusting. Whistling can be fixed by inserting a small button into the hole. It is not easy to repair a large hole. Very rarely the outside of the nose looks flat or dinted and cosmetic/reconstructive surgery is needed.

1:200 patients feel the nose is too “open” or dry after surgery (empty nose syndrome). This is treated with daily salt rinses or moisturising sprays like Nozoil.

Could I need more surgery or treatment in the future?

Yes, 1:20 patients have more surgery in the future for persistent or recurrent blocked nose, particularly if they have underlying allergy or if they re-injure the nose.

Surgery doesn’t cure allergy or irritation and most patients will need to start using steroid nasal spray again after surgery to prevent the turbinates enlarging again.

What are the alternatives to surgery? Are they appropriate for me?

This procedure is entirely elective. This means you have choice about whether to have surgery or not. It is safe to choose not to have surgery. Surgery can improve your symptoms and your quality of life and it is worth choosing surgery if your symptoms are significantly affecting your quality of life and haven’t improved with medicine or non-surgical treatment.

Many patients improve on medicine alone and never need surgery. Surgery doesn’t cure allergy or irritation and you would need to return to using medicine after surgery anyway. I prefer patients to use medicine for at least 12 weeks before deciding on surgery. The most effective medicine is a steroid nasal spray, often with an antihistamine tablet and saline rinses as well. Even if medicine alone is not enough, you will heal much more quickly after surgery if the nose has already been treated with a steroid nasal spray.

If medicine is working well, stick with it. If medicine isn’t enough then you can choose to have surgery as well.

What if I choose not to have surgery?

It is ok to choose not to have surgery. The worst thing that can happen is that your symptoms will persist.

See should I have surgery for more information.

How should I prepare for surgery?

Continue steroid nasal spray until the time of surgery.  You can also continue antihistamines and saline rinses if needed.  You’ll need to rinse the nose with saline four times a day for 6 weeks after surgery and practicing before surgery helps.

Avoid picking the nose; if there is any crusting or sores in the nostrils, the risk of poor healing and infection increases and it is better to cancel the surgery and wait until the sores have healed. If you think you may have sores or crusting, contact your surgeon for treatment to resolve this before surgery.

Stop taking any medications or supplements that promote bleeding for at least one week before your surgery and for two weeks after your surgery. These include Aspirin, Nurofen and other anti-inflammatories and many herbal supplements like echinacea, garlic etc. If you are not sure, ask the surgeon, practice nurse, GP or naturopath.

Follow the fasting instructions given to you by the hospital.

Stop smoking. Smokers are more likely to have side effects including heart and breathing complications, increased pain and bleeding and take longer to heal. The longer you have stopped smoking, the safer the surgery will be for you. If you smoke on the day of surgery, your surgery will be cancelled.  Ask your surgeon for a Quit pack if needed. The nurses can help with nicotine patches while you are in hospital.

For more information see preparing for surgery.

When will I come into hospital? How long will the operation take? How long will I stay in hospital?

You will come into hospital on the day of surgery.  The operation takes 60 minutes.  You will go home by 10 am the next day.

If you are having sinus surgery or tonsillectomy at the same time, read the information about these procedures as well.

How long will I need off work/school/sport?

You need two weeks of off work, study/school and sport after surgery.

You should not drive for at least 24 hours after a general anaesthetic. Do not drive on any day when you are taking strong pain reliever or if you don’t feel at your best, as there is an increased risk of having an accident.

Will I be awake or asleep for the operation? What kind of anaesthetic will I have?

You will have a general anaesthetic (completely asleep or unconscious) during the procedure as well as local anaesthetic (numbing injections) to reduce pain after surgery.

For more information see anaesthesia

How will I feel after surgery?

Initially you may feel less blocked in the nose, then post-operative swelling will start and you will feel very blocked for two weeks. Pain is mild and often feels like having a cold. Some patients have nausea or vomiting within the first 24 hours.

What do I need to do to recover well?
  • Resting with the head up relieves swelling and relieves blocked nose and pressure/pain.
  • Eating as well as possible, especially fruit and vegetables, helps healing.
  • Rinse with FLO saline rinse kit four times a day for six weeks.
  • Avoid vigorous activity for two weeks to reduce the risk of bleeding.
  • Don’t blow, pick or rub the nose for 7 days (this can cause bleeding or infection).
  • Walk at least 10 minutes three times a day. Avoid vigorous exercise.
  • To relieve congestion, you can use your steroid nasal spray twice a day. You can use a decongestant spray twice a day but not for more than 7 days.
  • If you use CPAP for sleep apnoea, continue to use it as normal.
When will I see the surgeon?

The surgeon will check on you in the recovery room, before you go home the next day, in the office one week after surgery and again 6 weeks after surgery. Some patients also have a 12 month visit or phone call to check on the long term outcome.

You will have dissolvable sponges in the nose that are rinsed away gradually with saline rinses.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

Your surgeon will take into consideration your work, sports/hobbies, support at home and other health problems as well as past reactions or complications with anaesthesia and surgery.

Your surgeon will answer any specific questions you ask.

If you use CPAP for sleep apnoea, continue to use it before and after surgery.

After nose and sinus surgery

How long will I need off work/study/sport?

You need two weeks of off work, study/school and sport after surgery. You should not drive for at least 24 hours after a general anaesthetic. Do not drive on any day when you are taking strong pain reliever or if you don’t feel at your best, as there is an increased risk of having an accident. Your car insurance may not be valid if you are impaired when driving after surgery.

What do I need to do to recover well?
  • Rest sitting upright or reclining at 45 degrees for 7 days to relieve swelling, blocked nose and pressure/pain.
  • The better you eat, the better you heal, especially fruit and vegetables.
  • Avoid medications like Aspirin and Nurofen, to reduce the risk of bleeding.
  • Stay within one hour of a hospital for 2 weeks after surgery in case bleeding occurs.
  • Walk at least 10 minutes three times a day. Avoid vigorous exercise for 2 weeks.
  • Don’t blow, pick or rub the nose (this can cause bleeding or infection).
  • Use the following medications:
  1. Flo saline rinses: half a bottle squirted into each nostril four times a day.
  2. Paracetamol 1-2 tablets every 4-6 hours as needed for pain, no more than 8 tablets per day.
  3. Celecoxib 1 capsule, every 12 hours, as needed, for strong pain not relieved by Paracetamol.
  4. To relieve congestion, you can use your steroid nasal spray twice a day. You can use a decongestant spray twice a day but not for more than 7 days.

If you use CPAP for sleep apnoea, continue to use it as normal.

What is normal? How will I feel after surgery?

Initially you may feel less blocked in the nose, then post-operative swelling will start and you will feel very blocked for two weeks. Pain is mild and often feels like having a cold. Some patients have nausea or vomiting within the first 24 hours. There will be mild blood stained discharge from the nostrils for up to seven days.

After septoplasty, there may be numbness in the top lip and front teeth for a few weeks and tenderness on the tip of the nose.

You have dissolvable sponges in the nose that are rinsed away gradually with saline rinses.

What is not normal?

Contact your surgeon or attend the nearest emergency department if you have:

  • severe bright bleeding from the nose not stopping within 5 minutes: if you have any bleeding from the nose or mouth suck on ice and take a dose of tranexamic acid. If bleeding stops, continue tranexamic acid 8 hourly for 6 doses. If bleeding doesn’t stop, attend your nearest emergency department.
  • severe pain not relieved by paracetamol and Endone.
  • fever >38 degrees for more than 24 hours.
  • vomiting for more than a few hours.
  • headache, neck stiffness, eye swelling or eye pain on looking at light or when moving the eyes.
When will I see the surgeon?

The surgeon will check on you in the recovery room, before you go home the next day, in the office one week after surgery and 6 weeks after surgery. Some patients also have a 12 month visit or phone call to check on the long term outcome. You will be given an appointment card before you leave hospital.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

If you use CPAP for sleep apnoea, continue to use it as normal.