Fast Facts

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

What is this for and is it effective?

Sinuses are air spaces inside the bones of the face, in the cheeks, forehead and between the eyes. The purpose of sinuses are unknown. The sinuses contain air and open into the side wall of the nose through narrow openings or channels called ostia. If the lining of the nose is swollen and inflamed (this is called rhinitis), the sinus openings can become blocked and this leads to sinusitis with pain/pressure, discharge/runny nose and sometimes cough, post-nasal discharge (mucus running from the nose into the back of the throat) and loss of smell. The lining of the nose can become swollen and inflamed due to a virus/cold, allergy, irritation or other problems like nasal polyps. Sinusitis can be acute and recurrent (episodes lasting a few weeks then being well for weeks or months before the next episode) or can be persistent or chronic (symptoms change from day to day, with some worse times and some better times but no completely symptom-free times).

Initial treatment for sinusitis is with medication, first with tablets for ten day then with steroid nasal sprays (Nasonex) and salt water rinses for weeks or months. If symptoms persist after 3 months of medicine treatment, a CT scan of the sinuses is arranged. The shape and openings of the sinuses are unique to each person. The CT shows the shape of the sinuses and the sinus openings and also shows which sinuses are unhealthy and how badly affected each sinus is. This allows the surgeon to decide if surgery would be helpful.

The aim of surgery is to improve the openings into the sinuses. For mild disease, minor adjustments are needed and for more severe disease (like nasal polyps) more extensive surgery is needed.  Most sinus surgery is done endoscopically; this means the surgery is done with thin rod cameras inserted through the nostrils, rather than through cuts in the skin of the face. Some patients with severe disease need to have small cuts in the skin of the eyebrow (for frontal or forehead sinus surgery) or in the gum inside the mouth (for the maxillary sinus).

Surgery doesn’t cure polyps or allergy; it is part of the treatment along with medication. Medication is needed before and after surgery. Most people have improvement in symptoms for at least 12 months after surgery. 7 out of 10 people have long term improvement and 3 out of 10 people have problems again.

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 to improve your symptoms versus doing too much and having a negative impact on the normal function of the nose and sinuses or causing a complication to the structures around the nose. My philosophy is to first do no harm; that means it is better to be conservative or careful initially and then do more surgery later if needed.

If too much of the lining of the nose or sinus openings are removed, you can feel irritation, dryness and crusting.

Temporary common side effects: 

Although this operation is designed to unblock the nose, initially 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”.  1 in 10 patients have worse headache for a few days after surgery.

Small bands of scar tissue (adhesions) while healing are common, 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

1:25 patients get a post-operative infection needing antibiotics. Serious infections needing readmission or surgery happen to 1:200 patients

1:100 patients get chest problems: after surgery it is important to breathe deeply into the bottoms of the lungs, to prevent collapse (atelectasis) of the lower parts of the lungs. Left untreated it can lead to infection (pneumonia).

1:200 patients have serious bleeding: 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. Occasionally, a more serious blood nose happens and treatment in hospital is needed. Bleeding can happen any time in the first two weeks after surgery. Bleeding is more likely if you are taking medications that promote bleeding, if you are too active or with nose blowing.

Serious temporary and permanent side effects or complications:

Less than 1: 1000 patients get clots in the legs called DVT. There are prevention strategies that begin in hospital and continue at home including wearing compression stockings for 5 days and leg exercises.

1:1000 people have complications involving the eye or brain coverings: The sinuses are next to the eye socket and sit below the skull base, which is a plate of bone separating the covering of the brain from the nose. It is possible to break or damage the bone between the nose and the eye or between the nose and the brain coverings. Damage to the eye can cause pressure on the eye from bleeding that needs to be treated immediately to prevent loss of vision or scarring in the muscles that move the eye, causing double vision when looking to the side. Eye complications are very uncommon and Dr Clancy has not had an eye complication for her patients before.

It is important to tell your surgeon if you are blind in one eye and rely on the other eye to see.

Damage to the bone between the nose and brain coverings can cause leakage of fluid from around the brain (called CSF) into the nose. This is usually fixed during the operation and there is no long term consequence. If it is not fixed, there is a risk of infection around the brain (caused meningitis). Dr Clancy has had two CSF leak complications, both of which were repaired at the time of surgery and both patients made a full recovery with no long term problems. If a leak is repaired, you may need to stay longer in hospital and take more time off work to recover.

1:200 people have numbness in the skin of the forehead or cheeks. Some patients with severe disease need to have small cuts in the skin of the eyebrow (for frontal or forehead sinus surgery) or in the gum inside the mouth (for the maxillary sinus). These cuts can cause damage to the nerves that give feeling or sensation in the face and this can lead to long term feelings of numbness or “pins and needles” in the face.

Could I need more surgery or treatment in the future?

Yes, 3 out of 10 patients have more surgery in the future for persistent or recurrent nose and sinus problems. You are more likely to need surgery again if you have nasal polyps or nasal allergy.

Surgery doesn’t cure polyps and allergy. Most patients will need to start using steroid nose spray again after surgery to control polyps and allergy and reduce the need for further surgery. Most patients with polyps need to stay on a steroid nasal spray or rinse every day for at least 12 months after surgery and for severe polyps, treatment is needed every day for the rest of your life.

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

Most sinus operations are elective. This means you can choose whether to have surgery or not. For mild disease without complications, 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 a minimum of three months 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 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?

For most people with sinus disease, it is ok to choose not to have surgery. The worst thing that can happen is that your symptoms will persist.

Sometimes sinusitis is severe and causes complications like infections around the eye and brain. Treatment in hospital with intravenous antibiotics and steroids and emergency surgery is needed to prevent long term complications.

See should I have surgery for more information.

How should I prepare for surgery?

Continue your steroid nasal spray every day until the time of surgery.  You can also continue antihistamines and saline rinses if needed. It is useful to have practiced using a saline nasal rinse kit 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.

Have a CT scan. Your surgeon always has the CT scan films on display next to the operating table during your surgery. This allows the surgeon to accurately understand the shape of your sinuses and reduces the risk of a serious complication. If the CT scans are lost or not available, the surgery will be postponed, for your safety.

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.

See preparing for surgery for more information.

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 60-120 minutes. You will go home by 10 am the next day.

If you are having another procedure at the same time (for example, septoplasty and turbinoplasty) you will need to 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. Your car insurance may not be valid if you are impaired when driving after surgery.

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. There will be mild blood stained discharge from the nostrils.

What do I need to do to recover well?
  1. Resting with the head up relieves swelling and relieves blocked nose and pressure/pain.
  2. Eating as well as possible, especially fruit and vegetables, helps healing.
  3. Rinses with FLO saline rinse kit four times a day for six weeks.
  4. You may need to take an antibiotic for 7-10 days as prescribed.
  5. Avoid vigorous activity for two weeks to reduce the risk of bleeding.
  6. Don’t blow, pick or rub the nose (this can cause bleeding or infection).
  7.  Patients having surgery for polyps will have extra medication to take after surgery (steroid tablets and steroid rinses).
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.

Sometimes you may 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 non emergency 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 as normal before and after surgery.

After 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 vigorous activity for two weeks and 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.
Wear white TED stockings for 5 days to prevent blood clots in the legs, remove them for showering then put them back on. Every hour, walk around, take 5 deep breaths and cough to prevent chest infection.

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. Endone 1-2 tablets every 4-6 hours for strong pain not relieved by Paracetamol.

Some patient will also need to take:

  1. an antibiotic like Keflex 500mg one tablet four times a day for 5 or 10 days Augmentin DF one tablet twice a day for 5 or 10 days.
  2. Prednisolone 25 mg tablets, one every morning for a week than half a tablet every morning for a week then stop.
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. After septoplasty there is pieces of silastic inside the nose that are removed one week later by the surgeon.

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.
  • 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 non emergency 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.

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