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? 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 (rhinitis), the sinus openings can become blocked and this leads to sinusitis. Sinusitis can cause pain and pressure, discharge or runny nose and sometimes cough, post-nasal discharge, sore 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
  • 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:

If symptoms persist after 3 months of medication, 2 tests are needed:

  •  CT scan of the sinuses. The shape and openings of the sinuses are unique to each person. The CT shows the shape of the sinuses and the sinus openings, which sinuses are diseased and how bad the disease is. This allows the surgeon to decide if surgery would be helpful.
  • blood tests for allergy to aero-allergens, like dust mite, grass, animals.

The aim of surgery is to improve the openings into the sinuses. For mild disease, minor adjustments are needed and for more severe disease (chronic rhinosinusitis with nasal polyps) more extensive surgery is needed.

Sinus surgery is done through the nostril with cameras (endoscopic or key hole), so you don’t look any different on the outside. 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.

If you also have blocked nose, you may need nasal airway surgery at the same time as sinus surgery. Watch the video below or see septoplasty and turbinoplasty for information about this surgery.

For more information about rhinitis, sinusitis and polyps see:

https://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis

https://www.allergy.org.au/hp/papers/crswnp

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.

Enough surgery will improve your symptoms and quality of life.

More extensive surgery can affect the normal function of the nose and sinuses. If too much of the lining of the nose or sinus openings are removed or change, you can feel irritation, dryness and crusting. This is called empty nose syndrome. For some people, this feels just as bad as their original symptoms.

For people with mild to moderate sinus disease, my approach is start small, then do more surgery later if needed. For people with more severe disease, especially chronic rhinosinusitis with nasal polyps, starting small doesn’t work and it’s necessary to plan for extensive surgery.

Temporary common side effects: 

Although this operation is designed to unblock the nose, the lining of the nose will swell after surgery and you’ll 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. If you are prone to migraine, sinus surgery can trigger a migraine.

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 cause blocked nose and sinuses and require another operation later.

1:25 patients get a post-operative infection needing antibiotics. Serious infections needing readmission to hospital 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 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. Prevention beings in hospital with TEDS stockings and leg compressors during surgery then early return to walking after surgery.

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. The skull base 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. Steroid nasal spray helps to 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. 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.

Chronic rhinosinusitis with polyps is a more severe disease, is treated with 3 months of medical therapy, then surgery and then 12 months of medical therapy. For patients too unwell to have surgery or who have recurrent disease after medical therapy and surgery, other medication may be prescribed by monthly injections, long term. Mepolizub

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.

For more severe sinus problems, like infected mucocoele, tumour or silent sinus syndrome, surgery is recommended.

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.

If you use CPAP for sleep apnoea, bring your CPAP machine to use after surgery.

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 1-2 hours. You will go home the same day or the next day, depending on how extensive your surgery has been. The surgeon will let you know in advance what to expect.

If you are having another procedure at the same time for blocked nose,  see 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. There will be mild blood stained discharge from the nostrils.

What do I need to do to recover well?

Resting and sleeping 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, starting 2 hours after surgery.

The surgeon will let you know if you need to take extra medications after surgery, like steroid, antibiotic, TXA.

Patients having surgery for polyps will have extra medication to take after surgery (steroid tablets and steroid rinses).

You can use your steroid nasal spray once or twice a day for blocked nose or a nasal decongestant spray. Don’t use nasal decongestant spray for more than 7 days.

Avoid vigorous activity for two weeks to reduce the risk of bleeding.

Don’t blow, pick or rub the nose (this can cause bleeding or infection).

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 and sleep with the head of the bed raised 45 degrees a 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.
To prevent blood clots in the legs and lung: every hour, walk around, take 5 deep breaths and cough to prevent chest infection.

Don’t blow, pick or rub the nose for 7 days (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 for 6 weeks after surgery. Start 2 hours after surgery.
  2. Paracetamol 1-2 tablets every 4-6 hours as needed for pain, no more than 8 tablets per day.
  3. Celecoxib 1 capsule, 12 hourly, as needed for strong pain not relieved by Paracetamol.

 

The surgeon will let you know if you need to take extra medications after surgery, like steroid, antibiotic, TXA.

Patients having surgery for polyps will have extra medication to take after surgery (steroid tablets and steroid rinses).

You can use your steroid nasal spray once or twice a day for blocked nose or a nasal decongestant spray. Don’t use nasal decongestant spray for more than 7 days.

It’s safe to use your CPAP machine, if you have one for sleep apnoea, after surgery. 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.

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 celecoxib.
  • 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.