What to expect from sinus surgery

If you’ve been told that you or your loved one need sinus surgery, it’s likely you have a fair few questions. It can be daunting to know where to start when it comes to understanding what happens during the procedure, how long it will take to recover and how you should prepare for the procedure.

And, while your doctor is always the best person to ask as they can give you personalised information, we’ve answered some of the biggest general questions you might have about sinus surgery.

What is sinusitis?

Sinusitis (also known as rhinosinusitis) is when the sinuses (the spaces in the head that make a thin mucus to drain the nose) become swollen or inflamed. This inflammation causes the sinuses to become blocked and filled with fluid, which can result in infection. This condition is commonly caused by the common cold or allergies; less commonly, it can be triggered by a viral infection, bacteria, fungus or parasite.

There are a number of different types of sinusitis, and each comes with its own treatment – from antibiotics and decongestants to pain killers. That’s why it’s important to get personalised advice from your doctor.

Symptoms of sinusitis

There are many different sinusitis symptoms, and these can occur all at once or separately over time. Symptoms include difficulty breathing through the nose, headaches, yellow nasal secretions (or snot), a sore throat and increased sinus pressure.

Symptoms can also lead to facial pain, aching teeth and a swollen face. Some patients may also experience a fever and a decreased sense of taste.

Other symptoms include bone or structural damages; blockages; orbital (eye socket) compression; optic nerve pressure, cerebrospinal fluid (CSF) leak; and excess bone formation.

Types of sinus surgery

Functional endoscopic sinus surgery (FESS) FESS is the most common nasal surgery and is an operation performed through the nose (meaning there are no external incisions) to improve the opening of the sinuses. This is used to treat chronic sinus infections, smaller sized tumours, traumatic injury and congenital anomalies.
Ethmoidectomy The ethmoid sinuses are hollow spaces located between the bridge of the nose and the eyes. An ethmoidectomy involves the removal of the septum (cartilage separating the upper nose) and part of the ethmoid bone to leave a larger sinus cavity, which can minimise sinus obstruction and treat ongoing sinus infections.
Maxillary antrostomy The maxillary sinuses are the largest sinuses near the sides of the nose (nasal cavity) and when they become blocked and can’t drain properly, it causes maxillary sinusitis. Maxillary antrostomy is another common procedure and aims to enlarge the opening of the maxillary sinuses by removing inflamed bone and tissue; this allows your sinuses to drain easier.
Powered septoplasty and turbinoplasty The cartilage in the nose that separates each nostril is called the septum and this should typically be straight and centred. However, if the septum is bent or deviated, is can cause the sinuses to become inflamed and swollen. A septoplasty procedure straightens the septal bone and cartilage, while a turbinoplasty is the reduction of the turbinates just enough to improve breathing and sinus drainage without affecting their function.
Balloon sinuplasty With a balloon sinuplasty procedure, an endoscope (a long flexible tube) is used to dilate the sinus ostium (the opening forming the drainage channel) and passageways to reduce sinusitis. With this procedure, there’s less trauma to the tissues because there are no incisions.
Open surgery Open surgery is often recommended when there’s a nasal structural abnormality causing chronic sinusitis. It involves a deflexion of the cartilage closest to nostril opening (caudal septal cartilage) and abnormal nasal structure. For this condition, an open rhinoplasty (changing the shape of the nose) is required.
Other surgeries Surgery for a larger tumour or mucus cyst (when the mouth's salivary glands become clogged with mucus - also called mucocele) is performed by removing part of the bone from the skull (craniotomy) or by removing infected tissue and bone that blocks natural drainage (ethmoidectomy), or removing a primary tumour in this area which may include part of the roof of your mouth, and possibly some of your teeth (maxillectomy) and/or a surgery done to remove tumours, including paranasal sinus and nasal nose cancers (craniofacial resection).

What happens during a sinus surgery?

For most sinus surgery procedures, you’ll find that general anaesthetic is recommended – which is when you’ll be asleep throughout the operation. However, in some cases, a local anaesthetic is enough – which is where the area being operated on is completely numb, but you remain awake.

We’ve put together an overview of what might be happening during a few common sinus surgeries.

Local anaesthetic Small sized cotton packs are placed in the nostrils (soaked in local anaesthetic and a synthetic adrenaline). The local anaesthetic is injected near the turbinates. The packing is then removed from the nostril, ready for it to be operated on.
General anaesthetic The nose is packed with cotton (soaked in a decongestant).
Bone or cartilage removal The endoscope (narrow tube with a high definition camera) is lubricated with local anaesthetic gel and guided into the nose and sinuses. Internal incisions and dissections are performed to remove abnormal tissue, obstructing cartilage and/or enlarged bone.
Presence of infection in the sinuses If there is an infection, the surgeon flushes the sinus with saline irrigation and antibiotics to clean the area. A small suctioning tube is used to remove the mucus. Radio frequency ablation (burning of tissues) reduces pain, infection and bleeding. When nasal polyps are present, they are removed using a power-assisted suction dissection. An intranasal stent may be placed between the middle turbinate and nasal wall to support the form of the nose. Mucus and blood are suctioned and the internal incision is closed with suture. Packing may be required.
Balloon sinuplasty The procedure is performed with a local anaesthetic (since it is shorter in duration). A small catheter is lubricated with local anaesthetic gel and guided into the nose and sinus cavity. The balloon is slowly inflated with sterile water and opens the sinuses to enable normal sinus drainage and function. There are no incisions made and less bleeding occurs. Nasal packing may not be required. These surgeries only require an overnight stay for monitoring.
Open sinus surgery (with craniotomy) A general anaesthesia, pain relief, antibiotics and paralysing agents are given intravenously. The eyelids are closed with gauze and tape. Body areas suitable for tissue donor grafts and wound closure are chosen. An incision/dissection is made deep into the tissue (avoiding the nerves). An osteotomy (cutting of bone) of the skull is performed with a micro-saw for an ethmoidectomy, maxillectomy or craniofacial resection. Depending on the condition, tissue, fat, glands, cartilage and/or bone is removed. A scalpel, drill and/or ablation is used to take a biopsy, open the sinus cavity for better drainage and seal the surrounding tissues. The skull is secured back in place with plates and screws. The donor tissue flap is sutured for skin closure.

Risks and complication of sinus surgery

As with all surgeries, there’s a risk of complications and adverse outcomes, and it’s important to discuss any concerns you have with your doctor. There is a risk of a shifting of brain tissue, blood, and cerebrospinal fluid (CSF) from its normal position inside the skull (brain herniation) causing a leak, carotid artery disease which could lead to a potential stroke or dizziness, numbness and difficulty with speech and vision as a result of optic nerve injury. Reduced sense of smell and excessive bleeding are also potential side effects as well further infection and scar tissue from the surgery.

In rare cases, there’s a chance of developing a brain swelling due to the abnormal accumulation of water within the brain (brain oedema) or cerebral infarction.

Benefits of sinus surgery

Sinus surgery can remarkably improve your ability to breathe and inhale more oxygen with less effort. It can also improve your sense of smell and taste and minimise the chances of future infection.

How do I prepare for sinus surgery?

As an nib member, if you think you might need surgery in the future, it’s important Contact us. We can check your health insurance coverage, provide tips on keeping costs low and give guidance on questions to ask your specialist so that you’re prepared.

In the days leading up to your surgery, you should receive personalised advice from your doctor. Generally, you’ll be asked to fast for at least six hours leading up to the surgery.

You should also consult with your specialists about whether to continue taking current medications. It’s also a good idea to stock plenty of pain relief medication, sterile gauze and tissues at home for when you’re released from hospital and head back home.

Make sure you organise for someone to drive you home from the surgery and if you experience cold or flu symptoms after being released, make sure you inform your specialist.

Your doctor will likely ask you to take a blood test prior to your surgery. This will include a full blood count, a urea and electrolytes to check the health of your kidney as this will have a direct effect on your anesthetic and other medications that may be used. There will be liver function tests, clotting tests (to see if your blood naturally coagulates and stops bleeding) and also a blood cross-matching.

The doctor may order other tests such as computed tomography (CT) scan, nasal smears, cultures and olfactory testing (the nerves that pass from the nose to the brain and contain the receptors that make smelling possible).

What does sinus surgery recovery look like?

After your surgery, you won’t be able to chew or swallow for a few days and will need to slowly transition from drinking to eating very soft food. Rehydrate with ice chips and drinking fluids and try eating soft and cool foods before starting again on your usual diet.

During your recovery time, generally you can take paracetamol if you have headaches or surgical discomfort, but it’s always best to check with your doctor. If you feel tired or weak, it’s important to sleep and rest. Use sterile gauze to dab bleeding or make a nasal sling and when bleeding changes into a clearer fluid, use tissues. If you have a nosebleed, pinch the nostrils and lean forward.

Your nose might be packed with cotton padding or gauze for the first day after surgery and you may be prescribed oral antibiotics to prevent infection. Removal of packing is usually within three days. Ice packs can reduce swelling surrounding the surgical area. Gentle nasal saline irrigations can help moisten dry inner nostrils. You can use nasal sprays and lubricants as ordered by the specialist to reduce swelling and make breathing easier.

Avoid exertion or lifting anything more than 4.5 kg for at least a week.

Seek your emergency contact specialist if you experience fever, increased severity in pain, nausea and vomiting or increased bleeding or shortness of breath or difficulty breathing.

Do I have any choice other than sinus surgery?

There are preventative and alternative treatments for sinus abnormalities that can improve your breathing by reducing the inflammation, swelling and discomfort. Some of these treatments and lifestyle changes include:

Avoid allergens
Analgesics - paracetamol, acetaminophen or ibuprofen
Normal saline nasal rinse – clears mucus in the sinuses
Antihistamines – relieves allergic symptoms
Corticosteroids therapy – reduces inflammation
Decongestants – narrows the blood vessels and decreases pressure (from swelling)

Sinus surgery FAQs

1) Can I go home the same day after surgery?

After an FESS procedure or balloon sinuplasty, you can usually go home within 4 hours. With other procedures, including open sinus surgery, the hospital stay is an average of seven days (generally this ranges between 3-14 days).

2) How long does sinus surgery take?

FESS procedure and balloon sinuplasty can take less than two hours. Open sinus surgery can take a little longer – generally up to three hours.

3) Will I be placed under general anaesthesia?

This all depends on your specialist’s recommendation. A general anaesthesia for FESS procedure and balloon sinuplasty is common, while open sinus surgery is always performed with a general anaesthesia.

4) Will my nose bleed much after surgery?

Bleeding after surgery all depends on the type of surgery, what happens during surgery, and your individual response – everyone is different. If your post-surgery bleeding increases despite the use of packing or sling, you should contact your specialist.

5) Can I blow my nose after surgery?

No. You should not blow your nose for up to 10 days. Make sure you also avoid straining and lifting anything heavier than 4.5 kg for at least a week.

6) Will I be given any medications for pain management?

Yes

7) I have congestion after sinus surgery. How long will it last?

Breathing without congestion should occur within 1-2 weeks.

8) What should I eat after sinus surgery?

After a FESS procedure and balloon sinuplasty, you can start rehydrating with ice chips and cool fluids. A soft diet is important in the first 3-4 days.

With open surgery recovery in hospital, you will be given ice chips, fluids, soft foods and then your usual diet as ordered by a physician.

9) How soon can I fly after sinus surgery?

You will not be able to fly until three weeks after a FESS procedure and balloon sinuplasty, while open sinus surgery recovery requires no travel for 6-8 weeks.

The tips throughout this article serve as broad information and should not replace any advice you have been given by your medical practitioner.