CARE AFTER ENDOSCOPIC SINUS SURGERY

Endoscopic sinus surgery is a procedure that is performed to open up blocked sinuses. It entails using scopes which provide good visualization of the nasal cavity structures without having to make any external skin incisions. Compared to yesteryears of open sinus surgery, endoscopic sinus surgery allows shorter hospital stay and faster recovery.

Endoscopic sinus surgery is recommended when there is failure of medical therapy in treatment of sinus infections.  It is also performed when there are polyps or tumours within the nasal cavity. Correction of deviated nasal septum causing nasal blockage can also be performed by endoscopy.

What to expect when you wake up from the surgery?

Usually the nose will be blocked with nasal packing and a gauze dressing is placed at the front of the nostril to absorb any blood stained discharge and changed whenever soaked. There are two types of nasal packing; dissolvable and non-dissolvable. The non-dissolvable nasal packing which looks like nasal tampon is usually removed 24-48 hours after the operation. The dissolvable nasal packing is left in place and will dissolve within few days.  Patients may have to breathe through their mouth because of the nasal pack.

Patients will experience some pain over the nose area and mild headache is expected. Analgesics are prescribed for pain relief. Inform the surgeon if you still experience considerable pain.

Once the nasal pack is removed, the patient is advised to pinch the nose for at least 15 minutes to stop the bleeding. The patient is also propped up in a sitting forward position and a kidney dish/basin is placed in front so that the patient can spit out any blood discharge trickling at the back of the throat.

The patient is then observed for any serious bleeding before allowed home. A small amount of blood stained discharge is expected for the next few days.

Post op advice for patients

• When lying in bed, keep the head elevated to reduce bleeding from the operated site.
• Patients should not blow their nose for 1 week after surgery. When they sneeze, make sure the mouth is open to reduce pressure in the nasal cavity and prevent bleeding.
• Nasal douching will be prescribed by the surgeon using pre-prepared salts which are dissolved into cooled boiled water. Patients are expected to perform the douching twice a day until healing is complete. The nasal douching will prevent dry crusting in the nasal cavity and allows easy dislodgment of blood clots.
• Patients should also avoid straining, heavy lifting, swimming and flying for a few weeks.
• Patients should avoid allergies and any food known to cause an allergic reaction. Reduce intake of dairy products which can increase mucous production. Refrain from smoking and exposure to secondhand smoke. Patients should also avoid crowded places in case they may catch an infection.
• Patients must comply with the medications prescribed by the surgeon which often includes antibiotics.
• Patients are required to come for follow-up at 5-7 days post operation. During the follow-up visits, the surgeon will monitor the recovery process by endoscopic examination in the clinic and suction removal of blood clots or secretions will be performed.

What next?

The recovery period can take between 2-4 weeks. Patients are often given at least 1 week home rest after the operation. The recovery process varies from patient to patient.

Some patients require long term medication after the endoscopic sinus surgery to prevent recurrence of the disease such as polyps.

Follow up is necessary until the recovery is complete and in patients with polyps they may still need a 6-12 monthly checkup to monitor for recurrence.