Sinus Surgery

INTRODUCTION:

The nasal sinuses are air-conditioning spaces surrounding the nasal cavity. Their true function is uncertain but their involvement in disease and inflammation is extremely common. Suffering with ‘sinus’ means different things to different people. Sinus surgery is only one option in the treatment and should be reserved for when medical treatment has failed.

REASONS FOR SURGERY:

Dr Wallace offers the operation for some or all of the following reasons:

  • Recurrent sinusitis infections
  • Blocked sinuses causing headache or facial pain
  • Chronic sinus infections with nasal or post-nasal discharge
  • Sinus polyps
  • Fungal sinusitis
  • Sinus tumours
  • Unexplained opaque sinuses on X-ray

RISKS OF SURGERY:

This surgery is associated with a moderate risk of complications.
The specific risks of sinus surgery of which you should be aware are:

  • Bleeding from the nose, or epistaxis is normal for several days after surgery. Late or ‘secondary’ bleeding up to 14 days after surgery requires further attention that may involve a return visit to hospital and the operating theatre.
  • Infection is rare but almost all patients feel as though they have contracted an head cold. True infection is associated with throbbing pain, discharge of pus from the nose and possibly a fever. Antibiotic intervention is then required.
  • Scar tissue developing within the nose can cause a recurrence of blockage. Compliance with the schedule of post-operative care will minimise this complication.
  • The sinus walls are very thin and separate the sinuses from the brain and the eye sockets. Consequently, there is a small risk of penetration of the walls and injury to these adjacent structures. However, untreated sinus conditions can themselves also spread to the brain and the eye.

ANAESTHESIA:

Sinus surgery is routinely performed with the patient asleep under General Anaesthesia. The duration is approximately 30 – 60 minutes. The Anaesthetist will assess your fitness for surgery prior to admission to hospital.

THE OPERATION:

Dr Wallace performs the surgery via the nostrils without any external incisions unless specifically mentioned before the operation. Telescopes and powered instruments are used but again there is no need for external incisions. Normally no nasal packing or dressings are required. Specimens are commonly sent for pathology examination.
After approximately 30 minutes in Recovery, you are taken back to the ward for continuing but less intensive observation. You may go home after several hours or you may stay overnight.

AFTER SURGERY:

Dr Wallace will visit you in hospital early the following morning. There should be little or no external swelling or bruising and minimal discomfort. Dr Wallace will review you in his office one week later and most patients take this week off work. The cost of the first 6 weeks of post-operative care is included in the surgical fee.
Avoid any vigorous physical activity for 2 weeks and sleep with an extra pillow to reduce nasal congestion. Nose blowing is allowed but needs to be gentle.

COMBINED OPERATIONS:

Sinus surgery is often combined with other procedures. The most common combination is with Nasal Turbinate Cautery to deal with the effects of hay fever or rhinitis. Another commonly combined operation is Septoplasty to straighten the inside structure of the nose and occasionally Rhinoplasty for external nasal re-shaping.

RESULTS:

It takes about 4 weeks for the sinuses to heal but up to 6 months for all the inflammation to settle. This only proceeds well if allergic factors are controlled and this may involve the use of a nasal spray, allergy immunotherapy or an exclusion diet.
The vast majority of patients will be very glad that they put themselves through the minor discomfort of a sinus operation. Within 2 – 4 weeks, breathing will be easier, sleep should be more refreshing and any pre-existing sinus headaches should be settling.