Nose & Sinuses
Sinus infection (Sinusitis)
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
What are sinuses?
There are four pairs of sinuses in the head that assist the control of temperature and humidity of the air reaching the lungs. Sinuses begin as pea-sized pouches in the newborn extending outward from the inside of the nose to the bones of the face and skull. They expand and grow throughout childhood and into young adulthood. Eventually they become air pockets or cavities that are lined with the same kind of lining that lines the nose. They are connected to the inside of the nose through smaller openings called ostia.
Normally the nose and sinuses produce a pint and a half of mucus secretions per day. These secretions pass normally through the nose picking up dust particles, bacteria and other pollutants along the way. This mucus is swept into the back of the throat by millions of tiny hair-like structures called cilia, which line the nasal cavity. The mucus moves into the throat and is swallowed. Most people do not notice this mucus flow because it is a normal bodily function.
Types of sinusitis
Sinus infection occurs in two types:
Acute sinusitis gives rise to severe symptoms but is usually short-lived. Acute sinusitis usually occurs following a cold. Typically a green-yellow nasal discharge occurs a week or more after the onset of the cold and this is associated with severe pain around the cheeks, eyes and/or forehead. This may be associated with swelling and a high fever along with toothache.
Chronic sinusitis is sinusitis that continues for many weeks. Chronic sinusitis may be caused by an acute sinus infection which fails to resolve or as a result of an underlying allergy affecting the lining membranes of the nose and sinuses. Common symptoms include nasal obstruction, headache, nasal discharge, low grade fever, reduced sense of smell, facial pain and halitosis.
What causes sinusitis?
It is worth noting that pain in the face may well be due to other causes such as tension headache, migraine, neuralgia and jaw dysfunction. The pain from sinusitis usually occurs as a result of blockage of the sinus opening. These blockages may be caused by infections, irritants, allergies or a structural abnormality.
Infections: Most adults will get colds and upper respiratory tract infections up to three times a year. Children get them more frequently. Bacterial infections often follow the common cold. When the mucus changes from clear to yellow or green it usually means a bacteria infection has developed. Both viral and bacterial infections cause swelling of the tissues inside the nose and thickening of the normal mucus. This slows down or even stops proper sinus drainage and infection in the sinus may ensue.
Allergies: Allergies can cause inflammation inside the nose. Common symptoms of an allergic reaction include nasal stuffiness, runny nose, sneezing and itchy watery eyes. Chronic sinusitis is sometimes associated with asthma. Allergies are responsible for asthma in some patients and may also cause nasal stuffiness making the asthma more difficult to control.
Structural problems: Occasionally structural problems within the nasal cavity can cause a narrowing. Some of these can be caused as a result of trauma while others may develop during the growth period. Occasionally the structural narrowing can be so severe that mucus builds up behind these areas of blockage giving rise to sinus infection.
Irritants: Air pollution, smoke and chemical irritants, for example some sprays containing pesticides, disinfectants and household detergents, may cause swelling and blockage of the lining of the nose causing a narrowing of the drainage opening from the sinuses. This can once again lead to impairment of sinus drainage and consequent infection.
Diagnosis and treatment of sinusitis
Acute sinusitis is usually treated with antibiotics and medication to reduce the swelling of the nasal lining e.g. decongestants. Chronic sinusitis may need long term treatment. Medical treatment options include antibiotics, decongestants and other treatments to reduce the swelling of the lining such as nasal steroid sprays. Antihistamines will have a place in patients who have an underlying allergy. In the vast majority of cases sinusitis can be managed effectively with medical treatment.
Occasionally symptoms will persist despite ongoing use of medicines in which case surgery may be necessary. The diagnosis of sinusitis by a specialist will involve the use of a nasal endoscope which the doctor can use to examine the nasal lining and the sinus openings.
Sinus surgery
Surgery is normally only considered if medical treatment fails. When surgery is needed the ENT specialist can choose from a number of different options depending on the severity of the sinus disease. Most sinus operations are performed without an external incision. Most surgeons will ask for a scan of the sinuses to assist with the planning of the operation.
You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist.
Nasal injuries TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
Nasal injuries can result in damage to the skin, bone, cartilage or any combination.
If the skin is cut this requires cleaning and then closing using either sutures or self adhesive strips. An injection to prevent tetanus is advisable if your vaccination is not up to date (every 10 years).
Bony fractures of the nose account for nearly 50% of all facial fractures. Fractures to the nasal bones cause a lot of swelling and it may take about five days for the swelling to settle down enough for the bones to be checked.
Your family doctor or the accident and emergency department should check your nose to exclude a septal haematoma (see below). They will often ask an ear nose and throat surgeon to check your nose seven to 10 days after the injury to see if the bones and cartilage need more treatment.
Treatment
X-rays do not contribute to the clinical management of nasal fractures, as the majority are simple and uncomplicated. Only when more serious injuries have taken place are they important and should include the skull and face.Most of the time when the swelling has settled down and there is either no or little change in the shape of the nose
If the nose is deformed after the swelling has subsided (three to five days after the injury), manipulation under anaesthesia can take place. Manipulation must take place before 14 days after the injury and the patient made aware that the deformity may not be corrected completely. Any residual deformity even after manipulation may require more surgery 12 months or more after the injury.
Complications
Septal haematoma
Blood collecting (haematoma) under the lining (mucosa) of the central partition wall of the nose (septum) is stripped off either side causing a purple swelling inside the nose. If this occurs it will give you nasal obstruction and pain and need treating by draining the blood away soon after it happened.
If the blood is left and not drained it can become infected or cause damage to the underlying support destroying cartilage and then leave a ‘saddle nose’ deformity. (explanation please) Treatment is by surgical drainage and a course of antibiotics.
Nasal obstruction
Nasal blockage usually occurs after the injury due to swelling inside the nose and this may take a few days to settle. If the nose is still blocked after three weeks it may be due to the septum being deviated and buckled which blocks the nasal passage. Septal deviation may require surgical correction if the blockage is significant.
Nosebleeds (epistaxis)
Nosebleeds are common and usually settle on their own with simple first aid by gently pinching the lower half of the nose for 15 minutes. Nasal packing or cautery in hospital is reserved for nosebleeds that do not stop of their own accord.
Rare complications
Cerebrospinal fluid leak
Severe nasal trauma can push the nasal bones into the face, giving the face a pug-like appearance. The thin cribiform plate at the roof of the nose may fracture causing the cerebrospinal fluid that bathes the brain to leak out.
Small fractures seal spontaneously with conservative management (95% within two weeks). Antibiotics are not given unless infection is proven to be present. If fluid leak continues , more treatment may be required.
Loss of sense of smell (anosmia)
The smell organ in the roof of the nose can also be damaged. Loss of sense of smell very rarely returns.
Nasal polyps TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
A polyp is a swelling of the lining of the nose, which is usually due to inflammation of the lining of the nose.
Causes
Nasal polyps come from the lining of the nose and often originate from the ethmoid sinuses, which drain into the side wall of the nasal cavity. Nasal polyps contain inflammatory fluid and, while they can be associated with allergy and infection, the exact reason why some people get them and not others is not known.
What are the symptoms?
Nasal polyps are more common in men (up to 4:1) yet in those who have late onset asthma, it can also occur in women. The chance of developing nasal polyps is between one and 20 for every 1,000 people and after the age of 60 the chance of developing polyps declines.
One-sided nasal polyps are rare and associated with a range of conditions and need further investigations both in adults and children.
Polyps look like small grapes and can appear singly or in clusters in the nasal cavity. The can cause:
• Blocked nose
• Runny nose and/or sneezing are seen in about half of patients
• A poor sense of smell and taste which may not always return after treating the polyps
• Catarrh
Treatment
There are no specific treatments for nasal polyps. Endoscopy, where a small illuminated endoscope is used to see up the nose will exclude any infection or any unusual feature.
Is surgery needed?
Medical treatment
Nasal polyps are known to shrink when nasal sprays or drops containing nasal steroids are used. Stronger steroids in drop form can be used but should only be used with care and limited to short courses because some is absorbed into the body.
Polyps respond and shrink using drops or sprays in up to 80% of people. New nasal steroid sprays can be taken to control symptoms for many years as very little is absorbed into the body and they can work well, but many take up to six weeks of treatment before their full effect can be felt.
Steroids in tablet form can provide good relief of symptoms but the effects are short-lived and they are used sparingly because of concerns about side effects. If medicines don’t work then surgery is needed.
Surgical treatment
Nasal polyps blocking the nose can be removed surgically and this often helps the patient to breathe better. In three out of four patients the polyps come back after an average period of four years.
If they return repeatedly the sinuses can be cleaned out and opened up and it is thought that this gives a longer period before they return. Local medical treatment is often still needed using anti-inflammatory sprays or drops.
Nasal obstructions TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
Nasal obstruction is the sensation of reduced air flow either through one nostril (unilateral) or both nostrils (bilateral). There are four main subdivisions:
• Mucosal swelling
• Septal deviation
• Collapse of the nasal valves
• Nasopharyngeal obstruction
Mucosal swelling
The mucosa is the thin moist lining that covers the bone and cartilage inside the nose.
Autonomic rhinitis
Clear mucus production is the primary problem with less nasal obstruction. This is due to overactivity of the glands in the nose. It is not common and usualy occurs in the over 60s.
Rhinitis medicamentosa
Overuse of some decongestant nasal sprays (Otrivine, Sinex). These can help decongest the nose for a few hours if you have a cold but should not be taken for more than a few days as they damage the lining of the nose.
Chronic infection
This is not common. It is associated with a mucky discoloured production of green mucus through the day.
Idiopathic rhinitis
Where neither allergy nor infection can be found yet the lining of the nose is swollen.
A range of rare conditions can affect the lining of the nose. These often cause a lot of crusting, spotting of blood and nasal obstruction. If there is a lot of crusting or whistling then your doctor may refer you to an ear nose and throat surgeon for further tests.
Septal deviation
The septum is a thin piece of bone and cartilage seperating the left and the right side of the nasal cavity. In some people the septum is bent or deviated over to one side and this blocks the air passage of the nose.
Septal deviation may be associated with a visibly deformed nose and a history of nasal trauma although it is not necessary as the cartilage may bend and deform as your nose grows.
Nasal obstruction is the predominant symptom, usually on one side. However, if other symptoms are present other disease processes must be excluded.
Management depends on the severity of nasal obstruction. Surgery to correct the deformity can be undertaken if the nose is blocked or unsightly.
Collapse of the nasal valves
Normally on breathing in through the nostrils there is a small amount of collapse of the nostrils. Often this collapse stops if the mucosal swelling (as mentioned above) is treated.
Occasionally the problem is primarily due to a ‘floppy’ valve or side wall of the nose collapsing. Treatment using external nasal splints can sometimes be help at night. Surgery in this area is not straightforward.
Nasopharyngeal obstruction
The back of the nose just before it enters the back of the throat is called the nasopharynx. The adenoids are the most common cause of nasal obstruction in children reaching maximum size between the age of three and five and then reduce in size often by the age of seven or eight and can hardly be seen by the late teens.
Snoring alone is not an indication for adenoid removal but if the child also stops breathing while asleep (apnoea – stops breathing for more than 10 seconds regularly without a cold) then adenoidectomy and tonsillectomy may be helpful.
Be aware
• In children with a blocked nose on one side and a one sided nasal discharge, a foreign body may be in the nose
• Nasal polyps are rare in children and further tests should be done
• Nasal obstruction of one side of the nose in adults, with or without bleeding, needs to be examined carefully by an ear nose and throat surgeon
• Avoid the long-term use of nasal medication purchased over the counter in chemists unless specifically advised by your family doctor or ear nose and throat surgeon. If in doubt contact your doctor and read the instructions carefully
Surgery on the nose-Rhinoplasty TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
What gives the nose its shape?
The shape of the nose on the outside is due to the shape of bone and cartilage and the overlying skin. The top of the nose is made of bone shaped like a roof, which is hard. The middle and tip of the nose are made of cartilage which is softer. The skin varies in thickness from person to person, and also affects the shape.
Reasons for surgery
Improving the features of the nose and face by cosmetic surgery can also involve improving its function and help with breathing.
There is a great deal of variety in human appearance. Nasal shape depends on the bony contours, dimensions of the face, skin colour, thickness and race.
Most people have reconciled themselves with their appearance but some are unhappy with it and seek surgery. The most common features people are concerned with are deviations of the nose to one side, a nasal hump, a nasal depression, too wide or too a narrow nose, over or under projection of the soft nasal tip.
There is no perfect shape to the nose and any alteration has to fit and suit the rest of the face.
It is important that expectations about the effects of surgery are not unrealistic. People who believe that their lives will change if they have cosmetic surgery are often disappointed.
What is rhinoplasty?
Rhinoplasty is an operation to change the shape of the nose. The type of rhinoplasty depends on which particular area of the nose needs correction. The nose can be straightened, made smaller or bigger and bumps may be removed. The shape of the tip of the nose can be changed. Pieces of cartilage or bone may be removed from or added to the nose to change its shape. Sometimes the wall that separates the nose into right and left (nasal septum) is twisted. We may need to correct it at the same time. The combined operation is called septorhinoplasty.
Techniques
Rhinoplasty surgery employs reduction, augmentation or refinement of the patient’s nose to give a balanced and proportioned nose.
Reduction rhinoplasty commonly involves the removal of a nasal hump along with re-breaking the nose to reduce the width.
The tip of the nose may be asymmetrical, depressed or the nose itself may need building up. Augmentation with can be achieved using tissue moved from another part of the patient’s body such as skin or cartilage from the ear or rib. Alternatively synthetic material can be used (gortex, silastic) but there is a greater risk of rejection or infection.
Approaches for the surgery can be either through the nostrils (intranasal) or by the use of a small incision on the under side of the nose (external).
How successful is the operation?
Everybody’s nose and face is different, so it may not be possible to make your nose look exactly like your perfect nose. The thickness of the skin is important in how much better the nose will look after rhinoplasty and in what can be done. If the skin is thin, it makes bumps or hollows in the nose difficult to hide. If it is thick not all changes that can be made on the inside will show up on the outside. Your surgeon will aim to produce a nose that looks natural. However, your surgeon may not be able to say exactly how your nose will look after your operation. It is important that you discuss your expectations with your surgeon. 90-95 % of patients are happy with the results of their operation but some people request more surgery.
How is the operation done?
Photographs will be taken to allow a record to be kept in your notes of how your nose looked before surgery, and to allow the surgeon to plan your operation. Rhinoplasty and septorhinoplasty are usually performed with you asleep. Cuts are made inside your nose. Occasionally a small cut on the skin between the nostrils or at the base of the nostrils may be necessary. The skin of your nose is gently lifted off the bone and cartilage underneath. A hairline fracture may be made in the nasal bones to allow the surgeon to change the shape of the nose. Pieces of bone and cartilage can be removed from or added to the nose to smooth out any bumps or dips.
Packs and splints
We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called ‘packs’, and they will block your nose up so that you have to breathe through your mouth. We may take them out the morning after your operation. You may get a little bit of bleeding when the packs come out – this will settle quickly. Sometimes we put small pieces of plastic in your nose to prevent scar tissue from forming. These are called ‘splints’ and we will take them out after a week. You will have a temporary splint on the outside of the nose for a week. This should be kept dry.
After the operation
The front of your nose can be a bit tender for a few weeks.
Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. You may get some blood-coloured watery fluid from your nose for the first two weeks or so – this is normal. Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. We may give you some drops or spray to help this. It may take up to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places.
There will be some stitches inside your nose – these will dissolve and fall out by themselves. You may have some bruising and swelling around your nose and eyes for one to two weeks. Sleeping upright with extra pillows for a few days helps. Most of the swelling has subsided after two weeks but it may be longer before the skin and soft tissues over the bone and cartilage settle. Fine swelling may take up to a year to settle at which time the final results of surgery may be judged.
Following rhinoplasty or septorhinoplasty, the skin of the nose is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least six months. The nose may feel a little stiff and numb for up to three months, particularly around the tip.
How long will I be off work?
You can expect to go home the day after your operation. Sometimes it is possible to go home the same day. You should rest at home for at least a week. Most people need one to two weeks off work, especially if their work involves heavy lifting or strenuous activity. You should not play sports where there is a risk of your nose being knocked for six weeks. Ask your nurse if you need a sick note for your time in hospital.
What can go wrong?
Sometimes your nose can bleed after the operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 – 8 hours after surgery or up to 5 – 10 days after surgery. Very occasionally patients need to have another general anaesthetic and return to the operating theatre to stop the bleeding.
Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore.
The operation may rarely leave you with a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes not problems at all and needs no treatment. Further surgery can be carried out if necessary to repair a hole in the septum.
Very rarely, you can have some numbness of your teeth, which usually settles with time.
Up to 10% of people may have some reservations about the end results and about 5-10% of patients need further operations in the future to further adjust the shape of the nose.
Surgery on the nose - Septal surgery TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
What is septal surgery?
The spetum is a thin piece of cartilage and bone inside the nose between the right and left sides. It is about 7cms long in adults.In some people this septum is bent into one or both sides of the nose, blocking it. Sometimes this is because of an injury to the nose, but sometimes it just grows that way. We can operate to straighten the septum.
Why have septal surgery?
If you have a blocked nose because of the bend in the septum, an operation will help. Sometimes we need to straighten out a bent septum to give us room to do other things, such as sinus surgery. The operation is not meant to change the way your nose looks. In some cases a bent septum may occur with a twist in the outside shape of the nose. In these cases septal surgery may be combined with nose re-shaping surgery (septorhinoplasty) to straighten the nose.
Do I have to have septal surgery?
A bent septum will not do you any harm, so you can just leave it alone if you want to. Only you can decide if it is causing you so much bother that you want an operation.
You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation. If you would like to have a second opinion about the treatment, you can ask your specialist. He or she will not mind arranging this for you. You may wish to ask your own GP to arrange a second opinion with another specialist.
How is the operation done?
The operation takes about 30-45 minutes. You might be asleep although some cases can be performed with only your nose anaesthetised. The operation is usually all done inside your nose - there will be no scars or bruises on your face.
We make a cut inside your nose and straighten out the septum by taking away some of the cartilage and bone and moving the rest of the septum back to the middle of the nose. Then we hold it all in place with some stitches. Complex cases may require a cut across the skin between the nosrils and may be combined with septorhinoplasty procedures.
Packs and splints
We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called ‘packs’, and they will block your nose up so that you have to breathe through your mouth. We will take them out two days after your operation. You may get a little bit of bleeding when the packs come out - this will settle quickly.
Sometimes we put small pieces of plastic in your nose to keep the septum in its new straightened position. They are called ‘splints’ and we will take them out after about two weeks.
After the operation
The front of your nose can be a bit tender for a few weeks. Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. You may get some blood coloured watery fluid from your nose for the first two weeks or so - this is normal. Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. We may give you some drops or spray to help this.
It may take up to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places. There will be some stitches inside your nose - these will dissolve and usually fall out by themselves.
You can expect to go home the day after your operation. Sometimes it is possible to go home the same day. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work, you should take two weeks off. You should not play sports where there is a risk of your nose being knocked for about a month
What can go wrong?
Septal surgery is safe, but there are some risks. Sometimes your nose can bleed after this operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 – 8 hours after surgery or up to 5 – 10 days after surgery. Rarely you may need to return to the operating theatre with another general anaesthetic to stop the bleeding.
Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore.
Rarely, the operation can leave you with a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes no problems at all and needs no treatment. Further surgery can be carried out if necessary to repair a hole in the septum. Very rarely you may find that the shape of your nose has changed slightly, with a dip in the bridge of your nose. Most people do not notice any change, but if you are not happy with it, it can be fixed with surgery. Very rarely, you can have some numbness in the teeth, which usually settles with time.
Is there any alternative treatment?
Only an operation can fix a bent septum, but nose spray or drops can help treat swelling in the nose which might be making your nose feel blocked.
If septal deformity is the cause of your nasal blockage there is no treatment other than surgery to correct the shape of the septum.
Functional Endoscopic Sinus Surgery (FESS) TOP
Disclaimer:
The details in this section are for general information only. Always check with your own doctor.
Sinuses and Sinusitis
Sinuses are air-filled spaces in the bones of the face and head. They are connected to the inside of the nose through small openings. The sinuses are important in the way we breathe through the nose and in the flow of mucus in the nose and throat.
When the sinuses are working properly we are not aware of them but they often are involved in infections and inflammations which cause symptoms. These infections and inflammations are called sinusitis. Sinusitis is caused by blocked, inflamed or infected sinuses. Patients will often complain of a blocked nose, pressure or congestion in the face, runny nose or mucus problems. Other symptoms include headache and lose of sense of smell. Sinusitis can be difficult to diagnose and your specialist will want to examine your nose with a telescope in order to help find out what is wrong.
Most patients with sinusitis get better without treatment or respond to treatment with antibiotics or nose drops, sprays or tablets. In a very small number of patients with severe sinusitis an operation may be needed. In rare cases if sinusitis is left untreated it can lead to complications with infection spreading into the nearby eye socket or into the fluid around the brain. These very rare complications are just some of the reasons that a sinus operation may become necessary.
What is endoscopic sinus surgery or FESS?
Endoscopic Sinus Surgery is the name given to operations used for severe or difficult to treat sinus problems. In the past sinus operations were done through incision (cuts) in the face and mouth but endoscopic sinus surgery allows the operation to be performed without the need for these cuts.
Before any operation patients will be treated using drops, tablets or sprays for a period of weeks if not months. Only if these treatments are unsuccessful will an operation become necessary. After an examination of your nose with a telescope your surgeon will discuss whether or not you will need to have a CT scan to help decide about the need for an operation.
What if I don’t have the operation?
Endoscopic sinus surgery is only one approach to the treatment of sinusitis. Endoscopic sinus surgery is as safe, and possibly safer, than other methods of operating on the sinuses.
In some patients an operation can be avoided by use of antibiotics and steroid medicines, again this should be discussed with your surgeon.
The operation
Usually the operation is done with the you asleep (General Anaesthetic) but it can also be done with just your nose anaesthetised (Local Anaesthetic). The operation is all done inside your nose. Rarely there maybe some bruising around the eye but this is very uncommon. There should be no need for incisions (cuts) unless the operation is a complicated one in which case this will have been discussed with you before the operation.
After the operation
Immediately after the operation you may feel your nose blocked. This may be because of some dressing inside your nose or some special plastic sheets called splints. These are not used in every case but your surgeon will explain if they have been necessary in your case. Dressings , if used, will usually be removed from your nose within 48hrs but plastic splints may have to stay longer. It is common to have a stuffy blocked up nose even after removing the dressing or splints and this does not mean that the operation has not worked.
It is common for the nose to be quite blocked and to have some mild pain for a few weeks after the operation. This usually responds to simple painkillers.
It is important that you do not blow you nose for the first three to four following your operation. Your surgeon will advise you on when you can start to gently blow your nose. Some doctors recommend the use of drops, ointments and salt water sprays after the operation. You will be given specific instructions by the ward staff before your discharge from hospital. Some mucus and blood stained fluid may drain from your nose for the first week or two following the operation and this is normal. It is important to stay away from dusty and smoky environments while you are recovering.
How long will I be off work?
You can expect to go home on the day of your surgery or the day after your operation depending on the size of your operation. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work you should be off work for at least one week. You will be given instructions on when to return to the hospital for your follow-up visit.
Possible complications
All operations carry some element of risk in the form of possible side effects. There are some risks that you must know about before giving consent to this treatment. These potential complications are very uncommon. You should discuss with your surgeon about the likelihood of problems in your case before you decide to go ahead with the operation.
• Bleeding is a risk of any operation. It is very common for small amounts of bleeding to come from the nose in the days following the operation. Major bleeding is extremely uncommon and it is very rare for a transfusion to be required.
• Eye problems: The sinuses are very close to the wall of the eye socket. Sometimes minor bleeding can occur into the eye socket and this is usually noticed as some bruising around the eye. This is usually minor and gets better without any special treatment, although it is important that you do not blow your nose. More serious bleeding into the eye socket sometimes can occur, however this is very rare. This can cause severe swelling of the eye and can even cause double vision or in very rare cases loss of sight. If such a serious eye complication did occur you would be seen by an eye specialist and may require further operations.
• Spinal Fluid Leak: The sinuses are very close to the bone at the base of the brain. All sinus operations carry a small risk of damage to this thin bone with leakage of fluid from around the brain into the nose, or other related injuries. If this rare complication does happen you will have to stay in hospital longer and may require another operation to stop the leak. On very rare occasions infection has spread from the sinuses into the spinal fluid causing meningitis but this is extremely uncommon. You can discuss this complication with your surgeon before the operation.
How often do complications happen?
In general, major complications are very rare. If you are particularly worried you should ask your surgeon about his or her experience of these complications.
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