What is endoscopic sinus surgery?

Endoscopic sinus surgery is a type of surgery. It removes small bits of bone or tissue that can block sinuses. This opens up your sinuses and may relieve your symptoms.

To do the surgery, your doctor puts a lighted tube into your nose. This is called an endoscope, or scope. It lets the doctor see your sinuses. Then the doctor puts special tools alongside the scope. The doctor uses these to remove whatever is blocking your sinuses.

Most people go home a few hours after surgery. But it may take 1 to 2 months before you feel completely normal. You can probably return to work in about 1 week and your normal routine in 3 weeks. But it depends on the type of work you do and how complex your surgery was.

After surgery, you will see your doctor to check how well you are healing. The doctor may use an endoscope to look at your sinuses again. Or the doctor may need to take out scar tissue or clean your sinuses. Doing these things can help sinuses heal.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Do not lie flat. Raise your head with three or four pillows. This can reduce swelling. Try to sleep on your back during the month after surgery. You can also sleep in a reclining chair.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. Also, try to sit and stand as much as you can.
• For 1 week, try not to bend over or lift anything heavier than 10 pounds. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• You can take a shower or bath. Use lukewarm, not hot water. Avoid swimming for 6 weeks.
• Avoid sawdust, chemicals, and excessive dust for 4 weeks.
• Avoid strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, for 1 week and then ease back into these activities over 2 to 3 weeks.
• Ask your doctor when it is safe for you to drive.
• You will probably be able to return to work or school in about 1 week and to your normal routine in about 3 weeks. But this varies with your job and the extent of your surgery.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Avoid hot and spicy foods right after surgery. They may make your nose run.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You also will be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Do not take aspirin, aspirin-containing medicines, or anti-inflammatory medicines such as ibuprofen (Advil, Motrin) or naproxen (Aleve) for 3 weeks following surgery unless your doctor says it is okay.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• You probably will not have an incision (cut). You will have a drip pad under your nose to collect blood. Change it only when it has bled through. You may have to do this every hour for 24 hours after surgery. When bleeding stops, you can remove it.
• If you have packing in your nose, leave it in. Your doctor will take it out.

Ice and elevation

• To help with swelling and pain, put ice or a cold pack on your nose for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
• Do not sleep flat. Sleep with your head raised up. You can also sleep in a reclining chair.

Other instructions

• Do not blow your nose for 2 weeks.
• Do not put anything into your nose.
• If you must sneeze, open your mouth and sneeze naturally.
• Use saline (saltwater) nasal washes to help keep your nasal passages open and wash out mucus and dried blood. You can buy saline nose washes at a grocery store or drugstore.
• Use a humidifier to keep room air moist, especially in the bedroom. Follow the directions for cleaning the machine.
• You can wear your glasses when you wish. Do not wear contacts until the day after the surgery.
• Make sure to go to all of your follow-up appointments after surgery. Your doctor will remove mucus and dried blood. This will help with healing.

Endoscopic surgery improves symptoms in most people.

But surgery doesn't always get rid of sinusitis. Some people may need a second operation.

Surgery works best when it's used along with medicine and home treatment to prevent future sinus infections. A second surgery and future sinus infections may be avoided if aftercare instructions are followed carefully.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

As with any surgery, there are always some risks involved. But endoscopic sinus surgery is very safe when performed by an experienced surgeon who has special training with endoscopic surgical techniques.

Minor complications (such as recurring blocked air passages and sinus infections) occur in a small number of people who have the surgery. Major complications (such as heavy bleeding, vision problems, or brain injury) occur in very few people. Most complications can be managed or prevented.

You will have a drip pad under your nose to collect mucus and blood. Change it only when it bleeds through. You may have to do this every hour for 24 hours after surgery.

You may have some swelling of your nose, upper lip, or cheeks, or around your eyes. Your nose may be sore and will bleed. You may feel "stuffed up" like you have a bad head cold. This will last for several days after surgery.

The tip of your nose and your upper lip and gums may be numb. Feeling will return in a few weeks to a few months. Your sense of smell will not be as good after surgery. It will improve and probably return to normal in 1 to 2 months.

You will probably be able to return to work or school in about 1 week and to your normal routine in about 3 weeks. But this varies with your job and the extent of your surgery. Most people feel normal in 1 to 2 months.

You will have to visit your doctor regularly for 3 to 4 months after your surgery. Your doctor will check to see that your sinuses are healing well. It is also very important to continue home treatment, like nasal rinses, for as long as your doctor tells you to.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery may take up to several hours. It depends on how badly your sinuses are blocked.

Endoscopic surgery may be needed when medicine has failed to improve or cure chronic sinusitis. It is the preferred method of surgery for most cases of chronic sinusitis that require surgery.