The sinuses are cavities located in the forehead, cheeks and between the eyes. They have a lining that constantly produces mucus, which is moved out of the sinuses and toward the back of the nose by the action of microscopic hairs (cilia). Dust, allergens, bacteria and fungal spores that are inhaled are trapped in the mucus and usually carried out of the nose by this system, which is very similar to the clearance mechanism of the lungs.
Sinusitis (properly called Rhinosinusitis) is inflammation of the sinus and nasal lining. It is the result of a combination of impaired mucus clearance, microorganisms (bacteria, fungi, viruses) and inflammation of the sinus lining.
Treatment of Sinusitis
Treatment is aimed at improving mucus clearance, removing microorganisms and reducing inflammation. Medical treatment is usually attempted first, with tablets, sprays and / or nasal washes.
If this is unsuccessful, surgery may be recommended. Surgery is performed to:
- Remove obstructions to mucus clearance
- Remove thick, infected mucus and other material from the sinuses
- Open the sinuses so that after surgery nasal washes and other nasal medications can get into the sinuses
- Improve the airway
Preparing for surgery
Always tell your ENT specialist and anaesthetist about your medical history and be sure to mention
problems such as allergies to medication. Inform your specialists about any medication you might be taking.
This includes any natural medicines such as vitamins and herbal remedies. If there is a family history of blood clotting problems (increased bleeding tendency, easy bruising or deep vein thrombosis) or problems with anaesthetics be certain to mention this as well.
Things to avoid taking at least three weeks before and one week after your surgery:
- Anti inflammatory medication such as Celebrex or Ibuprofen (Nurofen)
- Vitamin E
- Fish oil
- Garlic, ginger, ginseng and any other herbal remedies (there are more than 40 different herbs which have effects on blood clotting)
These substances can cause excessive bleeding and should be avoided around the time of surgery. Excess bleeding during the surgery makes surgery more difficult and can result in the procedure being stopped before it is completed. Bleeding after surgery can occasionally require treatment with nasal packing or more surgery.
Warfarin, Clopidigrel (Plavix) or aspirin taken for heart or stroke problems will also need to be stopped before surgery, however this should be discussed with both your ENT surgeon and your GP or cardiologist. Other short acting medications may be needed.
You should stop smoking as soon as possible. It is advisable to use this opportunity to quit smoking altogether.
Please remember to take your CT scans to the hospital – your surgery will not proceed without them.
Sinus surgery is performed using endoscopes placed through the nostril. Your surgeon will explain the procedure that will be performed in order to correct your problem.
If frontal mini trephines are used there will be a small incision in the end of each eyebrow.
Frontal mini trephines
In some cases, mini trephines are used as an aid to opening the frontal sinuses. A small incision is made in the corner of the eyebrow and the trephine is a small tube which is passed through a hole drilled in the bone into the frontal sinus.
Saline solution is flushed through the mini trephine which helps with identification of the frontal sinus opening and with clearing thick mucus out of the sinus.
Septal & Turbinate Surgery
Septoplasty (straightening the nasal septum) is often performed as part of sinus surgery to improve access to the sinuses and improve the nasal airway. Inferior turbinate reduction is often combined with sinus surgery to treat nasal blockage.
Sometimes RHINOPLASTY, a procedure that improves the function and external cosmetic appearance of the nose may be required as well. The procedure is usually done internally, but occasionally an “open” approach is required. This involves the use of a 5mm incision on the undersurface of the nose.
Your surgeon will let you know if you can be discharged on the same day after surgery or whether you will need to remain in hospital overnight. In either event you will need to ensure you have someone to pick you up from the hospital.
- Your nose will feel blocked and stuffy after surgery, as if you have a cold or a flu.
- You will get some blood and mucus from the nose, particularly over the first few days. Tape a piece of gauze under the nose with tape (paper tape such as Micropore is best) if needed rather than constantly wiping the nose
- Your ears may pop or bubble when you swallow. You may have splints and / or spacers in the nose, which are soft silicone dressings and are removed in the rooms after approximately a week
- You may be prescribed antibiotics, prednisolone and / or nasal medications depending on the nature and severity of the sinus disease. Cold and Flu tablets may also be recommended.
- Take pain relief as required. Your surgeon will advise you on which pain medication to take.
- Avoid aspirin and non-steroidal anti-inflammatory medicines such as Nurofen as they can make bleeding worse.
You will be provided with a FLO Sinus Care or FLO CRS or FLO Post Operative kit to wash the nose. Nasal and sinus washing is essential after surgery to clear blood clot and mucus from the sinuses and nose. If a blood clot is left in the sinus cavity, it can promote scarring, which can cause a poor surgical result.
The wash will start the day after surgery, and will be used at least 4 times daily until review which takes place 1 week after surgery.
Nasal washing is usually continued for a minimum of 6-8 weeks after the operation as it can take this long for the normal mucus clearance mechanisms to start functioning properly. In some cases, especially with nasal polyps, medications may be added to the douche, and this may need to continue long term.
Recommendations for the first 2 weeks after surgery
- Elevate the head of your bed to 30 degrees
- Avoid hot and spicy foods/drink
- Avoid hot showers/baths
- Avoid bending over
- Sneeze only with the mouth open
- Avoid vigorous blowing of the nose – this should be done very gently
- Avoid exercise other than gentle walking
Failure of the surgery
Depending on the nature of the disease which causes the problem in the first place, the underlying disease process may continue resulting in recurrence of symptoms. Usually this can be managed with medications but at times further surgery is necessary.
Overall, 85% of people having this surgery are satisfied with the outcomes.