Sinus Surgery

What is sinus surgery?

Your sinuses are cavities around the nose and eyes that are connected to the inside of your nose. They produce mucus which forms a protective layer and keep the nasal passages moist, which helps you breathe well and keep infections out. They are lined with fine hair-like cells called cilia, which direct the mucous to flow down to your nose.

Sinusitis is the swelling of these sinuses, which causes a lot of congestion and discomfort as well as sometimes making it difficult to breathe through your nose. Many things can cause sinusitis, including infections (viruses, bacteria, fungi), polyps (small growths on the lining of the sinuses) and having allergies. Sometimes, a deviated septum or other mechanical blockage in the nose can contribute to sinusitis as well.

Many people suffer from recurrent and debilitating sinus infections. This can be due to a problem where the sinuses drainage pathways are chronically blocked and if so, can be treated surgically with sinus surgery. For most people, this relieves their symptoms and cuts down the number of infections they get. As an added benefit, the operation should help you breathe better through your nose as well as often restoring sense of smell and taste.

You can discuss the possibility of sinus surgery with your surgeon to determine if it would be a good option for you.

Why choose sinus surgery?

The nose is an important part of the body that not only allows you to smell and helps with taste, but also forms a key part of your normal breathing. Depending on the way the nose develops, there could be bends and deviations, results of blunt trauma, or other issues that cause the nose to not work as well as it could.

Sinus surgery can help correct issues that affect the sinus, often improving or correcting breathing, smelling and taste problems, as well as relieving pain and recurrent infections. It also can be used to treat nasal polyps, which untreated can result in symptoms including nasal obstruction, disturbed sleep and decreased sense of smell.

One advantage of sinus surgery is that when performed by itself it does not usually result in any external scarring. It is not surprising that many people choose sinus surgery to greatly improve quality of life.

What kinds of problems can sinus surgery treat?

• Recurrent sinusitis due to
  • Structural abnormalities
  • Polyps of the sinuses
  • In conjunction with a septoplasty for a deviated septum
• Nasal polyps causing problems such as difficulty breathing, reduced smell or taste, facial pain and sleep apnoea.
• Chronic sinusitis
• growths or tumours involving the sinuses

What are the types of sinus surgery?

Two common types of sinus surgery are performed:

• Functional endoscopic sinus surgery. This is carried out with an endoscope, a thin glass tube with an attached camera, which allows the surgeon to see inside the nose and sinuses, and use a wide range of surgical instruments to carry out fine detailed surgery. The endoscope is inserted through the nose, allowing for obstructive tissues and other blockages to be removed by the surgeon. Many patients are happy to hear this entire procedure is carried out through the nose and no cuts are made on the skin, leaving little to no scarring in general. Some discomfort and swelling may occur, but this usually resolves very quickly. It is usually performed under general anaesthetic, meaning you are completely unaware. It usually takes 1-2 hours, and you can usually go home the day after surgery.
• Balloon sinuplasty. A newer type of surgery, this allows your doctor to use a special inflatable balloon inside a thin tube to open up the sinuses without removing any tissue. This is a newer technology, that is still finding it role in the australian surgical setting. If you don’t need to have any tissue removed in your sinus surgery, you may be an excellent candidate for this minimally invasive procedure. Speak to your doctor about if this option is right for you.

  The advantage of both of these surgeries is that they can performed multiple times and are usually performed with a single overnight stay. This means less time spent in the hospital and a faster recovery for you to be out enjoying the benefits.

Sinus surgery is a popular surgery because it offers a variety of benefits for those that need it, including:

• Breathe better. This is usually the most obvious benefit of sinus surgery. For people who have developed problems with their sinuses, they know exactly how much of a difference infections and internal damage can have on quality of breathing. Some people, though, have suffered breathing problems all of their lives due to birth defects and the change can be even more life changing.
• Smell better. Not surprisingly, patients who have a loss or decreased sense of smell because of a problem with their sinuses often report being able to smell as they once could, or for the first time.
• Taste better. Your sense of smell is heavily involved in how you taste. Many people are surprised at this change, as they didn’t realise how much of an impact their limited sense of smell has on taste and enjoyment of food.
• Less infections. Freeing up the sinus to work as they should allows for mucus to be produced and flow normally, rather than stagnate and contribute to infections. Most people report a reduction in sinusitis and infections as a result of sinus surgery.
• Less antibiotics. We have all heard the risks and dangers of using antibiotics too much. Recurrent infections can become resistant to normal antibiotics, requiring longer and less desirable courses of treatment. This can get so bad that people need hospital admissions due to bad infections. Reducing the amount of infections allows you body to get on top of the fewer infections, which can be treated more effectively with more common antibiotics and lower the risk of resistant bugs.

What are the risks of sinus surgery?

Every significant surgery carries risks, including infection, bleeding and adverse reactions to anaesthesia. Rare risks specific to sinus surgery include:

• Adhesions, scar tissue that my form deep inside your nose
• Reduced sense of smell
• Double vision
• Damage to your tear ducts
• Damage to the bone surrounding your eye
• Because of how close your sinuses are to your brain and eyes, injury to these structres can occur though are extremely rare

Is it easy to perform this surgery?

It can be hard to tell how complicated sinus surgery is, as the sinus are hidden away in the face. But there are some key points you surgeon needs to be careful with:

• Changes may not be visible during surgery. One of the big challenges with surgery is that the surgeon may not be see for sure if the problem is completely resolved. There also can be a fair amount of swelling, especially if tissue is removed, so a day or two is generally needed to start seeing changes. The advantage of most sinus surgeries is how minimally invasive they are, so it is relatively straightforward to repeat a procedure to optimise results if the first treatment is not satisfactory. This is relatively uncommon though, with an average revision rate of 17% over 10 years.
• General anaesthesia is needed for most surgeries. In the case of general anaesthesia, you will be unconscious for the surgery, and your anaesthetist will place a breathing tube through your mouth to help you breathe. This is sometimes chosen by people who prefer to be ‘asleep’ for the surgery as well, so talking to your doctor about the best option for you is always best.
• Every surgery must be customised. Whilst sinus surgery does involve generally a key series of steps, there is no standard plan of action. Every step in your surgery must be made based on your unique circumstances, and your surgeon must be ready to work around abnormal structures in the sinuses.

Can you go home soon after sinus surgery?

Yes! The vast majority of these surgeries are overnight, procedures, which means you are likely to go home the day after your operation. Oftentimes, dissolvable packs are used to prevent bleeding, which don’t need to be removed, but are dissolved with the prescribed salt water rinse. Some people, however, may need non-dissolvable bandages in the nose, which requires a stay overnight so that these can be removed the next morning. There are exceptions, though, so you will want to talk with your doctor to be sure what you should expect for your operation.

What is recovery like?

Most patients who get sinus surgery are feeling relatively normal after about a week of recovery time. You will definitely want to give yourself a week away from work and other major obligations to heal, but past that you can usually go back to your normal life. You will also need to avoid blowing your nose for a week or so, even if you feel you need to.

It is important to remember that there will be swelling well after that one-week period. Some swelling may remain for months after the surgery – although you are likely to forget about it after a few months. Your doctor may ask you to avoid some strenuous activities, such as running, for a week or more depending on your surgery.

Does sinus surgery lead to a lot of pain?

In the most common forms of sinus surgery, no cuts are made in the skin. As a result, these procedures are generally very well tolerated. Generally speaking, pressure in the nose and sinuses is more commonly felt, but generally no worse than a sinus infection. Usually painkillers like paracetamol is all that is needed for this pain; however, you should may be required to avoid NSAIDs such as ibuprofen as your doctor will discuss with you.

Depending on how much tissue needs to be removed, the amount of bleeding can be moderate to none at all, especially if a balloon sinuplasty is performed. Every patient is different, and your doctor will consider your unique situation to give you the best plan for getting back to your everyday life as soon as possible.