New York Eye and Ear Infirmary
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What to Expect Before Sinus Surgery

Content provided by Steven Schaefer, M.D.
Department of Otolaryngology/Head and Neck Surgery
The New York Eye and Ear Infirmary of Mount Sinai

Pre-operative Evaluation

All patients who are potential candidates for sinus surgery should undergo a complete head and neck examination and review of their most recent computerized tomographic images (CT scans) as part of their pre-surgery consultation. 

The patient’s physical findings, in particular the nasal endoscopic findings, and the CT scans should be reviewed with the patient. We recommend the use of the patient’s actual CT scans and a nasal model as the best method to describe the indications for surgery and the actual operative procedures. Well-informed patients are better able to participate in their own care.

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Informed Consent

Patients, or their legal guardian, must consent in writing to the proposed surgical procedures. We recommend that this be performed at the time the patient is considering surgery, and that the consent convey the risks, rewards, alternatives and potential complications. As discussed above, the patient’s CT scans and a nasal model are helpful. 

    Click here for a copy of consent form. 

Endoscopic sinus surgery has become the technique of choice over the past decade for the surgical treatment of most chronic sinus disease, which has not resolved after appropriate medical regimen. This approach to the sinuses is minimally invasive, effective and safe. Nonetheless, it is important to understand that some risk is intrinsic to all surgical procedures, including endoscopic sinus surgery.

More common complications are minor in severity. Such complications occur less than 5% of the time, and would include mild post-operative bleeding or infection. More serious complications are extremely rare, occurring less than one in a thousand. These complications include injury to the eye or brain or related structures because of the proximity of these organs to the sinuses, and abnormalities or variations in the patients’ facial skeleton and skull. 

While no surgeon or patient is completely immune from these rare complications, the surgeons at the New York Eye and Ear Infirmary rely upon on extensive experience and the latest in sinus surgery instruments, CT imaging and techniques to further decrease the chance for these events. 

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Pre-testing

All patients should undergo a complete history and physical examination within several weeks of their planned surgery. We recommend that this be performed by the patient’s own primary care physician because they know the patient best, are the best able to alter pre-operative medications, and can alert the surgeon to potential problems. Guidelines for pre-operative testing following the recommendations of the American Society of Anesthesiologists and are as follows:

 
Guidelines for pre-operative testing following the recommendations of the American Society of Anesthesiologists are as follows:

Healthy patients <40 years

CBC, SMA-7

Healthy patients <40 years who smoke

CBC, SMA-7, EKG, Chest x-ray

Healthy patients >40 years

CBC, SMA-7, EKG, Chest x-ray

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Pre-operative Medications

As a generalization, patients should avoid all medications, which increase bleeding 10 to 14 days prior to surgery. Aspirin is the most common such drug. Other medications which increase bleeding are:

Analgestic (Pain) Tablets Cold/Cough Preparations

Alka-Seltzer Effervescent
Anacin
Arthritis Pain Formula
Arthritis Strength Bufferin
Aspirin
ASA Compound
Ascriptin, Ascriptin A/D
Aspergam
Athropan Liquid
Buffaprin
Bufferin
Ecotrin
Emperin Compound
Excedrin
Fiorinal, Fiorinal Compound
Goody’s Headache Powder
Measurin
Motrin
Phenaphen
Pyrroxate
Vanquish

Alka-Seltzer Plus
Bayer Children’s Cold Tablets
Bayer Decongestant
Congespirin
Contact
Coricidin
Dristan
Sine-Aid
Sine-Off
St. Joseph Cold Tablets for Children
Super Anahist
Triaminicin
4-Way Cold Tablets

Sedatives (Sleep) Tablets Holistic & Homeopathic Medications

Cope
Dolcin
Dolor
Duragesic
Emagrin
Excedrin PM
Fizrin Powder

As the safety and side effects of these agents is frequently unknown or unclear, they should be discontinued prior to surgery.

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Patients with a history of stroke or mechanical heart valves, often require anti-coagulation therapy and the pre-operative cessation of these medications should be coordinated between the internist and surgeon. Smoking and consumption of alcohol should be discontinued two weeks prior to surgery.

We do not routinely recommend pre-operative antibiotics, but we believe that oral steroids are useful immediately prior to surgery in patients with nasal polyps. This regimen is considered safe and effective, but may present problems for patients with diabetes and ulcer disease. 

Please notify your surgeon if you have these problems, or are taking other medications that might suppress your immune system. Other pre-operative therapies might include the chronic rhinosinusitis protocol developed by the Mayo Clinic and saline lavage of the nose.

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What to Expect the Day of Sinus Surgery

Pre-admission

Plan to be admitted to the hospital approximately two hours prior to surgery. Do not drink or eat after midnight. If you are taking asthma inhalers, or other chronic medications, please bring these with you to the hospital.

Those patients undergoing surgery at the New York Eye and Ear Infirmary (main telephone number 212-979-4000) should register in Admitting Office, which is located on the first floor of the main building at 310 East 14th Street (corner of 14th Street and 2nd Avenue). 

All pre-operative testing, and paper work, will be in the Admitting Office and will accompany the patient to the Day Surgery Unit. If the patient has pre-operative sinus CT scan, these should be brought to the Day Surgery Unit and given to the nurses to convey to the surgeon.

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Day Surgery Unit 

While awaiting surgery, the patient will visit with our staff anesthesiologist, and discuss their medical history and prior anesthesia history. If the patient has a history of adverse reactions to anesthetics or other medications, it is essential to communicate this to the physicians and nurses. 

All prior records are very helpful. Many sinus procedures are now performed under local anesthesia with sedation, which offers the patient intra-operative comfort and rapid post-operative recovery. However, some patients will benefit from general anesthesia. Please discuss your wishes and concerns with the staff anesthesiologist.

While awaiting surgery, the nurses will review with the patient all pre-operative records, confirm the nature of the proposed surgery, and administer any required pre-operative medications. As a safety precaution, both the nurses and physicians will repeat the same questions in both the Day Surgery Unit and operating room.

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Family Members

Family members should wait for the patient on the same floor as the patient was admitted. For adults, this is usually the fifth or seventh floors and the ninth floor for children. Please communicate to nursing where family members are waiting so that the surgeon can discuss with them the outcome of the operation and arrange follow-up care.

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Post-operative Hospital Care 

Most patients will be observed for two or more hours after surgery in the Day Surgery Unit. Patients must be alert, stable and capable of drinking clear liquids as minimum for discharge.

Prior to discharge, the nurses and physicians will observe the patient to insure that they are well and are properly prepared for discharge. Rarely, patients are observed in the hospital overnight.

Patients are often discharged with a dressing beneath the nose, which is intended to absorb mucous and blood following surgery. Subsequent to sinus surgery, it is customary for patient to experience mild bloody discharge from the nose and some decrease in their ability to breath through the nose. 

However, if you need to change nasal dressings every few minutes, or if you feel more than a few tablespoons of blood draining into your throat, please notify the nursing staff prior to discharge, or follow our instructions for contacting the on-call surgeon prior to leaving the hospital or while at home.

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Discharge from Hospital 

At discharge, the patient should have a prescription for all post-operative medications, know when to return to see their surgeon, know who to call in case of emergency (212-979-4200) and what to do after surgery. 

These items will be discussed with the patient by nursing, and are reviewed under What to Expect After Surgery. Patients should not drive themselves home, and should have arranged transportation. 

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What to Expect After Sinus Surgery

Caring for Your Nose

As surgery is performed through optical endoscope, the extent of the procedures is not obvious and some degree of post-operative bleeding is normal. Therefore, the patient should expect to have to change the gauze placed beneath their nose multiple times during the first 24 hours following surgery.

If bleeding is continuous or copious, please contact your surgeon at 212-979-4200. Other abnormal events after surgery that your surgeon should be made aware of are fever (an oral temperature greater than 100.4 degrees Fahrenheit), chills or excessive sleepiness. If you have any trouble reaching us and have any distress, please go to the Emergency Department at the Eye and Ear Infirmary (212-979-4000). 

Sleeping on several pillows, and placing an ice pack over the bridge of the nose for five minutes, followed by a rest periods of five minutes helps reduce swelling, and post-operative discomfort. These measures should be continued for at least two days.

After the first 24 hours, bleeding should be minimal and the gauze dressing used as needed.

After the second post-operative day, the nose can be gently lavaged (washed) with normal saline using a bulb syringe or water pik® nasal irrigation attachment. 

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Activities at Home and Work

Patients response to surgery varies enormously. As a generalization, most patients can return to most daily activities (easily ambulate) the morning following surgery. Thereafter, they should advance their activities as tolerated. Most people feel well enough to work at home within one day and are free to leave the house for light activities. 

However, any work place, social, exercise or sexual activities, that raises one’s blood pressure, should be avoided for fourteen days or more. Nose blowing should be avoided for at least two to four weeks after surgery.

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Airplane Travel 

Airplane travel should be avoided for a minimum of two weeks following surgery. During this period the mucous membrane within the sinuses and nose is swollen, and the changes in air pressure, which accompany flying, are not well tolerated in this immediate post-operative period.

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Antibiotics and Other Medications

Most patients are given antibiotics for ten days following surgery. Patients with severe sinusitis may require longer courses of antibiotics. Patients with nasal polyps or allergic fungal sinusitis are often given oral steroids after surgery. 

Patients suspected of having chronic rhinosinusitis secondary to an allergic reaction to fungus within their nose, may be placed on the Mayo Clinic protocol. Post-operative pain is usually mild to moderate, and well managed with Tylenol with codeine or Vicodan oral tablets.

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Diet

Although surgery is limited to the nose and sinuses, anesthetics will cause temporary dysfunction of the gastrointestinal tract. Therefore, the patient should begin eating after surgery with clear liquids such as jello, carbonated beverages and clear soups. These can be advanced to a regular diet in most cases with 24 hours after surgery.

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Nose Blowing

Nose blowing must be avoided for at least two weeks after surgery to minimize post-operative bleeding. If the patient needs to sneeze, the mouth should be opened to prevent the build-up of air pressure within the nose. As the bones separating the eyes and brain from the sinuses are very thin, and sometimes absent, nose blowing can cause air to extravasate around these structures.

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Follow Up Care

Most patients are seen within the first week of surgery, and most follow-up appointments are given at the time of scheduling surgery. Please inform your doctor on the day of surgery if your appointment has not been scheduled, and appropriate arrangements will be made. If you do not have an appointment, please call 212-979-4201, 4202. 

The first post-operative appointment consisted of discussing the surgery, and removing any crusted mucous or blood clots which may have collected in the nose or surgical sponges that may have been placed within the sinuses at surgery. The nose is not actually packed so as to avoid the discomfort and airway obstruction associated with such practices. At one week following this appointment, the patient is asked to return for the nose to be inspected and cleaned as needed.

The needed for cleaning may be minimized by vigorously lavaging the nose with two cups of saline twice daily for the first six weeks, and thereafter once a day. Most patients also benefit from nasal steroid sprays, which should be used approximately 30 minutes following nasal lavage. 

Most patients are seen for follow-up visits depending on the rate of healing of the nasal passages and sinuses within the next at six weeks following surgery, and then at three-month intervals for the first year. Subsequent appointments are adjusted to the patient’s need for further care.

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Learn More About Rhinology & the Sinuses

General Description of Sinusitis

What is Sinusitis?

Medical Treatment of Sinusitis

Antibacterials, antifungals, and nasal steroids

Surgical Treatment of Sinusitis:

 

Definition

 

What to Expect When Undergoing Sinus Surgery

 

Ethmoidectomy & Antrostomy

 

Sphenoidotomy

 

Frontal Sinusotomy

 

Caldwell Luc

 

Orbital & Optic Nerve Decompression

 

CSF Rhinorrhea

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