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.
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.
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.
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.
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.
Nos 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.
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.