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.
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.
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.
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
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
- Alka-Seltzer Effervescent
- Anacin Arthritis Pain Formula
- Arthritis Strength Bufferin
- Aspirin ASA Compound Ascriptin
- Ascriptin A/D
- Athropan Liquid
- Emperin Compound
Fiorinal, Fiorinal Compound
- Goody's Headache Powder
- Alka-Seltzer Plus
- Bayer Children's Cold Tablets
- Bayer Decongestant
- St. Joseph Cold Tablets for Children
- Super Anahist
- 4-Way Cold Tablets
Sedatives (Sleep) Tablets
- Excedrin PM
- Fizrin Powder
Holistic & Homeopathic Medications
- As the safety and side effects of these agents is frequently unknown or unclear, they should be discontinued prior to surgery.
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.