Risks of surgery

In an ideal world, we would be able to offer a treatment for sinus disease that was both remarkably effective and also completely safe. Unfortunately, virtually all medical treatments whether tablets, sprays, or operations will be associated with some risks. Each time a new treatment is started, your doctor will discuss with you the benefits, risks, and alternatives (including what would happen if you had no treatment at all).

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All surgical procedures have consequences like a small amount of post-operative bleeding, and it is quite common to suffer regular but short-lasting nosebleeds after ESS. However, if the bleeding is severe or prolonged, help should be urgently sought. Infection is reasonably common after ESS and if you suffer an infection then you should discuss with a doctor whether antibiotics are required.

 

Minor complications are self-limiting and include damage to the eye socket that presents as a ‘black eye’ or swelling of the skin around the eye caused by infection, or a watery eye. The contents of the eye socket may be damaged resulting in impaired eye movements or loss of vision, but these are exceedingly rare.

 

There is also a very small number of patients who may have an injury to the portion of the skull that shares a party wall with the sinus cavity. This can cause a leak of the fluid that normally surrounds the brain (cerebrospinal fluid or “CSF”). If this would

arise during surgery, the surgeon can repair it with no additional related complications postoperatively.

 

Surgeons are very mindful of the impact that these complications have on their patients and do everything within their power to minimise the potential risks. There are many scientific papers that examine the rate of complications during sinus surgery and report these estimates:

• Minor bleeding or infection: common

• Black eye: 1 in 500 patients

• Severe bleeding, CSF leak: 1-2 in 1000 patients

• Visual disturbance: less than 1 in 10 000 patients

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However, it is important to note that these figures come from large databases and may not be relevant to your surgeon or your sinus disease. Your surgeon will be happy to discuss these risks with you before planning an operation.

 

Outcomes of surgery and risk of recurrence

Overall, you should expect a significant improvement of symptoms that are related to chronic rhinosinusitis such as blocked nose, smell, nasal discharge, and mucus running into the back of your throat (although the change in post-nasal drip is more unpredictable). The successful outcome of the surgery is reported by more than 8 out of 10 patients. In most cases, as CRS is an inflammatory disease and is not cured by surgery, the aim is to create an environment that allows for nasal medications to get access to the sinuses in order to be effective. Therefore, having surgery does not remove the need for nasal treatments and they are likely to be used for the rest of your life. Giving the chronic nature of sinus inflammation, approximately 1 in 10 patients

will require revision surgery within 3 years. Patients with severe asthma or aspirin intolerance are more likely to require revision surgery than other patients.

 

What are packs and how are they used

Depending on the extent of the procedure and surgeon’s preference, you might need what is called nasal packing. This is when your doctor places sponge-like material in the nasal cavity to absorb blood or other fluids right after surgery. It also may be soaked with anti-inflammatory medication that may improve healing after the surgery. Your doctor will inform you if packing dissolve by itself, or if it must be removed.

 

What to expect during recovery

The healing process of the nasal cavities varies from patient to patient and may take just a few days after polypectomy, ‘mini’ ESS and balloon sinuplasty while it usually takes 2 weeks for ‘full house’ ESS. Some patients may have mild nasal pain and headache, especially during the first week after surgery, which can be well controlled using paracetamol/acetaminophen tablets as needed.

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Many patients are able to return to normal daily activities after 8-10 days but it may take longer before you feel fully recovered. You should usually plan to take two weeks off from work, sport, and exercise although everyone recovers at different rates.

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Some things you will need to remember during the recovery period:

• Sleep with your head raised, perhaps using an extra pillow, for a while.

• Avoid blowing your nose for a week or so, except after nasal rinsing.

• Try to keep your mouth open when you sneeze. This will take some of the pressure off your nasal cavities.

 

Post-operative medications and how to use them

In the postoperative period, nasal saline irrigations are strongly recommended to clean the nose from secretions, blood clots and nasal crusting; they should be repeated at least twice per day. Nasal rinses can be done using a squeeze bottle, neti pot, or syringe, lean forward over the sink, at about a 45-degree angle. The tip of the device should go inside your nose, no further than a finger's width. Keeping your mouth open, squeeze the bulb syringe or bottle, or tilt the pot to pour the water into your nostril. Remember to breathe through your mouth, not your nose. The saltwater will run through your nasal passages and drain out of your other nostril and maybe your mouth. The procedure should be repeated with your other nostril, and, finally, you can blow your nose gently to clear out the remaining solution. They are usually started soon after surgery but your doctor will advise on this.

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Nasal corticosteroids, administered in addition to nasal irrigations or as nasal spray, are effective in preventing polyp recurrence for patients affected by chronic rhinosinusitis and should be continued for the long term, based on ENT doctor advice. In very selected cases, your doctor might also prescribe you also an antibiotic treatment to be taken after surgery, however, this is unnecessary in most cases.

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At the time of your hospital discharge, your next follow-up appointments will be scheduled. During the outpatient visits, the sinus openings are checked using and in your nostrils. In some cases, debridement (active cleaning) might be necessary to promote the healing process of the nasal cavities by suctioning secretions or blood clots and removing nasal crusting.

 

Role of septoplasty and turbinate surgery at the same time. Some patients may have sinus surgery combined with other nasal procedures such as:

• Septoplasty: straightening of the cartilage in the middle of your nose

• Turbinoplasty: improving the airflow by remodelling some of the bone in the nasal passage called the inferior turbinate

 

These procedures are useful especially for those patients complaining of severe nasal blockage non-responsive to medical treatments. If appropriate for your case, the ENT doctor will extensively discuss with you the need for such procedures before surgery.

 

Patient’s experience with endoscopic sinus surgery

Patient 1 reports:

I have experienced multiple episodes of rhinosinusitis with nasal obstruction, facial pain, nasal discharge, and secretions running into the back of my throat. I don’t get any relief with any nasal spray, even after long courses. I decided to trust my ENT doctor who proposed to me a surgical procedure called ESS to solve

 

my problem. The same evening after surgery I was sleeping at home in my bed. I followed the postoperative medical prescriptions meticulously, including many nasal irrigations every day. My surgeon checked my nose with the telescope two times after surgery in the first postoperative month. Now, three months after surgery have passed, and I could not have asked for a better outcome.

 

Video 1 shows the final result obtained three months after ESS, with patency of sinuses openings: