Chronic sinusitis is an illness characterized by prolonged infection and inflammation of the lining of the nose and the sinuses. Patients with chronic sinusitis experience a variety of symptoms, including facial pressure, nasal congestion, discolored nasal discharge, and “post-nasal drip.” A diagnosis of sinusitis should be made only after careful evaluation by your doctor. Sinusitis can be caused by infection, allergies, and chemical or particulate irritation of the sinuses.
For the majority of patients with sinusitis, infections can be successfully treated with medications. For a small percentage of patients, however, infections recur or persist even after long courses of medication. Such patients often benefit from surgery. After reviewing your medical history and x-ray studies, your ear, nose, and throat specialist can determine if you are a surgical candidate.
Endoscopic Sinus Surgery in Iran is a surgical procedure performed to treat a condition called sinusitis or inflammation of the sinuses. The endoscopic sinus surgery in Iran is thus a minimally invasive surgical procedure. Sinusitis or inflammation of the sinuses may occur due to blockage of the sinuses, which then fills up with fluids and may become infected. Sinusitis gives rise to symptoms like stuffy and runny nose, cough, fatigue, fever, pain in the face, dental pain, etc.
Endoscopic sinus surgery in Iran is a procedure designed to open the natural drainage pathways of the sinuses to restore their function and health. In chronic sinusitis, the sinuses are unable to drain adequately due to inflammation of the narrow drainage pathways. As a result, nasal secretions can become trapped in the sinuses and become chronically infected.
The goal of surgery is to carefully remove the thin, delicate bone and mucous membranes that block the drainage pathways of the sinuses. The term “endoscopic” refers to the use of small fiber optic telescopes that allow all of the surgery to be performed through the nostrils, without the need for any skin incisions. Endoscopic sinus surgery is generally performed on an outpatient basis.
Goals of the Procedure
Endoscopic sinus surgery is used to relieve symptoms associated with:
. Septal deviations or turbinate hypertrophy
. Nasal polyps
Endoscopic sinus surgery is designed to improve the drainage of the sinuses and to improve airflow through the nose. Endoscopic sinus surgery goals include:
. Reduction of the number and severity of sinus infections
. Improvement in symptoms associated with sinusitis
. Improvement of airflow through the nose
. Improvement in a patient’s sense of smell
Sinusitis signs and symptoms include:
. Sinus headache
. Facial tenderness
. Pressure or pain in the sinuses, in the ears and teeth
. Cloudy discolored nasal or postnasal drainage
. Feeling of nasal stuffiness
. Sore throat
. Occasionally facial swelling.
. Facial pain
. Pus-like nasal discharge
. Symptoms that persist for longer than a week and that are not responding to over-the-counter (OTC) nasal medications.
The following complications of sinus surgery have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is here for patient information only - not to make patients overly concerned - but to make them aware and more knowledgeable concerning potential aspects of sinus surgery. The surgeon will review the risks and benefits of the surgery when obtaining consent for the operation, and will be able to discuss the chance of these complications with respect to an individual's potential risks of surgery at that time.
. Failure to resolve the sinus infections or recurrence of sinus problems and/or polyps.
. Bleeding. In very rare situations, a need for blood products or a blood transfusion may be required. Patients have the right, should they choose, to have autologous (using their own stored blood) or designated donor blood prepared in advance in case an emergency transfusion is necessary. Patients are encouraged to consult with their doctor regarding these issues if they are interested.
. Chronic nasal drainage or excessive dryness or crusting of the nose.
. Need for further and more aggressive surgery.
. Need for allergy evaluation, treatments, or environmental controls. Surgery is not a cure for or a substitute for good allergy control or treatment.
. Failure to improve or resolve concurrent respiratory illness such as, but not limited to, asthma, bronchitis, or cough.
. Failure to resolve associated "sinus or nasal" headaches. The exact cause of headaches can be difficult to determine and may have many different causes that are not sinus-related.
. The patient or physician may require consultation with another specialist such as a neurologist.
. Damage to the eye and its associated structures.
. Damage to the skull base with resultant meningitis, brain abscess, or leakage of spinal fluid.
. Permanent numbness of the upper teeth, palate, or face.
. Nasal obstruction due to failure to control infection or polyps.
. Prolonged pain, impaired healing, and the need for hospitalization.
. Failure to restore or worsening of the sense of smell or taste.
In most situations, the surgery is performed as an outpatient at either the hospital or a surgical center (surgicenter). In both facilities, quality care can be provided without the inconvenience of an overnight stay. An anesthesiologist will review the patient's medical history before surgery, and will monitor the patient throughout the procedure. If the doctor has ordered pre-operative laboratory studies, the patient should arrange to have these done several days in advance, and bring all lab results to the hospital the day of surgery for review.
Arrange for someone to spend the first night after surgery with the patient, if possible in case the patient needs to remain overnight.
After surgery, the doctor will usually advise the patient to start using saline irrigation. There are many different ways to irrigate the sinuses; depending on the surgery that was performed, the surgeon will advise the patient on the best method for this to be done.
In general, patients that have sinus surgery should not take aspirin, or any product containing aspirin, within 10 days prior to the date of surgery. Nonsteroidal anti-inflammatory medications (such as Advil) should not be taken within 7 days of the date of surgery. Many over-the-counter products contain aspirin or Advil-like drugs. Therefore, it is important to check all medications carefully. If there is any question, call the doctors that prescribed the medications (surgeon, primary care physician, cardiologist or other specialists) or consult your pharmacist. Depending on the planned surgery, the surgeon may have the patient refrain from such medications for a longer period. Acetaminophen (Tylenol) is an acceptable pain reliever. Usually the surgeon will give prescriptions for post-surgery pain medications at the preoperative visit. It is best to have these filled prior to the date of surgery.
In most pre-operative preparations, patients must not eat or drink anything 8 hours prior to the time of surgery; the surgeon or hospital/surgicenter will let the patient know the specific details regarding what time to stop eating and drinking. This includes even water, candy, or chewing gum. Smokers should make every effort to stop smoking, or at least reduce the number of cigarettes as much in advance of surgery as possible. This will help to reduce postoperative coughing and bleeding.
If a person is sick or has a fever the day before surgery, they should inform the surgeon. If a patient wakes up sick the day of surgery, still proceed to the surgical facility as planned. The surgeon and the anesthesiologist will decide if it is safe to proceed with surgery.
It is important that patients know precisely what time they are to check-in with the surgical facility, and that they allow sufficient preparation time. Bring all papers and forms, including any preoperative orders and history sheets.
Wear comfortable loose fitting clothes that do not have to be pulled over their head. Leave all jewelry and valuables at home, including earrings, watches, rings, etc. Remove all make-up with a cleansing cream. Patients should thoroughly wash their face with soap and water. Do not apply make-up or cream to the face. If possible, avoid using hair clips or other materials to hold up hair.
Do not take any medication unless instructed by the doctor or the anesthesiologist. Usually, in the pre-operative holding room, a nurse will start an intravenous infusion line (IV) and the patient may be given a medication to help them relax.
Endoscopic sinus surgery is usually performed under a general anesthetic but for minor procedure a local anesthetic and sedation can be used. The operation usually takes between one and two hours.
The operation is performed through your nose and does not result in any facial scars or change to the outside shape of your nose. Your surgeon will use a small tube with a special lens called an endoscope to examine your each of your nasal passages. They will also use special instruments to remove any polyps and to widen the passages from your sinuses into your nose to allow for normal ventilation and draining.
Small amounts of bone and swollen lining blocking your sinuses are removed. Once the sinuses are unblocked, the inflammation usually settles and your symptoms should start to get better. Rarely there is maybe some bruising around the eye but this very uncommon. There should be no need for incisions (cuts) unless the operation is a complicated one in which case this will have been discussed with you before the operation.
Immediately after the operation you may feel your nose blocked. This may be because of some dressing inside your nose or some special plastic sheets called splints. These are not used in every case but your surgeon will explain if they have been necessary in your case. Dressings, if used, will usually be removed from your nose within 24 hours but plastic splints may have to stay longer. It is common to have a stuffy blocked up nose even after removing the dressing or splints and this does not mean that the operation has not worked.
You can expect mild bleeding for 1-2 days after surgery and a general sense of fatigue for 1-2 weeks after surgery. In general, pain can be successfully controlled with narcotic or non-narcotic medications. You will have a series of postoperative visits that are critical for a successful outcome. At each visit your doctor will perform a procedure called nasal endoscopy to check how the sinuses are healing. An additional procedure called debridement may be necessary in order to clean blood from the sinuses and prevent early scar tissue formation. (Please note that these procedures are not included in the surgical charge and thus are billed separately.) Your visit schedule will usually consist of 3 visits over the first 6 weeks. Thereafter, your visits will be spaced a few months apart, depending on how well your sinuses are healing.
After surgery, the patient will be taken to the recovery room where a nurse will monitor the patient's vital signs. Usually, patients will be able to go home the same day as the surgery once they have fully recovered from the anesthetic. This usually takes several hours. Patients will need a friend or family member to pick them up from the surgical facility. Someone (a responsible adult) should spend the first night after surgery with the patient in case any post-surgical problems develop.
On arrival at home from the surgical facility, the patient should go to bed and rest with their head elevated on two to three pillows. By keeping the head elevated above the heart, edema and swelling from the sinus surgery can be minimized. Patients may get out of bed with assistance to use the bathroom but should avoid straining with bowel movements because this may cause some surgical site bleeding. If the person is constipated, they should take a stool softener or a gentle laxative.
Some patients may have noticeable swelling of the nose, upper lip, cheeks, or around the eyes for several days after surgery. This swelling is normal and will gradually go away. People can help reduce it by putting an ice pack on the face, bridge of the nose, and eyes as much as tolerated. This will also help with postoperative edema and pain. Some patients have found frozen vegetables in packages (for example bags of frozen peas) to be a convenient ice pack which nicely conforms to the face. The frozen material should be separated from the skin by a towel or similar barrier to avoid any skin damage. Many clinicians suggest periods of 15 minutes of such ice-pack treatment followed by 15 minutes of removal to not damage the skin.
Moderate bleeding from the nose is normal, and will gradually decrease. The gauze dressing ("mustache dressing") will collect blood and should be changed as needed. It is not unusual to change these dressings every hour during the first 24 hours after surgery. It is recommended to purchase gauze pads prior to surgery so that the patient will have enough for dressing changes. After a few days the patient will probably not need to use the dressing any longer. Do not take aspirin, aspirin-containing medications, or nonsteroidal anti-inflammatory medications (such as ibuprofen/Advil, Naprosyn, and others) for as long as the surgeon has instructed following surgery, because such medications may increase bleeding and slow clotting at the surgical site.
It is best to eat a light, soft, and cool diet as tolerated once the patient has recovered fully from the anesthetic. Avoid hot liquids for several days. Even though people may be hungry immediately after surgery, it is best to go slowly to prevent postoperative nausea and vomiting. Occasionally, patients may vomit one or two times immediately after surgery. If vomiting persists, please contact the surgeon; the doctor may prescribe medication to reduce or eliminate vomiting. It is important to remember that a good overall diet with ample rest promotes healing.
Patients may be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic may also be prescribed and is to be taken as needed for pain. If the patient requires narcotics, they should not drive and should consider having a responsible person stay with them. In some situations the doctor may give steroids to be taken either before and or after surgery. Take this medication as prescribed, and not discontinue it prematurely. The steroids are instrumental in facilitating proper healing. If patients have any questions or they feel that they are developing a reaction to any of these medications, he or she should consult their doctor immediately. Patients should not take any other medication, either prescribed or over-the-counter, unless they have discussed it with the doctor.
How long does it take to recovery from sinus surgery?
Depending on the extent of the surgery, recovery may take a few days. It may take up to 3 to 5 days to feel completely back to normal. Patients should refrain from activities that increase heart rate or blood pressure such as running, exercising, weight lifting, or other similar activities. It is imperative to obtain guidance from the surgeon as to when they may resume all normal activities. Until this time, patients should rest and limit physical exertion.
In many cases, packs or nasal packing is placed in the nose to control postoperative bleeding. The surgeon will tell the patient when to return to the office to have these packs removed. Patients may need to call the office to schedule this postoperative appointment. Please arrange for someone to drive the patient to and from the office for this first visit in case any complications (for example, additional bleeding) develop. Patients should eat a light meal before coming, and avoid taking excessive pain medications. In addition, most patients will also have several subsequent office visits scheduled to assess healing, remove crusts, and insure a speedy recovery. These visits are very important as the surgeon may use the endoscope (camera to look in the nose) to clean up the sinuses and perform further debridement if necessary. This post-operative surveillance by the surgeon is very crucial in the individual's long-term success with the surgery.
After the packing has been removed, individuals may breathe through their nose, but should not blow or sneeze through it for 7 to 10 days to reduce the chance of bleeding. If a person must sneeze, they should try to sneeze through an open mouth. Many surgeons tell patients to expect some light blood-tinged drainage from the nose for several days. If bleeding becomes excessive, apply an ice pack (described previously) and rest quietly with head elevated while applying mild to moderate pressure to the nose. If bleeding continues, call the doctor's office.
One of the most important things patients can do after surgery is nasal irrigation. Immediately after the nasal packs are removed patients should use a saline nasal spray such as "Ocean Spray" several times per day to prevent crusts from forming in the nose. The surgeon will tell patients when to discontinue the nasal spray and will let them know the best way to irrigate the sinuses.
Patients should go back to work or school only when the doctor says you can and should plan on resting for several days following surgery. Avoid excessive talking, smiling, hard chewing, strenuous activities, and lifting heavy objects, bumping the nose, and bending over. Try not to rest eye glasses on the bridge of the nose until soreness and swelling subside. People may wear contact lenses once eye swelling and any eye irritation has resolved. Alcohol and tobacco should be avoided because they may prolong swelling and healing. Smoke, dust, and fumes may irritate the nose and cause an infection. In general, people may use usual make-up any time after surgery, as long as the structures (for example, eyelids) with make-up are relatively normal and are not irritated by the application of make-up. Be gentle while brushing the upper teeth. They will often be tender for several weeks, and some people may have some numbness of the teeth and palate for several months.
Patients should plan to remain in the general area where the surgery was performed for 3 weeks to allow for postoperative care and in case bleeding occurs, the patient can be seen by the surgeon that did the procedure and who should best be able to treat the patient.
. A sudden increase in the amount of bleeding from the nose unrelieved by pressure, ice, and head elevation.
. A fever greater than 101.5 F (38.6 C) that persists despite increasing the amount of fluid intake and acetaminophen (Tylenol) use.
. Persistent sharp pain or headache that is not relieved by the prescribed pain medication.
. Increased swelling or redness of the nose or eyes.
. Drainage of a thin, clear fluid in large quantities from usually only one side of the nose. This would be different from the clear, thicker mucus drainage normally produced by the nose.
It is important for all patients with chronic sinus disease to understand that they have a chronic illness. Successful sinus surgery will only help control the complications and discomfort of chronic sinus disease. The following three areas of prevention should always be remembered:
. Maximize Moisture. Patients should always remember to maximize moisture in their nose. Keeping sinuses moist makes mucus thinner, allowing the sinuses to drain better. This drainage in turn helps prevent infection. Use a humidifier, drink plenty of water, avoid drying substances such as alcohol and caffeine, try to avoid smoke, which dries out sinus linings, and use plenty of saline irrigation.
. Avoid Allergy Particles (Allergens). People may want to wear a mask when they clean or are exposed to dust. Sit in the non-smoking sections of restaurants. Avoid exposure to pollens during peak season, and keep an air-conditioner on during allergy season.
. Prevent Colds. Avoid exposure to colds and flu whenever possible; obtain a yearly flu vaccination.
The cost of Endoscopic Sinus Surgery in Iran starts from $500.