Nasal Surgery ( Septoplasty/Turbinate surgery/Sinus surgery)

Initial Blockage

Regardless of the various combinations of internal (“endonasal”) surgery, your nose will feel very blocked in the first 7-10 days before progressively unblocking from day 7 to ~ 3 months for final outcome.

The severe initial blockage is due to surgical tissue swelling. This is expected, so please don’t be alarmed that the nose is more blocked than before surgery.

Pain

Most patients report moderate pain in the nasal/mid facial area in the first week, requiring panadeine forte or similar for control. At each end of the distribution curve, some patients report horrible pain, some say there was none, both are in the minority

However, be concerned if the pain worsens again after a period of improvement. Infection has to be considered: please contact me.

We will write you a prescription for adequate analgesics before you leave hospital. Most endonasal surgery does NOT require an overnight stay

Note: Turbinate reduction by Coblation technique (private hospitals) and simple diathermy is minimally painful, as tissue is not dissected and there is no tissue stretch to stimulate pain endings

Bleeding

Expect a light ooze first 2-3 days, settling to crimson then orange stained mucus discharge another 1-2 weeks before drying out.

An ooze which doesn’t stop, or a trickle, are problems. Bleeding risk applies in the first 2 weeks; bleeding beyond the second week is uncommon but not impossible; the tissues should be healed by week 4. Average bleeding risk after endonasal surgery is around 5%. It can be serious, may need packing or even return to theatres to secure the bleeding point.

Pinch firmly across the nostrils, breathe through your mouth, and keep your head DOWN (not UP, up means swallowing blood down the throat. Swallowed blood causes nausea/vomiting, which only adds to the distress of a nosebleed).

Wait 5 minutes. Call my office OR attend your nearest EmergencyDepartment  if 5 minutes of compression fail to stop the nosebleed. You may need to consider calling an ambulance if you can’t be safely taken to hospital, and (obviously) don’t try to drive.

Isotonic Saline Rinsing/Douching

As a specialty, ENT surgeons cannot over-emphasise the critical importance of regular, several times a day douching with correctly prepared isotonic saline.

Saline douching washes away blood, clots, and mucus, before it hardens to form nasal crusts. This washing improves healing by optimizing the endonasal environment. One must use the correct salt concentration: the wrong concentration will impair or even damage the microcilia (“hairs”) which sweep mucus along. Mucus stagnation may cause infection, which then leads to poor healing/delayed recovery.

We recommend high volume douching, using a flush bottle. Common brands are FLO or NeilMed, at any chemist. These deliver the necessary volume, will work better than aerosol or metered pump preparations which only deliver a mist or small squirt. Volume is the key, but keep in mind that this may be limited in the first few days when the passage is swollen and blocked.

The printed instructions for FLO rinse mentions doing a “U turn”, bringing the saline out via the opposite nostril. This is unnecessary, and pretty uncomfortable. Just stand over the basin , squeeze with enough pressure to feel the saline go well up the nose, let it run back down the SAME side. Getting your ears water logged means you have been squeezing too hard, forcing saline up your Eustachian tube at the back of the nose: back off a bit.

A minimal frequency of 3x per day is absolutely needed in the first 2 weeks. If returned to work, one can buy a aerosol driven can ( eg Sterimar) which may be a pragmatic compromise at the workplace.