Sinus Surgery

Let me tell you about my sinus surgery experience.

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One Year Later

In the year since my sinus surgery, I have not had a sinus infection. That's a huge success, considering I was having as many as a half dozen infections - prolonged infections in most cases - in the several years prior to the surgery. My ENT is equally impressed by the results.

While I have had congestion from head colds and allergies, that quickly resolved itself. I have been proactive in such situations by doing the nose irrigation morning and night. I also do two puffs of Nasonex instead of the prescribed one puff (my ENT suggested that). I have not used any Sudafed-like products and only a few times took Mucinex.

Another issue has been nose bleeds. While not severe, they are annoying. The bleeding only occurred as the weather got colder and the air got drier. I have been using saline spray more often. The ENT also told me to use the A & D ointment in my nostrils to help prevent the effects of the dry air.

A year out, I am still confident the sinus surgery was the right thing to do. I have less congestion and can breathe easier. I don't have the sinus pressure (even when I'm congested) that I used to have. The pressure in my ears is almost completely gone. I will continue to urge others who are experiencing chronic sinus problems to look into the balloon sinuplasty. It helped me greatly!

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Five Month Follow-Up Appointment

Actually, it's been five months and a day since the sinus surgery. The ENT says everything looks good. The only thing he noticed was the turbinate on the left side was a little larger than the right side. However, he said that's not a problem, since it was larger to begin with and "you can't change the 'foundation' of your nose."

The only issue I've had was some throat irritation, which is a side effect of the Nasonex. The ENT says if it happens again, I should cut down to one dose a day, instead of two. I can resume two doses after the irritation clears up.

He says the Nasonex is the best medicine for my situation. That led him to ask about the price. I told him my refill last week with the discount/coupon card was $138. He called it outrageous and went to look for some free samples of it. I was given a bag of about six Nasonex inhalers. That should get me through most of this year!

Next appointment is in three months.

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Two months post surgery

I received another good report from the ENT at the two month follow-up appointment. I'm allowed to stop the nose treatments (irrigation, saline spray and A&D ointment). However, I should continue to use them to keep the nostrils from drying out. I do still use the spray before I do my Nasonex morning and night. I will continue using the Nasonex for a 12 month period.

All in all, everything seems to be going very well. I can breathe easier. I don't feel congested all the time. The pressure in my right ear continues to lessen. I return to the ENT in several months for him to continue to monitor my progress (hopefully).

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First head cold post surgery

A few days after my third check-up with the ENT, I came down with a cold. I figured this would be a good test, but I was hoping I wouldn't get sick for a few months after the surgery. Instead, it was a few weeks. The cold was not as bad as I had in the past, because the sinus pressure was noticeably less than at other times. The right ear pressure, which was always a problem, hardly existed. Unfortunately, there was a lot of fluid and pressure in my left ear. It was to the point I could hardly hear anything out of that ear, except for a loud ringing.

I called the ENT's office on a Sunday afternoon. The answering service took my message and the on-call doctor returned my call within a few minutes. I told him the situation with my ear and that I was just a few weeks past my surgery. He said the symptoms sounded as if the ear could be infected, but without seeing me, he couldn't say for sure. To be safe, he prescribed me an antibiotic and told me to follow up with my doctor when he gets back in town. I told him I had an appointment scheduled for Friday.

The antibiotic helped a little. I also began taking generic Sudafed and Mucinex to see if that helped. It might have, but not much. By Wednesday, the pressure in my left ear was a little bit less and I could "hear" the fluid sloshing around. If I bent forward, with my head down, I could feel the ear open up.

I went to my ENT appointment Friday afternoon. He looked in my ears. The right one was fine, the left one had a lot of fluid, but was not infected. The doctor got a little pressure gadget so he could try to "pop the seal" on the left side. I had to get some water in my mouth and swallow it as he shot little bursts of air up one nostril while he kept the other one closed. We did this six times - four on the left side and two on the right. I could feel a difference right away, but not complete relief.

To do the rest of the job, the doctor prescribed me a six-day steroid regimen and got me back on the Nasonex nose spray. He said the combination of the two would finish the process of opening things up. It did work by the third or fourth day.

The Nasonex will continue for a year, as he told me around the time of the surgery. I'm glad I get to use it, because I can tell a difference with it. In addition to that, the ENT told me to keep up the nose irrigation and the saline spray and ointment, but I could cut down on the number of times I use the ointment to at least three times per day. My next appointment was set for a month out.

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The Bill!

I'm glad I have insurance. I also can't understand how the list price is greatly reduced.

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Back to work

I returned to work wondering if I could keep up with the frequent saline/ointment regimen I had accomplished during my stay at home. I did OK, but instead of every two or two and a half hours, it was more like three hour intervals. Doing work, I would often forget to pay attention to the clock, or I'd be away from the office and have to push back a treatment.

Another issue was having a mirror to do the ointment. I guess you don't have to use one, but I do. Instead, I used the webcam on my office computer as a mirror. It worked well enough!

The ENT said I would likely be worn out after returning to work. I was pretty tired at the end of the day, but I don't think it was much more than after a really busy day in the past. Another warning was the cold weather. My first day back, the temperature was about 25F and windy. I had to walk for a while outside for work and that did sting the nose. It also made the roof of my mouth and upper, front teeth hurt.

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Second check-up

Everything is going great! The ENT says he can tell I'm doing the saline/ointment routine often and the healing process is about five days ahead of schedule. He cleared me to return to work 18 days after the surgery, which is about what's expected. He says the septum still looks straight.

I told him about the "obstruction" on the right side at the very back. He told me that inferior turbinate had a common problem on the very end of it. I forget the term he used. He told me he usually cuts off the "problem," but the tool he needed was not in the operating room, so he cauterized it. The only difference, he says, is that instead of instant removal, the cauterization means it will slowly go away. I'm OK with that.

I was told to continue with the irrigation, saline spray and ointment application as I'm doing now. I have another appointment next week for him to check my progress. He cleared me to gently blow my nose, if I need to, otherwise, the irrigation still works.

Long term, I will have to use the steroid nose spray (likely the Nasonex) for a year. He says that won't start until the healing from surgery is done. Starting too soon can cause problems. He says the nose spray will keep the airways open, which will help the sinus cavities recover from all the infections I've had over the years. I figured I'd have to use nose spray all my life, so if it's just a year, that's no big deal!

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Some observations

A week after the nose pack came out, I realize the post-surgery routine is a lot. The saline spray/ointment requirement is four times a day at a minimum. The ENT recommended six to eight times to "really improve the healing process." I think the most I did in one day was seven times. Honestly, it  takes a lot of planning/timing to get to six times.

The ENT said when I'm applying the ointment with the swab, I might feel scabs. I have definitely done that. On the right side, there is a real "obstruction" all the way at the back, just before I reach the throat. I can get the swab past it, but the first time in the morning is the most difficult. It takes some twisting and pushing, and does hurt. It's been like that since the packing bandages came out and I'll mention it to the ENT at my week two check-up.

The other two observations are being tired and protecting the nose. The ENT said I'd be tired, but I didn't realize how much. More than a week after the surgery, I had to take a nap on Sunday afternoon. I meant to just rest in bed for 20 minutes, but ended up sleeping for two hours. With three small children, protecting the nose is always on my mind. The septum is "sitting" in a V-shaped base - not connected. I can't move it too far left or right, or it will come out of that base. The nose is still tender to the touch, so even a little bump causes pain.

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Nose irrigation after sinus surgery.

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Applying A&D Vitamin ointment to my nose after sinus surgery.

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More post-op care

With the nose pack out and approximately four weeks of recovery/healing time, the majority of the sinus care is now on me. The ENT says without proper care, the surgical work would not heal and cause more problems than I had before. Scabbing, infection, hole(s) in the septum - yikes!

Besides taking the antibiotic pill twice a day, I had to keep the nostrils/sinuses well oiled and hydrated. To do this, he gave me an irrigation bottle and sinus rinse mix from NeilMed, Vitamin A & Vitamin D ointment from Fougera, and saline nasal spray from HuMist. The ENT required the spray and ointment four times a day, but said doing it six to eight times a day speeds up the recovery process.

Here's what I have to do:

Each morning, use the irrigation. I mix warm water and the sinus rinse salt mix in the squeeze bottle. I bend over the sink, put the bottle into a nostril and squeeze most of it into my nose. The water goes up the nostril, into that side's sinus cavity and then flushes blood, mucus, whatever, out the other nostril. I repeat for the other side. While I only have to do it in the morning, I do it before bed too.

Trying to do the saline spray and ointment up to eight times a day is difficult. I think the most I've been able to do is seven, but it's usually six times a day, which is still good. First, I spray the saline twice in each nostril. Next, I have to apply the ointment using a one-sided "cotton tipped applicator" - basically a giant Q-tip on a wooden stick. It's six inches long and it goes in through your nose and you stop inserting it when you feel it touch the back of your throat! As you slowly remove it, you move the swab up and down, coating everything along the way with the ointment. I demonstrate the process in the next post.

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Getting unpacked

After four days with bandages packed into my nostrils, I was ready to get them out. At the same time, I was nervous to get them out. The ENT told me before the surgery to forget the horror stories I've heard about the removal process others have experienced. He said it's no walk in the park, but it's not as bad as it was in the past.

He says the problem was gauze was used as common procedure, but during the days after the surgery, body tissue would grow into the meshy gauze. So, when it was removed, it would tear the tissue inside the nostril. He now uses a bandage that is similar to the smooth, back side of a Band-aid. The bandages also are covered in some type of antibiotic ointment that makes the removal a little better.

So, sitting in the chair in the ENT's exam room, waiting for a long time, I was growing more and more nervous. He entered and said, let's get that packing out. I was bracing my head against the chair's headrest, but he made me lean forward and tilt my head slightly downward. He said he had to remove three bandages from each nostril. He only did it twice for each, because he was able to grab two at a time on each side. Immediately after he removed the packing from one nostril, he sprayed a numbing medicine inside.

I have to say, it was not as bad as it could have been or likely had been in the past. There was a little discomfort, but all in all, the bandages slid right out. I did take a peak at them in the pan. They were whitish-yellowish and partially covered with blood and mucus. That's all I needed to see in a second's glance.

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At home and packed

As soon as I returned home from the surgery, I got into bed. My nose was still stinging and my eyes watering. Family helped me get propped up in bed with pillows behind my back and head. They set up a little tray beside the bed with Kleenex, water, Chapstick and put the baby monitor on it too, so they could hear me if I needed anything.

I had a little broth with crackers in it - just a few sips. Otherwise, I slept/rested for about two hours. After that, my nose was stinging just a little and my eye-watering had stopped. I still was not in any pain. I could feel the pressure in my nose from the packing. I had three strips of bandages, each of them about six inches long, in each nostril. I would have to deal with that for roughly four days until the ENT removed them.

Still in bed and not moving much, I began feeling queasy. I realized I needed to vomit. I did. A lot. It was all water and blood, since the last meal I had was dinner 20 hours ago. It filled nearly all of the kidney bean-shaped bed pan the nurse sent home with me. I was wondering where all the blood goes during sinus surgery when you're flat on your back. The answer: Your stomach!

I had a drip pad under my nose. It was three to four pieces of gauze. An elastic band with loops on each side that went around/behind the ears held it in place. A pretty good idea, instead of having to tape it to your skin and possibly your nose. I wore it most of the four days I had the nose packing in place. It would "catch" any blood or mucus that drips through the bandages. The alternative to not wearing it is carrying some sort of tissue with you (always) and wiping your nose (continuously).

The ENT said the pressure would be bad with the packing. It did get worse each day. Still, I really didn't use the prescribed pain killer. Tylenol was enough to handle the slight pain. I did use the pain killer (Hydrocodone), which has acetaminophen in it, at night. It makes me drowsy and helped me fall asleep.

The lack of sleep was the main problem during the four days with the nose packing. You have to breathe through your mouth, which dries out your mouth. It's not so bad when you're awake, but at night with your head propped back and your mouth open wide, it dries out so quickly. I woke up every hour or so to sip water. There were times when my tongue was so dry, it felt like rough like a cat's tongue.

Getting the nose pack out would be a big relief.

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Possibly the last song I hear: Royals by Lorde

That was my thought as I was wheeled into the operating room and the Top 40 station was playing. It took me by surprise. Anyway, as I slid over to the operating room, I thought - If I die during this, Royals is the last song I would have heard. Not bad, but would not be my choice.

Anyway, the day had come. We arrived at the Unity Healthcare Surgical Center at 7:30 a.m. - an hour before the scheduled surgery. I got checked in and answered the questions, gave my health insurance card for scanning and the medical wristband was put on me. Shortly after that, a nurse came to get me. I changed into a hospital gown and put my possessions in a locker. In the pre-op room, they took my blood pressure, put in an I.V. line on the back of my left hand. The nurse who would be part of the surgery came in and put the cuffs around my calves so that I don't get blood clots being motionless for two or more hours.

The anesthesiologist came in and introduced himself. He briefly told me about how things would go. Basically, a general anesthetic and I'd knocked out. Afterward, I'd go to recovery with a nurse and, eventually, reunited with my family. The ENT was next in. He met my wife and asked if we had any last questions. He also gave rundown of how things will go. After he left, the surgical nurse returned and wheeled my back to the operating room.

It all happened pretty fast. I got into the O.R. and onto the table. They put my arms straight out from my sides - like I was on a cross (creepy). Next, the anesthesiologist told me he was giving me a little something to relax. The nurse anesthetist put an oxygen mask over my mouth and nose and told me it was a little oxygen. A few seconds later, I was out.

Next, I looked like this:

My eyes were closed. I could hear a nurse talking to my family and then the sound of the curtain opening and closing. My nose was stinging - not hurting or throbbing - but stinging, like when you get chlorine water from a pool up your nose. It was making my eyes water and when I tried to open my eyes, the light was too bright.

Then, I noticed was my throat was sore. I couldn't even swallow saliva. This was because of the air tube I had down my throat during surgery. The nurse wanted me to take a pain pill and I was kind of cranky with her, saying I couldn't swallow anything, how could I take a pill!?! She gave me some ice chips and then brought in some water. I sipped two cups of ice water until my throat felt a little better. The nurse came back a while later with the pain pill broken into four pieces. Those I could swallow.

The next thing I remember is my family getting me dressed. I was able to stand up and get into a wheelchair. I don't remember being wheeled out or the elevator ride. I do remember it was cold outside and getting into the car. The car ride home is a bit of a blur.

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Surgery option A, B or A & B?

I had some choices to make about what the ENT could do. There's balloon sinuplasty - basically winding a catheter and then balloon through the passageways and inflating the balloon to open things up. A more invasive surgery for straightening out the septum and reducing the size of the turbinates is another option.

Here's a drawing the ENT did to explain things:

The balloon would be snaked through to all the openings that needed to be widened - the maxillary, ethmoidal and frontal sinuses, just to name a few places. The surgery would entail shaving down the septum "spurs" that are growing outward from center. It also would cut back the enlarged turbinates, which are those lobe-type masses growing to the center. The ENT assured me doing both would greatly improve things. My thinking is - if I'm going to be knocked out and doing the less invasive balloon sinuplasty, I might as well have everything done. So, that's what we decided.

Before the surgery, I had to have some tests done. This included blood work - a complete blood count (CBC), Prothrombin time (PT), and Partial thromboplastin time (PTT). I also needed a chest x-ray and electrocardiogram (EKG). I was able to get all of that done at one lab in town. It took about an hour and was painless.

I had one more appointment with the ENT about a week before the surgery. He said the tests were all positive and walked me through the procedure. It would take two to two-and-a-half hours. Then I'd be in recovery for about 30-45 minutes before my family could see me. I'd have nose packing in for four to five days. He told me this would cause a lot of pressure in my sinuses and ears, and the other thing to get ready for is the breathing through my mouth and the dry-mouth that comes with that when sleeping. Also, I could not lie down completely, only at a 30-40 degree angle.

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More than competENT, he's magnificENT!

I have nothing but good things to say about my ENT doctor. My first visit, he did his assessment. It required him spraying large amounts of some drug in my nose to try to get the passageways to open up more just so he could check things out. It didn't take him long to tell me things looked bad.

He ordered a CT scan of my sinuses. He also took me off the Flonase spray, which I had been on for about a year, because he said it's basically like spraying water up my nose. He prescribed Nasonex for me and told me to give it a month. By then, he could get the CT scan results and figure out what to do next.

He said I was an ideal candidate for surgery, because my sinuses were so closed up. However, he describes himself as conservative and wanted to see what the Nasonex would do.

A month later, after the CT scan and the Nasonex, I had another appointment with him. He asked if I had ever broken my nose. I told him I didn't think so, unless it was something minor. The CT scan showed a deviated septum and the wall/lining of my sinus cavities was quite thick - so thick it could be measured in millimeters, which is not normal. He said the Nasonex was improving the situation somewhat, but also gave me something else to try, an aerosol spray called QNASL. I didn't like it, so I went back to the Nasonex, which helped, but not enough.

At my next appointment, I told him I wanted to do the surgery.

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Stuffy nose

I've had sinus problems for a long time. I remember "sinus headaches" as a child. I remember taking some form of Sudafed for long periods of time while a teenager. During my 20s, the issue subsided - probably because I wasn't around so many people on a daily basis. But having children and being exposed to their germs - and those they brought home from daycare - did it. Over the past five years or so, my sinus problems got worse. I'd get a cold and have it for weeks. Nine times out of 10, it would become a sinus infection.

This past summer, after seeking a third round of antibiotics to try to get rid of an infection, the urgent care doctor sent me to an ENT. It was the beginning of something good and it should have been done a long time ago.