- After checking into the office, one of the medical assistants will escort you to an examination room. They will obtain a brief history of your nasal and sinus complaints as well as all pertinent past medical and surgical history. One of our ENT physicians will then meet with and discuss your history in more detail. Old records including previous CT scans, operative reports, etc., will be reviewed in details. A physical examination of the head and neck will be performed. Depending upon this exam, a Nasal Endoscopy and/or Flexible Laryngoscopy may be performed (see below for more details).
- Following the completion of the interview, examination, (possible) endoscopy, review of old records and previous testing, your physician will discuss their findings and propose a plan. This will be explained in depth and may require trials of medication, more testing or surgical intervention. Ample time for questions will be allowed.
What is nasal endoscopy?
- An endoscope is a small and thin (less than the size of a pencil) viewing tube with a light on one end and an eyepiece on the other end. It is used to look through small holes into larger spaces. Endoscopes are used by many types of doctors to evaluate not only the sinuses but also the lungs, stomach, and other areas.
- Nasal endoscopy allows a detailed examination of the nasal and sinus cavities. During the endoscopy, we will look for areas of swelling in the mucosal membranes, for the presence of pus draining from the sinus openings, for enlargement of the turbinates, and for the presence of polyps. If pus is seen, it may be sampled to determine what organism is causing the infection. Nasal endoscopy is the most important diagnostic exam that the doctor will need to determine what may be causing sinus problems.
- The procedure is performed in the office and is extremely well tolerated and is performed on adults and children who are able to cooperate with the exam. Prior to passing the scope, the patient’s nose is decongested and anesthetized with topical sprays. The patient then sits in a semi-reclined position and the scope is gently passed through the nasal cavity to the back of the nose. This exam allows a complete and detailed visualization of all nasal mucosa, nasal turbinates, openings into the sinuses, and nasopharynx. There are no lasting side effects to this procedure and the anesthetic spray wears off over the ensuing one to two hours.
- Common reasons for performing this procedure this nasal endoscopy procedure during your visit include nasal airway obstruction, suspected acute or chronic sinusitis, nasal/facial pain, altered sense of smell, suspected nasal polyps, nasal trauma, and nosebleeds.
Office-Based Flexible Laryngoscopy
- At times, additional examination of the throat and vocal cords may also be necessary. For this purpose, a transnasal flexible laryngoscope can be used in the office. This exam is extremely well tolerated and performed to patients of all ages. This can even be performed on newborns if medically required. Prior to passing the scope, the patient’s nose is decongested and anesthetized with topical sprays that do not sting or burn. The patient then sits in an upright position and the scope is passed along the floor of the nose into the back of the throat to a level just above the vocal cords. At this point the patient is asked to breathe deeply and phonate, allowing the physician to directly observe the structure and dynamic motion of the true and false vocal cords. There are no lasting side effects to this procedure and the anesthetic spray wears off over the ensuing one to two hours.
What to expect with balloon sinuplasty
- On the day of your Balloon Sinuplasty procedure we recommend you bring headphones/earbuds to listen to music during the procedure. Wear comfortable, loose fitting clothing.
- Anesthesia is applied initially via a nasal spray. Following this, cotton gauze soaked with anesthesia is gently placed near the openings of the sinuses. This produces a level of anesthesia that allows the introduction of the balloon into the sinuses. This is accomplished with the use of the nasal endoscopes.
- Once the balloon is introduced into the sinuses, it is inflated, producing the desired dilation and relieving the sinus obstruction. This inflation produces a popping or crackle sensation that is not usually painful.
- Once all of the offending sinuses have been dilated, patients are usually discharged from clinic without incident after a brief observation period.
- The procedure is usually well tolerated with the most bothersome sensation being numbness of the throat due to the anesthesia spray and/or gel. This sensation generally resolves in 1-2 hours.
- For the week following the procedure it is important to regularly rinse the nose and sinuses with nasal saline at least 3-4x per day. Pain is usually minimal and controlled with acetaminophen OTC.
What to expect the first week after endoscopic sinus surgery
- When you return home from sinus surgery, you will have drip gauze under your nose to collect drainage. For the first 24-48 hours, it is typical to have bloody drainage that may worsen with increased activity. You may change your drip gauze as often as you feel necessary. As long as you do not need to change the gauze every 15-20 minutes due to saturation, you are not bleeding too much. You may get rid of the gauze once the drainage stops. You are allowed to eat and drink anything you wish (nonalcoholic) after surgery. Some patients experience nausea, usually due to anesthesia, so you may want to eat lightly when you get home from surgery. You will not be able to breathe well out of your nose until the doctor sees you for your first follow-up visit. There is typically no swelling or bruising to the face, but inside your nose there will be a lot of swelling that causes a congested feeling.
- We will be asking you to use a saline mist spray and sometimes do a nasal wash regularly after surgery. There is no wrong way to do this – it may feel like the spray/wash just runs right out – and that is all right. The reason for the spray/wash is to keep the inside of your nose moist and to restart the normal cilia action of the nose. Most patients do not complain of “pain,” just a congestion/pressure feeling, like when you have a bad sinus infection. We will give you some pain medication, but most patients take just Tylenol/acetaminophen. Sleeping can sometimes be an issue because of the nasal congestion, so it may be helpful for you to elevate your head at night.
Your restrictions are:
- do not bend your head down
- do not lift anything over 15 pounds
- do not exercise, get overheated or do any strenuous activity
- do not blow your nose until your first office visit
- You may return to work when you feel like it as long as your work does not require you to do any of the above restrictions.
What to expect at your first office visit after surgery
- The reason for your post-operative visits are to allow the physician to help your nose “clean itself” and to keep the passages open. You have not been able to blow and there will be a lot of mucus inside your nose that needs to be removed. One of the reasons for the nasal saline spray/wash is to keep the inside of your nose moist so that when the physician cleans the nose out, the scabs are not hard and attached to the lining of the nose. It makes for a much less painful debridement. Sometimes the first visit may cause some bleeding. If this occurs, go back to the above restrictions for a while. Sometimes the first visit may be uncomfortable. We usually do not recommend patients take their pain medication, but if you do take the pain medication make sure someone drives you to the visit. After these appointments you should begin to breathe more easily through your nose. Between appointments, you may notice on occasion some black, thick, dry, hard mucus from your nose. This is normal and will steadily improve over time.
What to expect long-term from your surgery
- The purpose of nasal and sinus surgery is to reestablish normal function of your nose and sinuses. You may still get an occasional sinus infection, but it will be easier to treat. You should breathe considerably better through your nose and many patients, particularly those with blockage due to nasal polyps, will experience an improved sense of smell. Although sinus surgery will not cure your allergies, in most cases allergy medications used after surgery will better control symptoms due to the ability of the sinuses to function in a more normal fashion.