Dr. Undavia: Okay, so today we’re going to talk about sinus surgery, which we talk a lot about. Um, we talk a lot about it because we do a lot of it. We do it in the OR, we do it in the office. We do a lot of sinus stuff. Why don’t we just cut it and redo it? All right. Restarted. Okay. So today we’re going to talk about sinus surgery. A lot of the questions patients ask about are what, uh, what kind of things to expect, and we really, we go over the risks very thoroughly.
We go over what to expect, but some of the most basic questions that we might not get to are, what are the things that annoy our patients afterwards? Because there are annoying things. There is a recovery. It always gets better, but there are things that annoy each other. So I’m gonna start off, but then I’m gonna ask each of my partners here what they also experience in their patients. But we’re gonna go over what annoys them, when it typically happens. Does it go away on its own or do you do something about it? So I’m gonna go first.
One of the things that patients, if I was to call them the day after surgery, one of the things that they’re well aware of is a sore throat. And there’s a couple of reasons for that. Number one, they had a breathing tube when they had sinus surgery. There’s a lot of blood that can drip down from the back of the nose into the throat. And we want to prevent that from going into the lungs. So we put a breathing tube in. Plus patients are under general anesthesia for the most part. So we want to make sure that they’re breathing okay during the surgery. But that breathing tube can give you a little bit of a sore throat.Typically 36 to 48 hours, maybe 72 hours, but really it’s short-lived. I have patients eat and drink cold soft foods. It really does help. We give patients pain medications. They typically use it for a day or two and then they don’t really need it. So that can be very helpful. If it was very painful, we can prescribe something called a magic mouthwash which has a little bit of lidocaine to numb up the throat. I’ve also seen sometimes a breathing tube put pressure on the back of the palate and give patients little bit of an ulcer, that definitely does hurt. It is really rare, but if it does, it’s self-limited, takes care of itself, it can go away in a week or two. That’s kind of the first thing patients notice. Dr. Reddy, you wanna go over another one?
Dr. Reddy: Yeah, one of the most annoying things for patients is just feeling stuffy in your nose and your sinus area. It can feel like a worsening nasal obstruction or almost like a sinus infection. And it’s usually due to the different dissolvable packing material that’s in your nose. Sometimes we use nasal splints that we take out in the office after a week or so after the procedure and that can put a lot of pressure in your nose. And oftentimes it’s also just from the crusting and the old blood that kind of develops the mucus in your nose. And the usual remedy for that is the saline irrigations that we recommend the salt water rinses typically helps.
Dr. Smith: Good.
Dr. Undavia: Yeah, that’s a very how long is that gonna last?
Dr. Reddy: Usually, you know, it lasts the first week is the worst Especially if you have splints once the splints come out then you typically feel a lot better But if you don’t have splints, it’s usually about three days or so.
Dr. Undavia: I tell patients that it might last for several weeks, but the brunt of it is that first and second week, correct?
Dr. Smith: Perfect. So I’ll go with the teeth, the teeth sensitivity and numbness is something that sometimes we even forget to discuss in some of the pre-op discussions, but often if we do say it, we kind of glance over it and patients almost always are concerned when they wake up or the next couple of days, their front teeth feel like they’re not there or they’re sensitive or numb. So the front two teeth often can get numb whenever we do any septoplasty work. Some of that’s from the local anesthetic and sometimes that wears off within the first 24 hours. Sometimes that can just be from chiseling some of the bone in the bottom of the septum inside the nose and that part shares a nerve and often creates a lot of swelling and inflammation, which then triggers some kind of nerve issues with the teeth. Now that’s almost always temporary and usually resolves in the first couple of weeks. Sometimes it does last a little bit longer and lasts like two to three months. I’ve even seen it outwards to six months, but it’s very, very rare that it goes beyond the two to three week timeframe. But that teeth numbness is one thing. It can even extend back onto the palate. So some people will get a little bit of palate numbness as well, depending on how much swelling occurs around that nerve. The other thing is teeth sensitivity. And so because fluid and you know, even though the sinuses are all wide open, the sinuses do fill with clot and some mucus and fluid. And so the, if your teeth sit and the roots sit right next to the sinus, just like when you get sinus infections, sometimes it can cause T sensitivity. The fluid from healing can cause T sensitivity as well in the, in the lateral teeth, so you can get some sensitivity and some numbness in the teeth. And that’s something that patients often call or ask, Hey, what’s going on? Like my teeth are numb. So I would say that’s another big one.
Dr. Undavia: Agreed. It always goes away. Most patients rather than a few weeks, but it can sometimes be drawn out a little bit. I’ll go next. Another thing patients complain about is they can’t smell very well for a few weeks or they can’t taste very well for a few weeks. And there’s a simple, simple explanation for that. There is a lot of crust in the nose and it sits right on top of the smell receptors, which are on the middle turbinate, high up in your nose. And if that crust blocks some of the diffusion of the smell into the nose, and onto those receptors, you’re not gonna smell. And 80% of taste is smell. So if you’re not smelling, you’re also not tasting. But the good news is that as soon as that stuff comes off, your middle turbinate, you begin to smell. It’s not right away, but you begin to taste and smell a little more. And over a few weeks, it gets better. Sometimes the three of us will do some steroids if it feels like the crust is off, but it’s just totally inflamed. It always gets better.
Dr. Smith: Yeah, steroids usually make me feel great.
Dr. Undavia: Yeah, always. Always. All right, Dr. Reddy?
Dr. Reddy: Uh, another one is, um, watery eyes. So some patients, they get these, um, they’re, they’re tear ducts. Normally, you know, your, your tear ducts usually run from the, the inside corner of your eye into your nose called the nasal lacrimal duct. And when your nose is kind of congested and filled with gunk in your nose, essentially then that duct can get partially blocked and patients may sometimes notice that their eyes are kind of tearing up after this procedure. And that’s almost always a temporary thing. You just have to kind of wait for everything to heal up. And once your inside of your nose is more cleaned with the rinses, the saline irrigations, and the nasal sprays, then that typically gets better.
Dr. Undavia: I’ve had a patient tell me that they have blood go into their eyes because it goes up the neck.
Dr. Smith: All right, I’ll do a two for one here since we’re getting close to time here. But ear pressure and headaches. So often I’ll start with the ear pressure, just like you can get some sinus pressure. The middle ear is also a sinus as well. And so any drainage through the nose can cause some inflammation of that eustachian tube, which then leads to some ear pressure, pressure equalization. It’s rare that you get an ear infection from it, but that can happen. Especially when you’re using those sinus rinses, sometimes that the eustachian tube’s a little bit irritated. Sometimes the irrigation can even go back up into the eustachian tube. Usually that stuff mobilizes and comes out on its own with time and gravity. But so ear pressure is one, and headaches is a big one as well. So especially a lot of patients with sinus disease often have a headache history as well. And so if you have a headache disorder, sometimes the sinus procedures may exacerbate that headache disorder, make the headaches a little bit worse. I would say usually my patients that have maybe the hardest recovery are those that have a headache disorder. And I usually counsel them on this, that their headaches may get a little bit worse during the course of the healing process. They unanimously get better after the healing process is over. But, yeah, so I mean, I tell everybody that this kind of same thing that is two to three weeks until you feel good two to three months until you feel great. The headache disorder patients, sometimes it can take a full two to three months for their headaches to kind of get back to normal or better than normal. So that’s not out of the ordinary that I see somebody that has those increase or uptick in headaches. And sometimes we underestimate how much sinus is migraine disorders and headache disorders because a lot of the times migraines and headaches and sinus symptoms often overlap. So that’s something that I would say when it comes to annoyance, if a patient does have a headache disorder, it’s probably one of the main things that bothers them. And I know we’ve been giving all of these wonderful recovery things and painful things that we see in the office, but truly, when it comes to the overall outcome of it, these are kind of like minor hiccups or nuisances when it comes to the overall quality of life improvement that patients experience. Um, you know, patients all the time, you know, at two to three weeks, usually you’re saying, wow, I really wish I would have done this sooner. So I don’t want this conversation to kind of scare people away from considering this, these are really minor nuisances when you come, when it comes to, you know, the right patient, the right procedure, um, patients do fantastic with the right route, the right procedure.
Dr. Undavia: Um, I have one more last one. It’s kind of also a two for. It is about the fact that once we do get your sinuses and your nose open so you can breathe better, your sinuses don’t get clogged up, you don’t get the headaches and pressure, there’s actually more room for things to get into your nose. So sometimes in certain seasons, you might experience a little bit more of a itchy eyes or a runny nose because more of the allergens are getting into your nose. Now, because your nose is open, it’s actually easier to treat them, but initially you might feel that little bit of bump in your allergy symptoms. Also, the first winter that you might have after your sinus surgery, you might be a little taken back that first breath of cold air, especially if we open up your sphenoid sinuses where you can feel like, Whoa, I was really aware of that cold air that I just took a breath in with. But, but afterwards it gets much better also. Dr. Reddy, you got anywhere?
Dr. Reddy: No, I think we covered everything.
Dr. Undavia: All right, cool. If you guys have any questions, let us know.