What to Expect on the Day of Your In-Office Sinus Procedure

What you’ll learn

Listen to the audio version below.

Audio Transcript:

Dr. Smith:

Hi, welcome back to another episode of We Know Noses podcast. Dr. Smith and Dr. Reddy with me today as well. And we’re going to be discussing today on our episode, what to expect when you come into the office for a sinus or nasal procedure. Kind of what to expect coming up to it, what to expect in the beginning and during it and a little bit of what to expect afterwards as well. Dr. Reddy, if you want to start off, you can talk a little bit about, kind of what you may be discussing with patients in the pre -planning phase of what’s gonna happen and what a patient should expect when having a procedure done in the office.

Dr. Reddy:

Sure, so we’ll go through a hypothetical patient that has signed up for an in-office procedure and now we are talking to them about what to expect on the day of, right? So the first things I have patients do is we talk to them about some instructions for them to do prior to even coming into the office on the day of their procedure. So what I typically do is, and I’m sure you do something similar, is I send over a nasal spray, a decongestant spray, for them to use for a few days prior to the procedure, just to open up their nose a little bit, to make a little bit more room so that they’re a little bit more comfortable during the procedure.

The second thing we also send is some type of a combination of, calming medication, like an anxiolytic and maybe a pain medication that the patient typically takes about an hour prior to their procedure time. And so this is all done prior to even coming into the office.

Then once they’re in the office, we have a protocol in place for getting patients numb. Right. Do you want to go over that protocol?

Dr. Smith:

Sure. Sure. So, you know, I think we’ve mentioned in the past, but. you know, the numbing part of it is typically kind of one of the longer parts of the procedure. so typically we’ll have a patient in an office, a chair, kind of like what I’m sitting in now. We’ll tip that office chair and recline it into like a recumbent position. and we’ll start, basically starting to topically or just locally numb the inside of the nose.

So typically we’ll do that with a combination of a numbing gel. Typically I start with a lighter or milder numbing gel and a decongestant kind of mixed. We place these gels onto a flat or thin cotton pad. Some physicians just use cotton balls kind of pulled out, but we typically will use these little pledgets or cotton pads soaked in these numbing medications. And then we’ll place them along the bottom of the nose and kind of work our way to the top and further back in the nose with several of these cotton pads or pledgets on either side. And then those pledgets will sit in the nose for about five, 10 minutes. And then typically, now I know we all do this a little bit different, but typically then I use another set of pads soaked in a little bit stronger of a numbing medication that allows us to really get in there and do the brunt work of what we need to do.

And so the next set of pads, like two or three, will go on each side of the nose. And that’ll really get up towards the sinuses or turbinates or wherever else I’m going to be in the nose. And sometimes in the back where the eustachian tube opening is. And so we’ll let those pads sit in the nose for another 10, 15 minutes. And during this time, typically we’re, you know, setting up other things, instruments or loading up any images that we may need to load up for calibration. So we typically will have patients bring their images for the procedure.

And this is kind of the time that I typically will load them in and start maybe tracing or navigating their facial structures to their images for the procedure. And now this whole process takes around 20, 25 minutes then to get everything relatively numb with those cotton pads. And then we’ll usually use another after the nose is extremely numb and you really can’t feel much of anything. Then we’ll use a local injection and then nerve block in several areas in the nose along maybe the septum or the turbinates or up towards the sinus area. And those local numbing medications with or without sometimes some blood vessel constructors can help really block that area, give prolonged anesthesia so patients really don’t feel anything for the duration of the procedure. And so typically we’ll do those. And then after that’s done, that’s kind of when we start to discuss about, okay, now we’re gonna start the procedure.

And do you want to talk a little bit about do you have any differences that you do or anything?

Dr. Reddy:

That’s pretty much the same Once we get your nose completely numbed up, you know, we we try to talk you through the process as much as possible, so there’s no surprises and Just knowing what to expect prior to when it happens can be kind of a bit calming, right? So, you know, there’s gonna be certain times during the procedure potentially that you might feel some pressure and our patients might feel pressure on the cheek area, around the eyes and the forehead, and it shouldn’t be painful. And if it is, if you ever do feel any pain, we can always use more numbing medication. So I always tell my patients that if there’s any part of this procedure where you’re feeling a little bit of discomfort, you just let us know. We take a step back and we can always use more pain medication if we need to and more numbing solution.

Dr. Smith:

Yeah, exactly.

Dr. Reddy:

So, and so the you can expect to feel pressure around your sinuses by your eyes. You might hear these crackling sounds, which are sounds that are signs that your sinus cavities are kind of opening up a little bit. That’s all normal. You may hear a mechanical sound from one of our instruments called a microtubrider, which helps. It’s almost like a roto-router for your nose and sinuses that kind of cleans blockages and things.

So that’s kind of all expected. Typically there’s a couple people in the room. There’s the surgeon and then there’s an assistant. And oftentimes we have also a medical device representative that helps us with the equipment. So there’s typically three people along with the patient in the room. And then, you know, one complaint that I get with some of these procedures from patients is that the back of the throat can sometimes feel a little bit numb.

And so I give all my patients a warning that the back of your throat might feel numb from the numbing medication dripping down and that’s totally normal. And that lasts for about a half an hour. Other than that, these procedures are relatively well tolerated.

Dr. Smith:

Right. Yeah. So I, just like you do, I talk to them about those types of things. So, you know, sometimes you’ll feel less air movement or swallowing, maybe feel a little bit more labored. no, that’s not all the time, but that does happen sometimes. And that is a complaint. Now some people get extremely comfortable during these procedures even with just the kind of the anxiolytic and the pain medications that we offer and fall asleep. I’ve had several patients that I’m talking to the whole procedure kind of walking them and talking to them about what I’m doing and often fall asleep. So there are plenty of patients that do fall asleep during these procedures. You know typically we just like to have patients relaxed.

I don’t need patients fully asleep during the procedure. They fall asleep great and then we wake them up when we’re done. But if not and they’re awake the whole time, we usually converse with them and have a conversation during it. Following the procedure, typically in these in-office things, sometimes there’ll be some clotting gel or type of device that we might put into the sinuses or a drug eluting stent or something. But most of the time there’s not much that’s placed up into the sinuses.

We clean out everything and then we put like a little drip pad on the nose to capture any drainage that may occur after the procedure. So I normally tell patients after any type of nasal procedure, it’s common to have some bloody drainage, blood tinge mucus or bloody drainage for the first day.

Dr. Reddy:

Yeah, so most patients aren’t sent home with any packing. Correct. So there’s no packing that needs to be removed later. There’s it’s relatively rare that there’s any splints or anything like that placed as well. So most patients are sent home without anything in your nose.

Dr. Smith:

Correct.

Dr. Reddy:

And just a drip pad that catches some fluid that can be changed as needed. Correct. And then for post -op instructions, it’s similar to if you’ve gotten a nose or sinus procedure done under general anesthesia, but not as involved.

Dr. Smith:

Correct.

Dr. Reddy:

Right. So typically, we have our sinus surgery patients in the operating room irrigated their nose out three times daily. With our in -office procedures, it’s maybe just one time a day. Oftentimes our sinus surgery patients in the operating room are having restrictions on their activities for about two weeks where they can’t do any straining, any heavy lifting, any significant nose blowing. For our in-office patients, usually I don’t put them on activity restrictions for the most part. Maybe just try not to blow your nose really hard for like a couple days. But typically they can work out, they can do all of the normal activities.

There are also, in our in office patients are less likely to need post -operative medications, but they might be prescribed them on a case by case basis. Things like antibiotics and steroids, which are pretty much routinely given after surgery in the operating room. And the office, they’re much less likely to be given. From a pain management perspective as well. Typically, I give narcotics for our patients in the operating room under general anesthesia. However, in the office, if you get an office procedure, most of my patients don’t get pain medications prescribed. I just tell them to take over the counter Tylenol or ibuprofen. Is that similar?

Dr. Smith:

Yeah. Sometimes I’ll give patients like one or two just in case they need it for the first day, just to help kind of sleep off the first day. But, most of the time they don’t need it and just take Tylenol. I’ve had several patients that, you know, the next day say, I’m not even taking Tylenol. I don’t need anything. So yeah, I would say the pain is significantly less. The bleeding is typically significantly less and kind of the congestion and downtime typically is significantly less. I normally quote patients about half of the recovery of a traditional type of procedure.

Dr. Reddy:

Yeah. And then for post -op appointments, we typically see our in-office procedural patients about a week afterwards. And we sometimes have to clean out your nose and kind of remove some debris and some crusting and things. But the number of visits and the amount of cleaning you have to do after an in-office procedure is usually significantly less than if you’ve had a full surgery.

Dr. Smith:

Yeah, for sure.

Dr. Reddy:

And I think that pretty much covers most of what to expect.

Dr. Smith:

Yeah, agreed. A day of and a little bit of after.

Dr. Reddy:

Great we’ll catch you guys on the next episode. Take care.

Whether performed in-office or in the OR, sinus surgery is ultimately aimed at restoring normal sinus function and helping patients breathe easier.