Experiences with sinus surgery?

November 30, 2010 4:12 PM

What have your experiences been with (endoscopic) sinus surgery?

After having a sinus headache for about 4 years, I saw an ENT last week. He did a CT scan, and I found out that my sinuses (frontal, ethmoid, and maxillary...not sphenoid) are filled with gunk, and that additionally, the passages basically go nowhere, so nothing can drain. He diagnosed me with chronic pansinusitis, put me on antibiotics, and I go back to see him in a couple of weeks to discuss surgery. I'm assuming the surgery would include drainage of the sinuses and creation of a better drainage system.

I'd like to know what your experiences were with the surgery, including recovery time.

posted by altopower to health & fitness (28 answers total)

I am having this surgery on December 15, so remind me in a MeMail sometime later that month and I will Tell All.

As I described the surgery plan to someone, "Inside my nose it currently looks like a Picasso, and they're going to go in with magic lasers and turn it into a Mondrian."

My surgeon said that he actually had the procedure himself about ten months ago, and that he had had a 36-hour recovery period and took one painkiller.
posted by Sidhedevil at 5:00 PM on November 30, 2010

I had surgery to remove polyps in my sinuses a few years back. Prior to the surgery, I was barely able to breathe out of my nose; afterwards (well, after recovery), I couldn't believe how well I was breathing. I was lucky in that he didn't have to pack my nose with gauze, and I did bleed a bit afterward but it really wasn't bad. I had several follow-up appointments where he'd remove this "crust" as he called it that looked like huge scabs. Pretty uncomfortable and gross, but helped me breathe and they eventually went away.
posted by DakotaPaul at 5:01 PM on November 30, 2010

I had one sinus, on one side, drained and reshaped a few years ago. I'm not sure it made a huge difference, but I think it helped a little. I was fine after the surgery, with no major pain (it mostly just felt itchy up there). I was back to more-or-less normal life within a few hours, though I did feel some effects from the anaesthetic in the longer term.

That said, my experience is that some specialists (ENTs or otolaryngologists) are very eager to operate, while others are more cautious. Personally, I'd be uncomfortable going ahead with the surgery based on one CT scan. I'd feel more comfortable, based on my discussions with specialists, with at least a couple CT scans over time that confirm that all the blockages are long term. Scar tissue can be an issue with this type of surgery, so it seems worthwhile to make sure it is really needed before going ahead.
posted by ssg at 5:25 PM on November 30, 2010

Well . . . I went to the ENT because my ears had been stuffed for months, and got that way twice a year after a cold. I was hoping/anticipating that she'd put tubes in my ears. She sent me off for a CT scan, then showed me how my septum was deviated and some other big words were not right -- things that were supposed to be clear were not due to diseased tissue as a result of chronic sinusitis. I never knew I had chronic sinusitis, which I thought was odd, since my Mother-in-Law complains about *her* sinusitis quite a bit. I knew I'd had times where I'd wake up with a stuffy nose, but not often enough to want to act on it. So she wanted to go in and fix all that stuff, and put tubes in my ears at the same time. She assured me I'd breathe much better afterwards ( . . . except I never had a problem breathing before . . .)

I requested twilight anesthesia because I really didn't want the added recovery from being intubated. But once sedated, I was wiggly and fought with them (I remember some of this, and she told me the rest) so they ended up intubating me. I woke up and felt like the nurses were rushing me out the door, went home and did all the sprays 20 times a day, took the meds, basically slept for two days. Blew out a gigantic blood clot and took pictures ('cause I'm like that). I don't feel like the surgery or recovery was particularly bad, but then I've had two c-sections, so my comparison may be skewed. But my uvula felt swollen for over a week. Not sure what that was about, but it was annoying.

But. I did find out afterwards that this is apparently the an increasingly popular surgery -- as in, it doesn't take long for them to do it, lots of ENT practices are creating their own little out-patient offices to do it faster, but the retail bill from the hospital (not what your insurance is contracted to pay) was $30,000. They sent that bill to my house, so I would know what kind of amazing care I'd gotten. The impression I ended up with is that the surgery is a common money-maker, which is not to say it doesn't help some people. I don't feel like my ENT is a fraud or anything, but I breathe just as well as I always did and I still snore -- I think I'd have been just as happy if she'd skipped the big surgery and just put tubes in my ears. I don't really believe in random consumption just because, and if I'd known it cost that much, I wouldn't have done it. (Not that I believe the 30K was real dollars that would've gone to a better cause, just . . . ).

Sheesh. I went on forever. Hope some of it was useful.
posted by MeiraV at 5:31 PM on November 30, 2010

Scar tissue can be an issue with this type of surgery

Not so much any more, with the minimally invasive techniques.
posted by Sidhedevil at 5:31 PM on November 30, 2010

I had the surgery about 6 months ago. It was outpatient and in my case took about an hour or so longer than they had planned for. There wasn't very much pain, but I was pretty useless for about week - I was quite weak from blood loss and trauma. I went back to work after that, and it took about 6 weeks to fully recover.

Get a neti pot you like - you'll be using it a lot. The packing came out a week after the surgery. For 3 weeks after that the doctor had me run a 1/2 gallon of salt water through each nostril every day, 1/2 cup at a time. It was gross, but it felt good to get the scabs out because they were irritating.

The surgery was a life changer. I haven't felt this good in years. Before the surgery, I would have multiple sinus infections every year. I haven't been sick since. It's been a godsend.

If you have a strong stomach, you can find videos of what the surgery entails on youtube. I don't recommend viewing them - I'm not terribly squeamish and I nearly lost my lunch. My wife sure enjoyed them, though.
posted by Pogo_Fuzzybutt at 5:34 PM on November 30, 2010

I do have a neti pot (well, the squeeze bottle type) that I've never cared for, but only because it never felt like the water was going anywhere. Now that I know why, I don't hate the contraption anymore. So, I'm all good with using it, and hadn't thought about that being part of the recovery.

I did watch one video on YouTube, just of the drainage aspect, and LOVED it. I just kept thinking how awesome that guy was going to feel when he woke up!

MeiraV, it's interesting that you didn't find much of a difference after your surgery...sounds like maybe it just wasn't what you needed?

I breathe like crap. I've been congested literally for my entire life. I don't know what it's like to be able to breathe through my nose for any period of time. The headache, and its occasional friends eye and jaw pain, has become unbearable. I need something to be done about this.
posted by altopower at 5:48 PM on November 30, 2010

Oh, and Sidhedevil, you can count on a MeMail from me after you've had a suitable recovery time. :) Good luck to you and I hope it goes well!
posted by altopower at 5:50 PM on November 30, 2010

Have you tried nasal steroids?

Surgery this fast is too fast--having had surgery, and having had polyps reduced significantly using the spray--I'd go for the spray in a second. They came back a year or so after the surgery anyway.

I had a brilliant surgery (every ENT I've seen has commented on how good it was!) and it was still something I'd never go through again until exhausting every other possible alternative.

At the very least, get a second opinion.
posted by the young rope-rider at 5:57 PM on November 30, 2010

Apparently the steroids are not an option...I have moderate bleeding from my sinuses and the ENT said the steroids would exacerbate that.
posted by altopower at 6:03 PM on November 30, 2010

Hmm, I got some sort of gel to help with that...I guess I would reiterate a second opinion but if it turns out that surgery is the thing, it sucks, but it's less sucky than having horrible congestion 100% of the time.

Good luck!
posted by the young rope-rider at 6:05 PM on November 30, 2010

the young rope-rider, can you elaborate on your experience and how it led you to say the surgery sucks? I'm trying to get information on as many different experiences as possible, from both ends of the spectrum. Oh, and the gel you mention, that was to help with bleeding?
posted by altopower at 6:33 PM on November 30, 2010

I had multiple endoscopic procedures on my sinuses (including removal of tonsils/adenoids, straightening deviated septum, opening blocked sinus cavities, removing polyps, and scraping the turbinates (?) clean) about 15 years ago. It was surprisingly easy considering how many things were done, and the recovery wasn't bad.

It was outpatient even though I was under general anesthesia and spent the night in the hospital (there less than 24 hours total was outpatient apparently). The packing was removed the next morning (right after I ate breakfast!!!--the last meal I ate for a couple of weeks) and I was sent home to recover. I don't remember the recovery being particularly bad, about a week of sleeping/lying down all day and blowing stuff out I'd not care to really remember; constant use of saline spray to keep sinuses as moist as possible; and no sense of taste or smell at all for about 10 days or so, with another couple of weeks for it all to slowly return.

The change was drastic: I went from severe sinus infections every six months (like clockwork, almost to the day) and other associated gripes to breathing easily and regaining a sense of smell I had no idea was so profoundly diminished. I think I've had a sinus infection maybe two or three times in the 15 years since, and none were particularly severe and all cleared up fairly quickly. Allergies are much more manageable, because everything can drain!

My surgeon told me he was able to do 98% of the surgery with laser, only a little cutting required on my tonsil removal (which were quite large, given the years of chronic infection), so the recovery really was pretty mild. So I'd recommend it, very much. I told my college roommate at the time that I thought he'd probably need similar surgery, given his long-term symptoms, and he didn't follow up on that until last year, and finally had surgery too--and is soooo happy he did, it really is amazing how much clearing the inside of your face up does to sharpen your perceptions and experience of the world.
posted by LooseFilter at 6:33 PM on November 30, 2010

Apparently the steroids are not an option...I have moderate bleeding from my sinuses and the ENT said the steroids would exacerbate that.

I had the same problem. Plus with the blockage, the steroids weren't getting anywhere useful anyway.

I also had tried a neti pot in the past and considered it useless. What a difference the surgery made. Not at first though; the first day or so after the packing came out, it was pretty disappointing and discouraging. Then I got a couple of huge blood clots out - probably 1/3-1/2 cup in volume. After that, the difference was amazing.

YMMV of course, but I was well served by having it done.
posted by Pogo_Fuzzybutt at 6:43 PM on November 30, 2010

LooseFilter, it's interesting that you mention your tonsils. I had chronic tonsillitis for many years and had my tonsils/adenoids out when I was 25. It made a big difference in a lot of ways for me, but not enough. I have horrible allergies, and it encourages me to know that you've had improvement with yours since the surgery.

Pogo_Fuzzybutt: Then I got a couple of huge blood clots out - probably 1/3-1/2 cup in volume.

That is simultaneously gross and awesome. :)
posted by altopower at 6:56 PM on November 30, 2010

had a deviated septum that blocked both sinuses. had polyps. had sinus infections regularly. sinus partially blocked. had done steriods for years. finally had the surgery. no more infections and colds don't last forever. use the nasal rinse after surgery. it keeps the sinuses clean. i'm glad i had the surgery. put it off for 8 or ten years and shouldn't have.
posted by swmobill at 7:19 PM on November 30, 2010

I'm echoing much of what has been said above, but here goes:

Starting in high school, I started getting terrible seasonal allergies. The kind where almost nothing helps--I'd go through all the OTC antihistamines, then prescription antihistamines, even tried allergy shots, which were a little effective but didn't solve the problem. Anyway, almost every serious allergy attack would lead to sinusitus, so basically I'd have three or four sinus infections every year, each one lasting for weeks, and eventually I just felt congested most of the time--which, I later found out, was because even after a round of antibiotics I'd have some remaining sinus infection. Basically, my sinuses never really cleared up properly.

In the early 2000s I started seeing a really good ENT in New York. Instead of just throwing antibiotics at me, he used an endoscopic camera to look at my sinuses and put me through a round of CAT scans. He showed me the scans and the images: In non-medical terms, my sinuses were fucked. The main problem was that they weren't draining properly, which is why I always felt congested and tended to get sinus infections after every allergy attack. More than that, over the years the lining of the sinuses had essentially built up with scar tissue, which also made things worse.

So finally, after long discussions with my ENT--who's also a respected surgeon--I opted to have sinus surgery. He told me that I was a perfect candidate, and by this point I'd just had enough and was ready. This was three or four years ago.

In my case (and, I think, in most sinus surgeries) there are two goals: To remove any excess tissue from the lining of the sinuses, and to make sure that they're draining properly, which means opening them up a little bit where they connect to...well, wherever they drain. The inside of your nose, I guess. I had an endoscopic procedure, which means it's a camera-guided procedure done through the nostrils(!).

I checked into the hospital the morning of the surgery. I was given some kind of intravenous anti-anxiety med, and then something to put me to sleep once I was in the OR. I believe it was technically what they call a twilight anesthesia rather than a general anesthesia, but in any case, I was completely out. Next thing I know, I wake up and I have the distinct sensation of suffocating, because my sinuses have been completely packed after the surgery and I can't breathe through my nose. I panicked, but a nurse was standing there and basically said, breathe through your mouth. I did.

Amazingly, there wasn't a huge amount of pain after the surgery. What did suck was having my sinuses completely packed (imagine tampons jammed into your head) and being unable to breathe through my nose for a week or so. Of course, I had some good pain meds.

Then came the day that the packing got pulled out. It was a little like getting teeth pulled--not fun! And it was AMAZING how much cotton or whatever had been in my head. And it was also amazing to be able to breathe normally again. Immediately I could feel the difference, although it took months before the post-surgery swelling was completely down and I felt the full benefit of the surgery. I had to do regular sinus rinses with an antibiotic wash for a few weeks after the packing came out, and in the year since I've become a huge fan of the ayurvedic saline sinus rinse.

And in the end? Over the past few years I've had maybe one or two sinus infections after really bad colds, but they cleared up quickly and easily. My allergy symptoms have subsided by a huge amount, which is actually unexpected but a nice surprise. I don't walk around feeling congested and tired all the time. I sleep better. I feel healthier. And I take far fewer drugs.
posted by bassomatic at 8:18 PM on November 30, 2010

My problems also started in high school and gradually got worse. I never tried any OTC remedies or went to the doctor, I just put up with it. But around the 10-year mark in desperation I tried a nasal spray and that's all it took. One night of free-breathing bliss but within a week, I was using 3 bottles a day. I was living in Germany at the time and went to the doctor. [Warning: not for the faint-hearted] He tried to open up my rock-solid sinuses by inserting what looked skewers up my nose and hitting them with the heel of his hand. Yeah, that didn't work so he scheduled me for an out-patient operation under general anesthesia. Packed nose, two days of sleep, clots, some gruesome photos but quick recovery and didn't need the pain pills. He sent me home with cortisone nose drops.

For a while the operation worked but gradually the chronic rhinitis returned and colds that turned into sinus infections. I should have bought stock in the Kleenix company because I kept a box in every room and carried a handkerchief with me everywhere. Oddly, when I lived in Hawaii for a few years, it cleared up but other than that, it was a problem everywhere I lived and during every season, indoors and out.

Then several years ago I had a long airline flight and caught a heavy cold. Afterwards I could not breathe through my nose at all unless I was exercising vigorously. Eating was a nightmare as I'd have to stop chewing and breathe through my mouth. Lovely. Finally I made a doctor's appointment but before he could see me I happened to have a sports massage appointment. For the heck of it, I asked the masseur to massage my face explaining that I couldn't breathe through my nose. He pressed and stroked the sinus area really really hard, like almost-cheekbone-breaking hard and I could hear a crackling noise. After the second session, it was like a miracle. My sinuses cleared up entirely. I could breathe again. When I did see the doctor, I explained that my problem seemed to have cleared up without drugs or surgery. Several years later, they are still clear. I don't need to stock up on Kleenix. No sinus infections. It's a miracle.
posted by TWinbrook8 at 10:26 PM on November 30, 2010

I had the surgery two years ago and I've had one sinus infection since. I consider this one too many, but it's still a major improvement, as I used to get a few a year. I've also had several mild colds that went away on their own accord after a few, mildly uncomfortable days. This is new for me: all my colds used to turn into vicious, antibiotic-requiring sinus infections.

If you decide to get the surgery, get a couple latex gloves. Filling three fingers of them with cold water (and laying those three fingers down your nose and to each side of it) is a great comfortable way to inhibit swelling while not giving yourself an ice cream headache.
posted by fingersandtoes at 10:49 PM on November 30, 2010

I had my sinus polyps removed as a bonus to major upper and lower jaw surgery. My recovery was longer than normal and complicated, but that's because I had some at-the-time-undiagnosed bleeding issues that caused some problems. (Extra fun complication: my jaw was wired shut, so I'd have to hawk up the blood clots and push them out through my teeth with my tongue. Sexy!)

Anyway, once those delights passed and I could start breathing through my nose again, it was amazing. I went several years without a sinus infection or cold (not to mention countless sinus headaches on a regular basis), after normally having 3 or 4 colds/infections a year.
posted by scody at 11:23 PM on November 30, 2010

Also had polyps removed, septum straightened, turbinates cleaned out, oh, two decades ago?

Had the gauze packing, which gave me headaches until it came out when I got too warm, but boy, best surgery ever. Since then, maybe 1 sinus infection, down from having so many it was like a horrible drowning sloggy feeling all the time.
posted by canine epigram at 5:32 AM on December 1, 2010

Wow, this is all really great info!

So as far as recovery time goes, how long were all of you out of commission for? I have two children (one in school, but one still at home) and I work part-time, so I'm trying to get an idea of how long I'd be down for the count.
posted by altopower at 6:32 AM on December 1, 2010

Had similar surgery to canine epigram about three years ago. Compulsory week off work after the surgery because of the risk of infection, but I'd have been OK working again earlier than that.
posted by genesta at 11:19 AM on December 1, 2010

"the young rope-rider, can you elaborate on your experience and how it led you to say the surgery sucks? I'm trying to get information on as many different experiences as possible, from both ends of the spectrum. Oh, and the gel you mention, that was to help with bleeding?"

Yeah, I used to get nosebleeds which worried me about doing the steroids again (had done them a few years back). I got a gel which helped with that. My ENT also suggested doing the spray once every other day if I got nosebleeds. Basically, his thought was that the spray, if it works, is a LOT better than surgery because surgery does carry risks.

It sucked because it's surgery--felt completely miserable for days, hated moving, couldn't eat normally, bleeding out of my nose, had to have gauze on it and the tape that held the gauze on rubbed my skin raw, had to get surgery (you can't eat the night before, you have to go under anesthesia, you have to wear that stupid gown, arrange for someone to pick you up, you'll have to get childcare for the time you're on pain pills...)

It's boring, you have nothing to do and you're all spacey. You have to monitor your pills so you don't take too many, keep track of them...

And, I mean, it fucking hurts. You wake up in the middle of the night to take pain pills. Lots of stuff that I especially would try to avoid if I had a little one at home, unless I had help that could come stay with me (like a parent, sister, or friend).
posted by the young rope-rider at 3:45 PM on December 1, 2010

Give yourself a week before you even think about going back to work. It's not so much the pain (although there is some of that, for which you'll likely take some meds) but the fact that you just feel kinda disgusting because your sinuses are stuffed with blood-encrusted packing and you're breathing through your mouth and just generally drained. (The mouth breathing was the most difficult part for me.) Oh, and as rope-rider reminds me, for a few days at least you have to tape a piece of gauze around the end of your nose because you've got a thin bloody liquid draining out. You probably don't want to go out in public like that.

Ironically, as I write this I'm suffering my first lingering sinus infection since the surgery, which was about four years ago. It was sparked by a cold picked up from my two-year-old. I'm waiting to see if regular saline sinus rinses will knock it out. I've heard that a minority of people have to go back for the surgery again after a few years (and sometimes more than once) because their sinus tissue eventually get scarred again from more inflammation and infections, or because they get more polyps (which I think is a more recurrent condition, though I don't know a lot about it).
posted by bassomatic at 6:46 PM on December 1, 2010

I had this surgery about twenty years ago, at age 13, and it was painful, as others have said, but utterly worth it. (Maxilary sinus: drained and expanded, and a drainage path drilled; the surgeon who did the procedure pioneered it in kids and told my parents I had the smallest sinus he had ever seen in all his years of practice.) I don't remember a lot of the details of my recovery, and since I was so young I was not informed about a lot of the medical details, so I can't speak to that. I do remember the packing being removed the day after my surgery, and it was one of the most painful experiences of my life. I think I missed a week of school, and I couldn't chew for several days, but they may have better techniques now that heal faster.

For me it was totally worth it. I had continuous sinus infections for at least five years before the surgery and was on antibiotics all the time, and in the 20 years since I've had maybe five infections total? I don't think I've had one requiring meds in ten years. I did get a couple sinus infections in the year or two after the surgery but I was told that was normal and that they would taper off, and that's been true for me. My seasonal allergies also got much better.

I have a weird little spot in my face where I have no sensation (nerve damage) and if you poke the right spot on my cheek you can feel where they drilled the drainage passage. It's a fun party trick and has absolutely no bearing on my daily life. The other side effect is that it's been recommended I not take up boxing because my face is more fragile than most people's.

so yeah. Really worth it, in my opinion. However, I would suggest you get a second opinion before proceeding. It is surgery and should be taken seriously.
posted by min at 7:40 PM on December 1, 2010

Thanks guys...I have a lot to think about before my appointment on the 14th.
posted by altopower at 4:57 PM on December 2, 2010

I had my follow-up appointment last week. We decided to go ahead and schedule the surgery for January 11. There had been no improvement with antibiotics, and the headaches are getting worse, so I requested to go ahead and get it scheduled. It will be a balloon sinuplasty, which seems to carry fewer problems with recovery...no packing, little bleeding, etc.

Thanks for all your input...it's helped me a lot!
posted by altopower at 11:03 AM on December 24, 2010