Sinus surgery recovery as a singer

January 15, 2013 10:06 AM

After fighting a waxing / waning sinus infection for the past two and half years, I'm starting to accept the fact that I will probably need sinus surgery. Complication: I'm a working singer with a very busy year ahead of me. Can you help me understand the recovery process so I can figure out when to schedule this, if I need it?

I got this sinus infection in June of 2010, and I have not been completely well since. I've tried antibiotics (amoxicillin, augmentin, Z-packs by the fistfuls, Keflex, clindamycin, and Levaquin), steroids (flonase and prednisone), antihistamines (Zyrtec and Allegra), daily sinus lavage, and giving up milk and wheat. Nothing has gotten me better. In addition to the problems caused by the sinus infection, the pressure is exacerbating a probably-extant balance disorder to the point where it's interfering with my daily activities, so this has to get fixed. A sinus CT showed "significant chronic disease, inflammation, thickening, drainage, and debris" in my right maxillary sinus and my ethmoid and sphenoid sinuses. I'm on a hail-mary regimen of 2 weeks of Augmentin and a 3-week burst/taper dose of prednisone, but my hopes are not high.

Here's the complication: I'm a classical singer. I JUST took a new job at a church, and I have concerts with other organizations in March, April, May, and June. I was planning a trip that would involve a plane flight in July, and rehearsals for my next season start again in August; I have 9 or 10 concert series in the 2013-2014 season, outside of my church job.

How long after sinus surgery will I be able to sing? I would be having this done at the University of Washington, and they'll consult with a vocal specialist before or during the surgery, so I feel pretty confident that I'll be in good hands. Will I be out of commission for a week? Three? Six? When can I fly? As it stands, every time I get sick, I lose my voice, so there are also consequences to waiting.

(Also, as an extra bonus question, how long will I need someone taking care of me, and how long will I need someone here to help me take care of my children? I'm their primary caregiver during the day.)

posted by KathrynT to Health & Fitness (14 answers total)

Day of surgery you need someone to take care of you the rest of the day, bring you ice-gloves, etc. (Disposable glove with ice water in three fingers, lets you ice your nose without giving yourself an ice cream headache.)

As I recall, next day is uncomfortable but not "need someone taking care of you" bad. Probably want help with the kids here though.

Within 3-4 days, I think I was fine.
posted by fingersandtoes at 10:14 AM on January 15, 2013

I suppose this depends on what exactly you are having done. I had packing in for five days, during which sleeping and eating were particularly uncomfortable and difficult.

It depends on the age of your kids. I could barely do more than get up off the couch for about 48 hours after my surgery. After than I was pretty much functional, just kind of tired and uncomfortable. Running after two toddlers would have been impossible, but older kids I probably could have managed. My brother was about 7 when I had my surgery, and I think he was pretty freaked out by the sight of me, my face was all swollen and I had gauze taped to my nose that I would occasionally bleed though.

For a couple of weeks after I got my packing out I felt tired and run down and had some sinus pain, but it was pretty on par with what I was experiencing pre-surgery, so it wasn't too bad. Once I got the packing out I pretty much felt human again.
posted by inertia at 10:28 AM on January 15, 2013

My bleeding didn't fully stop for a week or so. 3 or 4 days of that I was drugged up pretty hard for the pain; laid up or sitting, no heavy activity. Followup got the rest of the clot out, and maybe some very light bleeding for a week or two, couldn't blow my nose for that time; nose was sensitive for 2/3 months. Your voice may change slightly, I didn't notice personally. I'd say a week to fly, 2 or 3 weeks to sing?
posted by MangyCarface at 10:35 AM on January 15, 2013

When I had mine, I was in pretty bad shape for about 2-3 days, and my wife had look after me pretty closely. I went back to work after 7 days, when the packing was removed. It was slow going for about another week after that, but not too bad.

It took about 4-6 weeks to get back to normal, though.

So figure about two weeks out of commission, and before you can fly - give or take. You could probably fly right after the packing comes out, but I can't imagine you'd want to.

Using a neti pot regularly and often (several times per day) will really help with healing.
posted by Pogo_Fuzzybutt at 10:37 AM on January 15, 2013

Best answer: Depends a lot on what you are getting done. I had a one-side turbinate reduction [different from what you are having I think, but still "we put you out for it" surgery] on December 27th of 2011 and had no packing afterwards. There was almost no bleeding. I took painkillers for only the first day or two (mainly because I was uncomfortable when sleeping) and was up and about, though crabby, in two days. The big hassle for me and what might be for you is that you have to do a lot of nasal rinsing in the first few months with distilled water and a neti pot. Post-surgery there are a lot of weird crusts that form in your nasal passages that you have to work on getting out. There are also fairly regular visits with the ENT to check up on things. I traveled a lot and traveling with all the nose stuff was a hassle but not horrible. I also had to take prednisone for the first ... two weeks? I am not sure but it sucked and gave me moon face and I hated it. Honestly the prednisone was the worst part. They may not even be able to tell you if you'll have packing since there's an aspect that they don't know what they'll do totally until they get up in there. I would assume a flat two weeks before you'll want to fly and maybe a month before you'll feel back to normal. This is, again, if you have something like I had. There are online forums where people discuss this stuff and I would stay away from them.
posted by jessamyn at 10:48 AM on January 15, 2013

Sounds like there's a wide variety of surgeries getting done under the term "sinus"... maybe you should ask your dr the typical recovery time (and add a day or two to that, they always underestimate, in my experience.) Like for me, I don't remember if I even had packing, but certainly not for weeks like Jessamyn did.
posted by fingersandtoes at 11:22 AM on January 15, 2013

My father has had multiple sinus surgeries. He's probably a lot older than you but he recovered very quickly each time (within days). I think he was only confined to bed for about a day. I know this wasn't your question, but I suggest you talk to your doctors very carefully about the range of possible outcomes and the probability of each because chronic sinus infections can be highly impervious to all kinds of treatments, very much including surgery.
posted by Dansaman at 11:43 AM on January 15, 2013

Best answer: As jessamyn says, it really depends on what you're getting done.

The end-result to your sound will be zero (we are trained in classical singing not to use the nasal resonators for the most part) and the risk to your vocal folds from anesthesia is minimal.

I have had two nose/septum/sinus-type surgeries in my life, stemming from the fact that I broke my nose quite badly when I was around 1 year old. The first surgery, which I had in my 20s, was quite extensive (as in, they effectively broke my nose off and put everything back in a different configuration) because I had a lot of problems that had to be corrected. The second surgery, which I had in my late 30s, was a sinus surgery that I imagine was a bit less involved than what you will be having. In either case, I was entirely back on my feet and performing as a classical singer within a month -- and I want to say it was closer to two weeks.

There will almost certainly be packing that you will keep in there for a period of at least a day to as long as a week. You will need someone to take care of you for the first 24 hours, but not after that.

Given that your first non-church engagement isn't until March, I would advise you to have the surgery as soon as possible. Missing a few weeks of church singing isn't the end of the world.
posted by slkinsey at 11:46 AM on January 15, 2013

I had turbinate reduction and a deviated septum fix in 2010 after similar sinus infection issues. You might inquire if your procedure permits you to have what I had -- a "bandage" made using your own blood, in lieu of packing. My ENT told me the worst part of sinus surgery is the packing, so if time is of the essence, you might try that. The bleeding was over the day after the surgery, I took pain pills the day of so I could sleep, I was up and around and doing light errands in a few days, I was back at (non-singing) work in a week, and I was on limited exercise for a few weeks. But everyone is different in how they heal. I hope things go smoothly for you.
posted by *s at 11:46 AM on January 15, 2013

As someone who had 6 sinus infections in a row and 6 scripts of antibiotics, large doses of guaifenesin (generic mucinex) was the only thing that put a stop to the cycle. I know this doesn't really have anything to with surgery but it might make you more comfortable and help with your balance/sinus pressure until then. Drink lots of water with it. It gives you a bad case of dry mouth.
posted by stray thoughts at 1:15 PM on January 15, 2013

Best answer: > A sinus CT showed "significant chronic disease, inflammation, thickening, drainage, and debris" in my right maxillary sinus and my ethmoid and sphenoid sinuses. I'm on a hail-mary regimen of 2 weeks of Augmentin and a 3-week burst/taper dose of prednisone, but my hopes are not high.

ENTs are surgeons. They know how to fix stuff with surgery. Surgery is a good answer for lots of people, you may be one of them, but don't let anyone talk you into anything without fully explaining risks, recuperation, and the potential impact on you as a professional vocalist. As a professional vocalist.

If you get any guff or handwaving, ask them under what conditions they'd let someone do surgery on their hands.
posted by desuetude at 12:15 AM on January 16, 2013

Best answer: In addition to discussing your vocal career with your surgeon, be sure and let your anesthesiologist know you are a professional singer. Although the risk of vocal cord injury due to airway management is small it can be reduced further (although at the expense of other potential problems). I have taken care of a few people who use their voice (professional or very serious amateur singers, newscasters) over the years and always made it a point to discuss my anesthetic plan and airway management in particular in some detail ahead of time. It may even be worth a special trip to the preop evaluation clinic (or whatever the equivalent is called at your hospital) to have this discussion in advance.
posted by TedW at 5:41 AM on January 16, 2013

Response by poster: ENTs are surgeons. They know how to fix stuff with surgery. Surgery is a good answer for lots of people, you may be one of them, but don't let anyone talk you into anything without fully explaining risks, recuperation, and the potential impact on you as a professional vocalist. As a professional vocalist.

I appreciate your caution. One of the reasons I chose this practice is that it includes no fewer than three specialists in the professional voice, who work closely with the Seattle Opera and many of our local big names. They're mostly throat guys, not sinus guys, but any surgical plan will definitely, DEFINITELY include close consults with one of them -- and I will definitely be using an anaesthesiologist who is familiar with what's going on here. I am lucky to be in a big city with a well-known opera house that has support for these kinds of professionals. Even the ARNP I initially saw framed everything around respect and caution for my voice.

The problem is, this is already affecting my voice. I've lost a fourth off the top of my range, and my low passagio is very rough. The top fourth isn't so much of an issue because I sing alto, but I need that low passagio to be clean, and right now it just isn't, no matter what I do. However, I spent all night with horrifying crud draining down my throat, which may indicate that this drug treatment is working better than I thought it was -- and when I just did some experimental singing, since starting this reply, I managed to ring a high C that didn't totally suck. So it may be that I can avoid surgery at least until this summer, if not entirely.

Anyway, it sounds like the answer to my question is "Don't do it if you need to be spectacular inside of a month or six weeks, but also don't expect that you'll be down hard for more than 3 days to a week." Which is really, really good information to have.
posted by KathrynT at 9:54 AM on January 16, 2013

Response by poster: Got the followup nag mail, which spurred me to post this followup: surgery is off the table for now! The sinus surgeon I met with agreed that surgery would probably help me tremendously, but had just attended a conference where a medical treatment was presented that apparently has outcomes similar to surgery in cases like mine. The doctor proposed that we give that a try, pointing out that even if it doesn't work, I will have lost nothing. And it's working GREAT, I have airflow through my nose like you wouldn't believe. The surgeon was really reluctant to go in with a knife until all other options had been exhausted, and boy am I glad for it.
posted by KathrynT at 1:10 PM on February 14, 2013 [2 favorites]