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School of Medicine
Preparing for Endoscopic Sinus Surgery
What do I need to know before having endoscopic sinus surgery?
- Preoperative prescriptions: Prior to surgery your doctor will most likely prescribe several medications that help reduce inflammation. It is important to follow your doctor's instructions and start the medications at the appropriate times before and after surgery.
- Preoperative physical: Your surgeon will require you to get medical clearance from your primary care physician before surgery. This will require a note from your doctor and in some cases a brief physical examination. Your Johns Hopkins surgeon will order basic lab tests and studies and your primary care doctor may want additional tests. This ensures that you have medical clearance for a safe surgery.
- Smoking: Smoking can severely affect the outcome of your sinus surgery. Smoking causes increased scar tissue and poor healing that leads to failure of endoscopic sinus surgery. If you do smoke your surgeon will usually require you to stop smoking 3-4 weeks before surgery and avoid smoking for an additional month after surgery.
- What to avoid before surgery: There are certain medications that can increase your risk of bleeding during and after sinus surgery. These medications include aspirin and NSAIDs such as Advil, Motrin, and Aleve. These should be stopped at least 2 weeks prior to surgery. Vitamins E and herbal medicines such as gingko biloba, ginseng, and garlic tablets can also increase your risk of bleeding and should be stopped prior to surgery. St. John’s Wort is a medication that should be avoided 2 weeks before surgery as it may interact with anesthesia. Anti-coagulation medicines such as Coumadin and Plavix are blood thinning medications that must also be temporarily stopped before and after surgery.
- Recommended over-the-counter medications: We recommend that you purchase two over-the-counter medications prior to your surgery. Nasal saline mist (Ayr, Ocean, Simple Saline) can be used every 3-4 hours after surgery to keep your nose moist and humidified. Afrin should be used after surgery if you have steady bleeding that doesn’t stop with a gentle head tilt. Both of these medications can be purchased at any pharmacy without a prescription and are good to have for after your surgery.
What can I expect on my surgery day?
- You will not be allowed to eat or drink anything after midnight before your day of surgery. Your doctor will tell you which medications you can take the morning of the surgery, but these should be taken with very small sips of water. This is extremely important to understand because the anesthesiologists can not put you to sleep safely unless you have an empty stomach, and therefore they will cancel surgery if you’ve had anything to eat or drink.
- Sinus surgery is performed with general anesthesia so you will be asleep during your procedure. After surgery you will spend a few hours in a recovery room to allow you to wake up. Most patients feel good enough to go home a few hours after their surgery.
- Please see the Postoperative Care Instructions packet for information about after your surgery.
What are the risks of endoscopic sinus surgery?
As with any surgery there are risks involved with having endoscopic sinus surgery. While risks with sinus surgery are exceedingly rare, it is important for you to understand what these are.
Bleeding: During surgery small amounts of blood loss are expected and these are tolerated well by patients. In rare cases excessive bleeding may occur that requires stopping the surgical procedure. Mild bleeding after surgery is also common and usually subsides after the first day. Vary rarely bleeding occurs after surgery that requires a visit to your surgeon and may involve placement of nasal packing to stop the bleeding.
- Infection: Patients are usually given a dose of antibiotics during surgery and a prescription for antibiotics after surgery to reduce this risk. Occasionally a patient may develop a sinus infection after surgery that requires a stronger antibiotic.
- Cerebrospinal fluid (CSF) leak: During endoscopic sinus surgery the surgeon is working beneath the bone that separates the brain from the nose. It is extremely rare for this bone to be injured during sinus surgery, which would result in a CSF leak. Such an injury would generally be identified at the time it occurred and would be repaired immediately. If a leak is diagnosed after surgery, as second procedure would be required to patch the opening. Failure to treat a CSF leak could result in meningitis, a potentially life-threatening infection.
- Changes in vision: The sinuses are very close to the eyes, and therefore injury to the eyes may occur during sinus surgery resulting in temporary or permanent double vision or visual changes. Injury to the tear ducts may also cause excessive tearing after surgery. Fortunately these are exceedingly rare complications. Swelling may also occur around the eyes after surgery. Temporary blurry vision does occur in some patients but resolves without the need for further treatment.
- Other risks include changes in your nasal breathing or sense of smell. If a septoplasty is performed during your sinus surgery there is a small risk of developing a septal perforation or numbness in your teeth. Some patients have persistent or recurrent sinus disease after surgery that requires treatment with antibiotics, steroids, or another surgery.