Post-Operative Endoscopic Sinus Surgery Instructions

General Instructions:

• Following Endoscopic Sinus Surgery (an operation to enlarge the sinus openings), absorbable packing may be placed inside the nose that may need to be removed at your first post-operative visit. Not infrequently, it may come out on its own prior to this visit – do NOT worry, this is not a problem.
• It is normal to have some bloody drainage from the nose; this will gradually decrease over the first few days after surgery.
• A “moustache” dressing is used to collect the drainage from the nose. You may change the dressing as needed.

Precautions

• Avoid blowing the nose for the first 2 weeks.
• Try to sneeze through the mouth instead of the nose.
• Call our office if there is any bright red bleeding, vomiting of blood clots, or spitting out bright red blood for a prolonged period of time.

Medications

• Oxymetazoline (Afrin®, Dristan®, Genasal®) may be used – 1 spray each nostril twice daily for the first 3 days following surgery to reduce the amount of bloody nasal discharge and congestion.
• Normal saline (Ocean®, Ayr®) nasal sprays may be used to moisturize and irrigate the nasal passages. Administer 1-2 sprays to each nostril 3 to 4 times daily.
• Vaseline®, Bacitracin® or Polysporin® ointment can help with nasal irritation, crusting, or chafing in the front of the nose. Apply with a Q-tip and apply liberally, but only a half-inch or the depth of the head of the Q-tip. This will moisturize and lubricate the front of the nose and help keep secretions from sticking, causing less irritation or itching; these products are available from your pharmacy.

Nasal Irrigations

Your child may be instructed to begin nasal saline irrigations. This is a very important part of the recovery process. The nasal saline helps to decrease the packing and blood retained in the nasal cavity, making the healing process smoother. The irrigations are performed with a bulb syringe, also used to clear an infant’s nose, and may be purchased at the drug store. The nasal saline may be purchased pre-packaged at the drug store, or a home solution may be prepared using the following: 1 teaspoon salt per quart of distilled water. The patient should irrigate the nose by filling the bulb syringe with the saline, and leaning over the sink with the head forward, gently flush the nasal cavity. Repeat several times. Keep the head forward to keep the fluids from running down the throat.

Other Nasal Care Instructions:

Saline (saltwater) Irrigation

• Ocean Mist® or Ayr® pump spray or a high quality contact lens wetting solution such as Bausch & Lomb® can be used to irrigate the nose.
• Contact lens solution is buffered salt water made gently for the eyes, so it is less irritating to the nose.
• Do not use contact lens cleaning solution.
• Saline solution can be vigorously flushed into each nostril. This can be applied from a squirt bottle, baby bulb aspirator or product bottle. Your child may sneeze or cough. The more vigorously you can flush, the more you will be rewarded by improved nasal breathing. This can be repeated several time a day when there is a lot of mucous discharge and can be especially valuable in early AM and before bedtime applications. It can be applied before and/or after nasal decongestant spray usage.
• Saline should not be used after nasal steroid spray (Flonase®, Rhinocort®, Nasacort®, etc.) application.

Nasal Decongestant Spray

• Afrin® , or generic oxymetazoline 0.05%, can be an effective decongestant in some situations.
• Afrin® will open the nasal passages within a few minutes providing immediate relief of nasal congestion. This can be especially helpful at bedtime to allow nasal breathing, and better quality, more comfortable rest.
• Afrin® is applied as 1-2 squirts to each nostril. Repeat application in 5-10 minutes will further decongest the nose if the first dose is ineffective.
• Saline nasal irrigation after Afrin® application can be very helpful to remove plugged debris and mucous.
• Afrin® and related products should be used infrequently, no more than twice a day for 2-3 days. Afrin® and other decongestant sprays can cause rebound congestion, i.e. addiction to the ingredients making it worse.
• Neosynephrine® is NOT recommended due to potential cardiac/heart rate effects.
• Infant Afrin® is a different medication than “regular strength” Afrin® and is NOT recommended.

Nasal Steroid Sprays (Flonase®, Nasacort AQ®, Rhinocort®, Nasonex®, etc.)

• Nasal Steroids such as these can be a very effective means to reduce nasal congestion.
• They are safe at doses recommended because they are topical/local medications and not absorbed into the body.
• There is less absorption of these preparations of steroids than commonly used asthma steroid inhalers.
• They do not, however, provide immediate relief from congestion like decongestants such as Afrin®.
• If you have been instructed to use nasal steroids, you must take them once a day, every day, to work well. Even with a cold or upper respiratory infection they will be effective. Nasal steroids take from a few days to up to two weeks to be fully effective. You should not start and stop usage, especially after obtaining relief from congestion. I will outline an appropriate trial for usage.
• Nasal steroid sprays are usually once-a-day applications of one or two squirts in each nostril as the patient sniffs in. If the first squirt is effective, the second may not be necessary. The spray should be directed into the nose, with the applicator tip inside the nostril directed at an angle parallel to the floor of the nose, slightly upward, not toward the eye or the ear. The patient should feel the gentle effect of the cool spray deep into the nose. Avoid bumping the walls of the nose with the applicator – minor trauma (bleeding) sometimes will occur.

Nose Blowing

• Even young children can blow their nose with some simple coaxing and rewards. Blowing the nose can be very effective in cleaning secretions/mucous from the nose and minimize the need for other medications.
• A couple of simple instructions may help even a reluctant child learn the fine art of nose blowing. First, try having the child blow a tissue held in front of the face with the mouth – simple in and out – so they can see the tissue flop in the breeze. Then switch to blow air in the mouth and out the nose. The more the tissue moves the greater the reward.

Postoperative Appointment

Your child will be scheduled an appointment 1-3 weeks following surgery. At this appointment, I may clean any remaining packing out of your child’s nose.