Complications that May Occur During Sinus Surgery
Sinus surgery is often recommended for those suffering from chronic sinusitis when medications, allergy shots and other treatments prove ineffective. Today’s sinus surgery is less invasive than it used to be. Known as functional endoscopic sinus surgery, or FESS, this sophisticated procedure is typically performed on an outpatient basis under local anesthesia (though sometimes general anesthesia is required), with or without sedation depending on the patient’s individual needs.
Sinus surgery does have some aftereffects, some of which are considered normal, including some pain, minor bleeding, nasal congestion and fatigue. There are also some less common physical risks of sinus surgery. Both are discussed below.
Common Issues that Are Normal
Some aftereffects of sinus surgery are not “complications” as such, but rather normal postoperative effects. They include the following:
Minor Bleeding. Bloody nasal secretions are normal for the first few days following surgery. Make sure to keep your head elevated and avoid blowing your nose. Sneezing can increase the pressure inside your nose, so if you feel a sneeze coming on, open your mouth, which will reduce the pressure. You will also need to avoid vigorous exercise for a couple of weeks. Do not take medications that thin the blood, such as ibuprofen, aspirin or Coumadin. Certain herbal supplements have the same effect and therefore need to be avoided; ask your doctor for a list. Note that heavy bleeding following sinus surgery is not normal. If bleeding does not stop after applying pressure to the nose for a matter of minutes — or if you sense that there is too much bleeding — contact your doctor immediately or go to the emergency room.
Pain. The amount of pain experienced after sinus surgery varies by patient. Some patients don’t have much pain at all while others experience significant pain in the first week postoperatively. Your doctor will prescribe you pain medication as necessary. Do not take any over-the-counter medications without approval from your doctor, as some of them can increase the risk of severe bleeding. To decrease postoperative discomfort the best surgeons use tissue glue rather than nasal packing.
Nasal obstruction and/or congestion. This also varies by patient, with some patients noticing significantly reduced nasal congestion right after surgery and others not experiencing any improvement for days or weeks. Several factors may influence a patient’s postoperative nasal congestion, including crusting, nasal packing and swelling. Your doctor will provide you with instructions for irrigating your nose and other measures that can help with nasal obstruction/congestion.
Fatigue. Most patients will feel tired for a few days or weeks following surgery. It is important to relax during the recovery period.
Potential Physical Risks
Damage to Eye or Tissue Surrounding It (intraorbital complications). Eye complications are exceedingly rare. However, the eye is separated from some of the paranasal sinuses by a thin sheet of bone, and in rare cases this proximity can cause bleeding into the orbit, which will need to be treated during the surgery but rarely leads to any chronic issues (sequela). Rarely, this can lead to loss of vision and blindness. Another rare issue is damage to the muscles that control eye movement. In some cases the tear ducts can be affected and excessive tearing may result. In extremely rare cases major orbital complications can lead to blindness, even without surgery.
Intracranial Complications. The nasal septum is linked to the roof of the nose near the brain. Should this bony layer fracture, brain fluid may seep into the nose. This can usually be identified and addressed during sinus surgery, but in rare cases it can lead to bleeding in the brain or meningitis, an infection of the brain lining.
Excessive Bleeding. Following sinus surgery many patients have some bleeding on the septum (the wall between the nasal cavities) or turbinates (internal nasal structures that humidify and filter air). This rarely causes major problems. Non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen and aspirin, as well as certain supplements, increase the risk of bleeding and should be avoided unless your doctor clears them. Bleeding usually stops after the first day but sometimes can last days or even weeks. Sometimes this leads to a blood clot, which will need to be removed, or scar tissue.
Changes in Voice. The sinuses affect resonance. Singers and other vocal professionals should therefore note that sinus surgery can change their voice.
Problems with Smell or Taste. A patient’s sense of smell typically improves following sinus surgery due to restored airflow. However, it should be noted that in some cases it worsens. This largely depends on swelling, infection, and/or allergies.
Infection. Most people who undergo sinus surgery decide to do so because of a chronic sinus infection that has been unresponsive to medication. Patients with sinusitis who undergo surgery are also at risk for other types of infections in this area (e.g., meningitis or abscesses) caused by the surgery. However, these same infections can also stem from not having surgery to address the sinus infection.
Movement of septum leading to nasal obstruction or pain. One of the main components of the nasal septum is cartilage, which is known to have “memory.” In other words, the cartilage can return to its original position. During surgery the surgeon will take steps to prevent this from happening. However, this is not always successful, and if the cartilage moves following surgery, this can lead to ongoing blockage. Scarring can also occur within the nose and may need to be addressed through additional surgery.