Endoscopic Sinus Surgery
The purpose of endoscopic sinus surgery is to open the passages of the sinuses allowing for proper drainage to the nose. It is called an endoscopic procedure because the physician uses an endoscope (a small, flexible tube with a light and a camera lens at the end) to view the inside of the nose. Small incisions or cuts are made to allow the scope to pass. The cuts are usually made inside of the nose. The physician may create new passages or open existing ones by removing polyps, cysts, or thickened mucous membranes.
Endoscopic sinus surgery usually takes between one and three hours in the operating room with the child under general anesthesia. Most young children spend the night in the hospital, but some older children may stay for only a couple of hours after surgery. Depending on the surgeon's preference and the needs of the child, endoscopic sinus surgery may be performed at the same time as another operation such as septoplasty, tonsillectomy and adenoidectomy, or insertion of ear tubes.
Your child will have intravenous (IV) fluids until time of discharge. Clear liquids for your child to drink are available in the recovery room. Most children are fussy the first few hours after this procedure. Your child may complain of a sore nose, not being able to breathe through the nose and difficulty swallowing. A pain reliever may be given for pain. An antibiotic is occasionally prescribed to prevent infection.
The head of the bed will be raised in the recovery room to help with swelling, breathing and drainage. At home, you should have pillows or a recliner chair available to help your child stay comfortable with their head elevated above the level of the chest.
There may be packing in the nose to prevent bleeding. The physician may remove this packing in one or two weeks or it may dissolve on its own. If the packing needs to be removed, it may be done in the physician's office for older, cooperative children, or may be done in the operation room under anesthesia. If packing is used, your child may be able to feel it in their nose. Your child should be told before surgery that they may feel like they have something in their nose when they wake up. If packing is not used, swelling may cause this feeling. Your child should know that they will not be allowed to forcefully blow their nose for a week or two.
If a septoplasty (straightening of the bone and cartilage in the center of the nose) is performed, then splints will be placed inside the nose at the end of the operation. These will be removed at the physician's office in one to two weeks and may cause some discomfort while they are in place.
At first, there may be some drainage from the nose. You may see a small piece of gauze taped under your child's nose, called a drip pad. This is usually only necessary for the first day, if at all. Drainage from the nose will likely be tinged with blood. Your child may cough or spit up some pink or brown mucus.
Your child may begin normal play after several days, but may need to stay home from school until the discomfort improves. Your child's physician may recommend the use of nasal ointment, salt water spray, or nasal steroid spray after surgery. If this is the case, please follow instructions carefully.
When to Call the Doctor
After surgery, monitor your child for symptoms that may indicate a need for you to contact your child's physician:
- Signs of dehydration, include dry mouth, sunken look around eyes, decreased amount of urine, no tears when crying and skin that forms and holds the shape of a tent when pinched
- Bright red bleeding from the nose or mouth
- Double or impaired vision
- A persistent leak of clear fluid from the nose
- Wheezing or a cough that sounds croupy (barky)
- If your child's temperature rises greater than 100.5 degrees Fahrenheit orally
- Vomiting (or if the vomiting becomes severe)
A visit with your child's physician will be scheduled for one to two weeks after surgery to make sure that the nose is healing properly. Consult your child's physician if you have any questions.