Endoscopic Sinus Surgery

What to Expect After Surgery      When to Call Your Child's Physician        Follow-up After Surgery

The purpose of endoscopic sinus surgery is to open the passages of the sinuses allowing for proper drainage to the nose and to reduce the chances of getting sinus infection.

It is called an endoscopic procedure because the surgeon uses an endoscope (a small, flexible tube with a light and a camera lens at the end) to view the 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 and is done 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, adenoidectomy, or insertion of ear tubes.

What to Expect After Surgery

• Your child will have intravenous (IV) fluids until time of discharge. Clear liquids for your child to drink are available in the Post Anesthesia Care Unit (PACU), also called the recovery room.
• 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 PACU 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 his/her head elevated above the level of the chest.
• Packing is almost never required for sinus surgery done on children with current technology and instrumentation. In the extremely rare case that this is required, dissolvable packing is generally used so that it does not nee to be removed.
• If packing is used, your child may be able to feel it in his/her 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 he/she will not be allowed to forcefully blow his/her nose for a week or two.
• At first, there may be some drainage from the nose. You may see a small piece of gauze taped under your child's nose. This is called a "drip pad." This is usually only needed for a couple of hours, if at all. The drainage from the nose will probably be tinged with blood. Your child may cough or spit up some pink or brown mucus.
• Most children are fussy the first few hours after this procedure.
• Your child may begin normal play after several days, but may need to stay home from school until the discomfort improves. Consult your child's physician for more specific recommendations.
• Your child's physician may recommend the use of nasal ointment, salt water spray, or nasal steroid spray after surgery. Follow instructions carefully.

When to Call Your Child's Physician

The following are some of the symptoms that may indicate a need for you to promptly contact your child's physician:

• bright red bleeding from the nose or mouth 
• double or impaired vision
• a persistent leak of clear fluid from the nose
• if your child vomits bright red blood or a coffee ground-like material
• if your child develops a croupy (barky) cough/cry or wheezing if your child's temperature rises greater than 101.5o F rectally or greater than 100.5o F orally 
• vomiting (or if the vomiting becomes severe)
• signs of dehydration (a child can become dehydrated when he/she has prolonged or severe vomiting and is not able to drink enough fluid) 

Follow-up After Surgery

A visit with your child's physician will be scheduled for one to two weeks after surgery and then again several more times in the months after surgery to make sure that the nose is healing properly. Consult your child's physician if you have any questions.