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What Is The Healing Time After A Sinus Surgery?
Question: On Monday I had sinus surgery under general anesthesia. The maxillary openings were enlarged and the sinuses were suctioned out. The ENT, who specializes in sinus disease, said the condition I have was fungal in nature and the sinus membranes were inflamed and formed polyps. He said he is seeing more and more patients with fungal sinusitis including those with diabetes. Post surgery I felt great and felt more energy and the tinnitus had decreased, this lasted three days. Now the same symptoms have reappeared including the evening headaches. Pain in sinuses, occipital pain and high pitched tinnitus. The ENT wants to put me on anti-fungal medications i.e Diflucan. If this does not correct the problem in a few days he will use a stronger drug with a steroid. I have been using a sinus nasal rinse 4X's daily, saline spray 10x's daily and oxymetozoline prn for 5 days. I still have a light case of thrush ( pasty mouth.) The mucous flow is sticky but not green or yellow . Also I feel warm but have no fever. I am completing a 10 day Ceftin antibiotic which I started pre-surgery. What is your opinion? The ENT stated he is seeing more and more patients who have fungal sinusitis and feels he can safely treat my condition. Why do my sinus headaches occur in the early evening? XXXX
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. The initial healing time after a sinus surgery is at least 4-6 weeks. The final healing time may exceed 4-6 months.
2. If you can share any pre-operative CT images, details of the procedure, I will be able to help you better. Check if any biopsy or culture was taken from the sinuses to confirm fungal infection. Was any nasal packing done in the immediate post-operative period?
3. One of the reasons for sinus headaches worsening in the evening are partially blocked sinuses that fill up during the day. The natural openings of the Maxillary and Sphenoid Sinuses (occipital headache) are located high up and these tend to fill up during the day. The outflow of the Frontal and Ethmoid sinuses is gravity dependent and these sinuses tend to fill up on lying down and cause morning headaches.
4. If there is any edema, swelling or infection after the procedure, medication will settle it. A combination of antibiotics instead of Ceftin (cefuroxime) will help. A follow up nasal endoscopy and suction should be done to remove any thick secretions, scabs and crusts that may have built-up and blocked the sinuses.
5. It is interesting to note that fungal infections may exist only within the sinuses (as against invasive fungal infections) and yet cause allergic reactions. This constitutes Allergic Fungal Rhino Sinusitis (AFRS). The efficacy of oral anti-fungals is doubtful in such cases. It is good that you are flushing out the sinuses regularly. Decongestant (oxymetazoline) drops may be causing rebound congestion.
6. The increase in tinnitus may be due to a thick post nasal drip blocking the eustachian tubes in the nasopharynx. A mucolytic may help.
7. It is true that fungal infections are now being recognized earlier, especially in diabetic and immuno-compromised patients. Since your doctor is experienced in treating such infections, medical management will now settle the symptoms in a few weeks.
If you have any further questions, I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. The initial healing time after a sinus surgery is at least 4-6 weeks. The final healing time may exceed 4-6 months.
2. If you can share any pre-operative CT images, details of the procedure, I will be able to help you better. Check if any biopsy or culture was taken from the sinuses to confirm fungal infection. Was any nasal packing done in the immediate post-operative period?
3. One of the reasons for sinus headaches worsening in the evening are partially blocked sinuses that fill up during the day. The natural openings of the Maxillary and Sphenoid Sinuses (occipital headache) are located high up and these tend to fill up during the day. The outflow of the Frontal and Ethmoid sinuses is gravity dependent and these sinuses tend to fill up on lying down and cause morning headaches.
4. If there is any edema, swelling or infection after the procedure, medication will settle it. A combination of antibiotics instead of Ceftin (cefuroxime) will help. A follow up nasal endoscopy and suction should be done to remove any thick secretions, scabs and crusts that may have built-up and blocked the sinuses.
5. It is interesting to note that fungal infections may exist only within the sinuses (as against invasive fungal infections) and yet cause allergic reactions. This constitutes Allergic Fungal Rhino Sinusitis (AFRS). The efficacy of oral anti-fungals is doubtful in such cases. It is good that you are flushing out the sinuses regularly. Decongestant (oxymetazoline) drops may be causing rebound congestion.
6. The increase in tinnitus may be due to a thick post nasal drip blocking the eustachian tubes in the nasopharynx. A mucolytic may help.
7. It is true that fungal infections are now being recognized earlier, especially in diabetic and immuno-compromised patients. Since your doctor is experienced in treating such infections, medical management will now settle the symptoms in a few weeks.
If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Bhatti, I appreciate your quick reply. We are the same age and I practice acupuncture and alternative medicine. Your answers were most welcome. 1. I need to deal with my impatience when it comes to healing surgical wounds. 2.The CT Scan from 1/31/14 showed normal sp henoid and frontal sinuses. The ethmoid showed small areas of mucosal thickening less then 5mm. Maxillary shows rounded soft tissue densities adherent to the surface of the sinuses. There are 4 in the rt. maxillary largest 10X13mm, there are 2-3 in the L, Maxillary largest 17X20mm. No fluid levels seen, no bony destruction. Nasal septal deviation. Conc. multiple mucosal abnormalities which could represent mucosal polyps or cysts. The procedure was balloonrhinoplasty. Openings were stretched larger and suction to remove mucous. I do not believe the polyps were removed.
He felt that with proper irrigation they would resolve by themselves, he said they were not mucocoels. No nasal packing was used and no material sent to pathology as far as I know. I indeed find this strange, he felt he did enough of these to determine if they were fungal. Also, the fact that I am a diabetic and have fungus on my toenails etc may have lead him to this conclusion. I do like factual information. Since I live 5 hours from his office he has been in contact with me and I will ask him about the followup endoscopy. I also question the use of oral fungicides. What about fungical sprays, or fungicidal medicinals used in the neti pot?? I stopped using the oxymetazoline or will only use it on occasion. I was previously diagnosed with closed Eustachian tubes and also feel that the ringing sound is due to post nasal drip. I had no tinnitus post op for three days. I would appreciate your opinion. How often should I use the neti pot? The ENT recommended 4-6 per day, I find this a bit much. Also, recommended was 10 times daily, I slowed to 2-3 x's. Let me me know your recommendations on this.
Do you feel the polyps should have been removed, but then do they grow back again. XXXX
He felt that with proper irrigation they would resolve by themselves, he said they were not mucocoels. No nasal packing was used and no material sent to pathology as far as I know. I indeed find this strange, he felt he did enough of these to determine if they were fungal. Also, the fact that I am a diabetic and have fungus on my toenails etc may have lead him to this conclusion. I do like factual information. Since I live 5 hours from his office he has been in contact with me and I will ask him about the followup endoscopy. I also question the use of oral fungicides. What about fungical sprays, or fungicidal medicinals used in the neti pot?? I stopped using the oxymetazoline or will only use it on occasion. I was previously diagnosed with closed Eustachian tubes and also feel that the ringing sound is due to post nasal drip. I had no tinnitus post op for three days. I would appreciate your opinion. How often should I use the neti pot? The ENT recommended 4-6 per day, I find this a bit much. Also, recommended was 10 times daily, I slowed to 2-3 x's. Let me me know your recommendations on this.
Do you feel the polyps should have been removed, but then do they grow back again. XXXX
Brief Answer:
Wish you a speedy recovery.
Detailed Answer:
Hi,
Thank you for writing back.
1. Once ventilation is established and any infection controlled, you can expect the polypoid mucosa of the sinuses to heal. Small polyps no not need to be removed.
2. Balloon Sinuplasty is a minimally invasive procedure which can achieve this. It is unlikely to cause any harm. You have minimal disease in the sinuses and hence this would be the ideal intervention.
3. Since you have diabetes, oral steroids are contraindicated. Nasal steroid sprays will help. There are no specific anti-fungal sprays available yet.
4. Over use of the nasal irrigation will also be harmful. 2-3 times a day is enough.
5. Recurrence of polyps is common. This will follow recurrence of any blockage or persistence of infection.
6. Request for a prescription of mucolytics and anti-inflammatory medication (such as chymotrypsin). This will also help reduce your tinnitus.
If you have any further questions, I will be available to answer them.
Regards.
Wish you a speedy recovery.
Detailed Answer:
Hi,
Thank you for writing back.
1. Once ventilation is established and any infection controlled, you can expect the polypoid mucosa of the sinuses to heal. Small polyps no not need to be removed.
2. Balloon Sinuplasty is a minimally invasive procedure which can achieve this. It is unlikely to cause any harm. You have minimal disease in the sinuses and hence this would be the ideal intervention.
3. Since you have diabetes, oral steroids are contraindicated. Nasal steroid sprays will help. There are no specific anti-fungal sprays available yet.
4. Over use of the nasal irrigation will also be harmful. 2-3 times a day is enough.
5. Recurrence of polyps is common. This will follow recurrence of any blockage or persistence of infection.
6. Request for a prescription of mucolytics and anti-inflammatory medication (such as chymotrypsin). This will also help reduce your tinnitus.
If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Bhatti, Your information was very helpful and informative. You mentioned chymotrypsin and I am familiar with the German research using enzymes for inflammatory conditions. In my office I have Wobenzyme, a combination of pancreatic enzymes, including chymotrypsin, pancreatin, bromelain, and trypsin.
I then found a book on my shelf about Systemic Oral Enzymes, it does mention its use for sinusitis but does not talk about dosage. The Wobenzyme has 3 mg of chymotrypsin per serving which is 3 tablets. I'm not sure if I can purchase just the chymotrypsin but I will "Google" it. I have been using Mucinex (Guaifenesin Oral Solution about 20ml qd. It is hard to tell if it is thinning the mucous. I live in a small town of 6,000 feet with lots of juniper trees and flowering plants.
I realize that allergic rhinitis with sinusits is very difficult to treat but I am willing to take steps to improve my health even if this s means moving to the ocean. Also, I avoid dairy products, wheat and fried foods. I love to eat Indian food and we have a restaurant about 50 miles from here, it is worth the trip. I did slow down on the nasal irrigation as it was drying up the nasal mucosa. What has been your experience with this condition and can one expect a full remission of symptoms with judicious medical treatments. What has been your experience with oxymetazoline and should one limit its use to bid for 3 days? Thank you for your assistance. Namaste'XXXX
I then found a book on my shelf about Systemic Oral Enzymes, it does mention its use for sinusitis but does not talk about dosage. The Wobenzyme has 3 mg of chymotrypsin per serving which is 3 tablets. I'm not sure if I can purchase just the chymotrypsin but I will "Google" it. I have been using Mucinex (Guaifenesin Oral Solution about 20ml qd. It is hard to tell if it is thinning the mucous. I live in a small town of 6,000 feet with lots of juniper trees and flowering plants.
I realize that allergic rhinitis with sinusits is very difficult to treat but I am willing to take steps to improve my health even if this s means moving to the ocean. Also, I avoid dairy products, wheat and fried foods. I love to eat Indian food and we have a restaurant about 50 miles from here, it is worth the trip. I did slow down on the nasal irrigation as it was drying up the nasal mucosa. What has been your experience with this condition and can one expect a full remission of symptoms with judicious medical treatments. What has been your experience with oxymetazoline and should one limit its use to bid for 3 days? Thank you for your assistance. Namaste'XXXX
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for writing back.
1. You may use Chymotrypsin with bromelain. Chymoral Forte is available in 100000AU strength.
2. Use a mucolytic such as bromhexine or ambroxol.
3. Allergy tests for both immediate hypersensitvity (IgE based) and Food intolerance (IgG based) can be done to identify any triggers.
4. Regular use of oxymetaxzoline may lead to Rhinitis Medicamentosa.
5. Good results are possible with control of diabetes, anti-histamines, anti-leukotrienes (such as montelukast), steroid nasal sprays (such as fluticasone, mometasone), steam inhalation, avoidance of triggers and irrigation suction of sinuses using Balloon Sinuplasty..
If you have any further questions, I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for writing back.
1. You may use Chymotrypsin with bromelain. Chymoral Forte is available in 100000AU strength.
2. Use a mucolytic such as bromhexine or ambroxol.
3. Allergy tests for both immediate hypersensitvity (IgE based) and Food intolerance (IgG based) can be done to identify any triggers.
4. Regular use of oxymetaxzoline may lead to Rhinitis Medicamentosa.
5. Good results are possible with control of diabetes, anti-histamines, anti-leukotrienes (such as montelukast), steroid nasal sprays (such as fluticasone, mometasone), steam inhalation, avoidance of triggers and irrigation suction of sinuses using Balloon Sinuplasty..
If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dr Bhatti, It has been four weeks since my balloon sinuplasty for AFRS. I have using a sinus flush using a pediatric bottle to which I add the buffered saline solution along with prepared plastic vials containing: vancomycin, itraconzole, and betamethasone. I flush the sinuses 2X' daily and have been doing this for two weeks. Also, I use simply saline nasal mist prn during the day. Unfortunately I still get occipital headaches with pressure in the sinuses with post nasal drip. Fortunately they occur at 5:00 p.m. after my practice is over. The neck spasms are debilitating. Originally I was able to take Ibuprofen and this would limit the headache pain, but recently I discovered my liver enzymes had elevated i.e. ALT 224, Alk Phos, 241, 13.3 Hemoglobin which my ENT surgeon attributes to the anesthesia, also I had been in Fluconissol. My internest will redo the value in two weeks. My liver and spleen are not enlarged, no fever, normal stool, no pain in RUQ. But I do not want to take any medications which might affect the transaminase values. I understand that Tumeric and bromalein may reduce the inflammation. There is anther factor that comes into play, the environment here is high desert with high pollen counts ( juniper trees) and dust from local mining companies. I am considering closing my practice and moving to northern California, close to the ocean, where there are very few allergens. So, I would appreciate your thoughts regarding my present health status. The sinus surgeon is about 5 hours from here, but I might have to pay a visit so he can do a sinus endoscopy. Can this be performed with a local anesthetic?XXXX
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for writing back.
1. You should get the nasal endoscopy done. It may be done under local anesthesia. Some times, even local anesthesia is not required.
2. Your occipital headaches may signify sphenoid sinus involvement, eye or cervical spine strain.
3. There is no cure for allergy. Have you done any allergy tests? These will help you decide whether to move to a different location.
4. Looking at the images of your Sinus CT will help. Kindly try to upload them here.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for writing back.
1. You should get the nasal endoscopy done. It may be done under local anesthesia. Some times, even local anesthesia is not required.
2. Your occipital headaches may signify sphenoid sinus involvement, eye or cervical spine strain.
3. There is no cure for allergy. Have you done any allergy tests? These will help you decide whether to move to a different location.
4. Looking at the images of your Sinus CT will help. Kindly try to upload them here.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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