The following instructions are based on Dr. Alford's experience with many endoscopic sinus surgeries and septoplasty operations. This handout is designed to answer the most commonly asked questions following surgery of the nose; it is not intended to provide answers to every question or situation that may arise. Attempt to follow the instructions faithfully; those who do so generally have the smoothest postoperative course. Our telephone number is: (713) 532-3223

Planning Before Surgery

• If you live in another city, we prefer you to stay in town with a friend or at a hotel for 5-7 days after discharge from the hospital. Please make these arrangements and let Dr. Alford's nurse know where you will be staying.
• Schedule your postoperative visit for 5 to 7 days after your surgery.

Immediately Following Surgery
You will awaken in the Post Anesthesia Care Unit (PACU). In the PACU, a team of highly-skilled nurses will assist you through the first stages of your recovery. Your nose will be blocked as a result of swelling from the surgery. For this reason, you must remember to breathe through your mouth. You can expect to stay in the PACU for 1 to 2 hours and then be transferred to the Outpatient Day Surgery Center (ODC). You will stay in the ODC for approximately 1-2 hours, until the nurses and physicians feel it is safe for you to be discharged.

No Packing
No packing is used following endoscopic sinus surgery. We now use a gel solution that coats the inner surfaces of the nose to stop any bleeding resulting from surgery. This gel will dissolve with the use of saline nasal spray. If the nasal septum is straightened, thin sheets of Teflon^® will be sewn inside the nose to assist in keeping the septum straight while it is healing. These Teflon^® sheets are removed by Dr. Alford one-two weeks after surgery. Removal of the splints is usually painless.

Use Of Nasal Saline Spray
The most important thing you can do after nasal surgery is to begin liberal use of nasal saline (salt water) spray the day after surgery. Specifically, you should spray your nose with 10 to 20 puffs of saline nasal spray in each nostril every hour that you are awake. You cannot use too much nasal saline spray following surgery. The salt-water nose spray will dissolve any blood or mucous left in your nose after surgery. This will improve your ability to breathe through your nose, while reducing swelling and speeding up your healing and recovery. Saline nasal spray can be purchased over-the-counter from pharmacies or grocery stores in 1.5 or 3.0 oz. Bottles. Your goal should be to use 1-2 bottles of spray each day. Several brand names of saline nasal spray are available; these include Ocean^®, Ayr^®,and Nasal^®. All brands are similar in their effectiveness so choose the brand most easily obtainable and be sure to USE IT.

Swelling
Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount of swelling varies from person to person, but it always seems more dramatic when involving the face. We suggest that you keep your head elevated as much as possible. The swelling itself is normal and is not an indication that something is wrong with the healing phase of your operation. Swelling after sinus or septal surgery is not usually seen on the face itself; rather, it manifests itself as a stuffy or blocked nasal passage. Any swelling of the face will be limited to the area around the eyes and will last for only a few days.

The most important thing to remember is that this condition always subsides. Some tips to shorten the duration of the swelling and improve the ability to breathe through your nose include:

1. STAY VERTICAL. IMPORTANT! Sit, stand and walk around as much as is comfortable beginning on your second postoperative day. Of course, you should rest when you become tired but keep your upper body as upright as possible.
2. AVOID BENDING OVER OR LIFTING heavy things for one week. In addition to aggravating swelling, bending and lifting may elevate blood pressure and start bleeding.
3. SLEEP WITH THE HEAD OF THE BED ELEVATED 45 DEGREES for 1-2 weeks following your surgery. To accomplish this, place two or three pillows under the head of the mattress and one or two on top of the mattress. It is recommended that you sleep on your back for 30 nights. Some patients find a reclining chair placed at a 45-degree angle to be more comfortable than a bed.
4. AVOID STRAINING DURING ELIMINATION. If you need a laxative, we recommend Correctol™ (available without a prescription at any pharmacy). Proper diet, plenty of water and walking are strongly recommended to avoid constipation.
5. AVOID SUNNING of your face for one month. Ordinary sun exposure is not harmful but always use a sunscreen with SPF15 or above.
6. AVOID EXERCISE for one week following surgery.

Nasal Drainage Or Bleeding
You should expect some blood-tinged drainage from your nose following any nasal surgery. The hospital nurses will place a drip pad under your nose when you are discharged from the hospital. This drip pad should be changed whenever it becomes soiled. If you develop active bleeding from the nose, spray each nostril 4 to 6 times with a decongestant nose spray such as Afrin™ or Neosynephrine™ and apply gentle external pressure to the lower portion of your nose. You may repeat this maneuver every 10 minutes for up to 30 minutes. If bleeding continues despite these steps, call Dr. Alford's office at (713) 532-3223.

Pain Medications
Even though you may not feel much initial discomfort following your surgery, pain medication should be taken as prescribed by Dr. Alford, every 4 hours for the first 24 to 36 hours after surgery. We find that many patients initially feel very well following surgery and are reluctant to take any medication for symptoms of pain. Unfortunately, the patients who "tough it out" often develop discomfort 18 to 24 hours after the procedure, which may then last for 3 to 4 days. Those patients who take their medicines faithfully, as instructed, have very little, if any, discomfort. After the first 24 - 36 hours following surgery, Extra Strength Tylenol^® may be taken every 4 - 6 hours or alternated with pain medication.

Antibiotics
You will take an oral antibiotic for 7 to 10 days following your surgery. All antibiotics should be taken with food or liquids to prevent nausea and promote proper absorption of the medication (do not consume milk or dairy products when taking your antibiotic as they can inactivate many medicines). Take your antibiotic as instructed by your physician until it is completely consumed. Do not forget to take your antibiotic and do not stop taking it because you "feel better."

Nausea
Nausea develops following many types of surgery and is not uncommon after septal or endoscopic sinus surgery. You may be given a prescription medication, Phenergan, to take if you develop any nausea. This is a suppository and should be kept refrigerated until needed. Keep in mind that Phenergan will not only settle your stomach but it will also make you sleepy.

Temperature
Generally, the body temperature does not rise much above 100 degrees following endoscopic sinus/septoplasty surgery. If you have a persistent temperature above 101.5 degrees that is not relieved by Tylenol^®, call Dr. Alford's office.

Weakness
It is not unusual for a patient to feel weak, have palpitations, break out in "cold sweats," or get dizzy following any type of surgical procedure especially when anesthesia has been administered. Within a few days these feelings will generally disappear without medication. Returning to a normal diet and light activity will shorten the duration of these feelings.

Resuming Activities

1. DO NOT SMOKE & AVOID ALCOHOL CONSUMPTION for 3 weeks. Both of these activities significantly slow the healing process.
2. WEARING GLASSES AND CONTACT LENSES. Eyeglasses may be worn immediately after surgery. Contact lenses may be inserted the day after surgery.
3. HOUSEHOLD ACTIVITIES. On your second postoperative day, you are encouraged to be up and around the house with your usual activities; however, no bending, no heavy lifting, and no strenuous activity for 1 week.
4. ATHLETICS. No swimming, strenuous athletic activity or exercises that involve straining or heavy lifting for 1 week following surgery.
5. RETURNING TO WORK AND RESUMING SOCIAL ACTIVITIES. When you return to work depends on the amount of physical activity and public contact your job involves and also the amount of swelling you develop; the average person is ready to return to work or go out socially 1 week after surgery.
6. DO NOT DRIVE A CAR while taking any sedative or prescription pain medications.
   

Postoperative Appointments
Your first postoperative appointment will occur 5 to 8 days after your surgery and should be scheduled before your surgery or at the time of your preoperative visit. Your second postoperative visit will be 1 month after your surgery and will be scheduled at the time of your first postoperative visit. If your appointment is not made while you are in the office, please call during regular office hours (8:30 a.m. to 4:30 p.m., Monday through Friday) to schedule a mutually convenient time.

Summary
Remember the things you were told before surgery:

1. Your nose will be stuffy and feel blocked after surgery; this is normal and will usually resolve within 2 weeks following surgery.
2. Use the nasal saline spray at least 10 to 20 puffs in each nostril every hour while you are awake.
3. Call Dr. Alford's office if you experience:
   • a persistent temperature above 101.5 degrees that is not relieved by Tylenol^®
   • sudden swelling or discoloration
   • active, persistent bleeding not resolved by decongestant spray treatment
   • foul smelling discharge from the nose or other evidence of infection
   • development of any drug reaction

Of foremost importance, BE PATIENT during the healing process. Remember, there is no such thing as a bad question. If you still have questions after reading the materials we have provided, please feel free to call Dr. Alford's office: (713) 532-3223.