Sinus Surgery: What You Need to Know

Pros

• Recovery isn’t typically painful, just uncomfortable (it feels like a stuffy cold), and you can usually head back to work after a week of downtime. 
• Results are permanent, and the revision rate for sinus surgery is low.
• The surgery can be life-changing for people plagued with sinus issues.  
• It’s almost always covered by health insurance, if you have a documented history of sinus and breathing issues.  

Cons

• You can expect drainage, congestion, and crusting for a few weeks after your procedure. You might also have teeth pain and numbness. 
• The surgery doesn’t always resolve all sinus issues.
• Some RealSelf members who rated the surgery “Not Worth It” were left with empty nose syndrome, a condition where the nasal passages are clear but the patient is still experiencing sinus symptoms and breathing difficulties.

Sinus surgery is typically covered by health insurance if your sinus issues have been documented through exams, a CT scan, or prescription medications. Ask your insurer what kind of documentation they need to approve coverage.

Your out-of-pocket cost, with copays and deductibles, will depend on your individual plan as well as your surgeon’s level of experience and office location. Find a double board-certified ENT/facial plastic surgeon who regularly performs sinus surgery.

If your sinus surgery is combined with a cosmetic rhinoplasty, the rhinoplasty won’t be covered by insurance.

The ideal candidate is someone who suffers from chronic sinusitis, sinus infections, headaches, facial pressure, drainage, or teeth pain and has already tried a variety of remedies, including antibiotics, allergy medication, and sinus rinses. 

Some patients have breathing issues due to a crooked septum, which makes half of the inside of your nose larger and can cause your turbinates to grow larger as well, blocking breathing. 

You should be referred to an otolaryngologist (ears, nose, and throat specialist, commonly called an ENT) to see if you need sinus surgery. For the best aesthetic results, find an otolaryngologist who’s also a board-certified facial plastic surgeon. 

They will likely request a CT scan to check for a deviated septum (a crooked wall between the nasal passages), enlarged turbinates (the thin, curved shelves of bone in the sides of the nasal cavity that warm and moisten air), infected tissue, and polyps that might be blocking your nasal passages. Typically, surgeons will fix only what a patient complains about. For example, if the scan shows a deviated septum but the patient isn’t having any breathing issues associated with it, they won’t recommend a surgery that isn’t necessary. 

“The exceptions are if we’re doing something cosmetic to the outside of the nose, we sometimes fix it on the inside too—and sometimes we have to fix the septum just to have access to the sinuses,” says Dr. Undavia.

Johns Hopkins Medicine advises that you stop smoking a month before your surgery and avoid smoking for an additional month post-procedure, since it can “severely affect the outcome of your sinus surgery. Smoking causes poor healing that leads to failure of endoscopic sinus surgery.”

It is also recommended that you stop taking NSAIDs (aspirin, Advil, Motrin, and Aleve) at least two weeks prior to your surgery and avoid vitamin E and herbal medicines such as ginkgo biloba, ginseng, and garlic tablets, which can increase your risk of bleeding. It’s also smart to cut down on alcohol consumption for two weeks beforehand, to avoid edema and bleeding.

St. John’s Wort can interact with anesthesia, so avoid it for two weeks before surgery. You’ll also need to stop any anticoagulation medicines (like Coumadin and Plavix), which can thin the blood too much and cause a nosebleed. Your doctor will let you know when you can start taking them again.

You’ll have prescriptions for pain medication and antibiotics, and some people also receive a steroid. Fill these prescriptions prior to undergoing surgery, so you can go directly home and rest. While you’re at the pharmacy, pick up some over-the-counter medicines: nasal saline mist (like Ayr, Ocean, or Simple Saline), to be used every four hours after surgery to keep your nose moist and humidified, and Afrin, which can be used after surgery if you have bleeding that doesn’t stop with a gentle head tilt.

Multiple procedures fall under the larger umbrella of functional endoscopic sinus surgery (FESS), including ethmoidectomy, maxillary antrostomy, and nasal antral windows into the frontal and sphenoid sinuses. The procedure is most often done under general anesthesia, though balloon sinus dilation surgery alone can be performed with local anesthesia. 

• Ethmoidectomy removes the partitions between the ethmoid sinuses, creating wider sinus cavities and removing any polyps or infected tissue (removal of infected tissue is sometimes called debridement). This procedure treats sinus infections and sinus obstructions that have been the cause of chronic sinus problems.
• Maxillary antrostomy enlarges the opening (ostium) of the maxillary sinus (under the cheeks). This allows for more room within the maxillary sinus cavity to improve drainage. It’s rare that this method doesn’t drain the sinuses or remove diseased tissue. “Sphenoid and frontal sinus antrostomies also open the windows between the sinuses and the nasal cavities,” explains Dr. William Portuese, a facial plastic surgeon in Seattle, Washington.
• A septoplasty with turbinoplasty improves your breathing and sinus drainage. It straightens the septum to improve air flow and reduces the size of the turbinates by cauterizing them or removing bone and tissue, preserving enough tissue for normal function. This is done with an instrument called a microdebrider, a tool so precise it carries low risk or complications. It has a tiny curved tip that straightens the septum while reducing the turbinates. 
• Balloon Sinus Dilation (BSD) is a minimally invasive technique using a very thin endoscope inserted into the nose. A small balloon is then gently inflated to widen blocked passageways and allow for proper drainage of sinus fluid. This procedure can help multiple sinus areas, including the sphenoid, the sinuses behind the eyes. Typically, patients notice less bleeding and a shorter recovery time with this method.

The University of North Carolina’s School of Medicine says sinus surgery takes two to four hours, depending on the extent of work needed. 

Your nose will feel achy and stuffy when you wake up in the recovery room. You’ll have a drip pad placed under your nose, and the recovery room nurse will give you extra gauze to take home so you can replace it as needed. You won’t need to stay overnight, but you will be groggy, so make sure you have someone there to take you home.

Most people can return to school or work after two days of downtime, but some need up to a week—and it can take several weeks to fully recover. During the first 24 hours, you may have to change your nasal drip pad several times an hour, but the frequency should decrease by day two.

You may have symptoms like those of a severe cold or sinus infection, with congestion that can last for several days. You’ll also feel a dull, achy pain for the first few days, though your surgeon should prescribe pain medication to keep you comfortable. You’ll also take antibiotics and possibly steroids for three or four weeks.

It’s normal to have some swelling and tenderness inside your nose after any sinus surgery, and this can last a couple weeks. With nasal endoscopic surgery, there probably won’t be visible swelling, bruising, or changes to the shape of the nose (unless you had a cosmetic procedure done as well), but “the nasal skin lining will become swollen after surgery, and it will take time to calm down,” says Dr. Thomas Lamperti, a facial plastic surgeon in Seattle, in a RealSelf Q&A. Other sinus surgeries may lead to noticeable swelling, especially between the eyes, and your cheeks might be tender to the touch.

If you had septum repair, you may have splints or light nasal packing in your nose. These will be removed at the first follow-up clinic visit, a week after surgery—unless you have dissolvable nasal packing, which your body would absorb as you heal. 

It’s also normal to have some bloody discharge for the first five days after sinus surgery, especially after you use a saline solution. If steady bleeding occurs, Johns Hopkins recommends Afrin spray. It’s also not unusual to cough up a bit of bloody phlegm for the first couple of weeks after surgery.

Follow these guidelines to help with your healing:

• For the first day, keep your activity to a minimum and get lots of bed rest. 
• Avoid blowing your nose for one week. 
• If you have to sneeze, try to keep your mouth open. 
• You can gently clean the tip of your nose with a Q-tip and peroxide, as often as necessary.
• You can shower or bathe after your surgery, but avoid using hot or steamy water for several days. 
• Try to keep your head elevated during sleep for at least three days. Sleeping with two or more pillows or using a recliner can help. 
• Avoid alcohol for a week after surgery, to prevent excess bleeding.
• Resume light exercise about 10 days after surgery. 
• Heavy lifting, bending, straining, or stooping during the first two weeks after surgery could cause bleeding, so avoid it if you can. 
• Because changes in air pressure can trigger bleeding, avoid flying for at least two weeks after sinus surgery. 
• Throughout your recovery, keep your nose moist with a saline nasal spray (Ocean, Salinex, or Ayr) as suggested by your doctor. 

At your first follow-up appointment, your doctor will remove any splints and clean your nose under local anesthesia, a process that may need to be repeated weekly for up to four weeks. It’s not just to help you breathe better but also to prevent scarring that could close off the sinuses. Your doctor may recommend that you take pain medication prior to these appointments, so be ready to have someone drive you.

“I tell my patients that 50% of the sinus treatment is done in the operating room and the other 50% is done in the office over the next couple of weeks,” says Dr. Undavia.

You’ll start to breathe easier after your first nose clearing and feel significantly better by week three. However, full recovery can take about eight weeks. Your nose needs time to heal, and the swelling can take that long to go down.  

“It has now almost been six months. I have been sinus infection–free and very happy with the appearance of my nose.”—emccartney16, RealSelf member

Your results should be permanent. A 2019 study in International Forum Allergy & Rhinology puts the long-term revision rate for endoscopic sinus surgery at 15.9% over a decade, but Dr. Undavia says the percentage is in the single digits, in his experience.

If you’re prone to nasal polyps, they may continue to form and need removal down the line.

All surgery carries some risk from the anesthesia and the possibility of infection during recovery. The most common side effect of sinus surgery is nosebleeds, which can be avoided by not blowing your nose or being too active for the first three weeks. 

Some patients report a decreased sense of smell or taste—it is temporary in most cases but potentially permanent. A few people have also noticed that their voice has changed, either in resonance or quality.

Another potential downside cited by Stanford Health Care is that the surgery doesn’t help allergies. If you have significant allergies causing the nasal polyps, you’ll need to continue taking sinus medications, though maybe less frequently or at a lower dose.

Rare complications include: 

• Injury to the eye or tear ducts, resulting in excess tear production or (more seriously) permanent double vision or blindness. 
• Damage to the surrounding structures of the face and a chance of bleeding into the eye socket, which can lead to vision problems if not caught early. 
• Fluid leaking out of the brain cavity or the spine, causing meningitis.