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Endoscopic sinus surgery

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					Sinus Manual May 2000.P65




                                                                                 May 2000



                     PREOPERATIVE                    Wear loose comfortable clothes on the day
                                                     of surgery. Wear tops that button down the
                     INSTRUCTIONS                    front. Do not wear pullover tops!
                                                     Have blood work drawn prior to the day of
  NO ASPIRIN, MOTRIN, IBUPROFEN,                     surgery. If unable to do so call our surgery
  VITAMIN E, COUMADIN,                               scheduler at (316) 689-9139.
  PERSANTINE, ST. JOHN’S WART, OR
  ANY BLOOD THINNERS FOR ONE                         Make arrangements for someone to take you
  WEEK PRIOR TO SURGERY.                             home. You will not be able to drive yourself
                                                     due to the medication you will be receiving.
  Make sure Dr. Scheinberg is aware of any           Someone should be with you the first night
  medications you are taking , allergies,            after surgery.
  history of bleeding problems, medical
  problems...etc.                                    The night before surgery take one antihista-
                                                     mine/decongestant (ex. Dimetapp, Claritin,
  Buy all medications and supplies prior to the      Allegra, Sudafed, Chlortrimeton, etc.)
  day of surgery. (list located at the end of this
  instruction manual).                                     POSTOPERATIVE
  Wash your face and hair with Phisoderm or                INSTRUCTIONS:
  other antiseptic soap the night before sur-
  gery twice. Do not wear makeup on the day          Breathe through your mouth. There may be
  of surgery!                                        a small packing in your nose. If packing is
                                                     necessary it is usually removed at the first
  Do not eat or drink anything, chew gum or          post-operative visit. Use the humidifier at
  eat mints after midnight.                          all times to help moisten the air you breathe
                                                     and keep the nose and mouth from drying 1
out.                                              pointing to the ceiling.
Use your pain medication as prescribed.           -Insert 3 ccs into each nostril, using a
                                                  syringe provided by our office.
Start antibiotics the afternoon of the surgery.
Make sure you finish the prescription.            -To speed melting place the ointment into
                                                  the syringe. Place the syringe into a coffee
Continue the antihistamine/decongestant
                                                  cup of boiling water for about 10 seconds.
medications the evening of the surgery as
                                                  Remove the syringe filled ointment and test
prescribed.
                                                  the ointment on your hand to be sure it is
DO NOT BLOW YOUR NOSE                             not too hot before inserted into the nose.
DO NOT SNEEZE THROUGH YOUR                        -Apply ointment after arising in the morning
NOSE! If you must sneeze open your                and repeat about one hour after dinner. Do
mouth.                                            not insert just before bedtime.
Do not bend your head below body level.           Glycerine or Olive oil 10% -20% in
This may cause fainting or dizziness.             saline nose spray will be substituted for
Do not have dental work done until ap-            ointment after the first two or three days
proved by Dr. Scheinberg.                         after the packing is removed. Spray each
                                                  nostril 3 times every 1-2 hours while awake.
A 4X4 or 2X2 gauze pad is taped under the
nose to catch any drainage. Change this as        The saline and oil (glycerine-olive oil-
necessary.                                        sweet oil etc.) is made by putting 6-10 c.c.s
                                                  of oil into a bottle of Ocean Nose spray (45
Polysporin or Neosporin ointment is in-           c.c.s saline solution).
serted into the nose twice daily, using a 5 cc
syringe applicator that will be given to you      Remember to shake the bottle prior to use!
after surgery.
                                                         SINUS WASHING
This is done the night of surgery if no
packing is used.                                  Wash nose as described the day following
When a septoplasty is done with the sinus         surgery or the night packing is removed.
surgery and a small packing is in place, the      Combine the following ingredients:
ointment use is begun when the packing is
removed. This is usually the next day or          1. 1 liter (quart) of boiled water
two after surgery.                                2. 2-3 heaping teaspoons sea salt
Do not insert ointment into your nose on          3. 1/4 to ½ tsp of baking soda
the day of your visit to the office as it will
clog up our instruments and prevent an            -Mix well
adequate post operative exam and clean-           -Use ear washing bulb syringe
ing.
                                                  -Fill syringe and lean forward over sink -
   TO APPLY OINTMENT                              nostrils pointing downward toward the sink.
       AT HOME:                                   -Wash nose twice daily by inserting syringe
-Place a pillow under your shoulders so that      into the nose and jet salt solution into nasal
your neck is extended and your nostrils are       cavity. Wash nose in morning and evening
                                                  and a third time during the day if possible. 2
Do one cupful on each side per washing         -Moderate activity may begin the first two
session.                                       to four days after surgery .
To increase the power of the nasal washings    Moderate to full activity is begun as toler-
insert about 1 ounce of hydrogen peroxide      ated and usually may begin after the first
into the first cup of washing solution.        week or two.
Wait about five minutes and then follow        Aerobic activity/weight lifting may begin
with the second cup of saline solution to      about two weeks after surgery. Begin
wash out the peroxide.                         slowly reaching maximum potential about
                                               3-4 weeks after surgery.
Corticosteroid nose sprays (Flonase,
Nasonex, Nasacort etc.) are begun about 1      Avoid activities that may cause injury to
week after surgery. This should be done        your nose. If injury occurs call the doctor.
about 1 hour after nose washing.
                                               Before beginning any major activity like
-Use two spays in each nostril once daily or   work, exercises, team sports check with Dr.
as directed on the prescription..              Scheinberg’s office.
Use ointment about ½ hour after using          Afrin (original formula) is used to help stop
Corticosteroid nose spray.                     nasal bleeding.
Typical order of use:                          A single dropperful, or 1 or 2 one second
                                               spray (if a sprayer is used) is inserted into
A. Wash nose with salt solution.
                                               the bleeding nostril with the head held
B. Use Corticosteroid nose spray               backwards and nostrils pointed to the
(Nasonex, Flonase, Nasacort etc.) one hour     ceiling.
after washing
                                               Notify Dr. Scheinberg any time you have to
C. Apply ointment ½ to 1 hour after using      use these drops. They should be rarely
spray.                                         used .
Bathe, do not shower for the first week or     Call the office to schedule your first post-
two. You may wash your hair.                   operative appointment prior to leaving day
                                               surgery or the hospital.
                  DIET:
Liquids the night of surgery. Drink plenty          POST OPERATIVE
of juices and water (prevents dehydration).        INCONVENIENCES:
Soft foods only the first day after surgery    -Numbness of the nose, upper lip and/or
                                               front teeth.
Advance your diet over the first 24 hours.
                                               -Oozing from the nose.
. Keep away from spicy foods the first
week.                                          -Numbness or an aching feeling in the teeth.

             ACTIVITY
Dizziness may occur after surgery. Move            SUPPLIES NEEDED:
slowly and always with assistance. This is     Phisoderm or antiseptic soap.
why you need to have someone with you at
                                               Humidifier-use deionized water if possible
home at least the first night after surgery.
                                                                                               3
                                                 and thus open up nasal passages. They help
to help keep the humidifier clean. This can      to decrease swelling after surgery inside the
be gotten your local supermarket.                nose. Because these are related to adrena-
Antihistamine/Decongestant (eg. Dimetapp,        line they may, on occasion, make one feel
Allegra, Claritin, etc.)                         nervous or restless. They may also raise
                                                 blood pressure in patients who are hyperten-
Polysporin or Neosporin ointment.                sive (high blood pressure).
Afrin (original formula) in dropper or           Mucolytic agents: Guaifenesin (pro-
sprayer form..                                   nounced Gwy-fen-nesin). This agent is
4X4 and 2X2 inch gauze pads with ½ inch          used often in combination with the antihista-
paper tape.                                      mines and decongestants. It works by
                                                 making the nasal secretions more watery.
Ear wash bulb syringe.                           This allows for reducing thick nasal secre-
Antibiotic-take until all gone. You may          tions to a more watery consistency. This
receive a prescription at your pre-op visit or   will help reduce symptoms of postnasal drip
the day of surgery.                              and dryness in the nose and throat. The
                                                 dose of this medication, to be effective
Pain medication - Take as prescribed. You        must be 2400 mg. per day in two divided
may receive the prescription at your pre-        doses.
operative visit or the day of surgery.
                                                 Combination medications: Many
Ocean nose spray                                 drugs contain a combination of one or more
Olive oil, or sweet oil                          of the above groups of medications. Be sure
                                                 that they do not overlap. For example,
ABOUT YOUR MEDICATIONS                           Dimetapp contains both an antihistamine
                                                 and a decongestant. Entex LA contains a
Antihistamines: These are anti-allergy
                                                 decongestant and a mucolytic agent
medications. Some of these medications
                                                 (Guaifenesin). If taken together you will get
may make you drowsy If over the counter
                                                 too much decongestant. Please be sure if
antihistamines (Dimetane, Chlorphe-
                                                 you are using over the counter medications
niramine, Benedryl, etc.) make you tired and
                                                 that you are not overlapping medications.
drowsy, ask Dr. Scheinberg or Jeannie to
give you the newer types of antihistamines       Antibiotics: These medications are given to
which will not make you drowsy. There are        you at the time of surgery in intravenous
more expensive than the over the counter         form and are continued after surgery in pill
preparations. These medications also work        or capsule form. They act to help protect
to dry up the nose by decreasing the secre-      you from infection and sinusitis. They must
tions that the nose makes. They also help        be taken for at lease 10 days to be fully
relieve allergy symptoms like itching of the     effective
eyes, ears and nose as well as the sneezing
that accompanies an allergy attack.              IT IS IMPORTANT TO KEEP
Decongestants: (Pseudoephedrine, Phe-            YOUR FOLLOW-UP
nylephrine, Phenylpropanolamine, Sudafed)        APPOINTMENTS. THE FUTURE
These are adrenaline related medications         RESULTS WILL DEPEND ON
and work to reduce internal nasal swelling       THIS.
                                                                                             4
IT IS IMPORTANT TO KEEP                       IMPORTANT PHONE NUMBERS:
YOUR FOLLOW-UP
APPOINTMENTS. THE FUTURE                      Office number: (316) 689-9227
RESULTS WILL DEPEND ON
THIS.                                         Jeanne’s number: (316) 689-9460
There will be an average of 6 weekly ap-      Exchange: (316) 262-6262
pointments after surgery to adequately keep
the sinuses clean.
                                              Clinic Toll-Free: 1-800-876-5111


                                              Please call Jeanne,(Dr. Scheinberg’s
                                              nurse) if you have any questions
                                              regarding these instructions.




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