Information Leaflets
In this Section, Information is provided regarding specific Ear, Nose and Throat operations. If you or your child or anyone your family is booked to have an operation then I encourage you to read carefully the relevant information. I have provided 2 sources of information:
1. ENT – UK: British Association of ENT surgeons
2. AAO-HNS: American Association of Otolaryngologists
The information from both sites is essentially similar.
ADULT OPERATIONS:
SEPTOPLASTY
Do I have to have septal surgery?
Is there any alternative treatment?
RHINOPLASTY
What gives the nose its shape?
How successful is the operation?
What happens after the operation?
SINUS SURGERY – FESS
What is endoscopic sinus surgery or FESS?
Do I have to have the operation?
How often do complications happen?
What is septal surgery?
The septum is a thin piece of cartilage and bone inside the nose between the right and left sides. It is about 7 cms long in adults. In some people this septum is bent into one or both sides of the nose, blocking it. Sometimes this is because of an injury to the nose, but sometimes it just grows that way. We can operate to straighten the septum.
Why have septal surgery?
If you have a blocked nose because of the bend in the septum, an operation will help. Sometimes we need to straighten out a bent septum to give us room to do other things, such as sinus surgery. The operation is not meant to change the way your nose looks. In some cases a bent septum may occur with a twist in the outside shape of the nose. In these cases septal surgery may be combined with nose re-shaping surgery (septorhinoplasty) to straighten the nose.
Do I have to have septal surgery?
A bent septum will not do you any harm, so you can just leave it alone if you want to. Only you can decide if it is causing you so much bother that you want an operation. You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation.
How is the operation done?
The operation takes about 30-45 minutes. You might be asleep although some cases can be performed with only your nose anaesthetised. The operation is usually all done inside your nose – there will be no scars or bruises on your face. We make a cut inside your nose and straighten out the septum by taking away some of the cartilage and bone and moving the rest of the septum back to the middle of the nose. Then we hold it all in place with some stitches. Complex cases may require a cut across the skin between the nostrils and may be combined with septorhinoplasty procedures.
Packs and splints
We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called ‘packs’, and they will block your nose up so that you have to breathe through your mouth. We will take them out the morning after your operation. You may get a little bit of bleeding when the packs come out – this will settle quickly.
Sometimes we put small pieces of plastic in your nose to prevent scar tissue from forming. They are called ’splints’ and we will take them out after about a week.
After the operation
The front of your nose can sometimes be a bit tender for a few weeks.
Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. You may get some blood-coloured watery fluid from your nose for the first two weeks or so – this is normal.
Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. We may give you some drops or spray to help this.
It may take up to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places.
There will be some stitches inside your nose – these will dissolve and usually fall out by themselves.
How long will I be off work?
You can expect to go home the day after your operation. Sometimes it is possible to go home the same day. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work, you should take two weeks off. You should not play sports where there is a risk of your nose being knocked for about a month. Ask your nurse if you need a sick note for your time in hospital.
Possible complications
Septal surgery is safe, but there are some risks. Sometimes your nose can bleed after this operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 – 8 hours after surgery or up to 5 – 10 days after surgery. Rarely you may need to return to the operating theatre with another general anaesthetic to stop the bleeding.
Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore. Rarely, the operation may leave you with a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes no problems at all and needs no treatment. Further surgery can be carried out if necessary to repair a hole in the septum.
Very rarely you may find that the shape of your nose has changed slightly, with a dip in the bridge of your nose. Most people do not notice any change, but if you are not happy with it, it can be fixed with surgery. Very rarely, you can have some numbness of your teeth, which usually settles with time.
Is there any alternative treatment?
Only an operation can fix a bent septum, but a nose spray or drops can help treat swelling in the nose which might be making your nose feel blocked.
If septal deformity is the cause of your nasal blockage there is no treatment other than surgery to correct the septum.
RHINOPLASTY
What gives the nose its shape?
The shape of the nose on the outside is due to the shape of bone and cartilage and the overlying skin. The top of the nose is made of bone shaped like a roof, which is hard. The middle and tip of the nose are made of cartilage, which is softer. The skin varies in thickness from person to person, and this also affects the shape.
What is Rhinoplasty?
Rhinoplasty is an operation to change the shape of the nose. The type of rhinoplasty depends on which particular area of the nose needs correction. The nose can be straightened, made smaller or bigger, and bumps may be removed. The shape of the tip of the nose can be changed. Pieces of cartilage or bone may be removed from or added to the nose to change its shape.
Sometimes the wall that separates the nose into right and left (nasal septum) is twisted. We may need to correct it at the same time. The combined operation is called septorhinoplasty.
How successful is the operation?
Everybody’s nose and face is different, so it may not be possible to make your nose look exactly like your idea of a perfect nose. The thickness of the skin is important in how much better the nose will look after rhinoplasty and in what can be done. If the skin is thin, it makes bumps or hollows in the nose difficult to hide. If it is thick not all changes that can be made on the inside will show up on the outside.
Your surgeon will aim to produce a nose that looks natural. However, your surgeon may not be able to say exactly how your nose will look after your operation. It is important that you discuss your expectations with your surgeon.
90-95 % of patients are happy with the results of their operation but some people request more surgery.
You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation.
How is the operation done?
Photographs will be taken to allow a record to be kept in your notes of how your nose looked before surgery, and to allow the surgeon to plan your operation.
Rhinoplasty and septorhinoplasty are usually performed with you asleep. Cuts are made inside your nose. Occasionally a small cut on the skin between the nostrils or at the base of the nostrils may be necessary. The skin of your nose is gently lifted off the bone and cartilage underneath. A hairline fracture may be made in the nasal bones to allow the surgeon to change the shape of the nose. Pieces of bone and cartilage can be removed from or added to the nose to smooth out any bumps or dips.
Packs and splints
We may need to put a dressing in each side of your nose to keep things in place and prevent bleeding. The dressings are called ‘packs’, and they will block your nose up so that you have to breathe through your mouth. We may take them out the morning after your operation. You may get a little bit of bleeding when the packs come out – this will settle quickly.
Sometimes we put small pieces of plastic in your nose to prevent scar tissue from forming. These are called ’splints’ and we will take them out after a week.
You will have a temporary splint on the outside of the nose for a week or 2. This should be kept dry.
Does it hurt?
Not really but sometimes the front of your nose can be a bit tender for a few weeks.
What happens after the operation?
Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose.
You may get some blood-coloured watery fluid from your nose for the first two weeks or so – this is normal. Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. We may give you some drops or spray to help this. It may take up to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places. There will be some stitches inside your nose – these will dissolve and fall out by themselves.
You may have some bruising and swelling around your nose and eyes for one to two weeks. Sleeping upright with extra pillows for a few days helps.
Following rhinoplasty or septorhinoplasty, the skin of the nose is very sensitive to the sun. It is important to wear strong sunscreen and a hat for at least six months.
The nose may feel a little stiff and numb for up to three months, particularly around the tip. Fine swelling may take up to a year to settle at which time the final results of surgery may be judged.
How long will I be off work?
You can expect to go home the day after your operation. Sometimes it is possible to go home the same day.
You should rest at home for at least a week. Most people need one to two weeks off work, especially if their work involves heavy lifting or strenuous activity.
You should not play sports where there is a risk of your nose being knocked for six weeks. Ask your nurse if you need a sick note for your time in hospital.
Possible complications
Sometimes your nose can bleed after the operation, and we may have to put packs into your nose to stop it. This can happen within the first 6 – 8 hours after surgery or up to 5 – 10 days after surgery. Very occasionally patients need to have another operation to stop the bleeding.
Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and sore.
Rarely, the operation may leave a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes no problems at all and needs no treatment. If necessary, further surgery can be carried out to repair a hole in the septum.
Very rarely, you can have some numbness of your teeth, which usually settles with time.
About 5-10% of patients need further operations in the future.
SINUS SURGERY – FESS
What is sinusitis?
Sinusitis is caused by blocked, inflamed or infected sinuses. Patients will often complain of a blocked nose, pressure or congestion in the face, runny nose or mucus problems. Other symptoms include headache and loss of sense of smell. Sinusitis can be difficult to diagnose and your specialist will want to examine your nose with a telescope in order to help find out what is wrong. Most patients with sinusitis get better without treatment or respond to treatment with antibiotics or nose drops, sprays or tablets. In a very small number of patients with severe sinusitis an operation may be needed. In rare cases if sinusitis is left untreated it can lead to complications with infection spreading into the nearby eye socket or into the fluid around the brain. These very rare complications are just some of the reasons that a sinus operation may become necessary.
What is endoscopic sinus surgery or FESS?
Endoscopic Sinus Surgery is the name given to operations used for severe or difficult to treat sinus problems. In the past sinus operations were done through incisions (cuts) in the face and mouth but endoscopic sinus surgery allows the operation to be performed without the need for these cuts. Before any operation patients will be treated using drops, tablets or sprays for a period of weeks if not months. Only if these treatments are unsuccessful will an operation become necessary. After an examination of your nose with a telescope your surgeon will discuss whether or not you will need to have a CT scan to help decide about the need for an operation.
Do I have to have the operation?
Endoscopic sinus surgery is only one approach to the treatment of sinusitis. Endoscopic sinus surgery is as safe, and possibly safer, than other methods of operating on the sinuses. The other methods of operating on the sinuses involve cuts in the face or mouth and if you feel that this maybe more appropriate in your case you should discuss this with your surgeon.
In some patients an operation can be avoided by use of antibiotics and steroid medicines, again this should be discussed with your surgeon. You may change your mind about the operation at any time, and signing a consent form does not mean that you have to have the operation.
How is the operation done?
Usually the operation is done with you asleep (General Anaesthetic) but it can also be done with just your nose anaesthetised (Local Anaesthetic). The operation is all done inside your nose. The surgeon will use special telescopes and instruments to unblock your sinuses. Small amounts of bone and swollen lining blocking your sinuses are removed. Once the sinuses are unblocked, the inflammation usually settles and your symptoms should start to get better. Rarely there maybe some bruising around the eye but this is very uncommon. There should be no need for incisions (cuts) unless the operation is a complicated one in which case this will have been discussed with you before the operation.
After the operation
Immediately after the operation you may feel your nose blocked. This may be because of some dressing inside your nose or some special plastic sheets called splints. These are not used in every case but your surgeon will explain if they have been necessary in your case. Dressings, if used, will usually be removed from your nose within 24 hours but plastic splints may have to stay longer. It is common to have a stuffy blocked up nose even after removing the dressing or splints and this does not mean that the operation has not worked.
Does it hurt?
It is common for the nose to be quite blocked and to have some mild pain for a few weeks after the operation. This usually responds to simple painkillers.
Can I blow my nose?
It is important that you do not blow you nose for the first 48 hours following your operation. Your surgeon will advise you on when you can start to gently blow your nose. Some doctors recommend the use of drops, ointments and salt water sprays after the operation. You will be given specific instructions by the ward staff before your discharge from hospital. Some mucus and blood stained fluid may drain from your nose for the first week or two following the operation and this is normal. It is important to stay away from dusty and smoky environments while you are recovering.
How long will I be off work?
You can expect to go home on the day of your surgery or the day after your operation depending on the size of your operation. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work you should be off work for at least two weeks. You will be given instructions on when to return to the hospital for your follow-up visit.
Possible Complications
All operations carry some element of risk in the form of possible side effects. There are some risks that you must know about before giving consent to this treatment. These potential complications are very uncommon. You should discuss with your surgeon about the likelihood of problems in your case before you decide to go ahead with the operation.
Bleeding
Bleeding is a risk of any operation. It is very common for small amounts of bleeding to come from the nose in the days following the operation. Major bleeding is extremely uncommon and it is very rare for a transfusion to be required.
Eye problems
The sinuses are very close to the wall of the eye socket. Sometimes minor bleeding can occur into the eye socket and this is usually noticed as some bruising around the eye. This is usually minor and gets better without any special treatment, although it is important that you do not blow your nose. More serious bleeding into the eye socket sometimes can occur, however this is very rare. This can cause severe swelling of the eye and can even cause double vision or in very rare cases loss of sight. If such a serious eye complication did occur you would be seen by an eye specialist and may require further operations.
Spinal fluid leak
The sinuses are very close to the bone at the base of the brain. All sinus operations carry a small risk of damage to this thin bone with leakage of fluid from around the brain into the nose, or other related injuries. If this rare complication does happen you will have to stay in hospital longer and may require another operation to stop the leak. On very rare occasions infection has spread from the sinuses into the spinal fluid causing meningitis but this is extremely uncommon. You can discuss this complication with your surgeon before the operation.
How often do complications happen?
In general, major complications are very rare. In a survey of all ENT surgeons who do this type of operation in England, eye complications happened in one in every 500 operations but there was no associated loss of vision. Spinal fluid leaks happened in one case in every 1000 operations, but were detected and repaired at the same operation so the risks are small. Minor complications, including bleeding from the nose occurred more often. One in four patients reported mild persistent bleeding after the operation, which resulted in readmission to hospital in some cases. If you are particularly worried you should ask your surgeon about his or her experience of these complications.