What are sinuses?
Sinuses are small cavities in the head that are located around the nose, eyes and within the forehead. Adults have four pairs of sinuses:
- maxillary sinuses
- ethmoid sinuses
- frontal sinuses
- sphenoid sinuses
Depending on your child’s age, they may not have yet developed all four sinus cavities. The maxillary and ethmoid sinuses are present at birth, the frontal sinuses grow after the age of 7, and the sphenoid sinuses grow after puberty.
These cavities help to make the head lighter. They also produce mucus that adds moisture to the nasal passages. The mucus provides a protective layer to help keep out unwanted particles (e.g., pollutants, dirt, and bacteria that can cause infections).
What is sinus surgery?
Sinus surgery is a procedure that aims to open the pathways of the sinuses and clear blockages. A doctor will often attempt other treatments and procedures before turning to surgery. An otolaryngologist/head-and-neck surgeon will do the surgery. Otolaryngologists are also known as doctors who specialize in problems with the ear, nose, and throat (ENT).
Why may my child need sinus surgery?
- They have a chronic and recurrent severe sinus infection (called sinusitis) that has lasted longer than three months.
- They have a current severe sinus infection (acute sinusitis) with other serious infections near the sinuses.
- They have an abnormal sinus structure.
- They have abnormal growths in their sinuses (e.g., nasal polyps, swollen or damaged tissue, tumour).
Functional endoscopic sinus surgery
Functional endoscopic sinus surgery is a minimally invasive technique used to open the pathways of the sinuses, remove growths and clear blockages. Minimally invasive surgeries use small tools, cameras and lights that fit through several tiny cuts in the skin. This allows the surgeon to perform surgery with minimal damage to the skin and muscle.
The surgery is done using a tool called an endoscope. This is a thin, flexible tube with a light and a camera at one end, like a telescope. The endoscope is inserted into the nose to reach the openings of the sinuses for diagnosis and for the surgical procedure. The tube has a channel with tiny surgical instruments that the surgeon uses while viewing the sinuses on a computer screen.
A computed tomography (CT) scan is also done before the surgery to assess your child’s sinuses and identify the blocked or infected areas. The image will help the surgeon match the surgical sites while using the endoscope during the surgery.
Functional endoscopic sinus surgery is usually done when your child’s sinus problems cannot be managed by medical treatments such as antibiotics or nasal steroid sprays alone.
Risks of functional endoscopic sinus surgery
Functional endoscopic sinus surgery is usually a low-risk procedure. The risk may increase depending on your child’s condition, age and health.
Giving consent before the procedure
Before the procedure, your child’s ENT surgeon will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks, and will help you weigh any benefits against the risks. It is important that you understand all of these potential risks and benefits of the sinus surgery and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
Food, drink and medicines before the procedure
- Your child’s stomach must be empty before sedation or general anaesthetic.
- If your child has special needs during fasting, talk to your doctor to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their doctor.
If your child is taking any medications or herbal supplements, talk with the surgeon in advance because some medications need to be stopped before the surgery.
Will the procedure hurt my child?
Your child will not feel any pain during the procedure. Before the procedure starts your child will be given sleep medicine, also called general anaesthesia.
On the day of the sinus surgery
When your child arrives at the hospital, they will be dressed in a hospital gown and assessed by a nurse. Your child may have an intravenous drip. You will also be able to speak to the ENT surgeon who will be performing the surgery and the anaesthetist or nurse who will be giving your child medication to make them comfortable during the procedure.
During the surgery, you will be asked to wait in the surgical waiting area.
Your child will have medicine for pain
Children are given medicine for treatments that may be frightening, uncomfortable or painful. This includes sedation and/or general anaesthesia. The procedure will be done while your child is asleep from general anaesthetic.
How is the procedure done?
The ENT surgeon will make small cuts inside your child’s nose, but there will be no cuts on the outside of the nose. With the endoscope, the surgeon will open the passages of your child’s sinuses and make the narrow passages wider. At this time, the surgeon will remove any polyps or inflamed tissues, or fix the abnormal sinus structure, and wash the sinuses. The drainage of your child’s sinuses is then checked for infection.
If your child’s adenoids need to be removed, they will be removed through the mouth.
The surgery often takes between one and three hours, but more extensive surgeries will require more time. It depends on the complexity of your child’s condition.
What happens after the procedure?
After the procedure, your child will be taken to the recovery room, also called the post anaesthetic care unit (PACU). This is where your child will wake up. Your child will stay in the PACU for about one hour. They will then be moved to a room in the nursing unit.
- Your child will be given fluids through an intravenous (IV) tube in their arm until they are able to drink easily.
- After the procedure, your child may have a sore nose, trouble breathing through the nose, and trouble swallowing.
- Your child will be given pain medication and antibiotics to prevent or treat infection if necessary.
- The head of your child’s bed will be raised to help their breathing, reduce swelling, and clear out drainage.
- There may be gauze, cotton packing, or plastic stents in your child’s nose to prevent bleeding. The packing may dissolve on its own or the ENT may remove it.
- At first, there may be some drainage from the nose. The drainage may have a small amount of blood. Your child may also cough or spit up some pink or brown mucus.
- The surgeon may advise your child to use nasal ointment, saltwater (saline spray), or nasal steroid spray after surgery. Follow instructions carefully.
How long will my child stay in the hospital?
Your child may require a stay in the hospital overnight or they may go home the same day as the surgery. Your child’s doctor will let you know when they are well enough to go home.
How should I care for my child at home after the procedure?
What to expect when returning from the hospital
- Your child will have a drip pad under their nose to collect mucus and blood. Change it only when it is soaked through. You may have to do this every hour for 24 hours after surgery. When bleeding and drainage stops, you can remove the pad.
- If your child has packing in their nose, leave it in. The surgeon will take it out.
- Your child may have some swelling of their nose, upper lip, or cheeks, or around their eyes. Their nose may be sore and will bleed. Your child may feel "stuffed up" like they have a bad head cold. This will last for several days after surgery.
- The tip of your child’s nose, upper lip, cheeks, and gums may be numb. Feeling will return in a few weeks to a few months.
- Your child’s sense of smell will not be as good after surgery. It will improve and likely return to normal in one to two months.
Positionings and activities
- Let your child get enough sleep and after the first week, encourage walking every day, starting with a short distance and duration and then increasing gradually.
- Do not let your child lie flat until they are evaluated at their next follow-up appointment. Raise their head with three or four pillows, and make sure they sleep on their back to reduce swelling. A recliner chair may also be useful. Your child should keep their head raised above chest level at all times.
- Do not let your child blow their nose (unless the surgeon says it is OK to do so).
- Do not let your child put anything into their nose.
- If your child must cough and sneeze, instruct them to open their mouth to reduce the pressure in the nasal cavity.
- Your child must avoid all activities within the first week after the surgery, and resume only light activities such as walking within the second week after the surgery.
- Do not let your child play contact sports or go swimming until the surgeon says it is OK to do so.
- You child can take a shower or bath with lukewarm rather than hot water.
- Your child should not bend or do any heavy lifting at all after the surgery until their surgeon say it is OK to do so.
- Do not let your child go back to school until the surgeon says it is OK to do so.
Pain management
- To help with swelling and pain, put ice or a cold pack on your child’s nose for 10 to 20 minutes at a time. Put a thin cloth between the ice and their skin.
- You may give your child medicine for pain or receive a prescription for pain medication before you leave the hospital. Follow the dosage instructions carefully.
When will the ENT surgeon see my child again?
The ENT unit will make a follow-up appointment with the surgeon for your child. This appointment will be approximately one to three weeks after the procedure. Your child will also need additional follow-up appointments in the months after surgery. These are to make sure that the nose and sinuses are healing as they should.
If everything appears normal during the appointment, the surgeon will:
- Check your child's nose to see how it is healing.
- Take out the packing from your child's nose.
- Tell you when your child can resume normal activities and play sports again.
When to seek medical attention
Please call your child's ENT clinic, a walk-in clinic, or your family doctor right away if your child has any of the following signs after going home:
- Fever of 38.5°C (101°F) or higher (temperature taken by mouth)
- Heavy or consistent bleeding from the nose
- Throwing up (vomiting) that does not stop
- Pain that gets worse or pain that occurs in a different body part (e.g., calf, thigh, or back of the knee)
- Foul-smelling, greenish-yellow drainage from the nose
- Swelling with warmth and redness of the nose
- Any visual signs that something is not right
If this is an emergency or you are worried, do not wait. Take your child to the closest Emergency Department right away.