Fears of Sinus Surgery – Alabama Nasal & Sinus Center
A recent article in the International Forum of Allergy & Rhinology (Vol. 1, Issue3, pp.219-224) got me thinking about what really concerns the patient considering endoscopic sinus surgery. What struck me, as an Otolaryngologist (Ear, Nose, and Throat physician), is that what appears to worry patients is not always discussed with the patient before surgery. Typically, my pre-operative counseling discussion with a patient considering surgery reviews the risks of endoscopic sinus surgery, including, but not limited to, risk of orbital injury or blindness, cerebrospinal fluid leak, bleeding and infection. However, the data from the article cited above reveals that patients are most concerned about the wait time for surgery, followed by concerns about undergoing anesthesia, the problem not being fixed by the surgery, and pain and discomfort. Believe it or not, most patients will not raise these types of questions in the pre-operative interview. I encourage you, dear reader, to not be intimidated by the white coat. Go ahead and ask the doctor about that which worries you most. The only dumb question is the one you never ask.
I hope to help you today by addressing each of the top concerns reported in the article. As for wait time for surgery, it’s impossible for me to speak specifically about every case. Generally, however, you can expect a two to four weeks wait before surgery can be scheduled. This is due to a myriad of factors, many of which are out of our control. I try to schedule patients for surgery as soon as possible given availability of OR time and limitations placed on us by insurance companies and delays in pre-certification.
Another common fear it the fear of death or complication from anesthesia. Modern anesthesia is very safe, as a general rule. The most important information for your surgeon and the anesthesia team to ensure a safe procedure is your personal and family history of response to anesthetics. The risk of death from general anesthesia is less than that of death from motor vehicle collision – a risk we all assume several times a day.
The one surgical risk that doctors and patients both care a lot about is the risk that the problem will not be fixed by the surgery. This risk is never eliminated, but can be moderated by thorough examination and exploration of all other treatment modalities, appropriate selection of the surgical candidate, and by careful surgical technique. Surgeon training and experience are key determinants of the success of any surgery, especially in highly technical surgery such as endoscopic sinus surgery.
Finally, pain and discomfort is a very well recognized concern and should be addressed before surgery. I am generally very aggressive in early postoperative pain management. This approach gives the patient the best chance of long term success from the surgery, allowing the patient to tolerate postoperative irrigations and clinical clean outs, and generally placing the patient at ease as they convalesce. The sinus surgery patient should not, however, expect no pain at all. Some tolerable level of pain is to be expected. However, a level of pain that causes suffering is to be treated with medications.
Modern sinus surgery has changed a great deal since endoscopic sinus techniques took hold in America in the early 1980’s. Yet, many laypersons still have a concept of sinus surgery as this very morbid operation where the patient has miles of gauze packed into their nose, which gets removed while the patient bites on a stick in the doctors office. This is not the case! Modern endoscopic sinus surgery rarely requires significant nasal packing post-operatively. When packing is required, it is usually of the absorbable type, which washes out over a week or two after surgery. Furthermore, most patients can return to work in just a few days after ESS. Any one considering sinus surgery should do some homework to find out about your surgeons training and experience so that you feel confident in him/her and come to the appointment ready to ask questions that concern you.
I hope this helps. Be blessed!
Last modified on Friday, October 04, 2013