Now that surgery is over, you can look forward to better breathing and fewer sinus infections. But before you get there, the healing process must run its course. Recovery from sinus surgery tends to vary according to the patient and the extent of the operation.

For most people, it’s a slow but steady journey in which you feel a little better each day and gradually ease back into your normal routine over several weeks. Following is an overview of what you can expect.

Going Home: The First Few Days

In the days immediately following sinus surgery, you’re likely to experience a few common postoperative symptoms:

• Fatigue. For the first week, you’ll feel more tired than usual. Don’t be surprised if you nap during the day and need more sleep than normal at night, especially for the first few days. Don’t fight it it’s all part of the healing process.

The fatigue from sinus surgery can be deceptive; unlike most other types of surgery, you don’t bear external scars as a reminder of what you’ve been through.

But your body still needs time to recover. Early on, calories that would normally be available for physical activity are instead directed toward healing your nasal and sinus passages.

• Dull headache. After surgery, you’ll probably have a headache for a day or two, but it should improve as the week progresses.

Don’t hesitate to take prescribed pain medication, especially at night, when headaches tend to be worse. Sleeping with your head elevated on several pillows can also help.

• Bloody mucus drainage. You can expect some mucus mixed with blood to drain from your nose for up to one week. This drainage will be greatest the first two days, during which you may want to tape a gauze bandage beneath your nose.

• Nasal congestion. You’ll probably find that you can’t breathe very well through your nose right after surgery because of swelling and bloody mucus drainage.

For the first three days, you should avoid blowing your nose, as this may cause bleeding. From then on, you may blow your nose gently if necessary.

The best way to clear your nose of mucus, as well as bits of dried blood that may accumulate, is with saline irrigation. I can’t overemphasize how critical postsurgical irrigation is; if you’re not already familiar with the technique.

You should start irrigating the day after surgery and do it twice a day for at least a week.

Within a week, you should be able to move air in and out of your nose fairly well, although there will still be some restriction. Be patient. In two to three weeks, you should be breathing better than ever.

What to Watch Out For

Fatigue, headache, blood-tinged mucus, and congestion are all normal postoperative symptoms that should not raise any red flags. However, two other postoperative symptoms bleeding and fever do warrant concern.

• Bleeding. Continuous flow of bright red blood from the front of the nose that doesn’t stop after a few minutes of sitting up and squeezing your nostrils together suggests a blood vessel has opened and won’t shut.

Such bleeding is most likely to occur in the first twenty-four hours after surgery but may occur anytime during the first week.

If this sort of bleeding occurs, call your doctor or go to an emergency room, where a physician will cauterize or pack the nose to stop the bleeding. In rare cases, further surgery may be needed.

• Infection. Your doctor will prescribe an antibiotic for you to take after surgery. Even so, you’re still at an aboveaverage risk for infection because your immune system is not yet at full strength and the mucous membranes that ordinarily serve as a barrier to bacteria are still recovering.

Also, Staph aureus, the bacteria that often reside in the nasal cavity, can multiply on the scablike crusts that form inside the nose after surgery. That’s another reason why flushing out the crusts with saline irrigation is so important.

Signs of infection include a fever of greater than 101 degrees, green nasal drainage, and severe facial pain or headache that’s not relieved by medication. If any of these symptoms occur, you should call or see your doctor.

Getting Back to Your Normal Self: The First Few Weeks

Here’s what to expect in terms of everyday living:

• Physical exercise. You should avoid heavy lifting, straining, and exercise that might cause a nosebleed during the first week after surgery. Try not to do anything that causes blood to rush quickly to your head.

For example, if you have to pick something up from the ground, bend at the knees to keep your head above your heart instead of bending at the waist. Also, parents need to be careful about picking up their young children.

After the first week, you may gradually resume normal activity if you feel up to it. Just use common sense. For exercise, slowly work your way up from brisk walking to running, and save backflips on the trampoline for last.

• Work. No matter your occupation, when you first start working again, you’re likely to find that you tire more quickly than you’d expect for the first few days, so you may want to return to a lighter schedule than usual.

How quickly you return to work depends on the nature of your job. If you work at a desk, you may be able to go back after a few days, although many people prefer to take a full week off so they return feeling good.

If your job requires a lot of activity, you should definitely take a full week off. And if it involves heavy physical labor, I’d advise taking ten to fourteen days off so there’s no further risk of bleeding by the time you return.

• Eating and drinking. You can eat and drink whatever you like after surgery. Be sure to take in plenty of fluids so you don’t get dehydrated and your nasal secretions stay moist.

• Driving. You can resume driving two or three days after surgery if you feel that you can do so safely. Of course, don’t drive if you’re taking any narcotic pain medication.

• Airplane travel. Airplane travel is safe two weeks after sinus surgery as long as you haven’t had complications. If you fly within a month of surgery and have residual nasal congestion or a history of ear pain with flying, you might want to take a bottle of nasal decongestant spray, like Afrin or Neo-Synephrine, with you on the plane.

A couple of sprays in each nostril when you board and again at the start of descent should help keep your nose and ears open.

Seeing Your ENT Doctor After Surgery

The first postoperative visit usually occurs about a week after surgery. Your surgeon will spray the inside of your nose with an anesthetic and then use an endoscope and a small forceps to remove any crusts that haven’t already been flushed out with your daily saline irrigations.

It’s mildly uncomfortable but usually not painful. Once the crusts are out, you should be able to breathe better. Any residual headache or facial pressure you’ve been having will likely improve within the next forty-eight hours, now that your sinuses are open and can drain again.

Additional follow-up visits will depend on the specifics of your surgery and how you’re feeling. In some cases, you may need to return in another week or two for additional cleaning.

Restarting Your Medications

If you regularly took allergy medications like nasal steroid sprays or antihistamines before the surgery, you can resume taking them within a week or two of surgery. Although surgery does not cure the underlying allergies, many patients find that their need for sinus and allergy medicines is much less following sinus surgery.

Also, people with nasal polyps will want to resume regular use of nasal steroid sprays, because they are effective at slowing the regrowth of polyps.

Completion of Healing: The First Few Months

After a month, most of the swelling in your nose should be gone and you should be feeling much better. However, your body is still not finished healing internally.

It takes about eight to twelve weeks for the mucous membranes that line the nose and sinuses to fully recover and for sinus function to return to normal. Many patients tell that they don’t feel the full benefits of surgery for several months.

It may take until the next allergy season before people realize how much better they’re breathing when the flowers are in bloom. Or it may be the next winter, when they notice that they’re having fewer colds and infections than usual.

Whatever the case, with time and patience, most people ultimately realize a tangible improvement from sinus surgery.

Revision Surgery

For the majority of people who undergo sinus surgery, it’s a onetime event. Others, however, need to return for one or more additional operations, a practice known as revision surgery.

Revision surgery is rare for Locals; it’s needed in less than 5 percent of cases. The most common scenario is when a band of scar tissue forms and blocks the OMC or sinus ostia, a process known as fibrosis.

A surgeon can usually fix the problem by cutting the scar band under either local or general anesthesia. The rate of revision surgery is higher for Systemics and the more severe Intermediates.

Most often, additional surgery is needed because polyps regrow, since surgery does not address the underlying cause of the polyp growth. The larger the polyps were to begin with, the more likely they are to regrow and eventually reobstruct the nose and sinuses.

However, it’s impossible to predict how quickly polyps will regrow to the point where revision surgery is needed it could be as soon as a year or two or as long as twenty years.

The decision to get revision surgery is much like the decision to have surgery in the first place: it’s a matter of quality of life. You should seriously consider it only if your symptoms are not responding to sinus medications and are significantly affecting your ability to function throughout the day.

The rate of success for revision surgery is lower than that for first-time sinus surgery. Still, the majority of patients do get significant improvement. The likelihood of success depends on the cause of failure. If it’s an isolated scar band, the chances of improved sinus function once the band is cut are high.

If, however, the sinus ostia are wide open on endoscopic examination and CT scan, but you are still having recurrent infections because of inflamed mucosa throughout the nose and sinuses, then the chances of additional surgery helping are lower.

In that case, you should consider nonsurgical treatment options, including regular nasal saline irrigations, broad-spectrum antibiotic therapy (including topical or intravenous delivery methods), and evaluation for underlying allergic and immune disorders.

Next, we’ll examine a phenomenon that has received a lot of attention from researchers and the media in recent years: fungal sinusitis.