Frequently Asked Questions About Sinus Surgery

At our office, Dr. Goyal specializes in surgery for nasal and sinus problems. Surgery can help when treatments like sinus medications, allergy treatments, and sinus rinses have not helped a patient’s sinus issues.

At our practice, we have treated thousands of patients needing sinus surgery. On this page, we try to answer some questions we are frequently asked about nasal and sinus surgery.

Please remember that each person’s medical condition is unique, so this page is for informational purposes. It is not meant to act as medical advice your specific issue. Some or much of the information may not apply to your particular case. It is always best to discuss your care with your doctor if you are seeking medical advice for your specific condition.

What is sinus surgery?

Sinus surgery is a surgical procedure that helps to enlarge the sinus openings.

The sinuses have little windows to allow air to circulate and mucus to drain. The surgeon will look for these windows and make them bigger.

This type of surgery is done through the inside of the nostrils using a tool called an endoscope. This avoids the need for incisions or scars on the outside of the face. The scope and other tools are inserted into the nostrils to perform surgery.

During endoscopic sinus surgery, the surgeon can look for the natural window into each sinus. This window is often blocked or swollen in most patients with chronic sinus issues. Using small tools, the sinus surgeon can then make the windows larger.

Sometimes, there are things like polyps, mucus, or other debris inside the sinuses. The surgeon can remove polyps, mucus, and debris at the same time.

There are four different sinuses on each side of the face and nose. The names of these sinuses are the maxillary, ethmoid, sphenoid, and frontal sinuses. Endoscopic sinus surgery can be used to treat each of these sinuses.

How do I know if I would benefit from sinus surgery?

The best way to know if you would benefit would be to have an evaluation with an ENT doctor who has experience in sinus surgery.

Patients who need nasal and sinus surgery usually have long term nasal symptoms. These symptoms can include things like nasal congestion, sinus pressure, nasal drainage, and a decreased sense of smell. Most patients having surgery also have not had much relief with medications.

After reviewing your symptoms and history, a specialist will work to diagnose what type of nasal issues you have. The evaluation usually includes a detailed examination of the inside of the nose with a little flashlight called a nasal endoscope. A sinus CT scan is usually also needed.

What types of conditions can be treated with endoscopic sinus surgery?

Many types of nasal problems can be treated with endoscopic sinus surgery. Some examples of conditions treated with sinus surgery include:

Chronic sinusitis
Nasal polyps
Recurrent sinus infections (also known as recurrent acute sinusitis)
Nasal and sinus tumors
Sinus mucoceles
Nasal obstruction
Allergic fungal sinusitis
Odontogenic sinusitis (sinus problems caused by tooth related issues)
Sinus cerebrospinal fluid leaks

How long is the recovery after nasal and sinus surgery?

A lot depends on the type of surgery someone needs. Whether or not there is nasal packing also affects the recovery.

The first week of recovery can be tough. The good thing is that most of our patients do not have a lot of pain. In fact, it is very rare for our patients to need any prescription pain medications after sinus surgery. One other good thing is that most patients can have sinus surgery without needing nasal packing. This can make the recovery much easier than it was in the past.

Most people do have a lot of fatigue, stuffiness, and nasal drainage. For the first week, there can be lots of drainage of mucus, bloody material, and clots.

Patients usually notice improvement in their nasal drainage and stuffiness after the first week. After a few weeks, most people can breathe much better. It usually takes a few more weeks for most of the initial healing to be completed.

Depending on the type of work they do, most of our patients do take the first week off from work or school. This gives them the time they need to recover.

Keep in mind that everyone responds differently to surgery and to anesthesia. Some people breeze through recovery after sinus surgery. Others have a tougher time.

Will Dr. Goyal perform balloon sinus surgery?

Balloon sinus procedures are also known as balloon sinuplasty. They may also be called names such as balloon sinus dilation. Many of our patients ask if that is the type of surgery they will have with Dr. Goyal.

Dr. Goyal can perform some procedures with the use of sinus balloon devices, but he rarely does. He finds that the best way to open most of our patients’ sinuses is through what we might call “routine” endoscopic sinus surgery. This type of surgery uses tiny forceps and a “shaving device” that allows the surgeon to enlarge the natural openings into the sinuses.

Making the openings larger in this way allows Dr. Goyal to monitor the healing and to help the openings stay open long term. If a patient has some sort of sinus flare up after surgery, these types of openings allow us to evaluate and suction inside the sinuses. They also help us take cultures from the sinuses to help treat any sinus infections.

Balloon sinuplasty relies on stretching the sinus openings to try to make them larger. Dr. Goyal finds he is able to create better permanent openings for most of his patients by using tools other than balloons. Learn more about why endoscopic sinus surgery may be a better option than balloon sinuplasty.

If you have any questions about the type of tools that would be used in your case, please do not hesitate to ask Dr. Goyal.

Who will perform my surgery? Are there students performing parts of the procedure?

Dr. Goyal performs all of his own surgical procedures. There will not be any students, residents, or other trainees performing your procedure when you have surgery with Dr. Goyal.

At the surgery center, an anesthesiologist or nurse anesthetist will administer your anesthesia. There are also nurses and surgical technologists who will be involved in your care at the time of surgery.

When do I have to be seen after surgery?

Most of our patients need to be seen 1-2 weeks after surgery. If you need follow up visit at a different time, our office will let you know.

How long do I need to stay away from sports or exercise?

You should stay away from sports, exercise, and any other physical activity for at least the first week after surgery. You should also not blow your nose for the first week. Straining, physical activity, and nose blowing can increase the bleeding you will experience during the recovery period.

When you are seen in the office for your post-operative visit, Dr. Goyal will see how things are healing. He can then let you know if your body is ready for your to increase your activity. Most of our patients are able to start slowly increasing their activity level about a week after surgery. After about two weeks, most patients can get back to normal activity.

How much will surgery cost?

We know costs have become increasingly important because many insurance policies require that patients bear a portion of the cost for surgery.

The cost for surgery will really depends on your insurance plan, what it covers, and your deductible. There are a few separate components to costs of surgery. These include:

Cost of the procedure performed by the surgeon
Cost for the services provided by the anesthesiologist
Cost for use of the surgery center facility
Cost for postoperative care after surgery

The last component is tricky because many patients are under the impression that the cost of surgery includes any care needed after surgery. CMS (Centers for Medicare & Medicaid Services) and insurance companies determines what is included in payments for surgery. For sinus surgery, CMS has determined that the payment for surgery includes payment only for the services on the day of surgery. They have required that the visits needed after surgery be billed and paid separately. For that reason, our office is required to submit one bill for the codes that describe what was done at the time of surgery. After surgery, the insurance company requires that separate bills be submitted for office visits and any associated care.

At our office, we do accept most major health insurance plans. That means that the price paid to the surgeon, the anesthesiologist, and the surgery center are all determined by your insurance plan. As a small medical practice, we do not have any say in determining the price insurance companies will pay for our services.

Our office does treat patients who wish to pay out of pocket for office visits, office CT scans, and surgery. If you do not have insurance and need information about out-of-pocket costs, please let us know.

I have already had sinus surgery, but it didn’t help. Would another procedure help me?

Our office specializes in treating patients with complex sinus issues. Dr. Goyal specializes in revision sinus surgery, so we hear this type of question a lot! It’s important to remember that there are many different types of sinus surgery procedures. Also, each individual doctor has different ways of performing surgery. Even if you have had surgery in the past, your sinuses may still have areas that are blocked. If that is the case, Dr. Goyal may be able to help improve your sinus issues with another procedure.

As a Rhinologist, Dr. Goyal specializes in procedures like revision sinus surgery for those who have had sinus surgery in the past. We can typically help improve the nasal and sinus openings so that the the sinuses can flow better and function more effectively.

The other good thing is that recovery after sinus surgery is better now than it was with older types of sinus procedures. Most of our patients are pleasantly surprised that their recovery is not nearly as uncomfortable as it was with their prior surgery.