Endoscopic Sinus Surgery

Instructions for Endoscopic Sinus Surgery with or without Septoplasty


Endoscopic Sinus Surgery with or without Septoplasty


Our goal is for you to have the most successful surgical outcome; therefore, we provide these instructions based on Dr. Alford’s experience performing many Endoscopic Sinus Surgeries. Please attempt to follow these instructions faithfully; those that do so, generally have the smoothest postoperative course.


Immediately after surgery

Your nose may feel “blocked” as a result of swelling from surgery. For this reason you must remember to breathe through your mouth.


We attempt to avoid the use of packing after sinus surgery, however about 10-20% of the time in order to ensure the best possible outcome after surgery we will use some form of packing.  When packing is used nasal saline spray use is still very important.  The packing will be removed by the physician 3-7 days after surgery. If no packing is used following endoscopic sinus surgery we will use a gel solution that coats the inner surfaces of the nose to stop any bleeding resulting from surgery.  This gel will dissolve with the use of the saline nasal spray.  If the nasal septum is straightened, thin Teflon® splints will be sewn inside the nose to assist in keeping the septum straight while it is healing.  The Teflon® splints are removed by Dr. Alford 1 week after surgery.  Removal of the splints is usually painless.


Use of Nasal Saline Spray is VERY IMPORTANT

The most important thing you can do after nasal surgery is to begin liberal use of nasal saline (salt water) spray the day after surgery.  Specifically, you should spray your nose with 10 to 20 puffs of saline nasal spray in each nostril every hour that you are awake.  You cannot use too much nasal saline spray following surgery.  The salt water nose spray will dissolve any blood, mucous, or gel left in your nose after surgery.  This will improve your ability to breathe through your nose, while reducing swelling and speeding up your healing and recovery.  Saline nasal spray can be purchased over the counter from pharmacies or grocery stores in 1.5 or 3.0 oz. bottles.  Your goal should be to use 1-2 bottles of spray each day.  Several brand names of saline nasal spray are available; these include Ocean®, Ayr®, and Nasal®.  All brands are similar in their effectiveness so choose the brand most easily obtainable and be sure to use it as suggested here. After the removal of the Teflon® splints at your 1 week follow up appointment you should begin to use Neil Med® Sinus Rinse 1-2 times a day for 1-2 weeks.



Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues.  The amount of swelling varies from person to person, but it always seems more dramatic when involving the face.  We suggest that you keep your head elevated as much as possible.  The swelling itself is normal and is not an indication that something is wrong with the healing phase of your operation.  Swelling after sinus or septal surgery is not usually seen on the face itself; rather, it manifests itself as a stuffy or blocked nasal passage.  Any swelling of the face will be limited to the area around the eyes and will last for only a few days. The most important thing to remember is that this condition always subsides.


Some tips to shorten the duration of the swelling and improve the ability to breathe through your nose include:



Sit, stand, and walk around as much as is comfortable beginning on your second postoperative day.  Of course, you should rest when you become tired, but keep your upper body as upright as possible.

  • AVOID BENDING OVER OR LIFTING heavy things for one week.

In addition to aggravating swelling, bending and lifting may elevate blood pressure and start bleeding.

  • SLEEP WITH THE HEAD OF THE BED ELEVATED 45 DEGREES for 7-10 days following your surgery.  To accomplish this, place two or three pillows under the head of the mattress and one or two on top of the mattress.  Some patients find a reclining chair placed at a 45 degree angle to be more comfortable than a bed.

If you need a laxative, we recommend Miralax™ (available without a prescription at any pharmacy).  Proper diet, plenty of water and walking are strongly recommended to avoid constipation.

  • AVOID SUNNING of your face for one month.

Ordinary sun exposure is not harmful but always use sunscreen with SPF15 or above.

  • AVOID INTENSE EXERCISE for one week following surgery.


Nasal Drainage or Bleeding

You should expect some blood tinged drainage from your nose following any nasal surgery.  The hospital nurses will place a drip pad under your nose when you are discharged from the hospital.  This drip pad should be changed whenever it becomes soiled.  If you develop active bleeding from the nose (which is bleeding that is continuous  and will be an amount that soaks a face cloth with blood in 10 minutes or less), spray each nostril 4 to 6 times with a decongestant nose spray such as Afrin™ and apply  gentle external pressure to the lower portion of your nose.  You may repeat this maneuver every 10 minutes for up to 30 minutes.  If bleeding continues despite these steps, call Dr. Alford’s office at 713-532-3223.


Pain Medications

Even though you may not feel much initial discomfort following your surgery, pain medication should be taken as prescribed by Dr. Alford, every 4 hours for the first 24 to 36 hours after surgery.  We find that many patients initially feel very well following surgery and are reluctant to take any medication for symptoms of pain.  Unfortunately, the patients who “tough it out” often develop discomfort 18 to 24 hours after the procedure, which may then last for 3 to 4 days.  Those patients who take their medicines faithfully, as instructed, have very little, if any discomfort.  After the first 24 to 36 hours following surgery, Extra Strength Tylenol® may be taken every 4-6 hours or alternated with pain medication.  Do not mix Tylenol® with other pain medications or “double up” by adding any other pain medication to the one prescribed.



You will take an oral antibiotic for 7 to 14 days following your surgery.  All antibiotics should be taken according to the directions given by the pharmacy, with food or liquids to prevent nausea and promote proper absorption of the medication (do not consume milk or dairy products when taking your antibiotic as they may inactivate many medicines).  Take the full course of this antibiotic as instructed by your physician. Please do not stop taking it because you “feel better” as this may cause unwanted bacterial resistance.



Nausea develops following many types of surgery.  You will be given a prescription medication, Zofran, to take if you develop any nausea.  This is an orally disintegrating tablet that is quickly absorbed when placed under the tongue.



A low grade temperate up to 100°F may be expected following surgery as the body is healing.  If you have a persistent temperature 101.5 degrees or greater that is not relieved by Tylenol®, please call Dr. Alford’s office.



It is not unusual for a patient to feel weak, break out in “cold sweats,” or get dizzy following any type of surgical procedure, especially when anesthesia has been administered.  Within a few days these feelings will generally disappear without medication.  Returning to a normal healthy diet, staying hydrated and light activity will shorten the duration of these feelings.


Resuming Activities

  • DO NOT SMOKE & AVOID ALCOHOL CONSUMPTION for 3 weeks.  Both of these activities significantly slow the healing process.
  • WEARING GLASSES AND CONTACT LENSES.  Eyeglasses may be worn immediately after surgery.  Contact lenses may be inserted the day after surgery.
  • HOUSEHOLD ACTIVITIES.  On your second postoperative day, you are encouraged to be up and around the house with your usual activities; however, no bending, no heavy lifting, and no strenuous activity for 1 week.
  • ATHLETICS.  No swimming, strenuous athletic activity or exercises that involve straining or heavy lifting for 1 week following surgery.
  • RETURNING TO WORK AND RESUMING SOCIAL ACTIVITIES.  When you return to work depends on the amount of physical activity and public contact your job involves and also the amount of swelling you develop; the average person is ready to return to work or go out socially 1 or 2 weeks after surgery.
  • DO NOT DRIVE A CAR while taking any sedative or prescription pain medications.


Postoperative Appointments

Your first postoperative appointment will occur 5 to 7 days after your surgery.  Your second postoperative visit will be 1 month after your surgery and will be scheduled at the time of your first postoperative visit.  If your appointment is not made while you are in the office, please call during regular office hours to schedule a mutually convenient time.



  1. Your nose will be stuffy and feel blocked after surgery; this is normal and will usually resolve within 2 weeks following surgery.
  2. *Use nasal saline spray at least 10 to 20 puffs in each nostril every hour while you are awake.*
  3. Call Dr. Alford’s office if you experience:
  • A persistent temperature above 101.5 degrees that is not relieved by Tylenol®
  • Sudden swelling and discoloration
  • Active, persistent bleeding not resolved by decongestant spray treatment
  • Foul smelling discharge from the nose or other evidence of infection
  • Development of any drug reaction


It is of utmost importance for you to take care of yourself and be patient during the healing process.  It is our pleasure to care for you and we welcome all questions, so please feel free to call Dr. Alford’s office: 713-532-3223.