The Healing Process  

PHASE ONE = NASAL CONGESTION:

• The first phase in healing is swelling + congestion.
• You will notice increased nasal congestion over the first 7 – 10 days.
• This is called the ACUTE INFLAMMATORY RESPONSE.

The Acute Inflammatory Process

STEP 1: First 3 hours

1. Congestion is NORMAL:
   • Removes damaged tissue
   • Delivers specialized healing cells: white blood cells
   • Delivers building blocks for healing: protein + energy
   • CONGESTION positions healing edges together removing tension.
   • With healing: TENSION = SCARRING. So congestion helps to diminish stretched, thin, tissue.
2. When nasal tissue is disrupted, blood vessels in the area become PERMEABLE.
3. They become “leaky” causing swelling + edema.  This may lead to:
   • Warmth (low grade fever),
   • Tenderness/ increased pain,
   • Redness (you can’t see, but we can see looking inside your nose with endoscopes).

The Acute Inflammatory Process

STEP 2: First 12 hours

1. PHAGOCYTES or NEUTROPHILS pour into the tissue.
2. They are the construction workers.
3. The HEALING begins.

STEP 3: Days 1 – 5 

1. MONOCYTES pour into the tissue.
2. They clear away dead cells and dead infection.
3. They are the clean-up crew.
4. The swelling slowly resolves

Clearing Secretions

STEP 1: Days 5 - 10, The Mucosa Heals then Separation Begins. 

1. The lining of your nose = nasal mucosa heals.
2. Any material resting on the surface must be cleared.

STEP 2: How Material is Cleared:

1. FROM THE SURFACE: The rinse bottle will wash away loose material:
   • Old blood
   • Dead infection
   • Scabs
2. FROM INSIDE THE TISSUE:  The specialized white blood cells (monocytes)
3. AT THE INTERFACE BETWEEN:  Here is where the true magic occurs = MUCOCILIARY CLEARANCE.

Clearing Secretions

STEP 3: Days 10 and Beyond:

1. MUCOCILIARY CLEARANCE = Special system for CONTINUOUSLY keeping your nose clear.
2. Once the cilia are working and now that the sinuses are dilated open, you will begin the final process of clearing infection.
3. Some succeed in 2-3 weeks, some take 2-3 months, some never completely clear.
4. One rule of thumb: Clearing your infection may take as long as you have had the infection. 

FREQUENTLY ASKED QUESTIONS

 

When can I eat and drink?

With your caregiver’s supervision, if you are alert and able to swallow normally, you may begin to drink as soon as you get home. You may eat if you feel hungry, but start with fluids first to see how you feel.

 

You say I will LOVE the nasal rinse bottle, are you crazy?

This is a common initial reaction. Our body tissues heal VERY slowly if dry. The salt water in your irrigation bottle keeps the healing moist so you will heal faster. When clotting is ready to come out, the irrigation will delicately flush it out. Patients who experience exceptional results, tell us they irrigate several times a day.  The opposite is also true... don't be THAT patient.

 

Should I worry about nasal congestion?

Don't worry, congestion is the first step in the healing process. Increasing congestion occurs the first week after your procedure. The saline irrigation bottle provides symptomatic relief without slowing the healing process.  PATIENCE... patience.  The healing continues for 6-8 weeks till maximal results.

 

Can I get a sinus infection DURING the healing process?

You may experience a SINUS INFECTION IN REVERSE.  This means your body can now FORCE the infection out now that the sinuses are openned and can drain.  As you push the infection out, all the tissue in contact with the infected drainage will respond JUST LIKE YOU HAVE A SINUS INFECTION.  So it is actually something to be happy about.

 

If it is normal to experience the symptoms of a sinus infection as I heal, when should I worry?

If you have a temperature over 101.5 degrees, let us know.  If your symptoms worry you after understanding the above explanation, please call.  You are always welcomed to make an appointment before your 1st scheduled post operative appointment.  The key is following our instructions, nasal rinse, and patience.

 

Why do I see blood sometimes with the nasal rinse?

Oozing is expected after the procedure.  Even red-tinged drainage several weeks after the procedure is nothing to worry about. The nasal rinses help to clear the healing debris from your nasal lining as you heal.  It will come out after the underlying tissue has healed.  If you are blowing to aggressively, some may come out before it's time.  If so you can see a flash of bleeding.  Nothing to worry about -- just follow the nose bleed instructions.  You may resume the nasal irrigation the following day, just more gently.

 

Can I use the nasal rinse bottle too much?

No. Our body can heal faster when our tissues are moist.  The debris will come out as soon as it is time.  This will help you feel better faster. Use one full bottle on the left side and one full bottle on the right side 2-3 times per day (4-6 bottles per day).

 

How about allergy medications, any concerns?

Resume all your regular medications after your procedure, especially allergy medications and nasal sprays. One exception is Afrin nasal spray. We recommend stopping this altogether.  Only use if you have a nose bleed.

 

The nasal rinses aren’t going through my nose very well.  It’s a mess/causes ear pain. What do I do?

Continue to irrigate, even if it goes in and out of one side without going all the way around. Over time the swelling decreases.  The rinse will go through. We would rather have a small amount going in and out compared to not doing any irrigation at all. Keeping your tissues moist and rinsed will help you feel better faster. With ear pain, try to squeeze the bottle LESS firmly. If you are having other problems with the nasal rinses, feel free to call the office for further instruction.

 

When can I blow my nose like NORMAL?

Review the post operative instructions - we discuss this there.  We know you want to blow your nose - realize this may cause bleeding.  Everyone heals at diferent rates, so these are simple guidelines.  If you are no longer having drainage, you may blow your nose 5 days after your procedure.  Keep in mind when you do blow your nose that some mild increased oozing may occur.

 

Do I need to replace the cotton balls after my first rinse?

If you are still oozing or don’t want to worry about oozing while resting, proceed with replacing the cotton balls with the extra you made prior to your procedure. Otherwise it is not necessary to replace them.

 

I had a balloon sinuplasty procedure, can I still get sinus infections?

We live in a sea of infection, floating around in the air, with your children, on that door knob.  So you will be continuously EXPOSED to infection.  BUT NOW, your sinuses are openned.  Now your body can push infectiuon out.  Now air is circulating through your sinuses (you will feel it).  So now, our goal with your balloon procedure:

• Less frequent nasal infections:
  • Wash your hands
  • Don't pick your nose
  • Don't touch your face
• Less severe sinus infections:
  • You will need antibiotics less frequently and for shorter courses. 
  • You will miss less work/ school/ life.
• You will clear the infections more easily:
  1. Often with the rinse bottle alone.

 

How long do I need to sleep with my head elevated?

We recommend you elevate your head on pillows for three nights; this will help with swelling.

 

Are there any activities I need to avoid following my procedure?

WEEK ONE- We would like you to return to basic activity as soon as possible. This includes walking, driving, going to work/school, any/all non-strenuous activities. Continue with any minor procedures planned. Let’s not take any unnecessary risks, however. Examples would be an activity that increases blood pressure or heart rate more than the average person walking up a flight of stairs.

WEEK TWO- A high intensity athlete may go to 50% of max.

WEEK THREE- No further restrictions.

 

Should I be worried if I experience symptoms of a nasal infection during the recovery?

Please don’t worry! Feel free to request an earlier appointment. As you push the sinus infection out, you may experience symptoms of sinusitis including facial pressure, and increased congestion and drainage. Don’t be concerned, we wouldn’t recommend antibiotics unless you have a temperature above 101.5°.

 

When can I expect to feel better?

We know you look normal from the outside, but there is a lot happening on the inside! Typically we expect the healing process to take at least 6-8 weeks. It takes at least this long for the swelling to go down and for the process of infectious material and procedure-related debris to be moved out.

Nosebleed Instructions = What to do?

 

CAREGIVER = You’ve got this.  No sweat!

 

STEP 1: UNDERSTAND WHAT IS HAPPENING: 

The first 12 hours, substantial healing occurs.  There are several small blood vessels that are in the process of healing.  If the patient becomes too active: blood pressure increases, the heart rate increases, and the vessel can begin to ooze.

 

STEP 2: FOLLOW THIS STRATEGY = IT WORKS!

We will decrease the heart rate, decrease the blood pressure, and the bleeding will spontaneously improve.  Here is how:

1. STAY CALM:  For the CAREGIVER and the PATIENT.  Caregiver = you are the captain of the ship.  If you look or sound anxious, your patient will pick up on that.  The patient will increase their heart rate + blood pressure and the bleeding will continue.  Take a few deep breaths and lower your blood pressure – slow your heart rate by slowing your respirations.  Now do have your patient do the same:  When blood pressure is raised, bleeding increases.
2. The RULE OF 3’s:  This really works well.  Have the patient SLOWLY take a deep breath in over the count of 3.  Then they hold that breath for a count of 3, then they slowly exhale on a count of 3.  Remember, slow, say it out loud: “one thousand one, one thousand two, one thousand three.”
3. DECREASE BLOOD PRESSURE further by having the patient sitting semi-reclined with the head elevated.  A recliner or propped up in bed.  This really decrease blood pressure in the nose.
4. APPLY PRESSURE to the source of bleeding: Place a cold Afrin soaked cotton ball into each nostril.Make sure you wedge it in – you wont damage anything.  Some people make small cottonballs – try placing 2 per nostril.  The patient can even gently squeeze the nostrils together with the cotton balls in place.
5. Apply a COLD WASHCLOTH over the patient’s face, eyes, nose.  Have additional wet washcloths in the freezer to replace every 15 minutes.
6. If the patient appears anxious, consider an extra CLONIDINE to help relax and decrease the blood pressure.

 

STEP 3: IF BLEEDING CONTINUES 

1. NASAL IRRIGATION with Icey Cold irrigation: Take your Saline Rinse bottle and fill it with warm water. Use the salt packet. Irrigate a full nasal rinse bottle in each nostril while you are leaning over a sink. (Just the way you were shown by Dr. Skarada and staff).  Try irrigating into the nostril that is not bleeding as much.  The blood clots will be pushed OUT of the side that is bleeding more.
2. Place an AFRIN SOAKED COTTONBALLS in each nostril (or 2 cotton balls). Keep track of how many you place as you will need to retrieve them later.  Place the 4x4s folded 4 times under the nose, the cold wash rag, work on breathing 3’s, exude a sense of confidence because you did it!  You likely stopped the nosebleed.

 

STEP 4:  IF BLEEDING CONTINUES – or at anytime IF YOU NEED GUIDANCE

If you completely saturate through the nasal drip pad in 15 minutes, contact our CLINIC during office hours or Dr. Skarada after hours. His personal cell phone: 503-877-9305