Recurrent Sinus Infections and Empty Nose Syndrome following Rhinoplasty or Sinus Surgery

Avoid Sinus Infections Post-op

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Recurrent Sinus Infections and Empty Nose Syndrome following Rhinoplasty or Sinus Surgery

You have had rhinoplasty or sinus surgery and now your getting sinus infections and postnasal drip.  Hopefully you are not getting sinus headaches as well.  What happened?

Rhinoplasty refers to fixing the appearance or looks of the nose.  Usually the work is entirely on the external or outer nose, the place where you put your sunglasses.

But, in rhinoplasty, the doctor wants to be sure that you have good breathing as well.  If the nose is too narrow, air can’t pass easily. Once the nasal bones are positioned, now it looks like the turbinates might be blocking the airway.  The doctor may decide to reduce the size of the turbinates—the shelves on the side of the nose. The turbinates provide moisture to the nose and factors that prevent infection.

There are various procedures that doctors do to open a narrowed airway.  These include Laser Turbinectomy, Somnoplasty, Coblation, Microdebridement, and Turbinectomy.  Despite care, sometimes too much nasal turbinate tissue is removed or destroyed. Where a deviated nasal septum is present, usually that is corrected at sinus surgery or rhinoplasty.

Nasal Cilia

         In the normal nose there are millions of tiny hairs that act like oars to move bacteria, pollen, dust and viruses out of the nose. You are bombarded daily with germs and pollen.  As long as the cilia move these invaders out, you stay healthy.

         As a result of damaging the nasal cilia, with poor movement or sometimes no movement at all, bacteria remain in place and multiply.

         Jack M., age 40, recently divorced, decided to fix his broken nose from his days in boxing. He had no history of recurrent infections or breathing problems. After the surgery his nose looked fine. But now he was plagued by sinus infections.  I explained to him that his turbinate tissue, where the cilia are concentrated, had been reduced significantly so that he now had less than 20 % of his former nasal cilia.  This was not enough to keep him free of infection. He required pulsatile irrigation to substitute for the absent cilia.

         Julie F., age 35 had been having sinus problems and a CT scan showed sinus disease. An excellent doctor had performed her surgery and after six weeks a follow up X ray showed that the disease had been properly removed.  But eight months after her sinus surgery, she continued to have sinus infections requiring antibiotics. On examination she showed correct nasal turbinate anatomy. The surgeon had not removed any turbinate tissue. When her nasal cilia were tested, they showed very slow movement.  Her problem was that her nasal cilia were “stunned” by the sinus surgery and had not yet returned to normal function. Once her nasal cilia were restored to normal speed, she was free of further infection.

Surgery Effects Cilia

         Routinely, any surgery whether it is correcting a deviated nasal septum, or opening the sinus cavity, or rhinoplasty can temporarily slow nasal cilia. There is inflammation and swelling from the surgery. Normally the cilia return to regular function after a period of time. But during that time there may be significant postnasal drainage, sinus headache and even sinus infection.

Prevent Infections after Surgery

         If you restore cilia after surgery, then the body can defend itself against infection.

         Recommendations:

                  Tea Lemon and Honey.  These stimulate cilia and thin the mucus. A thinner mucus helps cilia to move rapidly.

                  Humming.  A low-pitched sound/vibration can stimulate cilia movement.

                  Pulsatile irrigation. Use a pulsing stream that is designed to pulse at a rate in order to restore nasal cilia.  Dr Martin Hopp, of Tower ENT, uses the Hydro Pulse Nasal/Sinus Irrigator right after surgery for this purpose. Not only does this clear crusts and debris, but also restores cilia so that post-op infection is avoided.  Hydro Pulse irrigation relieves the patient of congestion and stuffiness during the recovery period.  You avoid infection and the need for antibiotics.

Empty Nose Syndrome -ENS

         At times, too much turbinate tissue has been removed at surgery.  On X ray the nose looks empty because you don’t see any turbinates. In ENS there is reduction of nasal cilia that defend against infection.

         For ENS the primary problem is lack of nasal cilia and decreased mucus. It is this absence that allows bacteria to grow and penetrate the nasal tissue and cause sinus disease. Therefore the best therapy is pulsatile irrigation because the pulsing saline going through the nose and sinuses, pulsating at a rate analogous to the normal pulse rate of the cilia, performs like regular cilia action. This pulsing action with enhanced saline used early will prevent the sinus infections that often accompany ENS.  Pulsatile irrigation for ENS also helps to massage the nasal tissue and bring more circulation to nasal tissue.  If biofilm forms in ENS, pulsatile irrigation is an effective means of removing these organized bacterial colonies.  Later, if sinus disease has developed as a result of ENS, pulsatile irrigation is effective in clearing the sinus disease.

Conclusion

         Careful discussion with your doctor before surgery can help prevent unwanted complications.  Getting nasal cilia back in full operation after surgery can keep the surgery patient free of these infections and speed healing.

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Sophie 8 months ago

I have always wondered about sinus surgeries, not getting to the cause. I think surgery is the last possible option, First go on a elimination diet, and find out if it is a food allergy.

Second, make sure it is not environmental dryer sheets, shampoo, soap, memory foam mattress, mold, radon, gas leak ect. If you need surgery find the best most conservative ent plastic surgeon one that knows the less is more!

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