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Interviewer: Protecting yourself and others against COVID-19. It seems like the further and further we get into the pandemic, the more ideas and more things people are doing to protect themselves.

But Dr. Richard Orlandi from University of Utah Health says, actually, some of the best things you can do to protect yourself and others just come right back to basics. Can you give us an idea of what the hierarchy of things are that we really should focus on that we know protect ourselves and other people?

Dr. Orlandi: Staying physically distant from one another. People have called this social distancing, and I prefer the term physical distancing, because we still want to interact with one another. But the idea of staying six feet apart so that if I cough or sneeze, that's not going to hit you, or if you cough and sneeze, it's not going to affect me. We know that that's how this virus is spread is either through respiratory droplets being sprayed out or if I touch my eye, my nose, my mouth, get those respiratory droplets on my hand, I touch your computer and then you type and then you touch your eye. And so that's how those things are happening. So that physical distancing is really important.

When we're not able to be physically distant, masking is important. Now, a couple of weeks, you and I talked about how masks were not as important because we were thinking of them in terms of I'm going to put a mask on so you don't get me infected. But we're changing the way we're looking at that, and really I'm going to put a mask on so I don't infect you, even if I don't have any symptoms, because we now are understanding that people may be able to transmit this virus the day before or a couple of days before they really have that fever, muscle aches, shortness of breath, coughing type of flu-like symptoms. That's going to help so that when I go to the store, I'm not spreading it to everybody else. Now, if all of us do that, we're keeping one another safe, and that's a great way that we can show our citizenship, our care for one another.

Interviewer: So it comes down to droplets, keeping your droplets away from other people, keeping other people's droplets away from you. And you do that by physically distancing yourself and also remembering not to touch your hands to your eyes, your nose, or your mouth. But Dr. Orlandi says this time of year, in particular, that can be really challenging.

Dr. Orlandi: Doggone it. In allergy season, what happens? Your nose itches. Your eyes itch. Try to avoid doing that. Or if you do it, if you rub your eye and you rub your nose, just hand sanitize afterwards. Hand washing is so important. Sanitizing the surfaces around you. If you work in an office where a lot of people are still coming to work, get those wipes out and wipe down your work area. Wipe down the doorknobs and things like that where we're all commonly touching.

Interviewer: And if we all keep it up and do it really, really well, it will make a difference.

Dr. Orlandi: Literally, what people are doing here in Utah, it's saving lives. And I would say stay physically distant but socially close. Check on your neighbors, check on your family and stay connected, but do it in different ways. Do it through video platforms. Do it through the phone. Go for a walk. Stay six feet away from one another. If there are things that we can do to slow down the spread of that virus, that's probably the best thing we can do for our healthcare systems and for our society and to get our economy back up and running as fast as we can.

This information was accurate at the time of publication. Due to the changing nature of the COVID-19 pandemic, some information may have changed since the original publication date.

Interviewer: Should you get tested for COVID-19? It's an ongoing question that many people have. Dr. Richard Orlandi is the Chief Medical Officer of Ambulatory Care at University of Utah Health and he says, as a general rule, if you are experiencing the following symptoms, you might want to consider getting a test.

Dr. Orlandi: If you have symptoms of fever, plus a cough, shortness of breath, malaise, that feeling of feeling sick, like you have the flu, we're saying go ahead and let's get you in and let's get tested. It doesn't matter where you've traveled. It doesn't matter if you've been exposed to someone. Let's just get you in and get tested.

Interviewer: Dr. Orlandi goes on to say, before you go, you should make a phone call first.

Dr. Orlandi: A lot of times, we can discuss your symptoms over the phone or through a virtual visit and get you to where you don't need to go to the test. We could say, "You know, we've talked about it. Based on what we're seeing and hearing from you, testing is not really necessary for you right now."

Interviewer: And if you're concerned whether or not you could possibly get COVID-19 at the testing site, Dr. Orlandi says you don't need to worry about that.

Dr. Orlandi: The good news is not a concern. We have done everything we can in working with our epidemiologists and our infectious disease experts to make that as safe as possible. So in between each test, our staff are wiping off any surface that could have come in contact with the patient, changing out their gloves, and doing everything necessary to make that as safe as possible for each one of our patients.

Interviewer: To find the telephone number to call about testing, or to find out the latest testing criteria and other COVID-19 information, go to uofuhealth.org/coronavirus.

This information was accurate at the time of publication. Due to the changing nature of the COVID-19 pandemic, some information may have changed since the original publication date.

Interviewer: How do you know if endoscopic sinus surgery or just sinus surgery is right for you? We'll talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: The purpose of this podcast is to help you understand if sinus surgery might help the issue that you're suffering from. You may have already done some research on the internet or have been to a doctor and they told you a few things, you may have forgotten some stuff or want a second opinion, and that's what we're going to find out. We're going to find out some basic information if sinus surgery is going to help your issue.
We're with Dr. Richard Orlandi. He's an expert in this thing at University of Utah Healthcare. Before we get into how do you know it's right for you, let's talk about how does the surgery change people's lives that do need this type of surgery?

Dr. Orlandi: The surgery can have a really big impact on the overall quality of life, not just the sinus problems. We know that patients with chronic sinus problems have a quality of life that's similar to someone in heart failure, way worse than diabetes, high blood pressure, things like that. And so what we're looking at is the overall picture, not just the sinus problems, but just not just the sinus symptoms, and so we're looking at sleep issues and the disorders in sleep.
Another thing that really affects quality of life is loss of sense of smell. We see that commonly with patients with sinus problems and the reason that's such a big deal is not only can you not smell spoiled food, natural gas, things like that, but much of what we perceive as sense of taste is really sense of smell. So when we lose our sense of smell, we really lose our ability to appreciate the food we're eating. We're looking at fatigue and we're looking at depression. These are things that are much higher in patients with sinus problems than our regular population and we're looking to really target those.

Interviewer: So people with sinus problems, not having a great life right now.

Dr. Orlandi: Absolutely not. It really impacts people in a much bigger way than we often think.

Interviewer: What sinus issues can sinus surgery help? Let's start right there.

Dr. Orlandi: Most of the time we're doing sinus surgery for people with chronic sinus problems or chronic sinusitis. It's a long-standing inflammation of the sinuses. Most people will feel symptoms of congestion, pressure in the face and in the sinuses, they're having frequent infections, those are the things we're mostly targeting.

Interviewer: Yeah. And a patient comes in generally for the infections, or is it the pain, or is it kind of all the above? Is there any one thing that they . . .

Dr. Orlandi: It's really all of the above. A lot of times we see patients because they've been to their primary care doctor over and over again for sinus problems and they're looking for a better long-term solution.

Interviewer: Okay. Are there some issues that this type of surgery won't help?

Dr. Orlandi: Yeah. I think the one that we most typically see is when patients are referred for facial pain or headaches and it's really not their sinuses. So clearly we're not going to be able to help them in that situation.

Interviewer: But in some instances that is caused by their sinuses, it sounds like.

Dr. Orlandi: It is, and so it takes doing some looking into it with an examination, with questioning, with sometimes a CAT scan to really be able to find out what's going on.

Interviewer: Yeah, and you're the expert in doing that.

Dr. Orlandi: One of them here, yes

Interviewer: One of the experts. Fair enough. All right. So beyond what issues it can help and it won't help, are there some people who are better suited for this procedure than others?

Dr. Orlandi: We usually try medications first to try to avoid surgery, and I think that's an important point. We go through people's medications, their history, what they've been on, what has worked, what hasn't worked, and really try to target different solutions for their problem. When those things have failed, then we start looking at surgery.

Interviewer: Now, are there questions somebody should ask before they consider a procedure like this or if they are?

Dr. Orlandi: I think that definitely they want to make sure that all their options have been exhausted. Obviously, surgery is an option, it's not the option. So we want to make sure that a patient is really going through all of those different options and making sure they've exhausted them. Now having said that, there is interestingly some evidence coming out more recently last year, too, about delaying surgery too long may lead to not as great an outcome. We don't know that yet and I don't think we're ready to jump into surgery, but we don't want to delay forever either.

Interviewer: I think you're showing right now again why somebody should come to a specialist such as yourself who has dealt with this before. You know, the research, the literature on that sort of thing. So, how would somebody move forward with this surgery? They've been to a specialist. What would be the next step, then?

Dr. Orlandi: Once they've been to a specialist, had a thorough evaluation, looked at all the options, and they decide to have surgery, then we go ahead and schedule that and we get everything ready ahead of time. We want to make sure that the medication is optimized at that point. Even though it's failed and they're requiring surgery, we want to do everything we can to try to reduce the inflammation prior to surgery and that, we think, leads to a better successful outcome.

Interviewer: Interesting. Are there some other things, other considerations people should think about that I haven't hit on?

Dr. Orlandi: No, I think you've hit on all of them. We really just want to get a thorough evaluation of all the options and then make a decision together. We try to make sure the patient, at least at our office we really want to make sure they understand all of the different options, the pluses and minuses associated with those, and that they really understand what the surgery is all about, what they can expect from it. Sinus surgery is not a cure. It's not like getting your appendix out. It's not like getting your gall bladder out. It's really important to understand that the surgery's important, but it's a part of their overall management. Unfortunately, sinus problems are a little bit like high blood pressure, diabetes. We manage it, we don't cure it.

Interviewer: All right. Any additional resources . . . I know somebody that might be considering this might want to learn a little bit more information. Do you have any good ones you could drive them to?

Dr. Orlandi: We've got some great information on our website here at the University of Utah at University Healthcare. We've got a number of different diagrams. Some people learn more visually, some people more reading through it, and so we have a lot of the explanations about the surgery risk, benefits and alternatives, those sorts of things there.

Interviewer: And how would they find that website? If you just go to Google and Google . . .

Dr. Orlandi: University of Utah sinus surgery, you're going to find it.

Interviewer: Going to get you right there. All right, well thank you very much. Appreciate that.

Dr. Orlandi: My pleasure.

Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you've heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: What is Endoscopic sinus surgery? We'll talk about that next on The Scope.

Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Endoscopic sinus surgery is more commonly just referred to as sinus surgery. This podcast's purpose is to tell you what this procedure is, how it compares to some other alternatives, and if there are any risks or side effects, and how it changes people's lives.
We're with Dr. Richard Orlandi who's one of the experts here at University of Utah Healthcare and Sinus Surgery. I think when somebody goes in to get surgery, the first thing they want to know is what difference is this going to make. How is it going to change my life? Let's ask that question first.

Dr. Orlandi: Absolutely. I think that's a great question and obviously the most important one. What can people expect? You know, sinus surgery is not a cure, and that's one of the first things I try to tell people. It is going to help with the management of your sinus problems overall, but it's not going to cure them. So it's going to require additional medical therapy afterwards. But what we're talking about is going in and opening up the sinuses primarily to let them drain, let air in, get medications in there to the surface of the sinuses to try to reduce the inflammation. That's the overall purpose.

Interviewer: So when you say, "open them up", is that the problem, because usually things are little too constricted in there?

Dr. Orlandi: Yeah. What we're finding is that with the sinuses, they drain through small openings into the nose. We think of the nose as a hallway and sinuses are like rooms off of that hallway. That opening between the room and the hallway is small. It's supposed to be. But when we have long-standing inflammation, the lining, or call it the wallpaper, will swell up and block off that doorway so things can't get in. Air can't get in and the secretions in the sinuses can't get out and that sets us up for chronic sinus problems.

Interviewer: Does that kind of turn into scar tissue? Is that what's going on?

Dr. Orlandi: No, it just stays really inflamed and it just won't, that inflammation just won't back down.

Interviewer: No matter what you do.

Dr. Orlandi: Absolutely. We try different things with medical therapy but when that doesn't work then we start looking at making the openings wider.

Interviewer: So somebody that's suffering this type of thing that this surgery might help, it makes a significant impact to their quality of life after they have it, from what I understand.

Dr. Orlandi: It's a huge impact. Sinus problems we know are correlated with sleep issues, with depression, with fatigue, not just the sinus symptoms themselves, and so when we get that sinus inflammation under control through a combination of surgery and medications, we're able to reduce those factors in people's lives as well.

Interviewer: I've heard they refer it to as endoscopic sinus surgery. You have told me that it's just sinus surgery, that all of it is endoscopic, which indicates that at one point it was different. So what exactly is endoscopic and how's that compare to the way things used to be done?

Dr. Orlandi: The endoscopic refers to using a scope. It's like a fiber optic-type scope that we use that goes through the nostrils. Previously sinus surgery was done by making incisions underneath the upper lip, alongside the eye, between the eye and the nose, and up in the forehead and the hairline. Rarely those things are still done for unusual circumstances, but now everything is pretty much done through the nostrils.

Interviewer: So a lot less invasive.

Dr. Orlandi: Obviously, yes, and much easier to tolerate, much less painful afterwards.

Interviewer: Gotcha. What are some of the risks or side effects that somebody should be aware of if they're considering this type of surgery?

Dr. Orlandi: Knowing those risks is important as you weigh the risks and benefits, obviously, and make a decision about sinus surgery. The sinuses are right next to the eyes and they're right next to the brain, and those two areas we worry about during sinus surgery. We think about it as sinus surgeons and make sure that things are safe. Injury to the eyes, including damage to the vision, and injury in the brain that could lead to a spinal fluid leak are the two things we worry about, and those are fortunately extremely rare. But any surgeon is going to have that in the back of his or her mind.

Interviewer: Yeah. It sounds kind of terrifying, but out of all the procedure you do, just not likely.

Dr. Orlandi: No, far less than 1%, and that's important to know.

Interviewer: Gotcha. What about some side effects afterwards?

Dr. Orlandi: Clearly, like many surgeries, we're going to make the problem worse for a few weeks or months before we make it better. So more swelling, inflammation, obviously people are going to be bleeding from the nose. Some surgeons will use packing, others do not. Most of the packing that's used now is dissolvable to try to cut down on bleeding. But those are some of the things that we look at immediately after surgery.

Interviewer: Singers or people that use their voice for a living, are they concerned that that's going to change?

Dr. Orlandi: Luckily, not a huge impact, but the voice does resonate through the nose and sinuses, and for a professional singer or someone who spends a lot of time with their voice, like yourself, we are going to see that the voice will change slightly in how it resonates.

Interviewer: Yeah, maybe for the better, in my case.

Dr. Orlandi: It can be for the better.

Interviewer: All right. What are some alternatives to surgery? If somebody just goes, "Gosh, I don't know. This seems like a huge commitment," what else can be done?

Dr. Orlandi: Yeah, the surgery, very rarely are we're dealing with a life or death problem here, right? So the surgery is always as an option but not necessarily does one have to have it. Continuing with the medical therapy is always an option and a lot of patients elect that. The surgery, obviously, isn't appealing for some folks and we certainly understand that.

Interviewer: And the benefits, though, in some patients, tell me a personal story of maybe somebody that had just some great results.

Dr. Orlandi: Yeah, I think that we see people when often they've gotten to that point where they just are done with, they've done everything, has gone as far as they can with the medical therapy, with medications, rinses, sprays, antibiotic pills, even steroid pills, and they're just not getting there. We're able to take a patient like, that open things up, and then get that medication accessing the sinus surface and keep that inflammation down. And you're taking someone who's . . . again, that fatigue and depression can really be an issue, and it really helps people out in addition to resolving a lot of the inflammation and pain and pressure in the sinuses.

Interviewer: This is your opportunity to address any myths or misconception that people might have about this procedure. What are those?

Dr. Orlandi: You know, a couple of them. One is that - and we talked about this already - that I'm going to have my surgery and it's going to cure my sinus problem. I'd love to believe in that myth, but unfortunately it's just not true. We talked a lot about, I hear people talk about I'm going to have my sinuses scraped. Yeah, that doesn't sound very good, does it?

Interviewer: No.

Dr. Orlandi: And what instead we find is, what we're doing is actually opening up the holes that we talked about and actually really preserving that natural lining. We want that lining there because if we scrape it out, not only does it sound horrible, but it's going to lead to more scar tissue. So we're actually very careful to preserve the function of the sinuses.

Interviewer: We've covered a lot of ground in what is sinus surgery or endoscopic sinus surgery. Is there anything that I left out that a patient might want to know about this procedure?

Dr. Orlandi: No, I think that maybe the last thing that's important is, you know, when you have your gallbladder taken out, you have it taken out, you're cured, you may have one visit with your surgeon afterwards to make sure everything is healed up, and you're done. Sinus surgery is not like that. It requires tailoring the medical therapy afterwards. It's very individualized. We do see patients for a few visits after the surgery, sometimes three or four or more, to really tailor their medication to make sure that they're getting the most out of the surgery.

Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you've heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: You're having sinus surgery and you're wondering how you prepare. We're going to talk about those issues next on The Scope.

Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier healthier life. You're listening to The Scope.

Interviewer: The purpose of this podcast is to help you, the patient who's decided that you want to get sinus surgery, to understand what you can do to best prepare for the procedure. There are a lot of things to consider, like how much time do you get off work, do you need to fast before, will you need to arrange for somebody to drive you.
We're going to talk about those and other things right now with Dr. Richard Orlandi. He's one of the experts here in this type of surgery at University of Utah Healthcare. So what's the first consideration that somebody should think about or do before surgery?

Dr. Orlandi: I think the most important thing is they want to be sure about their decision, and I certainly want, in our practice we want to make sure that our patients' questions and concerns are fully addressed before they make this decision. We don't want them to have any second thoughts. And so, again, we try to address every concern that patients have and then certainly encourage them to seek a second opinion.
This is not a surgery, typically, that we have to rush into. Patients have typically had their symptoms for a long time. I think it's something that people can get a second opinion, take their time with this decision, talk to family and others who have had the surgery.

Interviewer: So if they're feeling a little uncomfortable with it or whatever that's a good indication maybe you should ask more questions beforehand.

Dr. Orlandi: Absolutely.

Interviewer: And the sooner the better, of course, because you don't lose your surgery day.

Dr. Orlandi: Well, asking those questions an hour before the surgery may be waiting a little bit too long.

Interviewer: Gotcha. What should I do leading up to surgery day and when does that all start?

Dr. Orlandi: We want the patients to have as much of the inflammation under control as possible, so we ask our patients to continue with the medications that they've been on before. We may stop them for a few days ahead of time for various reasons, but really, we think that continuing that medication ahead of time is really important to control the inflammation.
One of the other things that's really important for us and for our patients is to know what to expect after surgery, so we go through a lot of their post-operative care, actually, before the surgery to make sure they know how to rinse their nose out with salt water, take their medications, and make sure that, actually, even their medication prescriptions that they're going to need after surgery, we try to get those filled ahead of surgery so it's one less thing for them to worry about on the day of the surgery.

Interviewer: We've got a podcast, actually, that covers what to do and what you need to be aware about after surgery, so if you have any of those types of questions, not only check the information that you receive, but you could check out that podcast as well.
So are there any other considerations? It sounds like business as usual, take those medications. How far are you starting out in prep, a week before?

Dr. Orlandi: No, I think that again we're starting about a couple of weeks where we're continuing the medical therapy and then we may fine tune it within a few days prior to the surgery. But it is very similar to other surgeries where you're going to want to follow the instructions that you've been given as far as stopping eating or drinking, usually it's around midnight, sometimes a little later if your surgery is in the afternoon. Making sure someone can drive you. This is a surgery that's done typically under general anesthesia, meaning you're completely asleep. It can be done under local anesthesia if patients prefer. The vast majority prefer to be asleep, understandably.

Interviewer: Absolutely. That's a good consideration. You're going to have to have somebody to drive you home. How many days off of work should you take?

Dr. Orlandi: For sinus surgery, people typically take about a week, sometimes less, sometimes more, but on average about a week. Now if someone is having their septum corrected, the septum is the wall that runs down between the left and the right side of the nose, that septum, it's called a septoplasty to fix that. That septoplasty can actually be a little bit more painful. You're basically talking about kind of breaking the inside of the nose. Now, patients won't be black and blue after that on the outside, but it does cause a little bit more pain and sometimes patients will kind of lean more towards a 10-day time off work after that.

Interviewer: When I'm going in for my day of surgery I'm going to have somebody drive me. Hopefully I've already gotten my prescriptions. Do I need an overnight bag?

Dr. Orlandi: Nope, this is a surgery that's called an outpatient surgery. You come in and go home the same day. Sometimes patients will need to spend the night if they have another condition like sleep apnea or something like that, and that's discussed with the anesthesiologist, but most often this is something that's done in and out the same day, and when the patients do have to spend the night we make those plans ahead of time and so they know that.

Interviewer: For that person that's going to pick me up, can they just wait? Is it that quick of a procedure or should they go do something else?

Dr. Orlandi: It actually depends. There are four sinuses on either side and your surgeon may chose to operate on only one or all eight, so it really depends on the extent of the procedure. This is not a life-threatening surgery so people don't have to wait in vigil in the family waiting room. If they want to go and do something else, we'll call them ahead of time to come pick you up. That's certainly fine, too.

Interviewer: So it sounds like a question to ask and just something to be aware of.

Dr. Orlandi: Absolutely.

Interviewer: What other things do you tell your patients when it comes to preparing for the surgery?

Dr. Orlandi: You know, I think we've covered it. I think again that the most important point is to make sure you're comfortable with your decision. Don't feel rushed into this. This is something that you can take your time deciding on.

Announcer: TheScopeRadio.com is University of Utah Health Sciences radio. If you like what you've heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: You had your sinus surgery and now it's afterwards and you've probably got a lot of questions. What's going to happen during your recovery, what do you need to do or avoid, and what are some common questions and issues that generally arise? That's what this podcast is going to talk about, after your sinus surgery.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: We're with Dr. Richard Orlandi. He's one of the experts here at University of Utah Healthcare and Sinus Surgery, and I think the first concern people would have after surgery is what am I going to look like? Am I going to be bandaged up? Am I going to have bruises? Is it going to look like I went through something major?'

Dr. Orlandi: That's a really important point. The thing to remember with any surgery that's happening just inside the nose, is no, you are not going to have bruises and you're not going to have a cast on your nose. If work is being done to change the outside appearance of your nose or a much more extensive procedure is being done to straighten out the inside of your nose, what we call the septum, the wall between the left and right side, then yes, that might happen. Hopefully, your surgeon is going to discuss that with you ahead of time. But for the vast majority of sinus surgeries, no, you're not going to be able to look at someone and tell that they had it done even hours or days later.

Interviewer: Did that not used to be the case?

Dr. Orlandi: That definitely did not used to be the case. When we were making incisions under the lip or between the eyes and the nose, quite a bit of bruising was going on. Now with everything being done with fiber optic scopes through the nostril, that's the endoscopic part of endoscopic sinus surgery, we're not seeing that happen.

Interviewer: A next question a patient probably is going to have is how long until I can . . . fill in the blank. Go back to work, exercise, smell the roses . . .

Dr. Orlandi: Let's go in the order of when these things are going to happen. Right after sinus surgery, because the nose has such a rich blood supply, we don't really want to get the heart pumping and the blood pressure up because it's going to cause the nose to bleed a little bit more. So we're going to hold off on vigorous exercise for three to five days. What I tell patients is, "Go ahead and go out for a jog when you feel up to and if your nose starts bleeding, stop and try again a day or two later." It's a little bit of trial and error but we typically want to hold off on that.

Going back to work, I think about a week is pretty standard. If we're doing work on the septum to straighten out the inside of the nose then we're going to wait about 10 days on average. Stopping and smelling the roses, a lot of times sinus problems can cause a reduction in the sense of smell. That can take a little while to come back, more on the order of two to three weeks or even longer for that to come back. Sometimes it doesn't come back all the way and that's really frustrating. That's a big quality of life issue. If you can't smell your food, much of what we perceive as taste is actually smell. Our patients are really concerned when they can't smell and taste very well because it does impact their enjoyment of food.

Interviewer: You've given us an indication of how long you should wait until you can do some common things. You said about a week off of work to recover. What am I doing in that week? Why can't I go back right away?

Dr. Orlandi: Most of the time patients are still having a little bit of discomfort or pain. They may still feel a little bit out of it just from having the surgery. It's right in between your eyes and so it's hard to ignore. Concentration can be an issue.

I've seen patients go back to work two days after surgery. I've seen patients go back to work two weeks after surgery. Everyone is different, but on average you're feeling just a little bit out of it and maybe sitting on the couch and watching ESPN is the better thing to do for a few days.

Interviewer: What does recovery look like? We already talked that we're not going to look like that preconceived notion that somebody punched me or beat me up with the bandages and the [inaudible 00:03:48], but what about bleeding and changing bandages and that sort of thing?

Dr. Orlandi: The inside of the nose doesn't look as good as the outside. There are a lot of raw surfaces. There is a little bit of oozing, and patients, especially for the first day, may wear a bandage or a piece of gauze underneath their nose with some tape going up to the face to try to catch that blood as it comes out. That'll diminish usually in 24 hours after the surgery and that won't be necessary.

One of the critical things that we encourage our patients to do is to rinse their nose out with salt water after surgery. I'm not talking a little misting spray. We're talking a quarter cup or a half of cup of saltwater in the nostril where the surgery was done, and on both sides, obviously, if the surgery was on both sides. That's going to rinse out a lot of that blood and secretions that can accumulate during the surgery.

That blood and secretions need to come out one way or the other, so I'd rather have the patients remove it day-to-day at home rather than have it have to be removed in the office. That is not comfortable at all.

Interviewer: And pretty crucial to the healing process that that gets out of there?

Dr. Orlandi: It is, because that accumulated blood can lead to scar tissue if it's not removed, and then that can block off the sinuses and then we're back to square one.

Interviewer: Gotcha. Are there any other really important parts of recovery that you should take seriously? Rinsing the nose sounds pretty important.

Dr. Orlandi: That's really the big one, frankly. We do put patients on antibiotics sometimes after surgery and we want patients to continue those. Obviously, patients will take their pain medicine as they need to. Those are really the big things. And then as we talked about, some exercise restrictions to not make things worse.

Interviewer: What does a timeline look like as far as getting back to normal? I'd imagine things are worse before they get better.

Dr. Orlandi: There is one other thing and it sounds so weird, but we ask patients not to swim for four weeks after surgery because chlorinated water can irritate the sinuses. Other than that, no. I think patients can expect to feel worse than they did before surgery for about three weeks. At about three weeks they can often feel about the way they did before surgery, and then we hope that that improvement continues and they steadily feel better afterwards.

The healing from sinus surgery, meaning the recovery back to normal, can take weeks to months. Now you may feel largely back to normal after three weeks to month, but that healing actually takes up to a year so there's going to be quite intensive care afterwards until we get to a point about a year after surgery where we're into the smooth sailing area.

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updated: November 9, 2018
originally published: February 5, 2015