Nasal turbinates are bony structures on the side wall of the nose, covered by spongy nasal lining. There are 3 on the left and 3 on the right side of the nasal cavity – superior, middle and inferior turbinate.  They function to increase the surface area of the nasal cavity, ensuring all the air that goes through the nose and down into the lungs is at the correct temperature and humidity.

In some people, turbinates can develop to be significantly enlarged (concha bulla) and contribute to nasal obstruction, sinusitis and exacerbate allergy symptoms.  Surgery to reduce the size of turbinates can ameliorate these symptoms.  Removal of the turbinates fully, however, is not recommended as this can lead to empty nose syndrome.

Turbinoplasty may be performed with septoplasty surgery and/or endoscopic sinus surgery.

The main risks of the turbinoplasty are bleeding (which is usually mild) and destabilisation / lateralisation of the middle turbinate; if a concha bulla is reduced the residual turbinate can shift position and another procedure may be required to reposition it again.

Functional endoscopic sinus surgery (FESS) is performed for symptoms of acute or chronic sinusitis, when medical treatment has failed or provided insufficient relief for a patient. FESS is sometimes performed in conjunction with a septoplasty and / or turbinoplasty.

Sinus development is variable from person to person; it also depends on the age of the patient.  Sinuses are hollow chambers in the skull consisting for maxillary (cheek) sinuses, ethmoid and sphenoid (between the eyes) sinuses and frontal (above the eyes) sinuses.  Sinus drainage channels are narrow – in some patient they can block completely or partially leading to sinus inflammation.  Allergies can contribute this chronic sinusitis in this way.

FESS is performed through the nose using various instruments to widen the natural drainage channels of the sinuses that are involved in causing symptoms in a patient.  It takes between 30-60 minutes depending on the complexity of the case involved.  Any pus or trapped mucous is removed.  Polyps are grape-like structures within the sinuses that can be associated with chronic sinusitis and are also removed if present.  In some people if chronic sinusitis with polyps is very extensive, there may be an underlying systemic inflammatory process involved – while surgery helps, it may not be curative and further surgeries +/- biological agents may be necessary.

The main risks of surgery are bleeding (which can be expected for several days afterwards).  There is a remote risk of injury to the eye causing double visions or black eyes, and even more rarely is injury to the bony roof of the nose causing a leak of brain fluid (cerebrospinal fluid).  Thankfully these risks are exceptionally rare.

Temporary soft dissolvable nasal dressings are placed in the sinus cavities at the end of the procedure.  At 2-3 weeks following surgery, it is not unusual to feel pressure like a sinus infection. This is usually because mucous normally produced by the sinuses is not able to drain on account of the dressings.  Should you feel like this following ESS, irrigation is the most important treatment.  Sometimes, when a patient is seen back in the clinic 4-6 weeks post-surgery, there are residual dressings to suction out of the sinus cavities.

The nose should not be blown for 3 weeks afterwards.  It can take 3 months for the nasal cavity to heal fully, but usually after 3-4 weeks the airway will start to open up.  Topical nasal irrigation twice weekly for 2 months after surgery and then 1 month is critically important to allow the nose to heal.

Adenoids can be removed for recurrent adenoiditis (+/- tonsillitis) and adenoid enlargement causing nasal obstruction and sleep disordered breathing / obstructive sleep apnoea.

The main risk of adenoidectomy is bleeding up to 10-14 days after surgery (<1% risk).  The voice is often less nasally thereafter, so the voice can also change.  There is also a very low risk of velopharyngeal insufficiency, where fluid and food can be regurgitated through the mouth upon swallowing.  In children with Trisomy 21, there is a remote risk of atlantoaxial subluxation.  The adenoids may regrow, especially if the child is very young getting them removed.

Tonsillectomy is a procedure where the tonsils are removed fully from the back of the throat. This is typically performed for recurrent tonsillitis and sleep disordered breathing / obstructive sleep apnoea.  Regardless of age, there is considerable pain to be expected for 14 days after surgery.  This pain is usually at its worst at approximately day 7-10 post operatively.  There is also a risk of bleeding for 14 days from surgery (3-4%). 

Tonsillotomy is where the tonsils are partially removed to ameliorate symptoms of breathing disorders and tonsillitis.  The benefit is that it is less painful and has a lower risk of bleeding that a full tonsillectomy; however, the residual tonsil tissue may regrow or may be insufficient to resolve the tonsils symptoms that prompted evaluation.

Regular analgesia with paracetamol / ibuprofen (children) and paracetamol/codeine/diclofenac (adults) will be prescribed +/- antibiotics postoperatively.

In the event of any bleeding following adenoid or tonsils surgery, the patient should attend the nearest public hospital that has a 24 hour on call Ear Nose and Throat service.

The nasal septum divides the right and left nasal cavities. It is made of cartilage at the front and bone further back.  In many people with nasal obstruction, the septum is not straight and is deviated.  This may be because of previous trauma to the nose; it may also become deviated as the septum develops, up until 16-17 years of age, where the bone and cartilage over lap or bend into an ‘s’ configuration, thereby occluding one or both nasal cavities.

A deviated nasal septum is a very common cause of nasal obstruction. It can be a contributing factor to sinusitis and contribute to symptoms of allergic rhinitis.  Less commonly, it may contribute to facial pain.

A septoplasty is an operation to remove the deviated or crooked section(s) of cartilage and bone within the nasal septum.  Taking approximately 30 minutes, this operation is performed under a general anaesthetic. It may be performed in conjunction with sinus surgery and/or turbinoplasty, or as a stand-alone procedure.

Typically, an incision is made on one side of the septum, approximately 1-2 cm inside the nostril. Once the crooked cartilage and bone has been removed, temporary soft dissolvable nasal dressings are placed in the nasal cavities.  These dressings fall out typically within 3—4 days once nasal irrigation has commenced.  Occasionally, the very front of the septum is displaced to one side – this is called a caudal septal deviation.  If this needs to be addressed, there will be dissolvable stitched placed to close the wound, but otherwise, stitches are rarely placed during septoplasty surgery.

Bleeding is to be expected following a septoplasty – usually more from the side of the incision site.  This can take 7-10 days to stop.  The nose should not be blown for 3 weeks afterwards.  It can take 3 months for the septum to heal fully, but usually after 3-4 weeks the airway will start to open up.

There is a risk of a septal perforation with a septoplasty – this occurs, in <1% of cases.  However, if the nose has been broken or a patient has had a previous septoplasty performed and is undergoing a revision procedure, the risk can be significantly higher.  With a perforation there can be whistling when breathing through the nose.  It can be addressed with a septal button at a later stage.

The appearance of the nose externally is unchanged.  There is no bruising visible externally around the eyes or cheeks.  Temporary numbness of the roof of the mouth can last for several weeks.  With the cartilage and bone removed, it can at times feel like there is a sail flapping inside the nose – this is typically temporary also, as the septum scars up in the weeks following surgery.  Topical nasal irrigation twice weekly for 2 months after surgery and then 1 month is critically important to allow the nose to heal.

Grommets are small plastic tubes that are placed in the ear drums.  The typical indications for grommets are fluid inside the ear drum (within the middle ear) that has persisted and not resolved by itself or with medication.  Fluid in the middle ear typically causes hearing loss, speech delay in young children and recurrent otitis media (ear infections).

Grommets may be placed under local or general anaesthesia.  The typically stay in for 6-9 months and then are extruded from the ear drum. 

The main risks with grommets include drainage from the ears (possibly blood stained), recurrence of fluid (and ear infection / hearing loss) after the grommets fall out and permanent ear drum scarring, weakness or perforation (1% of cases – this can also occur from the presence of fluid in the middle ear, however). 

Grommets may need to be reinserted.

Grommets do not prevent ear infections – they serve drain the fluid from the middle ear and keep the hole in the ear drum patent to allow the inflamed lining of the middle ear to resolve.