QUESTIONS AND ANSWERS

Q.1 Adult Patient: “Pom Ja Dee K’hun Mai Lung P’ha Tud?” [ Will I get better after operation?” ], and
Q.2 Adult Patient: “Arkarn K’hong Pom Ja Hai Mai Lung P’ha Tud?” [ Will my symptom(s) resolve after
operation? ]

A.1 & A.2 From a study of 64 Thai patients, between 1 and 5 years after sinus operation under endoscopic vision, symptoms that are likely to improve (per cent of patients) are as follows: dripping d own the back of throat/ postnasal drip (65.57%), runny nose/ rhinorrhoea (54.24%), blocked nose/ nasal obstruction (39.22%), facial pain (62.5%), sneezing (44.83%) and bad smell/ cacosmia (73.08%). Some of your symptoms will improve but expect some to
remain. By the way, reports from abroad may indicate better results than mine but I can only speak from my experience.

May I remind you that this surgery may help you in two ways (i) prevention of complications of sinusitis and (ii) improvement of some of your symptoms.

Q.3 Adult Patient: “P’ha Tud Ki K’hruang?” [ How many operations? ]

A.3 From a study of 64 Thai patients seen between 1 and 5 years after their first endoscopic sinus operation by
myself, 11 out of 64 patients (17.19%) underwent a revision operation ranging 12 to 52 months (average 25 months later). If we consider your case in the next 5 years, you may have at least a 17% chance of having another operation within 5 years.

Q.4 Adult Patient: “Siang Mai?” [ Risks ? ]

A.4 Yes, there are always risks from anaesthesia and from surgery. For chronic sinusitis and polyps, I have not seen any major operative complications among my “FESS” sinus patients: for example, no injury to eye or brain and no death.

However, I have had some complications at other hospitals. Examples are one temporary lowering of eyelid (ptosis) after injecting a local anaestheic agent in one patient, one eye infection after sinus operation in another patient, and one patient developed a nose bleed in the recovery room that required blood transfusion.

In any case, you should know that risks include double vision, blindness, fluid leaking from the head, injury to the interior of skull, infection, nose bleeding. blockage of tear duct etc but I will make efforts to prevent them from happening.

Q.5 Adult Patient: “Ja Tong Ma Truad Nan Tao Rai?” [ How long must I come for follow-ups? ]

A.5 Follow-up appointments depend on many factors but perhaps start with 1/2, 1, 2, 4, 6, 8, 10, 12 months appointments. After that, if you are much better, may be twice a year for up to 10 years.

Q.6 Adult Patient: “Rok Ja Hai Mai?” [ Disease(s) will disappear? ]

A.6 Let’s talk about one disease at a time. Polyps are likely to return and expect a repeat operation within 3 years.
To prevent recurrence, I recommend steroid spray for the nasal passages (if there is no contraindications and side effect) and daily steam inhalation (if there is no contraindication e.g. asthma and side effect), and ideally there should be an hour interval between the two treatments.

On chronic sinusitis, think how long you have had it. May be we can get it resolved or cured in half that time. If you have had it for four years, two years may be needed. It may have something to do with the slow recovery of sinus
lining and mucus transport which may take years to return to normal.

Q.7 Adult Patient: “Sinus Arai Ti P’ha Yark” [ Which sinuses are difficult for operations? ]

A.7 You have four pairs of sinuses around your nasal passages/cavities. In chronic sinusitis, difficult sinuses for surgery are the frontal sinuses and the sphenoidal sinuses.

In the old days people talked about the maxillary and ethmoidal sinusitis. In Thailand, a computed x-ray study (CT scan) of 88 patients at Khon Kaen University has shown evidence of frontal sinus infmmation in 18.2% and sphenoidal sinus inflammation in 16.5%. Therefore, infected/ inflamed frontal and sphenoidal sinuses do occur.

These sinuses can be difficult to treat. Among my “revision surgery” cases, 16 / 72 cases (22.22%) underwent
revision operations 17 times, and frontal and/or sphenoidal sinuses were involved in most patients (at least 12 cases).⁹