Nasal and Sinus Surgery
Chirurgie du nez et des sinus

© John Messmer 1999

When sinuses do not drain properly, doctors will sometimes recommend surgery to assist the proper clearance of mucus. Formerly, this was a major procedure that involved lifting up the upper lip to enter the maxillary sinus and cutting a hole into the sinuses. Now it is possible to use a flexible instrument to go up the nose and enlarge the actual opening that is there rather than creating a new one. This makes recovery easier generally.

Sometimes the turbinates also must be made smaller. The turbinates are bony folds that project into the nasal cavity. There is much discussion in medical circles as to the function of these structures, but they probably serve to warm and moisturize the air we inhale. The sinus openings (ostia) can be blocked if the turbinates are malformed. Reducing the size of the turbinates may be necessary if this is the case.

The nasal septum separates the nasal passages and can become deviated through trauma such as a blow to the nose or possibly at birth. Sometimes the area where the bony part of the septum and the cartilage part meet will thicken with time. Either of these situations can result in narrowing of the airway with the result that breathing is difficult. Occasionally, this will contribute to poor nasal drainage also, such that when the sinuses are fixed, the septum must be corrected and the turbinates reduced.

For the singer, many questions arise: how will this affect my voice? How soon will I be able to sing after surgery? What about intubation and my vocal folds? Will there be pain?

How a person will feel after surgery is a function of how much bone must be removed and will vary from person to person. If the surgery is being done for good medical reasons, people usually feel better after surgery. Typically, the voice improves in resonance and clarity. Pain is usually mild to moderate, but individuals will vary. Pain medication is generally sufficient to control the pain.

Intubation does not have to be traumatic. If your surgeon and anesthesiologist understand that you are a singer, vocal fold trauma can be avoided. Anesthesiologists are dedicated to avoidance of any sort of trauma during surgery and will do whatever is necessary. Often it is a result of the surgeon moving the patient’s head around that causes the tube to bump the folds. The laryngeal mask is a possible alternative. This device fits over the larynx, but if it does not fit properly over the laryngeal opening, a tube will be necessary. The anesthesiologist will not risk your life to protect your vocal apparatus.

Most singers can sing immediately after surgery, though you will attract attention in the recovery room ;-). Practically speaking, assuming a normal recovery, you should be able to pick up in a couple days. However, people vary in their ability to recover from surgery so it would be reasonable to discuss this with your surgeon first. It would be a good idea to avoid committing to a performance for a couple weeks post-operatively. Lessons, practice and so on can usually begin in a couple days.

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