How To Communicate the Benefits and Risks of Surgery to the Patient

It is very helpful to have the patient's CT scans with you to illustrate what is happening in their sinuses and what procedure is planned, and to show the proximity of the orbit and brain when discussing possible complications (Fig. 9.1). An alternative is to have a diagram of the sinuses available. We normally describe sinus surgery to patients who have little medical knowledge as "plumbing" of the sinuses. Another analogy that patients understand is describing the sinuses as 14 little rooms connected by corridors on either side, and sinus surgery as like these being converted into a big hall on each side (Fig.9.2a, b). We say that surgery helps drainage, reduces the surface area from which polyps can form, and allows access to topical nasal medication. However, it is important to emphasize that surgery is not always a "cure" for all of the patient's symptoms, particularly in the presence of allergic rhinitis or when the patient also has late-onset asthma.

Tempering patients' expectations is vital. If patients feel better postoperatively than they expected, they are often pleased and happy. However, if their progress does not meet their idea of what they thought would happen, they will often be unhappy. For example, in patients with late-onset asthma, severe nasal polypo-sis, and aspirin sensitivity, we emphasize that polyps often recur and that their condition is akin to "asthma of the nose." Surgery can help these patients, but it cannot eradicate their problems.

In other conditions, such as immune deficiencies, ciliary dyskinesia, or cystic fibrosis, it is important to temper the patient's expectations further and emphasize to the patient which, if any, of their symptoms are likely to be improved by surgery.

We normally specifically mention that symptoms of catarrh may not be eradicated. Although purulent catarrh and postnasal drip will hopefully become clearer with surgery, many patients who complain of these symptoms have a hyperawareness of mucus or a minor degree of globus pharyngeus, and it is wise to temper their expectations preoperatively.

While surgery can reduce the surface area that is capable of producing mucus, it often cannot reverse the mucosal pathology that produces the secretion of mucus. Notable exceptions are in fungal rhinosinusitis and bacterial rhinosinusitis, where there are no underlying cilial or immunological problems. In these patients, the likelihood of eradicating these symptoms is much greater.

As has been stressed before, it is important not to falsely raise patients' expectations that their sense of smell will be improved after surgery for marked polyposis (although by using the technique of preserving and gently "lateralizing" the middle turbinate, we have achieved mainly good results). In patients who have absolutely no sense of smell following previous polyp surgery, be cautious about promising any improvement because they have often had their olfactory mucosa removed or have synechiae obstructing their olfactory clefts. With anosmia secondary to other causes, such as trauma or a neuropathic virus, the sense of smell will not improve, and this should be stated before surgery.

Dealing With Asthma Naturally

Dealing With Asthma Naturally

Do You Suffer From ASTHMA Chronic asthma is a paralyzing, suffocating and socially isolating condition that can cause anxiety that can trigger even more attacks. Before you know it you are caught in a vicious cycle Put an end to the dependence on inhalers, buying expensive prescription drugs and avoidance of allergenic situations and animals. Get control of your life again and Deal With Asthma Naturally

Get My Free Ebook


Post a comment