Post-Surgery Nasal Swelling: Managing Anxiety and Sleep Issues

After surgery on the nasal septum and bilateral inferior turbinate reduction, there is persistent unilateral turbinate swelling, along with sleep disturbances and anxiety?

Last week, I underwent surgery for a deviated septum and bilateral inferior turbinate reduction.
Currently, one week post-operation, the wounds still appear bright red when I look in the mirror, but there is no longer significant bleeding like immediately after the surgery.
Only a little blood-streaked clear nasal discharge occurs, and when I dab a tissue inside, I notice some blood that has turned brown.
The swelling on the right side of my nose is particularly noticeable.
During my discharge and follow-up visit on the fourth day post-op, I experienced nasal congestion but did not undergo endoscopy.
The prescribed oral medications include Mometasone, Tranexamic Acid, and Phenylephrine.
After discharge, the right side of my nose felt especially swollen; I initially thought there might be residual packing inside, but despite suctioning during the follow-up, the swelling remained the same.
I realized that the white tissue I saw might be my nasal mucosa, which has swollen to the point of being in close contact with my septum.
The left side still has a narrow passage, but I can slowly inhale and exhale; however, the swelling on the right side is most prominent in the triangular area beneath my eyes, on my cheekbone, and around my nostril, fluctuating between being very swollen and slightly reduced.
This has persisted until today, and it seems that even the area above my right eye has started to feel uncomfortable.
My attending physician has many patients, and although he gives me time to ask questions once I finally get into the consultation room, I often think of questions only after leaving, and I am not entirely clear about my condition.
Regarding my sleep and anxiety issues, (1) I started feeling inexplicably anxious on the day of admission (with rapid heartbeat and high blood pressure, and general anesthesia taking a minute or more), (2) I had the expectation that "breathing would be unobstructed a few days after surgery," but instead, I have experienced ongoing swelling, (3) during the follow-up, the doctor did not provide specific recommendations for what I could do, (4) I also had the expectation that "I used to fall asleep as soon as I lay down," so I am puzzled as to why I am now having such difficulty sleeping.
There may be other reasons, but in summary, I have been unable to sleep well for a week.
In the last couple of days, I have also experienced sudden awakenings due to feeling like I can't breathe, and I sometimes feel short of breath or as if my breaths are ineffective.
Lastly, the thought that "poor sleep will hinder recovery" adds to my anxiety about the entire situation.
Questions: Why is there still swelling filling my nasal passages even though there is no longer significant bleeding? Are there any methods to reduce the swelling in my nose, or am I truly left to wait for it to resolve on its own? A few days ago, I tried applying ice packs (but only used the ice bag without wrapping it in a towel), and later learned that excessive cold could exacerbate inflammation.
Therefore, last night, I decided to stop icing and let it heal on its own, but today there has been no improvement whatsoever.
I am really troubled by this...
It doesn't seem like a major surgery, but I desperately want to escape this situation.
Regarding my sleep issues, should I seek help from a psychiatrist, and would that be beneficial? Lastly, how can I effectively communicate with my physician? Although I am not rushed out of the office, I often have questions that I cannot articulate, or the physician does not provide explanations that leave me confused or uncertain...
I am unsure if I will receive a response, but I want to thank the doctor in advance for their help!

Niming, 20~29 year old female. Ask Date: 2023/08/23

Dr. Ji Zhaoyun reply Otolaryngology

Hello, swelling during the first week post-surgery and the issues you mentioned are quite common.
"The attending physician has many patients, and although he gives me time to ask questions once I finally get into the consultation room, I always think of questions only after leaving.
I'm also not very clear about my condition..." I suggest that for your next follow-up appointment, you write down the questions you want to ask and hand them directly to the physician.
This will save time and ensure that nothing is overlooked.
Wishing you peace and good health.

Reply Date: 2023/08/23

More Info

Post-surgery nasal swelling and related anxiety and sleep issues are common concerns following procedures such as septoplasty and turbinate reduction. It’s understandable to feel anxious and frustrated when recovery doesn’t go as smoothly as expected. Let’s break down your concerns and provide some insights into managing these post-operative symptoms.

Understanding Nasal Swelling
After nasal surgery, it’s normal to experience swelling, particularly in the first few weeks. The swelling can be attributed to several factors:
1. Surgical Trauma: The surgery itself causes trauma to the tissues, leading to inflammation and swelling as part of the healing process.

2. Fluid Accumulation: Post-operative swelling can also result from fluid accumulation in the tissues, which is a natural response to surgery.

3. Expectations vs. Reality: Many patients expect immediate relief from nasal obstruction, but it can take time for swelling to subside and for the nasal passages to open up fully.

The presence of blood-tinged mucus and the ongoing swelling you described are not uncommon. The fact that you are seeing some improvement, such as reduced bleeding, is a positive sign. However, persistent swelling, especially if it seems to fluctuate, can be concerning.

Managing Swelling
To help manage nasal swelling, consider the following strategies:
- Follow-Up with Your Surgeon: It’s crucial to keep your surgeon informed about your symptoms. They may recommend nasal sprays, decongestants, or other medications to help reduce swelling.

- Nasal Irrigation: Using saline nasal sprays or performing nasal irrigation can help keep the nasal passages moist and may aid in reducing swelling.

- Avoid Irritants: Stay away from smoke, strong odors, and allergens that could exacerbate swelling and discomfort.

- Cold Compresses: While you mentioned concerns about ice packs, gentle cold compresses applied to the outside of the nose can help reduce swelling. Just be sure to wrap ice in a cloth to avoid direct contact with the skin.

Addressing Sleep Issues and Anxiety
Sleep disturbances and anxiety are common after surgery, especially when physical discomfort is present. Here are some strategies to consider:
1. Sleep Position: Elevating your head while sleeping can help reduce nasal congestion and improve breathing. Consider using extra pillows or a wedge pillow.

2. Relaxation Techniques: Engage in relaxation techniques such as deep breathing exercises, meditation, or gentle yoga to help manage anxiety and promote better sleep.

3. Consult a Specialist: If your sleep issues persist, it may be beneficial to consult with a sleep specialist or a mental health professional. They can provide tailored strategies to address anxiety and sleep disturbances.

4. Medication Review: If you were prescribed medications for anxiety or sleep, discuss their effectiveness with your doctor. Sometimes, adjustments may be necessary to find the right balance.

Communicating with Your Doctor
Effective communication with your healthcare provider is essential for a smooth recovery. Here are some tips for better communication:
- Prepare Questions: Before your appointments, write down any questions or concerns you have. This will help ensure you don’t forget to ask important questions during your visit.

- Be Honest About Symptoms: Clearly describe your symptoms, including their severity and how they affect your daily life. This information can help your doctor make informed decisions about your care.

- Request Clarification: If you don’t understand something your doctor says, don’t hesitate to ask for clarification. It’s important that you feel comfortable and informed about your treatment plan.

Conclusion
In summary, post-surgery nasal swelling and related sleep and anxiety issues are common but manageable. By staying in close contact with your healthcare provider, employing self-care strategies, and addressing your concerns proactively, you can navigate this recovery period more effectively. Remember, healing takes time, and it’s important to be patient with yourself as your body recovers. If symptoms persist or worsen, don’t hesitate to seek further medical advice.

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