Antral washout at York Hospital

What is antral washout?

Antral washout is a procedure to clear infection from your maxillary sinus, one of the air-filled spaces in your cheekbones that can sometimes become blocked and infected. A fine tube is passed into the sinus through the thin bone inside your nose, so it can be flushed with sterile fluid to wash the infection away and reopen the natural drainage hole.

What conditions does it treat?

Your consultant might suggest antral washout if you have:

• chronic (long-standing) sinus infections that have not cleared up with antibiotics or other medical treatment
• acute sinusitis that has not responded to medical treatment
• a sinus infection linked to a dental problem
• a connection between your mouth and sinus (an oro-antral fistula) alongside a sinus infection
• in severe cases, a sudden, short-term (acute) bacterial sinus infection, though this is not the routine treatment for this.

What are the benefits of having antral washout?

Antral washout clears infected fluid from your sinus and reopens the natural drainage hole, which can bring quick relief from the pressure and congestion a blocked sinus causes. Because it is a simpler, quicker procedure than more extensive sinus surgery, it can often be done as a day case, and the inside of your nose heals quickly afterwards without needing stitches. A sample of the fluid can also be sent for testing, which helps your doctor target any ongoing antibiotic treatment more precisely.

Are there different types of surgical approaches?

Antral washout can be carried out under general or local anaesthetic, depending on what suits you and your consultant's recommendation. It's a simpler, more limited procedure than functional endoscopic sinus surgery (FESS), which is a more thorough operation now generally used for long-term or repeated sinus problems. If your infection keeps coming back after a few washouts, your consultant may suggest moving on to FESS instead.

What happens before the operation?

Before recommending antral washout, your consultant will check that it's a suitable option for you. It may not be recommended for young children, if you have a bleeding disorder or a fractured jaw bone and it isn't generally used in people with poorly managed diabetes or high blood pressure. If you're having the procedure under local anaesthetic, numbing swabs are usually placed in your nose for about 10 minutes beforehand to prepare the area.

What happens during the procedure?

Antral washout is quick, often taking less than 5 minutes for each side treated, and can be done under local or general anaesthetic depending on what's been agreed with your consultant. Here's what generally happens:

1. If you're having local anaesthetic, numbing swabs are placed in your nose for about 10 minutes, followed by a local anaesthetic injection.
2. Your surgeon passes a very fine specialised needle through the thin bone between your sinus and the inside of your nose.
3. The sinus is flushed with sterile saline solution to wash away the infected fluid and open the natural drainage hole.
4. If the drainage hole is badly blocked, your surgeon may widen it slightly so infection can drain away more easily in future.
5. A sample of the fluid may be sent to a laboratory to help guide any further antibiotic treatment.
6. The needle is removed; since the inside of your nose heals quickly, no stitches are needed.

What does recovery look like?

Antral washout is usually done as a day case, so you'll be able to go home on the day of your procedure once your team is happy with how you're doing. You'll need to arrange for someone to drive you home, as you shouldn't drive yourself straight afterwards.

Once home, over-the-counter pain relief such as paracetamol should ease any discomfort, and it's important to take any prescribed antibiotics or use nasal sprays exactly as directed. Avoid blowing your nose for the first 48 hours, and avoid strenuous activity for at least 2 days, since there's a risk of nosebleed during this time. You can usually go back to activities like swimming or diving after about 2 weeks, and your consultant can advise you on when to return to work.

What are the risks and complications?

Most people recover well from antral washout, but as with any procedure, there's a small risk of complications. These can include:

• pain or discomfort
• bleeding or a nosebleed, which usually settles quickly
• infection, including the original sinus infection returning
• feeling faint during the procedure
• rarely, fluid escaping into the cheek or around the eye, causing swelling
• very rarely, air entering the bloodstream (an air embolism), which can be serious.