I'm going to have sinus surgery for a blockage I have on both sides. How will I breathe after it's over? I'm scared of what will happen with my nose being packed. How will I be able to eat and drink? Is surgery the best way to go? Or can it be taken care of with medicine and maybe go away?

C.B.

I wish there were a single answer to the question of packing the nose after surgery. Unfortunately, there is an amazing range of possibilities. On the one hand, your doctor may place no packing whatsoever, or perhaps just a bit of dissolvable packing. On the other hand, your first post-op visit may remind you of the magician's handkerchief trick as the doctor pulls yard after yard of bloody gauze from your nose.
You see, the nose is a pretty big place. What you see on your face is really the tip of the iceberg -- there is an amazing amount of space deep in that nose of yours. Put your fingertip between your eyes, at about the level of your eyebrows. Now shove your tongue up against the roof of your mouth. Almost everything below your fingertip and above your tongue is nasal cavity (with the exception of the roof of the mouth, of course).

What's left behind in your nose after surgery depends partly on you and partly on your doctor. If you bleed excessively during the operation, your doctor may have no choice but to leave in a lot of packing. The packing is placed to put pressure on the bleeding areas -- remember, direct pressure is one of the most effective ways to stop bleeding.

But what if you bleed very little? Might you still wake up with yard after yard of packing? Maybe. That's because some ENTs (ear, nose and throat doctors) do this on a routine basis. Some of us (like me) place large packs only when we absolutely must, but some ENTs were trained to do this after every sinus or nasal operation. You'll have to ask your ENT about his or her preferences.

Back to your other questions: Assuming you are heavily packed, how will you breathe? Through your mouth! Sure, some people hate breathing through their mouth, but it beats the alternative. How will you eat and drink? Once again, the old-fashioned way. It will be a bit challenging (we're used to being able to breathe with a full mouth) but you'll get the hang of it.

Your last question is the meaty one: Is surgery the best way to go, or could your problem be taken care of with medicine, or perhaps go away? There is no single answer to this question, either. For almost any medical problem, one has several options:

• Ignore it. (Live with it. Forget about it.)
  
• Observation. (No treatment, but you do not ignore the problem. You would see a doctor periodically for re-evaluation.)
  
• Medical intervention. For sinus and nasal problems, this would include one or more of the following: antibiotics, nasal corticosteroid sprays, oral corticosteroids, allergy treatment (antihistamines, cromolyn nasal spray, avoidance of known allergens, use of HEPA filters, allergen desensitization, etc.).
  
• Surgical intervention. Impossible to describe all possibilities here, but this would include simple office procedures as well as operations performed under general anesthesia.
  
• Alternative therapies. For sinus and nasal problems, I know some patients depend on their chiropractors and homeopaths -- don't ask me to explain how their methods work! There are, of course, many other alternative approaches (herbal preparations, colloidal silver, etc.).
  

What is the best option? The one that makes the most sense to you, after you have reviewed all of the facts. If you are confused about why your doctor has recommended an operation, you must question him further. He must be able to defend his recommendation, and his reasoning must make sense to you. If it does not, then it's time for a second opinion.