What Actually Happens During Your In-Office Sinus Procedure — Every Step, Start to Finish

Patients who are scheduled for an in-office sinus procedure at SAWC almost always ask the same question in some form: what is actually going to happen? Not the medical explanation — they have already heard that. They want to know what they will feel, what they will hear, what the room looks like, who will be in it, and what happens from the moment they sit down to the moment they walk out the door.

This is that answer. Every step, in the order it happens, exactly as I perform it.

Clinical answers written in plain language — not marketing. Subscribe to the Airway & Sinus Wellness Review.

Before You Arrive — What You Take at Home

Before you come in, you will have already taken two prescribed medications at home — a mild oral sedative and a pain medication. The timing on your prescription is specific and important. These medications are working by the time you arrive. That is intentional. The sedative reduces anxiety so that the local anesthesia is more effective and the experience is more comfortable from the start. You will need a driver. You cannot drive on the day of the procedure regardless of how alert you feel.

The Procedure Room — Getting Comfortable

When you are brought into the procedure room, you sit in a chair that reclines. We get you positioned comfortably. We offer a warm blanket — most patients take it. We offer an eye mask. And we ask what music you want to hear. This is not a trivial question. Music you choose yourself, in a genre that relaxes you, changes the entire character of the experience. I have done these procedures with country, jazz, classic rock, hip hop, classical, and more genres in between. You pick.

One of our providers comes in first, explains exactly what we will be doing step by step, and answers any questions before anything begins. Nobody starts working in your nose without telling you what is about to happen.

The Anesthesia Sequence — Why We Take 15 Minutes

The anesthesia is the foundation of the entire procedure. We take it seriously and we take our time with it.

We begin by spraying the nasal cavity with a topical decongestant and anesthetic spray. This starts the process and opens the nasal airway slightly, which makes the subsequent steps easier. Then thin strips of gauze soaked in topical anesthetic are placed along the floor of the nose. These numb the nerves that travel upward through the nasal floor into the sinuses and back toward the nasopharynx — the same nerves that serve the Eustachian tube openings. A topical numbing gel is then applied directly into the nasal cavity under endoscopic guidance, reaching deeper into the nasal space. Additional gauze strips are layered in for comprehensive coverage across the full nasal cavity.

Then we let you rest for fifteen minutes. This is not empty waiting time. This is when the anesthesia penetrates the mucosa and the nerve endings go quiet. Patients who have had procedures at other practices are sometimes surprised by this — fifteen minutes is longer than what many practices allow. But the difference in patient experience between ten minutes and fifteen is significant. We do not rush this step.

When I Come In — The Examination and Targeted Injections

After fifteen minutes, I come into the room. I remove the gauze strips and examine the nasal mucosa endoscopically — looking at the tissue directly to confirm the anesthesia has worked and to plan the specific locations I will be injecting. I suction out any residual gel. Then I place three to four targeted injections of local anesthetic precisely at the locations where I will be working. These injections are the final layer — they focus the numbing medication exactly where it needs to be.

By this point the nose is thoroughly anesthetized and you are ready.

Eustachian Tube Dilation — First, If Scheduled

If Eustachian tube dilation is part of your procedure, I perform it first. The balloon catheter is gently guided to the Eustachian tube opening in the posterior nasal cavity — the torus — and carefully introduced into the tube itself. My assistant inflates the balloon to twelve atmospheres. I let you know when one minute has passed. I let you know when thirty seconds remain. Then we count down the last ten seconds together. The balloon is deflated and removed. If the other side needs treatment, the sequence repeats.

You may feel mild pressure during inflation. You may hear a subtle popping sound. Both are expected. I tell you about them before they happen.

The Sinus Balloons — Sphenoid, Frontal, Maxillary

After the Eustachian tube work is complete, I move to the sinuses. The balloon catheter is adjusted and guided to each sinus opening in sequence — sphenoid first, then frontal, then maxillary — under direct endoscopic visualization throughout. At each opening the balloon is gently introduced into the sinus ostium, inflated briefly to dilate the drainage pathway, then deflated and moved to the next location. Each inflation takes only a few seconds.

You will hear popping sounds during this sequence. This is the microfracturing of the bony and cartilaginous walls of the sinus openings as they expand — it is exactly what is supposed to happen and it is the mechanism that makes the results durable. You may feel brief pressure for a few seconds during each inflation. Between the sinus openings you will feel nothing. If the ethmoid sinuses also need to be addressed, they are treated next in the same manner.

NEUROMARK® Posterior Nasal Nerve Ablation — If Scheduled

If NEUROMARK® is part of your procedure, it follows the sinus balloon work. The NEUROMARK device — a Neurent Medical FDA-cleared radiofrequency ablation system — is slowly guided to the back of the nose. The device has small wings that open and are positioned against the estimated location of the posterior nasal nerve. Radiofrequency energy is deployed for thirty seconds. I move the device to multiple locations in the posterior nasal cavity, applying the radiofrequency energy at each position. I then focus additional applications specifically on the inferior turbinate surface at the back of the nose to open the posterior airway.

Turbinate Reduction — The Final Step

After the NEUROMARK work is complete, I inject additional local anesthetic into the swell bodies of the septum and the inferior turbinate — the specific tissue I will be reducing. I make a small opening into the front of the inferior turbinate, then develop a channel inside the turbinate tissue itself. Using an instrument called a microdebrider, I reduce the swell body and the inferior turbinate from within — preserving the outer mucosal surface while removing the tissue bulk that was obstructing the airway.

When the reduction is complete, I place a small piece of dissolvable packing into the opening inside the turbinate. I call this the cork in the wine bottle. It sits in that channel and prevents post-procedure bleeding while the tissue heals. It dissolves on its own — no removal required.

A cotton ball goes in the nasal opening. You are done.

After the Procedure — Before You Leave

Before you go anywhere, we go through your discharge instructions together. Every step of your recovery is explained — what to expect today, what to expect over the next seventy-two hours, when you can resume activity, how to use the saline spray, what medications to have ready, and how to reach us if you have questions. All of your questions are answered before you leave.

Throughout the procedure we talk. About sports, music, holidays, your work, your family. Patients learn things about me and my family if the conversation takes us there. I find that conversation — real, genuine, unhurried conversation — is one of the most effective comfort tools available in a procedure room. It keeps the patient present and relaxed in a way that scripted reassurance never does. By the time most patients leave, they have forgotten to be nervous about the experience they just had. That is the point.

Want to Understand More?

This post is part of the Why Sinus Treatments Fail — And What Starts Before Them section of the Airway & Sinus Wellness Review.

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About the Author

Franklyn R. Gergits, DO, MBA, FAOCO is an otolaryngologist and rhinologist with over 30 years of clinical experience. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale, where he performs in-office balloon sinuplasty, turbinate reduction, NEUROMARK® posterior nasal nerve ablation (Neurent Medical, FDA-cleared radiofrequency ablation system), and Eustachian tube dilation under local anesthesia. He performed the first balloon sinuplasty in Pennsylvania and holds dual Entellus Centers of Excellence certifications. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis, with a preprint available at Preprints.org (DOI: 10.20944/preprints202603.0858.v1). ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. Individual procedures vary based on clinical findings and patient needs. If you are considering an in-office sinus procedure, please consult a qualified physician for evaluation and individualized recommendations.