Endoscopic sinus surgery, sometimes called functional endoscopic sinus surgery (FESS), is a minimally invasive procedure to treat problems in the sinuses.
What is endoscopic sinus surgery?
Endoscopic sinus surgery is a procedure to remove blockages and treat other problems in the sinuses using an endoscope — a thin, rigid tube with a camera and a light.
Who may need endoscopic sinus surgery?
Endoscopic sinus surgery can help people who experience nasal congestion, pain, drainage, difficulty breathing, loss of sense of smell (anosmia), or other symptoms due to:
- Sinusitis
- Nasal polyps
- Nasal obstruction or blockage
- Sinus and nasal tumors
The goals of endoscopic sinus surgery include:
- Reduce the severity of sinus infections.
- Improve sinusitis symptoms
- Improve the drainage of the sinuses.
- Improve airflow through the nose.
- Improve the sense of smell.
- Allow access for nasal rinses to reach the sinus cavities for cleaning and medication delivery.
Preparing for Endoscopic Sinus Surgery
Because general anesthesia will be used, you will be instructed not to eat or drink after midnight before the procedure. Other preparations, which may include:
- Prescription medications to be taken before and after surgery to help reduce inflammation.
- Preoperative physical exam to provide medical clearance for the surgery.
- Smoking cessation is often required and should start three to four weeks before surgery and continue for a month after surgery. Smoking causes increased scar tissue and poor healing, leading to endoscopic sinus surgery failure.
- Stopping certain medications and supplements could help reduce your risk of bleeding during and after sinus surgery and prevent interference with anesthesia.
What happens during endoscopic sinus surgery?
Endoscopic sinus surgery is usually performed as an in patient procedure with the patient under general anesthesia (asleep). During the surgery:
- The sinus surgeon inserts an endoscope — a thin camera rod with a light at the end into one nostril and magnifies and visualizes the sinus tissues.
- After locating the issue, the surgeon uses specialized instruments alongside the endoscope to open the sinuses by carefully removing causes of sinus blockage, such as mucous membrane swelling, nasal polyps and scar tissue.
- If a deviated septum causes breathing problems, specialized instruments can straighten the septum and reduce the size of the turbinates.
- Most patients require nasal packing that needs to be removed the following day..
Postoperative Care
For relieving discomfort and keeping your sinuses clear, GET
- Nasal saline spray: Nasal saline mist spray can be used every two to three hours after surgery, making your nose more comfortable. Saline sprays are over-the-counter medications and can be purchased in any pharmacy.
- Sinus irrigation: You will start sinus irrigation with sinus rinse kits a week after your surgery. Rinse at least twice daily for best results, following the instructions provided by your doctor. If you haven’t done it before, irrigation may feel strange. Soon, however, it will become soothing as it helps clean out the debris left behind in your sinuses after surgery.
Endoscopic Sinus Surgery Recovery
You may experience the following symptoms after endoscopic sinus surgery:
- Bleeding: It is normal to have some bloody discharge for the first 2 to 3 weeks after sinus surgery, especially after you irrigate your sinuses. If you experience steady bleeding, tilt your head slightly and gently breathe through your nose. You may dab your nose with a tissue, but avoid blowing your nose. You may use oxymetazoline nasal spray if this does not stop the bleeding. Several sprays will usually stop any bleeding. If the spray fails to stop steady nasal bleeding, visit your doctor.
- Pain: You should expect nasal and sinus pressure and pain for several days after surgery. This may feel like a sinus infection or a dull sinus ache. Use the postoperative pain medication prescribed by your doctor.
- Fatigue: You can expect to feel tired for the first week after surgery. This is normal; most patients plan on taking at least one week off work to recover. Every patient is different, and some return to work sooner.
- Nasal congestion and discharge: You will have nasal congestion and discharge for the first few weeks after surgery. Your nasal passage and breathing should return to regular two to three weeks after surgery.
Consult the Best ENT Doctor In Bangalore, Dr SHALINA RAY, For Functional Endoscopic Sinus Surgery to aid the healing process. During these visits, the care team will clean your nose and sinuses of fluid and blood left behind after surgery. The cleaning involves some discomfort, so taking pain medication 45 minutes before your visit is best.
What to Avoid After Endoscopic Sinus Surgery
- Nose-blowing, heavy lifting, and straining: You should avoid straining (anything heavier than 20 pounds) and nose-blowing for at least ten days after surgery, as these activities may cause bleeding. You can resume 50% of your regular exercise regimen one week after surgery and your normal routine two weeks after.
- Steroid nasal sprays: If you were taking nasal steroid sprays before surgery, you should avoid using these for at least two weeks after sinus surgery to allow the lining of the nose and sinuses to heal. Your doctor will tell you when it is safe to restart this medicine.
Endoscopic Sinus Surgery: Risks and Complications
As with any surgery, there are risks involved with having endoscopic sinus surgery. Complications are rare and may include:
- Bleeding: Minor blood loss is expected during surgery, and patients usually tolerate it well. In rare cases, excessive bleeding may occur, requiring the surgeon to stop the surgery. Very rarely, bleeding after surgery becomes excessive and requires a visit to your surgeon to get nasal packing to stop the bleeding.
- Infection: To reduce this risk, you may be given antibiotics during surgery and a prescription for antibiotics after surgery. Occasionally, a person may develop a sinus infection after surgery that requires a more potent antibiotic.
- Cerebrospinal fluid (CSF) leak: During endoscopic sinus surgery, the surgeon works beneath the bone that separates the brain from the nose. It is sporadic for this bone to be injured during surgery, which would result in a CSF leak. Such an injury is generally identified and repaired right away. If a leak is diagnosed after surgery, a second procedure is required to patch the opening.
- Vision changes: The sinuses are very close to the eyes, which makes an eye injury possible during sinus surgery, resulting in temporary or permanent double vision or other vision changes. Injury to the tear ducts may cause excessive tearing after surgery. Fortunately, these are exceedingly rare complications. Swelling may also occur around the eyes after surgery. Temporary blurry vision can happen in some patients but goes away independently.
- Other risks include changes in your nasal breathing or sense of smell. If a septum is altered during the sinus surgery, there is a small risk of developing a septal tear or numbness in your teeth. Some patients have persistent sinus disease after surgery, requiring treatment with antibiotics, steroids or other surgery.
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FAQs
Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive procedure performed using a nasal endoscope to restore normal sinus drainage, remove blockages, and improve ventilation without making external facial incisions.
FESS may be recommended for patients with chronic sinusitis, recurrent sinus infections, nasal polyps, or blocked sinus drainage that has not improved despite appropriate medical treatment.
If loss of smell is caused by chronic sinus inflammation or nasal polyps, many patients experience improvement after successful treatment. The extent of recovery depends on the underlying condition and how long the symptoms have been present.
No. FESS is performed entirely through the nostrils using an endoscope, so there are no visible external cuts or facial scars.
Yes. If nasal polyps are contributing to sinus blockage, they can often be removed during the same endoscopic procedure to improve sinus ventilation and reduce symptoms.
Many patients can go home on the same day or after a short hospital stay, depending on the complexity of the surgery, their overall health, and the surgeon’s recommendation.
While FESS provides long-term relief for many patients, sinus symptoms may recur in some individuals, particularly if allergies, nasal polyps, or other underlying conditions continue. Regular follow-up and appropriate medical care help reduce this risk.
Whether nasal packing is required depends on the surgical technique used and your individual condition. Many modern FESS procedures minimize or avoid nasal packing whenever clinically appropriate.
Nasal breathing gradually improves as swelling decreases during healing. Some temporary congestion is expected initially, but most patients notice progressive improvement over the following days and weeks.
Yes. If left untreated, chronic sinusitis may lead to persistent infections, worsening nasal obstruction, reduced quality of life, and, in rare cases, complications involving nearby structures. Early evaluation and appropriate treatment can help prevent these problems.
