Functional surgery (FESS) in which a thin endoscope is inserted through the nostril to clean diseased areas of the nose and paranasal sinuses and to widen the natural sinus openings.
Indication
- Chronic rhinosinusitis (over 12 weeks) unresponsive to adequate medical therapy (nasal corticosteroid, irrigation, antibiotics)
- Nasal polyposis (polyps inside the nose) causing nasal obstruction and loss of smell
- Recurrent acute sinusitis attacks (4 or more per year)
- Fungal sinusitis (allergic or non-invasive forms)
- Mucocele, sinus cysts, and benign sinus lesions
- Anatomical issues (concha bullosa, septal deviation with sinus ostium narrowing)
- Endoscopic approach to selected orbital and skull base pathologies
Preparation
- Endoscopic nasal examination and paranasal sinus CT mapping
- Optimization of allergy and asthma treatment if present
- No food or drink for 6-8 hours before the procedure
- Blood thinners are adjusted with physician approval
- Stopping smoking 2-4 weeks beforehand is recommended for healing
How it's performed
- General anesthesia is administered
- Access is gained through the nostril with a thin endoscope and special surgical instruments; no skin incision is made
- Images are projected onto a monitor; the natural opening of the affected sinus is identified and widened
- Polyps, thickened mucosa, and pathological tissue are carefully removed
- The natural sinus anatomy is preserved as much as possible (functional surgery principle)
- If needed, dissolvable nasal packing or thin silicone stents are placed inside the nose
Post-procedure
- Most patients are discharged the same day or after 1 day in the hospital
- Saline irrigation is recommended for nasal cleaning during the first week
- Strenuous activity and forceful nose blowing are avoided for 2 weeks
- Healing is monitored with endoscopic check-ups at weeks 1, 2, and 4
- Nasal corticosteroid therapy is continued depending on the underlying condition (polyps, allergy)
Risks
- Nosebleed (epistaxis) — usually mild, rarely requiring packing
- Adhesions (synechiae) and re-narrowing of the sinus opening
- Temporary decrease in sense of smell
- Orbital (eye socket) complications (very rare)
- Cerebrospinal fluid (CSF) leak (very rare, in procedures near the skull base)
- Anesthesia reactions
FAQ
Can symptoms recur after endoscopic sinus surgery?
Even when surgery is successful, the underlying chronic condition (allergy, polyposis, asthma) is not eliminated by surgery. Therefore, maintenance with nasal corticosteroid spray, saline irrigation, and regular check-ups is continued; in some patients, polyps and symptoms may recur over time.
Is the surgery painful, and when can I return to work?
Because it is performed under general anesthesia, no pain is felt during the procedure. Afterward, mild headache and a feeling of fullness in the face are common and controlled with simple pain relievers. Patients usually return to desk work in 5-7 days, and to heavy physical work in 2-3 weeks.
Will I have packing in my nose?
In modern endoscopic surgery, classic gauze packing is often not needed. Self-dissolving/absorbable packings or thin silicone splints are generally preferred, which significantly improves comfort.
I had surgery for polyps; will my sense of smell return?
Loss of smell is common in polyposis and chronic sinusitis. Significant improvement in smell is possible after surgery combined with medical therapy; however, recovery may take months and varies by patient.
Related Information
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Nasal Polyp Surgery
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Nasal polyp surgery — endoscopic removal of nasal polyps using the FESS technique.
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Nasal aspiration — controlled suction clearance of nasal secretions, especially in infants and young children.
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Allergy test
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Allergy test (ENT) — detection of sensitivity to inhalant allergens through skin prick testing.
Salivary Gland Surgery
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Rhinoplasty — surgical correction of functional and structural deformities of the nose.