Functional endoscopic sinus surgery (FESS) that clears the nose and sinuses for nasal polyps unresponsive to medical therapy.
Indication
- Nasal polyps unresponsive to maximum medical therapy (steroid spray, oral steroid, antiallergic)
- Chronic rhinosinusitis with persistent nasal obstruction, runny nose, and loss of smell
- Recurrent sinus infections and headache attacks
- Aspirin sensitivity + asthma + nasal polyps triad (Samter's triad)
- Imaging showing a mass completely obstructing the sinuses due to polyps
- Widespread nasal polyps developing in childhood on a background of cystic fibrosis
Preparation
- A paranasal sinus CT (tomography) scan is performed before the procedure
- Anesthesia consultation, blood tests, and an ECG when indicated
- Aspirin, blood thinners, and certain herbal products are stopped with physician approval
- Patients planned for general anesthesia fast from food and fluids for 6-8 hours
- If active sinus infection is present, appropriate antibiotic therapy is completed first
How it's performed
- The patient is brought to the operating room and vital signs are monitored
- General anesthesia is usually administered; in selected cases local anesthesia plus sedation may be preferred
- A thin endoscope and specialized microsurgical instruments are introduced through the nostrils; no skin incision is made
- Polyps and diseased mucosa are cleared using techniques (FESS) that protect the sinus openings
- If needed, the sinus openings are widened, and septal deviations may be corrected in the same session
- Bleeding is controlled; an absorbable pack or silicone splint may be placed
Post-procedure
- Discharge usually on the same day or after one overnight stay
- Regular saline nasal rinses for the first 2 weeks and use of the steroid spray prescribed by the physician
- Endoscopic cleaning (debridement) is performed at the first follow-up
- Most patients continue long-term nasal steroid therapy because of polyp disease
- Follow-up visits are scheduled at 3, 6, and 12 months to monitor for polyp recurrence
Risks
- Bleeding; rarely requires additional intervention
- Polyp recurrence — more common with concurrent aspirin sensitivity and asthma
- Temporary or permanent loss of smell
- Very rare injury to structures adjacent to the eye socket or skull base
- Development of intranasal adhesions (synechiae)
FAQ
Can polyps recur after surgery?
Nasal polyposis is a chronic condition; surgery substantially relieves symptoms but recurrence is possible. Regular use of steroid sprays and follow-up visits reduce the risk of recurrence.
Will I have nasal packing, and is its removal painful?
Modern practice mostly uses dissolvable packing; classic packing, when used, is removed after 24-48 hours. Discomfort during removal is manageable with appropriate analgesia.
Will my sense of smell return?
After polyps are removed, most patients experience partial or full recovery of smell; however, in patients with long-standing loss, recovery may be limited.
When can I return to work?
Office workers usually return within 5-7 days; those doing heavy physical work after about 2 weeks. Heavy lifting and forceful nose-blowing are not recommended for 2-3 weeks.
Related Information
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