15854 Sinus Surgery Overview

Overview

Sinus surgery is an operation to open up the air-filled spaces in the face and forehead that we call sinuses. These spaces drain into the nose through small openings. When those openings stay blocked, mucus builds up and the sinuses become infected or inflamed. The most common type is called functional endoscopic sinus surgery. The surgeon uses a thin tube with a camera (an endoscope) passed through the nostrils, so there is usually no cut on the face. They remove small pieces of tissue, polyps or bone that are blocking drainage, and widen the natural openings so air and mucus can flow again.

Yes. Sinus surgery is one of the more common operations done by ear, nose and throat specialists. It is used for people whose sinus problems keep coming back or never fully clear, and for those with nasal polyps (soft fleshy growths inside the nose).

It can be needed at any age, but it is most often done in adults with long-lasting sinusitis (sinus inflammation lasting more than 12 weeks) or nasal polyps. Children sometimes need it too, but doctors are more cautious and usually try other treatments first. Older adults can have it safely, though the care team will review other health conditions and medicines carefully beforehand.

Symptoms

Common symptoms

• A blocked or stuffy nose that does not clear with usual treatment
• Thick mucus or discharge from the nose, or mucus dripping down the back of the throat
• Pressure, fullness or pain in the face, forehead, around the eyes or upper teeth
• Headache that is often worse when bending forward
• Reduced sense of smell or taste
• Bad breath or a bad taste in the mouth
• Cough that is worse at night
• Feeling tired or worn down, and poor sleep because of blocked breathing

Symptoms in children

• A runny or blocked nose that lasts for weeks
• Breathing through the mouth and snoring at night
• Irritability, poor sleep and tiredness during the day
• Pulling at the ears or complaining of ear discomfort
• Reduced appetite or fussiness with feeding in younger children
• A cough that lingers, especially at night

Symptoms in older adults

• Symptoms that are less obvious, such as tiredness, a low-grade cough or generally feeling unwell
• A blocked nose that is put down to 'just age' or 'just allergies'
• Poor sleep and day-time drowsiness from mouth breathing
• More chance of symptoms being confused with other long-term conditions, so a careful review is helpful

Causes

Main causes

• Long-lasting sinusitis (sinus inflammation) that does not clear with medicines
• Nasal polyps — soft, fleshy growths that block the nose and sinuses
• Allergies that keep the lining of the nose swollen
• A curved or crooked wall inside the nose (deviated septum) or other shape problems that narrow the drainage openings
• Repeated infections, or a single infection that never fully settles
• Fungal growths inside a sinus (less common)
• Problems with the immune system that make infections more likely

Risk factors

• Asthma, especially when it comes with polyps
• Allergies such as hay fever
• Smoking or being around tobacco smoke
• Conditions that affect the immune system
• Cystic fibrosis or other conditions that make mucus thick
• Dental problems in the upper teeth that can spread to a sinus
• Working or living in dusty or polluted air

When to see a doctor

See a doctor urgently if:

• Fever with worsening facial pain or swelling
• Any swelling, redness or puffiness around an eye
• Vision changes, double vision, or severe one-sided headache
• A severe nosebleed that will not stop
• Symptoms that are quickly getting worse rather than better

Book a routine appointment if:

• Sinus symptoms lasting more than 10 days, or that keep coming back several times a year
• Symptoms that have not improved after a full course of treatment from your doctor
• A blocked nose or loss of smell that lasts for weeks
• Sinus problems that are affecting sleep, work, school or mood
• You are considering surgery and want to talk through the options

Diagnosis

Your doctor will ask about your symptoms, how long they have lasted and what treatments you have already tried. They may look inside your nose with a small camera on a thin tube (nasal endoscopy) to see swelling, polyps or pus. If surgery is being considered, a scan is usually arranged to show exactly which sinuses are blocked. Allergy tests or other checks may be suggested if allergies or other conditions seem to be playing a part.

Tests that may be done

• A full history and physical examination, including looking in the nose and throat
• Nasal endoscopy — a tiny camera passed gently into the nostril to see inside
• CT scan of the sinuses to show blockage and help plan surgery
• Allergy testing, such as skin prick tests or blood tests
• Sometimes a sample of mucus or tissue to check for infection
• In some cases, blood tests or a lung check if asthma or another condition is suspected

What to expect at your appointment

The assessment is usually straightforward and does not hurt. Nasal endoscopy can feel a little strange or tickly, and a spray is often used first to make it more comfortable. A CT scan is quick and painless. You will usually be told the results and the next steps at a follow-up appointment, and you can bring a list of questions with you.

Treatment

Treatment starts with the least invasive options. Many people improve with nasal rinses, medicines to reduce swelling, and treatment for allergies. If symptoms continue after a good trial of these, or if polyps are blocking the nose, surgery may be discussed. The aim of surgery is to improve drainage and breathing, not to remove all sinus tissue. It is usually done together with ongoing medical treatment.

Self-care at home

• Rinse the nose gently with salt water (saline) as advised — this helps clear mucus and reduce irritation
• Use a humidifier or steam from a warm shower to keep the air moist
• Drink plenty of fluids to keep mucus thin
• Avoid smoke, strong smells and dusty places
• Sleep with your head slightly raised if you feel congested at night
• Follow your care team's instructions after surgery about lifting, blowing your nose and returning to normal activity

Medical treatments

Doctors use a range of approaches before considering surgery. These can include salt-water nasal rinses, nasal sprays that reduce swelling in the nose lining, medicines to control allergies, and antibiotics if there is a bacterial infection. Some people are helped by a short course of steroid tablets when polyps are a problem. Your doctor will explain which options suit you, how long to try them, and what to expect — always ask your pharmacist or doctor before starting or stopping any medicine.

When is surgery considered?

Surgery is usually considered when symptoms have continued for many weeks or months despite good medical treatment, when nasal polyps keep blocking the nose, or when a sinus infection has spread beyond the sinus (which is uncommon and needs urgent care). It may also be offered when repeated infections are seriously affecting daily life. Your specialist will talk through the expected benefits, the risks, and what recovery involves so you can decide together.

Living with this condition

Most people notice a difference in breathing and facial pressure within a few weeks of surgery, though full healing can take a couple of months. Expect some stuffiness, mild bleeding and crusting at first. Your care team will usually arrange follow-up visits to clear the nose gently and check healing. Keep up nasal rinses as advised and be patient — improvement is often gradual rather than instant.

Lifestyle tips

• Keep away from cigarette smoke and vaping, which irritate healing tissue
• Follow your after-surgery plan for rest, then build activity back up slowly
• Use salt-water rinses regularly in the early weeks, as directed
• Avoid blowing your nose hard, straining, or heavy lifting until cleared
• Keep rooms well ventilated and not too dry
• Treat allergies early so they do not stir up sinus symptoms

Diet and exercise

There is no special diet for sinus problems, but eating a balanced diet and drinking enough fluid helps keep mucus thin. After surgery, gentle walking is fine once you feel ready, but avoid strenuous exercise, swimming and heavy lifting until your care team says it is safe — usually a couple of weeks. Ask before flying or travelling far in the first few weeks.

Mental health and emotional wellbeing

Long-standing sinus problems can wear you down. Poor sleep, facial pain and a blocked nose can affect concentration, work, school and mood, and it is common to feel frustrated or anxious. Feeling nervous before surgery is also very normal. Talking to your doctor, a nurse or a counsellor can help. If low mood or worry is lasting or feels overwhelming, please reach out to your local mental health service or crisis support line — you do not have to cope alone.

Prevention

You cannot always prevent sinus problems that need surgery, especially if polyps or the shape of your nose are involved. But good day-to-day care can reduce how often sinuses get inflamed: keep allergies under control, avoid smoke and dust, use salt-water rinses when you feel congested, treat colds gently and see your doctor if symptoms linger. After surgery, following your follow-up plan helps keep the openings clear.

Vaccines

Keeping up to date with recommended vaccinations, including flu and other routine jabs your doctor advises, can help you avoid infections that trigger sinus flare-ups. Ask your pharmacist or local health service what is recommended for you.

Screening programmes

There is no general screening test for sinus problems. If you have asthma, allergies or polyps, regular check-ups with your doctor can help spot problems early and keep treatment on track.

Complications

If left untreated

• Symptoms that continue or get worse, affecting sleep, work and mood
• Repeated courses of antibiotics and time off work or school
• Nasal polyps that grow and further block breathing and smell
• Rarely, infection spreading to the eye or the area around the brain — this is uncommon but serious and needs emergency care
• Long-term loss of smell that may not fully return

Long-term outlook

The outlook is generally good. Most people who have sinus surgery notice easier breathing, less facial pressure and fewer infections, especially when they keep up nasal rinses and treat allergies. Some people need further treatment or, occasionally, another operation over time. Surgery is not a cure-all, but for the right person it can make a real difference to comfort and quality of life.

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