17478 Functional Endoscopic Sinus Surgery

Overview

Functional endoscopic sinus surgery (FESS) is an operation that widens the small drainage openings of your sinuses. Your sinuses are air-filled spaces in the bones around your nose, cheeks and forehead. They drain through tiny channels into your nose. When those channels stay blocked, mucus builds up and the sinuses become inflamed and infected again and again. During FESS, the surgeon passes a thin, flexible tube with a tiny camera (an endoscope) through your nostrils. This lets them see inside your nose on a screen and gently remove blocked tissue, polyps or narrow bone, so air and mucus can flow again. There are no cuts on the outside of your face, so there is no visible scarring.

Yes. Sinus surgery is one of the more common operations done by ear, nose and throat (ENT) specialists, and long-lasting sinus inflammation is very common in the general population.

It is most often done in adults with long-lasting sinus problems that have not settled with medicines. It can also be done in children in selected cases, and in older adults. People with nasal polyps (small fleshy growths inside the nose), allergies or asthma are more likely to be offered it.

Symptoms

Common symptoms

• A blocked or stuffy nose that lasts for weeks or months
• Thick yellow or green mucus dripping from the nose or down the back of the throat
• Pressure, aching or pain in the face, cheeks, forehead or around the eyes
• Reduced sense of smell, or food tasting bland
• Headache, especially in the morning or when bending forward
• Tiredness, poor sleep and trouble concentrating
• A cough at night, or a scratchy throat from mucus dripping down
• Bad breath or a bad taste in the mouth

Symptoms in children

• A blocked nose and mouth breathing, especially at night
• Snoring or restless sleep
• A cough that is worse at night
• Irritability, clinginess or poor appetite
• Sometimes ear problems or speech sounding blocked
• Children may not describe facial pain clearly, so watch for tugging at the nose or face

Symptoms in older adults

• Symptoms are similar, but may be put down to ageing or 'just a cold' for longer than they should be
• Reduced smell and taste can affect appetite and nutrition
• Poor sleep and tiredness may be more noticeable
• Other health conditions and medicines can affect treatment choices, so a full review is helpful
• Dryness in the nose is more common with age and can make symptoms feel worse

Causes

Main causes

• Long-lasting sinus inflammation (chronic sinusitis) that does not improve with medicines
• Nasal polyps — soft, fleshy growths inside the nose that block the drainage channels
• Repeated sinus infections that keep coming back
• Allergies that keep the lining of the nose swollen
• A blocked or narrow drainage channel, sometimes because of the shape of the bone or a bent dividing wall inside the nose (deviated septum)
• Fungal growths inside the sinuses in some people

Risk factors

• Asthma or allergy-related conditions
• Nasal polyps, or a family history of them
• Smoking or living with someone who smokes
• Exposure to dust, pollution or chemical irritants at work
• Frequent colds or infections in childhood
• A weakened immune system or certain long-term health conditions
• Untreated dental problems in the upper jaw, which can occasionally spread to the sinuses

When to see a doctor

See a doctor urgently if:

• You have swelling, redness or pain around one or both eyes
• You have a fever with severe face pain or a badly blocked nose that is getting worse
• Your vision changes in any way
• You have bleeding after surgery that will not stop, or a lot of clear fluid from the nose
• Pain after surgery is severe or getting worse instead of better

Book a routine appointment if:

• Nasal symptoms have lasted more than 10 to 12 weeks
• You have had several sinus infections in a year
• Your sense of smell has faded or gone
• Sleep, work or mood are being affected by your nose symptoms
• Medicines from your doctor are not helping enough
• You want to talk about whether sinus surgery might be right for you

Diagnosis

An ear, nose and throat (ENT) specialist will ask about your symptoms, how long you have had them and what treatments you have already tried. They will look inside your nose, often using a thin camera on a small tube, to see the drainage channels and check for polyps. A scan of your sinuses may be arranged to show exactly where the blockage is. Before surgery is offered, you will usually have tried a course of medical treatment for several weeks to months.

Tests that may be done

• A careful examination of your nose, sometimes with a thin flexible camera (nasal endoscopy)
• A CT scan of your sinuses, which is a painless X-ray-based scan that shows the air spaces clearly
• Allergy testing, such as skin prick tests or a blood test
• A swab or sample of mucus if an infection is suspected
• A smell test in some clinics
• Routine blood tests and a heart tracing (ECG) before surgery, to check you are fit for the anaesthetic

What to expect at your appointment

The camera examination can feel a little odd or tickly, but it is quick and usually not painful. You may be given a numbing spray first. The CT scan takes only a few minutes and does not hurt. You will then have a conversation about what was found, what the options are, and what surgery would involve, including the risks and the likely recovery time.

Treatment

Treatment usually starts with medicines and simple nose care, given over several weeks to months. If symptoms still affect your daily life after that, surgery may be discussed. Functional endoscopic sinus surgery is one option, and it is often combined with ongoing medical treatment afterwards.

Self-care at home

• Rinse your nose with salt water (saline) using a rinse bottle, spray or neti pot — ask your pharmacist which is suitable and use cooled, boiled or sterile water
• Use steam from a bowl of hot water or a warm shower to loosen thick mucus
• Keep rooms moist with a humidifier and avoid very dry, smoky or dusty air
• Drink plenty of fluids through the day
• Sleep with your head slightly raised to help drainage at night
• Avoid smoking and stay away from smoky places
• Follow your care team's instructions carefully after surgery, including gentle nose rinses and avoiding heavy lifting or nose blowing

Medical treatments

Doctors commonly use anti-inflammatory nose sprays to reduce swelling in the nose lining, salt-water rinses to clear mucus, and a short course of anti-inflammatory tablets for flare-ups. Antibiotics are only used when there are signs of a bacterial infection. Allergy treatment, such as antihistamines or allergy avoidance, can help if allergies are part of the picture. Your clinician will choose what suits you, review how it is working, and change the plan if needed. Always follow the instructions given to you and ask your pharmacist if you are unsure about anything.

When is surgery considered?

Surgery may be suggested if symptoms continue after a good trial of medical treatment, if polyps keep blocking the nose, if infections keep returning, or if there are signs that infection is spreading beyond the sinuses. FESS is done under a general anaesthetic through the nostrils. The surgeon removes polyps, opens narrow drainage channels and clears infected tissue, using a camera for guidance. It usually takes about one to two hours. You may have mild packing or dissolving material in the nose afterwards, and some people stay in hospital overnight. Most people have some bloody mucus, blocked nose and mild discomfort for the first week or two, and then notice gradual improvement. As with any operation there are risks, including bleeding, infection, scar tissue, and rarely injury to the eye or a leak of fluid around the brain. Your surgeon will explain these in detail.

Living with this condition

In the first week after surgery, plan to rest. Your nose will feel blocked and you may have some blood-stained discharge, which is normal. Avoid blowing your nose hard, heavy lifting, straining and strenuous exercise for the time your team advises, usually around one to two weeks. Most people take one to two weeks off work, depending on the job. Improvement is usually gradual over several weeks to a few months, and ongoing nose rinses and sprays help keep the channels open.

Lifestyle tips

• Avoid cigarette smoke and vaping, and ask others not to smoke near you
• Keep up with allergy control at home — wash bedding often and reduce dust
• Use a humidifier in dry weather or in air-conditioned rooms
• Wear a mask if your work exposes you to dust or fumes
• Keep up regular salt-water nose rinses during the recovery period
• Attend your follow-up appointments so your team can check healing and clear any crusting

Diet and exercise

Eat and drink normally after surgery, and drink plenty of water to keep mucus thin. Gentle walking is fine and helps circulation. Avoid strenuous exercise, swimming, diving and flying for the period your surgical team advises, usually a few weeks. Alcohol can increase bleeding risk in the early days after surgery, so it is best avoided for a short while.

Mental health and emotional wellbeing

Long-lasting nose problems can wear you down. Poor sleep, a reduced sense of smell and constant blocked breathing can affect mood, concentration and confidence. It is also normal to feel nervous before surgery or worried during recovery. Tell your care team how you are feeling — support is available, and small setbacks in recovery are common and usually temporary.

Prevention

Not all sinus problems can be prevented, especially when polyps or the shape of your nose are involved. But good nose care, treating allergies, avoiding smoke and getting infections treated early can reduce flare-ups and may lower the chance of needing surgery in the future.

Vaccines

Keep up to date with the vaccinations your doctor recommends for you. Annual flu vaccination and other routine jabs can help you avoid infections that trigger sinus flare-ups. Ask your GP or pharmacist what is suitable for you.

Screening programmes

There is no routine screening test for sinus problems. If symptoms keep returning, see your doctor rather than waiting.

Complications

If left untreated

• Ongoing blocked nose, facial pain and poor sleep
• Repeated sinus infections needing repeated courses of treatment
• Nasal polyps growing larger and further blocking the nose
• Loss of sense of smell that may become long lasting
• Effects on work, school, mood and concentration
• Rarely, infection spreading to the eye or, very rarely, around the brain
• Rarely, infection spreading to the bone or to nearby teeth

Long-term outlook

The outlook is generally good. Most people who have sinus surgery notice less blockage, fewer infections and better quality of life, with improvement building over weeks to months. Some people need ongoing nose sprays and rinses, and a small number need further surgery later on. Working closely with your ENT team gives you the best chance of a good result.

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