Sinus surgery FESS

Overview

Sinus surgery (often called Functional Endoscopic Sinus Surgery or FESS) is a procedure to open blocked sinuses. The sinuses are small, air-filled spaces inside the bones of your face and skull. When they become inflamed or infected for a long time (chronic sinusitis), surgery can help drainage and airflow.

Sinus surgery is a common procedure. Thousands of people have it each year in the UK and around the world.

It mainly affects adults with chronic sinusitis. Children may have it less often, and only if their sinus problems don't get better with standard treatments.

Symptoms

Common symptoms

• Long-lasting stuffy nose or blocked nose
• Pain or pressure in the face (around the eyes, forehead, or cheeks)
• Thick yellow or green discharge from the nose
• Reduced sense of smell or taste
• Headache that doesn't go away

Symptoms in children

• Constant runny nose or stuffy nose
• Ear pain or trouble hearing
• Irritability or trouble sleeping
• Worsening of asthma symptoms

Symptoms in older adults

• Same common symptoms, but may also have dizziness or balance problems
• Feeling very tired
• Less appetite or weight loss

Causes

Main causes

• Chronic inflammation of the sinuses (chronic sinusitis) – often due to allergies or infection
• Nasal polyps – small growths in the nose that block sinus drainage
• A deviated septum – the wall inside the nose is crooked, blocking airflow

Risk factors

• Allergies (hay fever, dust mite allergy)
• Asthma
• Smoking or exposure to smoke
• A weak immune system (due to illness or medicines)
• Previous sinus infections that were not fully treated

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above

Book a routine appointment if:

• If you have sinus symptoms that last longer than 12 weeks despite trying self-care or medicines
• If you have frequent sinus infections (more than 4 per year)
• If you have nasal polyps that affect your breathing or sense of smell

Diagnosis

A doctor will ask about your symptoms and examine your nose and face. They may use a thin, lighted tube (endoscope) to look inside your nose.

Tests that may be done

• Nasal endoscopy – a small camera goes into your nostrils to see the sinuses
• CT scan – a special X-ray that gives clear pictures of the sinuses
• Allergy testing if allergies are suspected
• Sometimes a sample of discharge is taken to check for infection

What to expect at your appointment

The diagnosis is usually straightforward. Your doctor will explain what they find and discuss treatment options, which may include medicines or surgery if needed.

Treatment

Treatment starts with medicines and self-care. Surgery (FESS) is considered only when these don't work well enough.

Self-care at home

• Use a saline (salt water) nasal spray or rinse to keep the nose moist
• Inhale steam from a bowl of hot water (be careful not to burn yourself)
• Avoid smoke, strong perfumes, and other irritants
• Drink plenty of fluids to thin mucus
• Get enough rest

Medical treatments

Doctors may prescribe nasal steroid sprays, antihistamines (for allergies), or antibiotics for bacterial infections. These are given by your doctor based on your specific situation. Never take antibiotics without a prescription.

When is surgery considered?

Surgery (FESS) may be recommended if chronic sinusitis does not improve after 12 weeks of medical treatment, or if there are nasal polyps blocking the sinuses. FESS is done under general anaesthesia (you are asleep). The surgeon uses a small camera and instruments through the nostrils to open blocked sinus passages and remove any polyps or diseased tissue.

Living with this condition

After FESS, you may have some bleeding, stuffiness, and mild pain for a few days. Most people go home the same day. You will need to rinse your nose with salt water several times a day to help healing.

Lifestyle tips

• Avoid heavy lifting or strenuous exercise for about 2 weeks after surgery
• Do not blow your nose forcefully for at least a week
• Use a humidifier at home if the air is dry
• Stay away from people who are smoking or have colds

Diet and exercise

Eat a balanced diet with plenty of fruits and vegetables to support healing. Drink lots of water. Light walking is fine, but avoid contact sports or swimming until your doctor says it's safe.

Mental health and emotional wellbeing

Chronic sinus problems can be frustrating and affect your sleep and energy. Surgery can improve symptoms, but recovery takes patience. Some people feel anxious about the procedure or the recovery. Talk to your doctor or a counselor if you feel overwhelmed.

Prevention

You can't always prevent sinus problems, but you can lower your risk. Avoid smoking, treat allergies promptly, and keep your nasal passages moist.

Vaccines

Getting the flu vaccine and pneumonia vaccine (if recommended by your doctor) may help prevent infections that could lead to sinusitis.

Screening programmes

There is no routine screening for sinus problems. If you have persistent symptoms, see your doctor.

Complications

If left untreated

• Chronic sinusitis can cause nasal polyps to grow larger and block the nose completely
• In rare cases, infection can spread to the eye or brain, causing serious illness
• Persistent symptoms can affect your quality of life, sleep, and ability to work or study

Long-term outlook

For most people, FESS greatly improves sinus symptoms. Many feel better than they have in years. Full recovery takes a few weeks to months, and some people need to continue using nasal rinses or sprays. The outlook is very good – most people are satisfied with the results.

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