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Functional Endoscopic Sinus Surgery (FESS)

What is a nasal polyp? What is chronic rhino-sinusitis?

Nasal polyps
Nasal polyps

Nasal polyps are non-cancerous, painless, teardrop or grape shaped swollen outgrowths on the lining of the nose or sinuses. They develop as a result of chronic or reccurrent rhino-sinusitis, due to asthma, allergies, drug sensitivity or certain immune disorders.

While small nasal polyps may not cause any symptoms, larger growths or groups of nasal polyps can block the nose and lead to breathing problems, a loss of the sense of smell, and infections. Large nasal polyps can also change the shape of the nose itself.

Chronic rhino-sinusitis is an inflammation of the nose and sinuses (lasting usually for at least 3 months) that does not improve sufficiently with pharmaceutical treatment. Symptoms of chronic rhino-sinusitis include a blocked and/or runny nose, facial pain, headache, reccurrent lower respiratory tract infections, and bronchial asthma.

When is FESS (functional endoscopic sinus surgery) recommended?

The most common reasons for endoscopic sinus surgery are chronic rhino-sinusitis and nasal polyps, while less common reasons include recurrent infections, an impaired sense of smell, sinus infections that spread to the eyes, face or brain, tumors of the nasal and sinus cavities (cancerous or non-cancerous growths), CSF leaks (in which the cerebrospinal fluid escapes through the nasal passages), and blocked tear ducts.

How is the surgery performed?

FESS surgery may be performed under local or general anesthesia based on the extent and duration of the intervention, and takes around 30 to 80 minutes.

During the procedure, our surgeon inserts an endoscope (a small tube) with a tiny camera  through the nostrils to inspect the nose and the sinuses. Afterwards small instruments are used to remove polyps and other obstructions, and to enlarge the narrowed openings that connect the sinuses to the nose, which in turn improves drainage from the sinuses into the nasal cavity.

Sometimes in combination with sinus surgery, an operation of the nasal septum and inferior turbinates may also be necessary. For further information about the procedure information about the procedure please visit our septoplasty page.

What are the risks and benefits of the surgery?

The main goal of sinus surgery is to improve sinus drainage. By widening the natural drainage pathway, it is possible to reduce the risk of sinus infections. The removal of nasal polyps may improve breathing significantly. As an additional benefit, medications (sprays, rinses, nebulized medications) delivered directly to the lining of the sinuses may become more effective.

Complications of sinus surgery are rare. They may include bleeding, damage to the eyes or vision, and intracranial complications (brain injury, brain fluid leak, brain infection). However, it is important to note that the sinuses are found next to the orbits (eye sockets), directly below the brain. A failure to treat chronic rhino-sinusitis in itself may lead to serious problems, such as infections of the eyes or brain.

Before the operation you will receive a patient information sheet and an informed consent form which will provide you with detailed information regarding the risks of the operation, as well as what to expect before, during and after the FESS surgery. By all means feel free to discuss the possible risks or any other concerns with your ENT surgeon before making a treatment decision.

There are certain risks associated with general anesthesia too, these will be explained to you on a separate information sheet. You will be required to sign a second informed consent form regarding anesthesia. You will also have some preoperative tests to ensure that these risks are reduced to minimum.

It is important to call your surgeon immediately if you develop a fever, a permanent nosebleed, vomiting or a severe headache after your release from the hospital.

Am I a good candidate for FESS?

Your ENT (ear, nose and throat) surgeon will decide if surgery is necessary in your particular case.

You will be asked to undergo some tests (nasal endoscopy, blood and allergy tests, CT scan of the nasal cavity and paranasal sinuses, ECG), and to see your anesthesiologist and internist before your operation. This is to ensure that your general health allows a sinus surgery under general anesthesia to be carried out safely.

All of our patients are asked to complete a detailed medical history form. It is important to fill out the questionnaire to the best of your knowledge because the answers you provide will help our surgeon decide whether you are eligible for FESS.

How to prepare for the surgery?

  • Prepare a list of all of your symptoms and any known medical conditions, past illnesses and allergies, even if they seem unrelated to your current condition. For this purpose, you will be given a detailed form to complete, followed by a physical examination.
  • Be aware of any restrictions to adhere to prior to procedure. Your ENT surgeon will provide you with all the information you need to prepare for the diagnostic tests.
  • List all the drugs and medications you take, including vitamins and supplements
  • Ask a family member or friend to accompany you to your appointment and aks them to help you recall the information to be provided during your consultation.
  • Before surgery you will receive a patient information sheet and an informed consent form which you will be requested to read carefully and sign. These documents will contain everything you need to know regarding preparation, the surgery itself and recovery.

What to expect after FESS?

You can expect to have mild to moderate pain during the first few days after surgery because of the nasal packing. The pain can be significantly reduced by the use of oral pain killers. Removal of the nasal packing may cause some discomfort the degree of which may vary depending on individual sensitivity. You may expect nasal stuffiness, discomfort, and drainage for about 3 to 10 days. The day after the surgery swelling around the nose is normal.

You should only take medication approved by the ENT surgeon at our clinic. In order to ensure a safe and fast recovery follow your doctor’s recommendation at all times regarding post-operative care.

It is normal if you feel a bit groggy and sleepy for about a day after surgery due to general anesthesia.

If there is no bleeding, you will be discharged on the day after surgery. You will be advised to rest as much as possible for about two weeks. Your surgeon will be able to give you more detailed information and advice.

For 2-3 weeks after surgery you will be advised to avoid any intense physical activity that may increase the risk of nosebleeds.

You need to be careful when blowing your nose. In the first few days you are advised to wipe your nose without blowing. Afterwards you may gradually start blowing your nose.

You may be asked to use a nasal oil/ointment and irrigation set after your surgery for up to 3-4 weeks.

Why is regular check-up important after FESS?

The first follow-up exam will take place a week after surgery. At this appointment you will receive a nasal cleaning treatment to prevent infections and the development of adhesions. The second follow-up exam is usually due 2 weeks after surgery. Afterwards, regular follow-ups are necessary to stop polyps from reappearing.