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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 reccurring 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, lost 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 running nose, facial pain, headache, reccurrent lower respiratory tract infections, and bronchial asthma.

When do you need functional endoscopic sinus surgery (FESS)?

Most common reasons for endoscopic sinus surgery are chronic rhino-sinusitis and nasal polyps, while less common reasons include recurrent infections, impaired sense of smell, sinus infections that spread to the eye, face or brain, tumors of the nasal and sinus cavities (cancerous or non-cancerous growths), leaking brain fluid into the nose, and tear duct blockage.

How does the procedure work?

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 view the nose and the sinuses. Afterwards small instruments are used to remove polyps and other obstructions, enlarge the narrow openings that connect the sinuses to the nose, which in turn improves the drainage from the sinuses into the nose.

Sometimes during sinus surgery, the nasal septum and inferior turbinates may require surgery as well is. Additional information about surgery of the nasal septum and turbinates is provided under the description of the respective operation.

What are the benefits and risks of the operation?

The main goal of sinus surgery is to improve the drainage pathway of the sinuses. By widening the natural drainage pathway, sinus infections should be reduced, and by removing nasal polyps, nasal congestion and breathing improves significantly. As a secondary benefit, medications (sprays, rinses, nebulized drugs) delivered directly to the lining of the sinuses may become more efficacious.

Potential complications of sinus surgery are rare but include bleeding, damage to the eye or vision, and intracranial complications (brain injury, brain fluid leakage, infection of the brain). However, it is important to note that the sinuses are found next to the orbits (eye sockets) and directly beneath the bottom of the brain. Failure to treat chronic rhino-sinusitis in itself may lead to severe problems, such as infection of the eye or brain.

You will get a patient information sheet and informed consent form for detailed information about FESS surgery, risks of the operation, and perioperative tasks. By all means, you will discuss with your doctor the possible risks of surgery before you make a treatment decision.

There are certain risks associated with general anaesthesia, for which we will provide a separate information sheet and an informed consent form. The tests that you will have before your surgery will ensure that these risks are reduced to minimum.

  • It is important to call your surgeon immediately in case of fever, permanent nasal bleeding, vomiting or serious headache.

Am I a good candidate for functional endoscopic sinus surgery?

Your ENT (ear, nose and throat) surgeon will advise surgery as necessary.

You will be asked to undergo some tests (nasal endoscopy, blood and allergy test, nose and paranasal sinus CT, ECG), and to see your anaesthesiologist and internist before your operation to ensure that your overall health condition is good enough to safely allow a FESS surgery in general anaesthesia.

All of our patients are asked to complete a detailed medical history form that is necessary for our surgeon and physicians so that they can decide if you are suitable for FESS surgery.

How should I prepare for the surgery?

  • Prepare a list of all of your symptoms and other medical conditions, past illnesses and allergies, even if they seem unrelated to your nose or sinuses. For this reason, you will receive a detailed test to complete, followed by a physical examination.
  • Be aware of any pre-appointment restrictions. Your ENT surgeon will provide you with all the information regarding preparation for the diagnostic tests.
  • List all your medications and drugs, including vitamins and supplements
  • Ask a family member or friend to accompany you, someone who can help you recall all the information need to be provided during your consultation.
  • Before surgery you will get a patient information sheet and an informed consent form with the necessary pre- and postoperative information to read and sign.

What should I do after FESS?

In case of nasal packing you can expect to have mild to moderate pain during the first postoperative days. This can be well controlled with oral pain killers. Nasal packing removal may cause some discomfort depending on individual sensitivity. You may expect nasal stuffiness, discomfort, and drainage for 3 to 10 days. The day after the surgery swelling around the nose is normal.

You should only take medications approved at our clinic, and check with your ENT surgeon about any post-operative care you will need to perform to allow your nose to recover properly.

It is normal if you feel slowed down and deconcentrated for about a day after the surgery due to general anaesthesia.

If there is no bleeding, you will be discharged on the first postoperative day. You will usually be advised to rest for around two weeks after surgery. 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 intensive physical activities that may lead to nose bleeding.

You need to be careful when blowing your nose. In the first few days you are advised to wipe your nose and avoid blowing. Afterwards you may gradually start blowing your nose.

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

Why is regular check-up important after FESS?

The first control examination is due after a week, when a nasal cleaning treatment is needed to prevent nasal infections and formation of adhesions. The second control is usually due within 2 weeks. Afterwards regular check-up is needed to recognize any polyp reappearance.