FESS (Sinusitis)

Functional Endoscopic Sinus Surgery (FESS) -Sinusitis

What are the sinuses?

Sinuses are air-filled cavities located around the nose and eyes. They produce mucus that drains into the nasal cavity, helping keep the nose moist, filtering air, and protecting against infection.

What is the role of healthy sinuses?

• Allow normal airflow and mucus drainage
• Help humidify and filter inhaled air
• Reduce weight of the skull
• Contribute to voice resonance

What symptoms are associated with sinus disease?

• Persistent nasal blockage
• Thick nasal discharge or post-nasal drip
• Facial pain or pressure
• Headache, especially around eyes or forehead
• Reduced sense of smell
• Recurrent fever during sinus infections
• Snoring or disturbed sleep

When is medical help required?

Medical evaluation is advised if sinus symptoms persist beyond 10–12 weeks, if infections recur frequently, if facial pain or nasal blockage affects daily activities, or if symptoms do not respond adequately to medical treatment.

What treatment options are available for sinus disease?

Non-surgical treatment

1. Antibiotics for bacterial sinus infections
2. Nasal steroid sprays to reduce inflammation
3. Saline nasal irrigation
4. Antihistamines when allergy is associated
5. Medical management is the first line of treatment

Surgical treatment (definitive treatment)

When is functional endoscopic sinus surgery recommended?

1. Chronic sinusitis not responding to adequate medical therapy
2. Blocked sinus drainage pathways causing repeated infections
3. Nasal polyps causing obstruction and recurrent symptoms
4. Fungal sinusitis requiring surgical clearance
5. Complications of sinusitis affecting the eyes or brain
6. Recurrent acute sinusitis with anatomical obstruction
7. Sinus disease associated with deviated nasal septum or turbinate enlargement

What situations commonly require FESS?

• Chronic rhinosinusitis lasting more than 12 weeks
• Recurrent sinus infections despite proper medications
• Nasal polyposis with nasal blockage
• Mucoceles or sinus cysts
• Fungal sinus infections
• Sinus-related headache with proven blockage
• Failure of previous sinus surgery

How is functional endoscopic sinus surgery performed?

1. The surgery is performed under general anaesthesia
2. A thin endoscope is inserted through the nostrils
3. No external cuts or facial scars are made
4. Blocked sinus openings are widened
5. Diseased tissue, polyps, or infected material is removed
6. Normal sinus drainage pathways are restored
7. Surgery duration varies depending on disease extent

What procedures may be combined with FESS?

1. Septoplasty for deviated nasal septum
2. Turbinoplasty for enlarged turbinates
3. Polypectomy for nasal polyps
4. Combined surgery improves overall nasal airflow and outcomes

What are the benefits of functional endoscopic sinus surgery?

• Improved sinus drainage
• Reduction in frequency and severity of infections
• Relief from facial pain and pressure
• Improved nasal breathing
• Better sense of smell in selected patients
• Improved quality of life
• Reduced dependency on long-term medications

What are the possible limitations and risks?

1. Temporary nasal blockage during healing
2. Mild bleeding or nasal crusting
3. Need for postoperative nasal care
4. Rare risk of injury to surrounding structures
5. Symptoms may recur if underlying allergy is not controlled

How does recovery and after care progress?

1. Most patients are discharged the same day or next day
2. Nasal congestion and mild blood-stained discharge are common initially
3. Saline nasal rinses are advised during healing
4. Avoid nose blowing for at least one week
5. Strenuous activity should be avoided for 7–10 days
6. Normal work or school can usually be resumed within 5–7 days
7. Regular follow-up and nasal cleaning improve surgical success

Is functional endoscopic sinus surgery safe?

Functional endoscopic sinus surgery is a well-established and safe ENT procedure. 
When performed for correct indications using endoscopic guidance, it provides excellent long-term symptom relief with low complication rates.