Sinus surgery opens blocked sinus openings and removes diseased tissue in chronic sinusitis and nasal polyps. It is performed through the nose with an endoscope; there is no external incision, and no scar or facial swelling is expected.
This page explains when surgery is considered in chronic sinusitis, how endoscopic sinus surgery (FESS) differs from balloon sinuplasty, how the operation proceeds and what recovery involves.
What is chronic sinusitis, and when is surgery considered?
The sinuses are air-filled cavities that open into the nasal cavity through small openings. When these openings are blocked, the sinus cannot ventilate, secretions accumulate and inflammation becomes persistent. Symptoms lasting longer than 12 weeks are defined as chronic sinusitis.
The AAO-HNS clinical practice guideline on adult sinusitis and the European EPOS 2020 position paper recommend appropriate medical treatment first. Surgery is considered in patients who do not respond to this treatment and whose CT scan shows disease.
| Condition | First-line approach | When surgery is considered |
|---|---|---|
| Chronic sinusitis without polyps | Saline rinses, steroid spray, antibiotics if indicated | Symptoms persist despite adequate treatment |
| Chronic sinusitis with polyps | Steroid spray, short course of oral steroids | Obstruction and loss of smell persist |
| Recurrent acute sinusitis | Treatment of each episode, search for an underlying cause | Several episodes a year with a structural cause |
| Localised disease such as fungal ball or mucocele | Diagnosis by imaging | Usually surgery once diagnosed |
What are the symptoms?
- Nasal obstruction and facial fullness
- Thick, discoloured nasal or post-nasal discharge
- Reduced sense of smell
- Pressure over the face and teeth, headache
- Frequent "colds" that keep returning
- Tiredness and poor sleep
How is the operation performed?
Endoscopic sinus surgery is performed under general anaesthesia. It takes 1–3 hours, depending on how many sinuses are treated.
- Endoscopic assessment: the inside of the nose is viewed with a fine camera and compared with the CT plan.
- Opening the sinuses: the blocked openings of the maxillary, ethmoid, frontal and sphenoid sinuses are widened according to the extent of disease.
- Clearing diseased tissue: polyps and inflamed tissue are removed while preserving the lining.
- Associated problems: a deviated septum or enlarged turbinates are corrected in the same session (septoplasty).
- Closure: no sutures are needed; dissolvable or short-term packing may be placed.
In limited, non-extensive disease, balloon sinuplasty can be an option: a balloon placed in the sinus opening is inflated to widen it, without removing tissue.
| Criterion | FESS | Balloon sinuplasty |
|---|---|---|
| Tissue removal | Yes, diseased tissue is cleared | No |
| Disease with polyps | Suitable | Not suitable |
| Extent of disease | Limited and extensive disease | Only limited, selected disease |
| Anaesthesia | General | General, or local in selected patients |
| Evidence base | Broad | Comparative data in a limited patient group |
What does the evidence say?
A meta-analysis of FESS outcomes in chronic sinusitis reports significant improvement in patient-reported symptom scores. A further meta-analysis comparing balloon dilation with FESS found that, in selected limited disease, the balloon method can achieve similar symptom improvement, whereas FESS is preferred in polypoid and extensive disease.
These are group-level findings; the individual result depends on the extent of disease, the underlying cause and adherence to treatment after surgery.
Planning a visit from abroad
| Step | When | What happens |
|---|---|---|
| First contact | Weeks before | History and any previous CT scan or reports shared; preliminary opinion |
| Arrival and consultation | 1 – 2 days before surgery | Endoscopy, CT scan if not already available, informed consent |
| Surgery | Day 0 | General anaesthesia; discharge same day or next morning |
| Follow-up | Days 1 – 7 | Packing removed, saline rinses started, first endoscopic check with crust removal |
| Departure | Day 7 – 10 | Flying is usually possible after the first endoscopic check |
| Remote follow-up | Weeks 2 – 12 | Continued sprays and rinses; checks remotely or with a local ENT specialist |
What does recovery look like?
The times below are typical ranges; they vary between individuals and are not a personal guarantee.
| Period | What to expect |
|---|---|
| First 48 hours | Congestion, slight blood-stained discharge; head elevated |
| Days 1 – 3 | Packing removed if used; saline rinses started |
| Week 1 | First endoscopic check; crusts cleared |
| Days 7 – 10 | Return to desk work for most patients |
| Weeks 2 – 4 | Heavy exertion and flying after the check-up |
| Weeks 6 – 12 | Mucosal healing complete; medical treatment and follow-up continue |
Regular saline rinses and the prescribed sprays after surgery are as important as the operation itself for maintaining the result.
What are the risks?
The list below is not exhaustive; individual risks are discussed at the consultation and during the informed-consent process.
- Bleeding, infection, anaesthetic risks
- Crusting, adhesions and temporary dryness
- Temporary or lasting change in the sense of smell
- Re-narrowing of the sinus openings, recurrence of polyps
- Rarely, involvement of structures around the eye or the skull base (cerebrospinal fluid leak, bruising around the eye)
- Need for further surgery
How is the decision made?
At the consultation the inside of the nose is examined endoscopically; polyps, discharge and the state of the sinus openings are assessed. A CT scan of the sinuses is obtained for diagnosis and surgical planning. Allergy, asthma and aspirin sensitivity are asked about.
The decision for surgery rests on the duration of symptoms, the response to medical treatment and the CT findings taken together. Continuing treatment after surgery is part of the plan.
The information on this page is for general guidance only and does not replace a medical consultation. Whether sinus surgery is suitable for you can only be determined after examination and imaging.
