Functional Endoscopic Sinus Surgery (FESS)

Overview

Functional endoscopic sinus surgery (FESS) is the standard modern operation for chronic sinus disease that does not respond to medical treatment. Using a thin telescope (endoscope) passed through the nostrils, the surgeon opens the natural drainage pathways of the sinuses, removes blockages, diseased tissue, or polyps, and restores normal ventilation and drainage — all without external cuts.

The word "functional" reflects the aim: rather than stripping out the sinuses, FESS restores their own ability to drain and clear mucus, which also allows nasal sprays and rinses to reach the lining more effectively afterwards. It is commonly used for chronic rhinosinusitis, nasal polyps, and recurrent sinus infections, and is often combined with ongoing medical treatment.

This page is an educational overview only. It is not medical advice, and no outcome can be guaranteed. A specialist decides whether FESS is appropriate for you.

Who May Need This

FESS may be considered for people with chronic rhinosinusitis — long-standing nasal blockage, facial pressure, discharge, and reduced sense of smell — that has not improved adequately with medical treatment, and for those with nasal polyps or recurrent sinus infections. It may also be used for fungal sinus disease, certain complications of sinusitis, and to access the skull base or eye area for other conditions.

It is generally reserved for people whose symptoms persist despite a proper trial of medication. Eligibility is determined by an ENT specialist after nasal endoscopy and a CT scan confirm the extent and nature of the sinus disease.

When It May Be Recommended

FESS may be recommended when medical treatment — nasal steroid sprays, saline rinses, antibiotics when appropriate, and allergy management — has not controlled chronic sinus disease, when polyps block the nose, or when infections keep recurring. It may also be recommended to treat or prevent complications and to improve delivery of ongoing topical treatment.

The decision weighs the likely symptom improvement against the risks of surgery and the fact that disease can recur. Medical treatment is usually optimised first. The final recommendation depends on individual evaluation.

Diagnosis and Evaluation

Evaluation includes a history of sinus symptoms, allergy, and asthma, and a nasal endoscopy to inspect the nasal lining, drainage areas, and any polyps. A CT scan of the sinuses is essential — it maps the disease and the detailed anatomy near the eye and skull base, which is vital for planning safe surgery.

Allergy testing and assessment of asthma or aspirin sensitivity may be arranged, since these affect long-term outcomes. General health, bleeding tendency, and medications are reviewed, and a second opinion may be valuable, particularly for revision surgery or extensive disease.

Treatment Options

Chronic sinus disease is first treated medically — steroid nasal sprays or rinses, saline irrigation, treatment of allergy and infection, and, for polyps, sometimes steroid tablets or newer biologic medications. Many people are well controlled without surgery.

When medical treatment is not enough, FESS is the main surgical option, with the extent tailored to the sinuses affected. Balloon dilation of sinus openings is an option in selected cases. Surgery and ongoing medical treatment work together — surgery opens and clears the sinuses, and medication maintains control.

How It Is Performed

FESS is performed under general anaesthesia (sometimes local with sedation for limited procedures). Using an endoscope in the nostril and fine instruments such as a microdebrider, the surgeon opens the blocked sinus drainage pathways, removes polyps or diseased tissue, and clears the affected sinuses, working only through the nose with no external incisions.

Image-guidance technology may be used to navigate safely in complex or revision cases. Dissolvable material or light packing may be placed to control bleeding and support healing. The operation commonly takes one to two hours, and most people go home the same day or after a short stay.

Preparation

Preparation includes completing the CT scan and endoscopy, reviewing medications, and stopping blood thinners such as aspirin or ibuprofen only if your surgeon advises. A course of steroids or antibiotics is sometimes given beforehand to reduce inflammation and bleeding. You must follow fasting instructions before anaesthesia.

Arrange for someone to take you home. If travelling abroad, bring copies of your imaging and records, and plan for the recovery period your team recommends before flying, since air travel is usually avoided for a short time after sinus surgery.

Benefits and Expected Goals

The goals of FESS are to improve sinus drainage and ventilation, relieve nasal blockage, facial pressure, and discharge, often improve the sense of smell, reduce recurrent infections, and make ongoing topical treatments more effective. Many appropriately selected patients notice meaningful symptom improvement after healing.

Benefits vary by individual and by the underlying cause. Because FESS does not cure the tendency to inflammation, lasting benefit depends on continued medical treatment, and disease or polyps can recur. Your surgeon can discuss realistic goals for your situation.

Risks and Possible Complications

FESS is generally safe, but because the sinuses lie close to the eyes and brain, there are important, though uncommon, risks.

• Bleeding, occasionally needing packing or further treatment
• Infection
• Recurrence of sinus disease or polyps
• Rarely, injury near the eye causing vision problems, double vision, or bruising
• Rarely, a leak of fluid from around the brain (CSF leak) needing repair
• Temporary or, rarely, persistent change in the sense of smell
• Scarring or adhesions inside the nose; risks related to general anaesthesia

Your surgeon will explain the risks specific to your anatomy and disease and how any complication would be managed. Report vision changes, heavy bleeding, or persistent clear nasal drainage urgently.

Recovery, Follow-up & Aftercare

Recovery varies by patient. The nose is usually blocked with swelling and crusting for one to two weeks, and saline rinses are essential to clear crusts and support healing. Most people return to light activities within a few days and work within one to two weeks, avoiding nose-blowing, heavy lifting, and strenuous exercise as advised.

Follow-up often includes endoscopic cleaning of the nose and resuming steroid nasal sprays or rinses and allergy and asthma treatment to maintain control and reduce recurrence. Follow the surgical team's instructions closely, and if treated abroad, arrange ongoing medical treatment and follow-up with your ENT doctor at home before returning.

Medical Tourism Planning

If you are considering FESS abroad, choose a JCI- or ISO-accredited hospital with sinus (rhinology) expertise and, ideally, image-guidance technology for complex cases. Confirm the surgeon's experience with endoscopic sinus surgery and request a written plan and cost estimate before travelling.

Plan for the in-country recovery your team recommends before flying, and importantly arrange ongoing medical treatment and follow-up at home, since long-term control of inflammation is key to lasting benefit. Consider medical travel insurance.

Estimated Cost Factors

The cost of FESS depends on the country and hospital, surgeon and anaesthetist fees, the extent of sinus disease, whether image guidance is used, length of stay, and pre- and post-operative medications and imaging. Revision or extensive surgery generally costs more.

Many international destinations offer these procedures at a fraction of typical prices in higher-cost countries, but figures vary by case. Online prices are only estimates — always request a personalized written quote for your specific situation before deciding.

Choosing a Hospital or Specialist

Look for a hospital with recognised accreditation and a dedicated ENT department with rhinology expertise and endoscopic and image-guidance facilities. Confirm the surgeon's experience with FESS, including revision surgery and management of complications.

Ask about post-operative nasal cleaning and medical treatment, international patient services, and how follow-up would continue after you return home. Transparent written cost and treatment plans are signs of a quality programme.

Alternatives

Alternatives to FESS include ongoing medical treatment — steroid nasal sprays or rinses, saline irrigation, and treatment of allergy, infection, and asthma — and, for polyps, steroid tablets or biologic medications in selected people. Balloon sinus dilation may be an option for limited disease.

Often the best approach combines surgery with medical treatment. Each option has different benefits, risks, and durability, so discuss them with your ENT specialist to find the plan that fits your disease and health.

Questions to Ask Your Doctor

• Have we optimised medical treatment before considering surgery?
• How extensive is my sinus disease, and how much surgery is needed?
• Will you use image guidance, and what are the specific risks in my case?
• How likely are my symptoms or polyps to recur, and what will reduce that?
• What ongoing medication and follow-up will I need afterwards?
• How long should I stay in-country, and when is it safe to fly?
• What is included in the written cost estimate?