Endoscopic sinus surgery (FESS): when it is considered and what to expect

Chronic rhinosinusitis causes a blocked nose, facial pressure, reduced smell and thick discharge lasting three months or more. Nasal polyps are soft swellings that can sit in the nose and sinuses. Treatment starts with nasal steroid sprays and saline rinses; the NHS says surgery may be suggested if polyps have not improved after about 12 weeks of medical treatment.

ENT UK states the aim of endoscopic sinus surgery is better long-term symptom control, not a cure. It also lists alternatives, including short courses of steroid tablets and specialised medicines called biologics, and notes that many patients manage without surgery.

This operation is not helpful for a headache or face pain without evidence of sinus disease on examination and scans, which is one reason a CT scan usually comes first.

You will typically continue steroid sprays and rinses up to surgery, and your surgeon may give a short steroid course beforehand to reduce bleeding in the operating field. Tell the team about aspirin, anti-inflammatories and blood thinners, which can increase bleeding, and about any asthma, since polyps and asthma often go together.

Plan two weeks away from work and from people with coughs and colds.

Under general anaesthetic, a thin tube carrying a camera is passed through each nostril. The surgeon removes polyps and diseased tissue and widens the natural openings of the sinuses so that they drain properly. There are no cuts on the face.

The nose may be packed lightly or fitted with dissolvable material. Many people go home on the same day. Nasal rinses begin soon afterwards, as instructed.

Nosebleeds are very common, with minor spotting typical; ENT UK says a severe bleed happens in roughly 1 in 20. Bleeding into the eye socket occurs in about 1 in 500 (0.2%), and a leak of the fluid around the brain in about 1 in 1,000. Double vision or a watering eye is very rare. General anaesthetic has its own risks.

ENT UK states that serious complications are very rare, but they are real, which is why the operation is not offered lightly.

ENT UK says nasal blockage typically resolves within one to two weeks. Avoid blowing the nose for two days, and then only gently. Take two weeks off work and avoid heavy exercise, lifting and flying for two weeks. Steroid sprays and saline rinses are continued indefinitely, which is how the benefit is maintained.

The NHS adds that polyps commonly grow back, usually within a few years, and a steroid spray may be needed afterwards to stop them returning quickly.

• Bleeding that does not stop with pressure: call 999 or go to A&E.

• Clear watery fluid dripping from the nose, especially with a severe headache or stiff neck.

• Double vision, swelling around the eye or reduced vision.

• Fever, increasing pain or swelling of the face.

• What do my scan and examination show, and are the sinuses really the cause?

• Have I used the medical treatments correctly and for long enough?

• Would a biologic medicine be an option for me?

• What are the chances I will need further surgery?

The surgical technique is similar. NHS access usually follows documented medical treatment and a CT scan; private providers may arrange scans and surgery faster. Whichever route, the long-term plan depends on continuing sprays, rinses and review, so ask what follow-up is included.