Functional Endoscopic Sinus Surgery (FESS)

Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive surgical procedure used to treat selected conditions affecting the nose and sinuses. It uses an endoscope, a thin instrument with a light and camera, to provide a detailed view of the nasal passages and sinus openings during surgery.

FESS may be considered when persistent sinus problems do not respond adequately to appropriate medical treatment or when structural problems contribute to impaired sinus drainage.

At Garv Diagnostic Centre & Hospital, Dr. Vaibhav Kuchhal, ENT Specialist, evaluates patients with chronic or recurrent sinus symptoms and determines whether FESS may be appropriate based on their symptoms, examination findings, investigations, and medical history.

What Is Functional Endoscopic Sinus Surgery?

FESS is performed through the natural openings of the nose, generally without external facial incisions. The procedure aims to improve access and drainage of the affected sinuses while preserving as much healthy nasal and sinus tissue as possible.

An endoscope allows the surgeon to see the nasal and sinus structures on a monitor during the procedure. Specialised instruments can then be used to address areas contributing to the patient's sinus problem.

The exact surgical approach depends on the sinuses involved, the underlying condition, and the patient's individual anatomy.

When Is FESS Recommended?

FESS may be considered for selected patients with persistent or recurrent sinus conditions, particularly when appropriate medical treatment has not provided adequate improvement.

Possible reasons for considering FESS include:

• Chronic sinus symptoms
• Recurrent sinus infections
• Persistent nasal blockage associated with sinus disease
• Ongoing facial pressure or discomfort related to sinus problems
• Reduced sense of smell associated with sinus disease
• Sinus disease caused by structural blockage
• Certain nasal or sinus growths
• Other conditions where improved sinus drainage may be clinically beneficial

Not every patient with sinus symptoms requires surgery. An ENT specialist first determines whether the symptoms are related to sinus disease and whether surgical treatment is appropriate.

How Are Sinus Problems Diagnosed?

The ENT specialist begins by discussing the patient's symptoms, duration of symptoms, previous treatments, and medical history.

A clinical examination may be followed by additional investigations, depending on the suspected condition.

These may include:

• Nasal endoscopy
• CT imaging of the sinuses
• Assessment of nasal structures
• Review of previous medical treatment
• Other investigations when clinically required

These findings help identify the areas affected and determine whether surgery may be beneficial.

How Is FESS Performed?

FESS is generally performed under general anaesthesia, meaning the patient is asleep during the procedure.

During surgery:

1. General anaesthesia is administered.
2. An endoscope is introduced through the nostril.
3. The nasal passages and sinus openings are examined under direct visualisation.
4. Areas contributing to blocked sinus drainage are identified.
5. Specialised instruments are used to address the affected areas.
6. Diseased or obstructing tissue may be removed where clinically necessary.
7. The surgeon checks the treated areas before completing the procedure.

In selected cases, navigation guidance may be used to provide additional anatomical information during surgery.

The exact steps depend on the patient's sinus condition and the extent of disease.

What Happens After FESS?

After surgery, the patient is monitored while recovering from anaesthesia. Nasal congestion and mild discomfort are common during the early recovery period.

Temporary symptoms may include:

• Nasal blockage
• Mild facial pressure or discomfort
• Small amounts of nasal discharge or bleeding
• Tiredness
• Temporary changes in the sense of smell
• Throat discomfort following anaesthesia

The doctor will provide specific instructions regarding medication, nasal care, activity, and follow-up.

Recovery After FESS

Recovery varies depending on the extent of surgery and the patient's individual condition.

Nasal congestion may continue during the early healing period. The ENT specialist may recommend saline nasal care or other treatments to help support healing and maintain appropriate nasal hygiene.

During recovery, patients may be advised to:

• Take prescribed medicines as directed
• Follow nasal care instructions
• Avoid strenuous activity for the recommended period
• Avoid forceful nose blowing when advised
• Attend scheduled follow-up appointments

Follow-up is particularly important after FESS because the nasal and sinus tissues need to be assessed as they heal.

Possible Risks and Complications

As with any surgical procedure, FESS has potential risks.

These may include:

• Bleeding
• Infection
• Nasal congestion
• Pain or facial discomfort
• Temporary changes in smell
• Scar tissue formation
• Persistence or recurrence of sinus symptoms
• Injury to surrounding structures
• Changes in vision or eye-related complications in rare cases
• Cerebrospinal fluid leakage in rare cases
• Anaesthesia-related complications
• Need for further treatment

The risks depend on the extent and location of sinus disease and the specific procedure performed. Your ENT specialist will explain the risks relevant to your condition before surgery.

What Should You Know Before FESS?

Before surgery, inform your doctor about your medical conditions, medications, allergies, previous nasal or sinus procedures, and any previous reactions to anaesthesia.

You may receive instructions regarding:

• Pre-operative investigations
• Fasting before surgery
• Medication use
• Nasal preparation
• Activity restrictions
• Post-operative nasal care
• Arrangements for transportation and recovery support

Following these instructions carefully can help with preparation and recovery.

Does FESS Cure Sinus Problems Permanently?

FESS is intended to address specific anatomical or disease-related problems affecting the sinuses. It may improve sinus drainage and help reduce symptoms in appropriately selected patients.

However, sinus conditions can have different causes, and symptoms may recur in some patients. Ongoing medical treatment or nasal care may still be recommended after surgery depending on the underlying condition.

Your ENT specialist can explain the expected benefits and limitations of surgery based on your diagnosis.

When Should You Seek an ENT Evaluation?

Consider an ENT consultation if you experience persistent or recurrent symptoms such as:

• Nasal blockage
• Facial pressure or discomfort
• Recurrent sinus infections
• Persistent nasal discharge
• Reduced sense of smell
• Symptoms that continue despite appropriate treatment

These symptoms can have several causes. A detailed ENT evaluation can help determine whether sinus disease is present and whether FESS or another treatment approach may be appropriate.

Consult an ENT Specialist at Garv Diagnostic Centre & Hospital

Persistent or recurrent sinus symptoms can affect breathing, sleep, concentration, and daily activities. When medical treatment does not provide adequate improvement, an ENT evaluation can help determine whether surgical management should be considered.

Dr. Vaibhav Kuchhal, ENT Specialist at Garv Diagnostic Centre & Hospital, can assess your symptoms, review relevant investigations, and discuss whether Functional Endoscopic Sinus Surgery may be appropriate for your condition.

Contact Garv Diagnostic Centre & Hospital to schedule an ENT consultation and discuss your sinus symptoms and treatment options.

Frequently Asked Questions

Q: Is FESS performed through the nose?

A: Yes. FESS is generally performed through the nasal passages using an endoscope and specialised surgical instruments, without conventional external facial incisions.

Q: Is FESS painful?

A: The procedure is generally performed under general anaesthesia, so the patient does not feel pain during surgery. Nasal congestion, pressure, or mild discomfort may occur during recovery.

Q: How long does it take to recover after FESS?

A: Recovery varies depending on the extent of surgery and the individual patient. Nasal congestion and other temporary symptoms may continue during the early healing period.

Q: Will FESS improve my sinus symptoms?

A: FESS may help appropriately selected patients by addressing structural or disease-related problems that interfere with normal sinus drainage. The expected benefit depends on the underlying condition.

Q: Will I still need medication after FESS?

A: Some patients may require ongoing nasal care or medical treatment after surgery, depending on the underlying sinus condition. Your ENT specialist will provide individualised post-operative recommendations.