Functional endoscopic sinus surgery (FESS)

Sinusitis (or rhinosinusitis) is a common condition in which the linings of the sinuses (the cavities behind your nose, cheekbones and forehead) become infected and inflamed.

Your sinuses are small, air-filled cavities which are located at the front of the skull behind your cheekbones and forehead and are connected to the inside of your nose. The sinuses produce mucus which usually drains into your nose through small channels. If you have sinusitis, the lining of your sinuses becomes inflamed and swollen, causing symptoms including pain, a blocked nose, a reduced sense of smell or a discharge.

There are two main types of sinusitis:

Acute sinusitis

Acute sinusitis is usually caused by an allergy, bacterial or viral infection and may occur immediately after a cold. It usually clears up on its own, within two or three weeks without any treatment.

Chronic sinusitis

This sometimes begins as acute sinusitis which doesn’t improve within a few weeks. It can also be caused when the structure of your sinuses is not quite right, or perhaps nasal polyps are blocking them and preventing them from draining correctly. Depending on the exact cause of your condition, nasal surgery may be recommended as a chronic sinusitis treatment.

Sinusitis causes a blocked nose with a discharge which can be green or yellow. There may be pain or tenderness around your cheeks, eyes or forehead, and you may have a fever. You may also have toothache, bad breath (halitosis) and a reduced sense of smell.

Symptoms can include:

• A sinus headache - you can identify this with some common sinus headache symptoms such as pain and tenderness around the eyes, achy feeling in the face and worsening of symptoms when lying down
• Pain/tenderness around cheeks or forehead
• Nasal congestion symptoms such as a blocked nose
• A discharge from your nose (may be yellow or green)
• A fever
• Toothache
• Bad breath (halitosis)
• Ear congestion
• A reduced sense of smell

Your doctor will be able to diagnose sinusitis after discussing your symptoms and examining the inside of your nose. If you meet many of the sinus infection symptoms you may be recommended to see an ear, nose and throat (ENT) specialist for further tests and diagnosis and sinusitis treatment, including FESS surgery.

FESS is a minimally invasive surgery carried out to treat some of the causes of chronically blocked sinuses.

Your Consultant will tell you how long you should avoid eating and drinking beforehand. Before the FESS operation, you’ll be given a nasal spray to reduce the thickness of the lining in your nose.

During your FESS surgery, a thin endoscope will be inserted into your nose to help your surgeon see into your sinuses and insert small surgical instruments. There’s no need to make any incisions on the outside of your nose.

The surgery may involve removing any tissue, such as nasal polyps, that’s blocking your sinus.

FESS surgery is normally performed under a general anaesthetic, which means you’ll be asleep during the operation. You’ll be able to go home the same day, but you should arrange for someone to drive you home from the hospital.

The operation can take between one and two hours, making it a fairly quick procedure. It’s rare that you’d have to stay in hospital overnight.

Like all surgery, FESS comes with a few risks, however these are rare, and most studies report an 80%-90% success rate, meaning the risk is almost always worth the procedure.

Your Consultant will guide you through the risks as part of the consent process.

You will most likely experience drainage from the nose after the surgery. You may have some bleeding which is nothing to worry about. This may continue over the week; however, you’ll be provided with padding or gauze to absorb it.

After the surgery you may have packing inserted into your nose to stop any bleeding. This should be removed the following morning. If your nose starts bleeding again, you should pinch the soft part of the nose, apply an ice pack and rest.

You’ll need to avoid blowing your nose hard for a few days, but gentle sniffing will do no harm. A nasal spray may help clear your nasal passages.

You may need a few days off work and strenuous exercise should be avoided for a week or two.

Some cases may require you to return in a few years, as tissue can grow back. However, this isn’t always the case, and the surgery allows your airways to open and become clearer.

The cost for FESS surgery is listed in the ENT section of our treatment prices page. To book an appointment, complete our online booking form or call our Private Patient Team on 01580 363158.