Functional endoscopic sinus surgery opens the sinus openings and restores natural drainage in chronic sinusitis, nasal polyps and sinus blockage that do not respond to medication. It is done through the nose, with no external incision.

When does chronic sinusitis need surgery?

The decision for surgery starts when your main symptoms (blocked nose, discharge, facial pain or loss of smell) have lasted at least 12 weeks and this has been confirmed by endoscopic examination or imaging. But duration alone is not enough: medical treatment is tried first, with a steroid nasal spray, a short course of oral steroids if needed and, if there are no polyps, targeted antibiotic treatment in addition. If your symptoms do not improve despite these treatments, surgery is considered.

There is an important point here: delaying surgery can come at a cost. Research shows that patients who have surgery within 12 months of diagnosis get clearly better results than those who wait more than 5 years. Delay can lead to irreversible damage to the sinus lining and higher healthcare costs. So for some patients, the “let’s wait a little longer” approach actually has a price.

In the end, the decision is not a rigid rule tied to a single trial of medication; it is made at the point where the expected benefit of surgery outweighs the benefit of continuing medical treatment.

Why is a CT scan requested before surgery?

The sinuses have a very complex anatomy that we cannot fully see with the naked eye or with an endoscope: a system of small, separate, honeycomb-like cells surrounded by the skull base, the eyes and important blood vessels and nerves. On top of that, anatomical variations are common from person to person, so two patients’ sinus structures can differ considerably.

Computed tomography (CT) lets us draw this three-dimensional map before surgery. It allows us to anticipate which areas are blocked, how close we will be working to critical structures (the eye and the skull base) and which areas need treatment. This is an essential part of planning the operation safely and precisely.

What happens with packing and aftercare after surgery?

After surgery a Merocel pack is placed inside the nose for 1 day, and you stay in hospital for 1 night of observation. The pack is removed the next day, and after discharge you start using a nasal rinse solution straight away. This helps keep the healing lining clean and reduces crusting. The first follow-up appointment is 1 week after surgery.

Does sinusitis come back after surgery?

To be honest, surgery is not a definitive, permanent cure. Chronic sinusitis is a disease with an underlying tendency to inflammation; rather than removing that tendency, surgery opens the drainage of the sinuses so that treatments can reach them more effectively. In a 12-year follow-up study, some recurrence was seen in about 79% of patients with nasal polyps, and about 37% of them needed another operation.

The risk of recurrence is not the same for everyone: it is clearly higher in patients with asthma, allergies or aspirin/NSAID sensitivity (AERD). The extent of surgery also makes a difference: more extensive surgery can lower the chance of a repeat operation and lengthen the time before recurrence, compared with a limited procedure.

That is why aftercare matters for a lasting result at least as much as the surgery itself: long-term steroid nasal spray and regular nasal rinsing help keep the lining healthy and reduce the risk of recurrence. In short, surgery is not an end point but the start of a long-term management process.