Why sinus infections keep coming back
Your sinuses are air-filled spaces in the bones around the nose, and each drains into the nose through a narrow opening. When those openings swell shut — from allergy, infection, polyps or anatomy — mucus stagnates behind them. Stagnant mucus becomes infected, infection causes more swelling, and the swelling blocks the drainage further.
That cycle is why antibiotics can clear an episode and yet the infection returns weeks later: the medicine treats the infection but does nothing about the blocked pathway that caused it.
Chronic sinusitis typically means
- Nasal blockage and thick discharge for twelve weeks or more
- Facial pain, pressure or heaviness, often worse bending forward
- Reduced or absent sense of smell
- Post-nasal drip and a cough that will not settle
- Repeated courses of antibiotics with only temporary relief
- Fatigue, poor sleep and reduced concentration
Medical treatment comes first
FESS is not a first-line treatment, and a good ENT surgeon will try to avoid it. A properly conducted course of medical therapy resolves a large proportion of cases: intranasal steroids used with correct technique for an adequate duration, saline douching, treatment of underlying allergy, and antibiotics only where genuinely indicated.
Surgery becomes appropriate when this fails — when symptoms persist despite maximal medical treatment, when polyps are obstructing the nose, when there is fungal sinus disease, or when a CT scan shows anatomical blockage that medicine cannot open.
What a proper assessment includes
- Nasal endoscopy — a direct view of the drainage pathways, polyps and discharge
- A validated symptom score (SNOT-22) — records the true burden on sleep, mood and daily function, and provides an objective before-and-after comparison
- CT scan of the sinuses where surgery is being considered — this maps the anatomy the surgeon will work through
- Allergy assessment where the history suggests it
Record your sinus symptoms before your visit
SNOT-22 is a standardised questionnaire that records the burden of sinus symptoms, including effects on sleep and daily activity. Your answers stay on your own device.
Open the questionnaire →What FESS involves
"Functional" is the important word. Older sinus operations stripped out lining and made large openings; modern FESS aims to restore the sinuses' own function by removing only what obstructs the natural drainage pathway, preserving healthy lining so the sinus can work normally again.
The whole procedure is done through the nostrils using an endoscope, so there are no incisions on the face and no external scars. Polyps are removed, obstructing bony partitions are opened, and the natural openings of the affected sinuses are widened. Where the septum is also deviated, it is usually corrected in the same sitting to allow proper access and airflow.
Recovery
- Night of surgery: usually one night in hospital; some blood-stained discharge is expected
- First week: the nose feels blocked from swelling and crusts; saline douching begins and becomes the most important part of your recovery
- Weeks 2–3: most people are back at work; a clean-up of crusts in clinic is often done
- Weeks 4–12: smell and airflow improve progressively as the lining heals
Douching diligently and attending post-operative reviews genuinely affects the outcome — the surgery opens the pathway, but the healing weeks determine whether it stays open.
Results, risks and the honest caveats
Patients with high symptom scores who have failed medical treatment are precisely the group that benefits most from FESS, and large improvements in breathing, smell, facial pressure and sleep quality are usual. Most people find their subsequent medical treatment works far better because sprays can finally reach the sinuses.
Risks are uncommon but real: bleeding, infection, adhesions inside the nose, and rarely injury to structures adjacent to the sinuses — the eye and the base of the skull lie next to them, which is why detailed CT planning and careful technique matter.
The most important caveat concerns polyps. FESS removes them, but in conditions where polyps regrow — particularly with allergic or eosinophilic disease and asthma — surgery controls the disease rather than curing it permanently. Continuing nasal steroid treatment and follow-up after surgery is what keeps recurrence at bay. Anyone who promises a permanent cure for nasal polyps is overstating the case.
Swelling around the eye, double vision or reduced vision, severe headache with fever, confusion, or a persistent one-sided bloody discharge. These are uncommon but need immediate assessment.
സൈനസ് ശസ്ത്രക്രിയ — ചുരുക്കത്തിൽ
സൈനസുകൾ മൂക്കിലേക്ക് തുറക്കുന്ന വഴികൾ അടഞ്ഞുപോകുമ്പോൾ കഫം കെട്ടിനിന്ന് വീണ്ടും വീണ്ടും അണുബാധയുണ്ടാകുന്നു. ആന്റിബയോട്ടിക് അണുബാധയെ മാറ്റും, പക്ഷേ അടഞ്ഞ വഴി തുറക്കില്ല — അതുകൊണ്ടാണ് പ്രശ്നം ആവർത്തിക്കുന്നത്.
ആദ്യം മരുന്നുചികിത്സ തന്നെയാണ് വേണ്ടത് — ശരിയായ രീതിയിൽ നേസൽ സ്പ്രേ, ഉപ്പുവെള്ളം ഉപയോഗിച്ചുള്ള കഴുകൽ, അലർജി നിയന്ത്രണം. ഇവ ഫലിക്കാതെ വരുമ്പോഴാണ് ശസ്ത്രക്രിയ പരിഗണിക്കുന്നത്.
FESS: മൂക്കിലൂടെ ദൂരദർശിനി (എൻഡോസ്കോപ്പ്) ഉപയോഗിച്ചാണ് ചെയ്യുന്നത് — മുഖത്ത് മുറിവില്ല. സാധാരണയായി ഒരു രാത്രി ആശുപത്രിയിൽ, 1–2 ആഴ്ചയ്ക്കുള്ളിൽ സാധാരണ ജീവിതത്തിലേക്ക്. ശസ്ത്രക്രിയയ്ക്ക് ശേഷവും മരുന്നും തുടർപരിശോധനയും തുടരേണ്ടതുണ്ട്, പ്രത്യേകിച്ച് പോളിപ്പ് ഉള്ളവരിൽ.
Frequently asked questions
Who needs FESS surgery?
FESS is recommended for chronic sinusitis that has not responded to a proper course of medical treatment, for nasal polyps obstructing the nose, for fungal sinus disease, and for recurrent infections caused by blocked sinus drainage. It is not a first treatment — medical therapy is tried first in almost every case.
Are there any cuts on the face with sinus surgery?
No. Functional endoscopic sinus surgery is performed entirely through the nostrils using an endoscope, so there are no incisions on the face and no visible scars. This is a major difference from the older open sinus operations.
How long is recovery after FESS?
Most patients spend one night in hospital and return to routine work within one to two weeks. The nose feels blocked with crusting for the first two to three weeks, which improves with regular saline douching. Sense of smell and airflow continue improving for up to three months as the lining heals.
Will nasal polyps come back after surgery?
Surgery removes polyps effectively, but in patients with underlying allergic or eosinophilic disease — often alongside asthma — polyps can recur over time. This is why continuing nasal steroid treatment and attending follow-up after surgery is essential. Surgery controls the disease and restores the airway; it does not permanently cure the tendency to form polyps.
Is a CT scan necessary before sinus surgery?
Yes. A CT scan of the sinuses is essential when surgery is being planned. It shows the extent of disease and maps each patient's individual anatomy, including the position of the eye and skull base, which the surgeon must navigate around. Surgery is not planned on symptoms alone.
Can chronic sinusitis be cured without surgery?
Frequently, yes. Many patients improve substantially with correct-technique intranasal steroids used for an adequate duration, saline douching, allergy management and targeted antibiotics where indicated. Surgery is reserved for those whose symptoms persist despite this, or who have polyps or anatomical blockage.
Related information
This page is general health information about endoscopic sinus surgery (fess) and is not a substitute for a personal medical consultation. Every patient is different; treatment decisions — including whether surgery is appropriate — should be made after an examination by a qualified ENT surgeon. If you have sudden severe symptoms such as difficulty breathing, heavy bleeding, sudden hearing loss or severe headache, seek emergency medical care immediately.