Endoscopic sinus surgery

What the operation changes

The sinuses are air spaces connected to the nose through small openings. In chronic sinus disease, inflamed tissue, polyps or narrowed pathways may interfere with drainage and make treatment difficult. Using an endoscope through the nostrils, the surgeon opens affected pathways and removes diseased tissue or selected partitions of bone where needed, preserving healthy lining and support.

The operation is planned from your examination and CT. It may involve one area or several sinuses. Septoplasty and turbinate reduction treat different sources of nasal obstruction and may be performed during the same operation when indicated.

Preserving useful tissue

The goal is to clear the disease and create useful access while preserving healthy lining and structural support where possible. The lining helps move mucus; surgery is tailored to the areas that need treatment rather than removing tissue simply to make a larger space.

When nasal breathing also needs attention

A deviated septum or enlarged turbinates may contribute to blockage separately from sinus inflammation. If those findings need treatment, Dr. Fewins explains what septoplasty or turbinate reduction would add. A combined operation addresses identified problems, with recovery instructions covering each part.

When surgery may help

Persistent symptoms, objective evidence of disease, prior treatment, overall health and quality of life all matter. There is no single medication schedule that every patient must complete before an operation is reasonable.

• Chronic sinus inflammation that remains burdensome despite appropriate treatment.
• Nasal polyps that obstruct the nose or prevent medication from reaching diseased areas.
• Disease such as fungal material or more extensive involvement that requires removal rather than dilation alone.
• Selected recurrent acute infections or persistent disease after prior treatment, once the cause is established.

Surgery is less likely to help when the main problem is recurrent viral illness, migraine or another cause that the operation does not address. This distinction is part of the evaluation, not something an online checklist can decide.

Balloon dilation or endoscopic surgery?

A balloon widens a natural sinus opening. Endoscopic surgery can also remove polyps and diseased tissue and open areas a balloon cannot treat. They solve different problems. Selected patients benefit from a combination.

When significant polyp, fungal or other extensive disease needs to be cleared, dilation alone is insufficient. For more limited disease, a smaller intervention may be enough. Dr. Fewins explains the proposed extent and why it fits your scan and symptoms.

Compare balloon sinuplasty.

Planning and the day of surgery

Dr. Fewins reviews the actual CT images before surgery and has them available during the operation. He uses image guidance when it helps him carry out more complete, thorough surgery: for revision cases with altered landmarks, significant disease such as extensive polyps, or substantial anatomic irregularity. The system relates instrument position to the CT anatomy. Its use is selected for the case; it is not necessary for every operation.

The anesthesia plan, facility and expected time depend on the procedure and your health. You receive individual instructions about eating, drinking and medications. Arrange a responsible adult to drive you home after sedation or general anesthesia and help during the initial recovery.

Packing, spacers, splints or medication-releasing implants are selected when useful. Their use and removal schedule vary; your postoperative instructions will explain what was placed.

Recovery is part of the treatment

Congestion, fatigue and a modest amount of blood-tinged drainage are common early on. Breathing can initially feel worse because of swelling and crusting. Many people plan roughly one to two weeks for the early recovery, with timing adjusted to the extent of surgery and their work. Healing continues beyond that first period.

Saline rinses are an important part of recovery. Use distilled, sterile, or previously boiled and cooled water, and follow your individual instructions about when and how to rinse. Prescription sprays or steroid rinses may continue as the lining heals. Activity restrictions and medication changes come from your surgical team.

Call promptly for heavy or persistent bleeding, worsening pain or fever, or symptoms outside the recovery instructions. New vision changes, swelling around the eye, severe unusual headache or neurological symptoms require urgent assessment.

What follow-up is checking

An early sense of congestion does not tell the whole story of healing. At follow-up, endoscopy helps Dr. Fewins see the lining, crusting and openings directly. Debridement is used when needed to remove material that interferes with healing or assessment. How often it is needed depends on the operation and the way the nose heals.

Before returning to strenuous exercise, heavy lifting or work that involves physical exertion, check your instructions with the team. Feeling well enough for desk work does not necessarily mean the nose is ready for every activity. Tell us if rinsing is difficult or a medication is causing a problem so the plan can be adjusted.

Benefits, risks and longer-term care

The goal is better daily function and quality of life. Surgery changes anatomy and access for treatment; it does not erase every inflammatory tendency or prevent every future infection. Continued medication and follow-up can be especially important with polyps or recurrent disease.

Risks include bleeding, infection, scarring, persistent symptoms, changes in smell and the possibility of another procedure. Rare but serious complications involve the eye or vision, the skull base or leakage of fluid around the brain. Anesthesia has its own risks. Dr. Fewins discusses the risks most relevant to your anatomy and health before you decide.

Common questions