FESS effectively removes nasal polyps, restores sinus drainage, and produces significant improvement in breathing, smell, and sinus symptom burden - for most patients this improvement is substantial and the surgery is clearly worthwhile. However, 'permanent cure' is not the correct framing for nasal polyposis, and understanding why matters for long-term management. Nasal polyps are not tumours to be excised and forgotten - they are the end-product of persistent mucosal inflammation, driven by eosinophilic inflammatory processes that are frequently but not always allergic in origin. Removing the polyps does not remove the inflammatory mechanism that produced them. When that mechanism is active and untreated, new polyps form in the open sinus spaces that surgery created, often within months to a few years. The factors that most strongly determine how long FESS benefit lasts are: consistent post-operative intranasal corticosteroid spray use - which reduces mucosal inflammation and slows polyp reformation - and formal allergy evaluation to identify and treat any allergen sensitisation contributing to the inflammation. Patients who have FESS and then stop their nasal spray, or who have never had their allergy status evaluated, tend to develop polyp recurrence significantly sooner than those who follow a structured post-operative management programme. The surgery itself is one part of a longer treatment relationship, not a single intervention that produces indefinite benefit without ongoing care.
Written by Dr. Deeksha Bhaskar Shetty, MBBS, MS (Otorhinolaryngology), FAAI (Fellowship in Allergy, Asthma and Immunology), Consultant Otolaryngologist (ENT Specialist), Bengaluru. Phone: 9538390563.
