Functional Endoscopic Sinus Surgery, or FESS, is the standard surgical procedure for chronic sinusitis that has not responded adequately to medical treatment. It uses a thin camera introduced through the nostril to visualise the sinuses directly, and surgical instruments to open blocked sinus passages, remove nasal polyps, and restore natural drainage without any external cuts or incisions. Most patients go home the same or the following day. The important question is when FESS is needed rather than continuing medical treatment. Surgery is appropriate when the patient has had an adequate trial of appropriate medical management - intranasal steroids, saline irrigation, antihistamines where allergy is present, and sometimes a course of systemic steroids - and has not achieved satisfactory symptom relief. CT scan of the sinuses is used to assess the extent of sinus disease and guide surgical planning. What I always ensure before recommending FESS is that allergy has been evaluated and managed, because the most important predictor of how long FESS results last is whether the underlying allergic inflammation is controlled. A patient who has FESS without allergy evaluation tends to re-develop polyps and obstruction faster than one whose allergy has been identified and treated.
Written by Dr. Sushma Charan Singh, MBBS, MS ENT/Otorhinolaryngology, FAAI (Fellow of the American Academy of Allergy, Asthma and Immunology), Advanced Course on Diagnosis of Allergy and Immunotherapy, ENT Specialist and Otorhinolaryngologist, ENT Care Clinic, A-193, Haribhau Upadhyay Nagar, Ajmer, Rajasthan 305004. Phone: +91 6376482141.
