About the procedure
Functional endoscopic sinus surgery (FESS) is a surgical procedure performed through the nostrils to open the sinus passages providing relief for many patients with chronic sinusitis with or without nasal polyps.
Over the past 10 years, there have been major improvements in how this surgery is done. Better imaging, more precise surgical techniques, specialised instruments, advances in anaesthesia, and closer follow-up care have all led to much better outcomes for patients.
Dr Phillips has extensive training in endoscopic sinus surgery and takes a careful, detailed approach.
Most patients who are suitable for this surgery will have already tried appropriate medical treatments for their sinus condition before surgery is considered.
The way sinus surgery is performed has changed significantly over the last 10 years. The focus is now on restoring normal sinus function by opening blocked areas and treating all affected sinuses.
Older methods, sometimes described as a “sinus scrape,” often did not give lasting relief. Current techniques aim to properly open the affected sinuses so they can drain, be appropriately cleaned, and be easily monitored in the rooms after surgery.
In some cases, image-guided technology is used during the procedure to ensure all diseased areas are treated. After surgery, nasal packing is often not needed. In the past, removing nasal packs caused significant discomfort, but this is now uncommon.
With improvements in both surgery and anaesthesia, significant bleeding is also unusual during and after the operation. As result, many patients are able to go home the same day, although an overnight stay may occasionally be recommended if the surgery is more extensive.
After surgery, regular saline rinsing is recommended as an important part of recovery. A low-pressure, high-volume rinse should be used 4 times a day for at least 2 months. Follow-up appointments are also essential, allowing the sinuses to be checked and any remaining debris that has not been washed out by the saline to be gently cleared.
Further information about recovery can be found in the post-operative handouts.
To discuss endoscopic sinus surgery further, an appointment can be made with Dr Phillips.
Post operative instructions
What to expect
Immediately post op:
A small piece of gauze is usually placed under your nose after surgery. Breathing through your nose is often fairly comfortable at this stage. Pain is usually mild due to the local anaesthetic used during the procedure.
Day 1:
Some blood-stained fluid may ooze from your nose overnight. This is normal and does not mean there is active bleeding. Your nose may feel more blocked compared to immediately after surgery because of this ooze of blood and serous fluid. You can change the gauze under your nose as necessary (eg. if it becomes full).
You may occasionally have 2 small, clear splints present inside your nose if there has been extensive septal deviation correction during the same operation, held in place with stitches.
A saline wash bottle will be provided to you by the nurses and should be started on this day. This step is as important as the surgery for healing. The bottle should be filled with cooled, previously boiled water, and the supplied solvent should be added.
While leaning over a sink, insert the bottle into your nostril and gently squeeze the bottle. A lot of the fluid will run through and come out of the nose, which is expected. Half the bottle should be used on each side. This should be done at least four times a day for about three months.
At night:
Taking pain relief before bed on the first night can help you with comfort. Sleeping with your head raised on two pillows is recommended. A towel on the pillow and gauze under your nose can help catch any drainage and protect the skin.
Day 2 – 7:
During this time, it is common to feel as though there is a cold, with nasal blockage and congestion. Some numbness around the tip of the nose and upper lip may also be noticed. This is normal and settles with time.
Day 8 – 10:
If splints are present in your nose, they are usually removed at the first follow-up visit. Breathing often improves straight away, and the feeling of congestion reduces. If there are no splints used your first follow-up visit will be scheduled around 2-3 weeks post op.
Any concerns or unexpected changes should be addressed promptly by contacting the clinic, where support is readily available during the recovery period.
Frequently asked questions
Pain relief?
FESS is generally not a very painful procedure. A feeling of pressure or fullness in the sinuses is more common than pain after surgery in most people.
Regular pain relief is recommended for the first 24 hours, then taken as needed.
Anti-inflammatories such as ibuprofen or Celebrex along with regular paracetamol will be recommended. Stronger pain relief will be provided for you from the hospital pharmacist to use if required with written instructions.
Antibiotics?
Antibiotics are not usually prescribed after FESS. There is little evidence for benefit in average uncomplicated cases.
What should I eat?
A normal diet can be resumed after surgery.
What are the activities I shouldn’t do?
- No very hot showers or baths – 72 hours
- No heavy lifting or nose blowing – 7-10 days
- No vigorous or strenuous exercise – 7-10 days
- No blood thinning medication – 2 weeks or until advised by your surgeon.
How much time do I need off work?
Most individuals require around one week away from lightwork, although this may vary depending on recovery or if a more strenuous work is undertaken.
How important is the wash bottle?
Regular use of the wash bottle is essential following this procedure. It plays a critical role in supporting healing of the nasal lining after surgery. Use at least 4 times daily is required, though more frequent use – up to 10 times per day – may provide additional benefit without causing harm.
Using the wash bottle more than 4 times per day will not result in any harm.
What do I do if I get bleeding?
If bleeding occurs, start by using a wash in the nose. Sit leaning forward with your mouth open, applying firm pressure to the sides of your nose down at the tip for a total of 10 minutes. Use of ice packs over the nose may also be helpful. If this is unsuccessful after 10 minutes, then give yourself another wash. If bleeding persists, seek care at the nearest public hospital with an Emergency Department.