When Is FESS Necessary In Sinus Problem

Sinus is often used as a catch-all explanation for symptoms ranging from a blocked nose and facial pressure to headaches and frequent colds. However, not every blocked nose is caused by sinusitis, and having sinusitis does not automatically mean that surgery is required.

This distinction is important because endoscopic sinus surgery (ESS/FESS) is generally not considered the first-line treatment for sinus problems. The need for surgery depends on the underlying cause, how long the symptoms have persisted, their impact on everyday life and whether appropriate medical treatment has provided relief. Current clinical guidance also recommends confirming the diagnosis before considering an operation.

Many people experiencing sinus-related symptoms can be treated without surgery. Depending on the underlying condition, treatment may involve nasal saline irrigation, steroid nasal sprays, allergy management and, in selected cases, antibiotics or other medications.

"A short episode of sinusitis is very different from chronic rhinosinusitis that continues for several months. Surgery is generally not recommended simply because someone has experienced one or two episodes of a sinus infection," said Dr.

This is also why repeatedly using antibiotics for every episode should not replace a proper evaluation to determine the underlying cause of recurring symptoms.

When Is FESS Considered?

Functional Endoscopic Sinus Surgery (FESS) is primarily considered for people with chronic rhinosinusitis or certain structural problems affecting the sinuses when symptoms continue despite appropriate medical treatment.

"Patients experiencing persistent nasal blockage, facial pressure, reduced sense of smell, nasal discharge or recurrent infections may be considered for surgery, particularly when these symptoms interfere with sleep, work or daily activities," added Dr.

Nasal polyps can also contribute significantly to sinus problems. "They can obstruct the normal drainage pathways of the sinuses and may require surgery when medical treatment does not provide adequate control. Phenotyping the disease is quintessential in chronic rhinosinusitis coupled with planned surgery. FESS may also be considered in selected patients who experience recurrent acute sinusitis," highlighted Dr.

A CT Scan Alone Does Not Mean You Need Surgery

One common misconception is that a CT scan showing "blocked sinuses" automatically means that surgery is necessary.

That is not necessarily the case.

"A CT scan is an important tool when planning sinus surgery, but its findings need to be interpreted along with the patient's symptoms, clinical examination and response to treatment. Current guidelines caution against determining the extent of surgery solely on the basis of mucosal thickening or the degree of sinus blockage visible on a scan," explained Dr Chintapalli.

This is particularly important because some people may show changes on a CT scan without having symptoms severe enough to justify an operation.

What Happens During FESS?

FESS is performed through the nose using a small endoscope, meaning that there are generally no external cuts or visible facial scars. The procedure aims to improve the natural drainage pathways of the affected sinuses and remove diseased or obstructing tissue when required.

The purpose of the procedure is not simply to "clean out" the sinuses. Instead, the goal is to improve drainage and ventilation and, in suitable patients, help ongoing medical treatment work more effectively.

"It is also important to understand that surgery does not necessarily mean that sinus disease will disappear permanently. Conditions such as chronic rhinosinusitis and nasal polyps can recur. In some cases, surgery is performed to reduce the inflammatory burden in the airway so that medications can subsequently be optimized. Some patients, particularly those with reactive airway disorders, may continue to require medication and regular follow-up even after surgery," shared Dr.

The Right Diagnosis Matters More Than the Decision to Operate

The key question should not simply be, "Can sinus surgery be performed?" Instead, the focus should be on whether surgery is likely to benefit that particular patient.

"Someone with persistent symptoms, documented sinus disease and an inadequate response to appropriate medical treatment may benefit significantly from FESS. On the other hand, someone who experiences an occasional sinus infection, has allergies or has a headache that has been labelled as sinus-related without proper evaluation may not require surgery," said Dr.

A thorough ENT evaluation is therefore essential before making a decision about surgery. FESS can be an effective treatment when used for the appropriate indication, but having sinus-related symptoms does not automatically mean that an operation is necessary.