ENT and Head & Neck Surgery
Sinusitis and FESS
Medical therapy and FESS — functional endoscopic sinus surgery — for chronic sinusitis.
What is FESS and when is it performed?
FESS (Functional Endoscopic Sinus Surgery) is the minimally invasive technique that endoscopically opens obstructed sinus ostia. Indications: chronic rhinosinusitis unresponsive to 12 weeks of maximal medical therapy, nasal polyps, mucocele, sinus tumour, and odontogenic sinusitis. Surgery takes 60–90 minutes with no external incision. Recovery: 1 week of nasal saline irrigation protocol, 2–3 weeks of intensive-activity restriction, full healing in 6–8 weeks. Success rate is 85–90% in patients adherent to irrigation.
Diagnostic algorithm
Sinusitis diagnosis combines clinical (12+ weeks of nasal obstruction, postnasal drip, facial pain/pressure, hyposmia/anosmia) and imaging (paranasal sinus CT). Allergic rhinitis, immunodeficiency, and anatomical anomalies are accompanying factors that shape the plan.
When polyps are present, polyp burden is graded with the Lund-Mackay score. Asthma comorbidity, NSAID sensitivity, and eosinophilic inflammation (CRSwNP phenotype) are decisive; biologic agents (dupilumab, omalizumab) are considered in selected cases.
Process
- 1
Consultation
2–4 weeks priorCT imaging, endoscopic nasal evaluation, allergy testing.
- 2
Optimisation
2 weeks priorTopical steroid, oral antibiotic if needed, home irrigation protocol.
- 3
Surgery
60–90 minutesGeneral anaesthesia, endoscopic ostium opening.
- 4
Discharge
Same daySame-day discharge, 7-day irrigation protocol begins.
- 5
Post-op follow-up
Weeks 1, 3, 12Endoscopic check, crust cleaning, granulation-tissue follow-up.
Frequently Asked Questions
- Post-op pain is typically mild-to-moderate, controlled with standard analgesia. The first 24–48 hours feature swelling and pressure as the main complaints.
- First 4 weeks: 2–3 times daily. Next 8 weeks: once daily. In chronic rhinosinusitis, daily lifelong irrigation is recommended.
- Recurrence rate is 20–50%, depending on phenotype and adherence. Topical steroid and regular irrigation reduce recurrence. Biologics are an additional option in eosinophilic phenotype.
- Generally safe after 7–10 days. For long-haul flights, 14 days is recommended. Cabin pressure may mismatch sinus pressure earlier than that.
- CT shared → tele-consultation → arrival in Istanbul → surgery day → next-day discharge → 5 days hotel rest + daily irrigation + first endoscopic check → safe return.
References
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