Endoscopic sinus surgery (FESS)

Chronic rhinosinusitis affects 10% of the population in Europe. Endoscopic sinus surgery or ESS (previously referred to as functional endoscopic sinus surgery or FESS) is the commonest operation performed for patients with chronic rhinosinusitis. Patients may present with a range of symptoms ranging from nasal obstruction, reduced sense of smell, nasal discharge and facial pain.

Prior to consideration of any surgery, patients are treated for weeks if not months with topical medications such as nasal douches, nasal steroid sprays or drops, oral antibiotics and oral steroids.

Treatment must be tailored to the individual patient. If there is no improvement, a CT scan of the sinuses is necessary to illustrate sinonasal anatomy for surgical planning and to help determine the extent of disease.

Surgery itself is conventionally carried out under general anaesthesia, particularly for moderate to severe sinonasal disease. It typically takes 1 to 1.5 hours and involves opening up the natural drainage pathways and removing unhealthy tissue or nasal polyps. The aim of surgery is to improve the nasal airway, alleviate nasal obstruction and to permit better delivery of medication. The sense of smell can improve after surgery but is not guaranteed.

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