Sinus Surgery

What this procedure is

Sinus surgery, often called functional endoscopic sinus surgery, is a procedure used to open the sinus passages and improve airflow. During this process, a doctor uses an endoscope—a thin, flexible tube with a tiny camera and light—to see inside the nose and sinuses. This allows the clinician to identify and remove blockages without making cuts on the outside of the face.

Because the tools are inserted through the nostrils, there is usually no visible scarring. The main goal is to help the sinuses drain more naturally while keeping as much healthy tissue as possible. Your clinician may use this approach to help you breathe more easily and reduce the frequency of sinus infections.

What it treats or fixes

This procedure is most often used to treat chronic sinusitis, which is long-term swelling and irritation of the sinuses that has not improved with medicine. It can also help with several other issues, including:

• Nasal polyps: Small, non-cancerous growths that can block the nasal passages.
• Structural issues: Removing small pieces of bone or tissue that prevent the sinuses from draining properly.
• Recurrent infections: Clearing the pathways so that bacteria and mucus do not get trapped as easily.

By opening these pathways, the surgery helps nasal sprays and rinses reach the sinus lining more effectively. This can lead to a reduction in facial pain, pressure, and the feeling of a constantly stuffed nose.

How common it is & where it's done

Sinus surgery is a very common and routine procedure performed by ear, nose, and throat (ENT) specialists. It is typically performed as an outpatient procedure, which means most patients are able to go home the same day rather than staying overnight in a hospital.

The surgery usually takes place in a hospital or a specialized surgery center. To keep you comfortable, your clinician may use general anesthesia, which puts you into a deep sleep, or local anesthesia with sedation. Your care team will determine the best setting and comfort options based on your specific health needs.

Recovery: What to Expect

Most patients are able to go home the same day as their procedure. For the first few days, you may feel some mild congestion, pressure, or "stuffiness," similar to a cold. Your clinician may recommend using saline (saltwater) rinses or sprays to keep the nasal passages moist and help clear out debris as you heal.

To help your body recover, you should follow these general guidelines:

• Avoid blowing your nose for at least one to two weeks.
• Avoid heavy lifting or intense exercise until your clinician says it is safe.
• Keep your head elevated when resting to reduce swelling.

It is normal to see some light pink drainage for a few days. However, you should call your clinician if you experience a high fever, a severe headache that does not go away with medicine, or heavy bleeding that does not stop.

Risks & Possible Complications

While sinus surgery is generally safe, all medical procedures involve some risks. The most common issues are minor bleeding or temporary swelling inside the nose. In some cases, small amounts of scar tissue (called adhesions) can form, which your doctor may need to remove during a follow-up visit.

Other rare risks include a temporary change in your sense of smell or taste. Because the sinuses are located near the eyes and the base of the brain, your surgical team uses specialized tools and cameras to protect these sensitive areas. Your clinician will review your health history to help minimize any risks before the surgery begins.

Outcomes & Long-Term Results

The goal of surgery is to open the sinus passages so they can drain more easily and allow air to flow better. Most patients feel a significant improvement in their symptoms, such as less pressure and fewer infections, within a few weeks after the initial swelling goes down.

It is important to remember that surgery is often one part of a larger treatment plan. While the procedure fixes the physical structure of the sinuses, you may still need to manage underlying issues like allergies or asthma with medications. Following your clinician’s long-term care plan is the best way to ensure lasting results.

Emotional Support & Reassurance

It is completely normal to feel nervous before any procedure. You may find comfort in knowing that modern sinus surgery is endoscopic, meaning it is done through the nostrils with a tiny camera. This usually means there are no visible cuts or scars on the outside of your face, and the recovery is often faster than older surgical methods.

Your care team is there to help you feel at ease. Feel free to share any concerns or ask questions about what to expect on the day of surgery. Focusing on the relief you will feel from chronic sinus pain and pressure can help you stay positive as you prepare for your path to better breathing.

Why doctors recommend it

Clinicians often recommend sinus surgery when other treatments have not worked well enough to manage your symptoms. If you have chronic sinusitis—which is long-term swelling and irritation of the sinus lining—your clinician may first try medications like antibiotics, steroid nasal sprays, or saline rinses. If these do not clear the blockage or stop the symptoms after several weeks, surgery may be the next step to help you breathe better.

Another common reason for this procedure is the presence of nasal polyps. These are small, soft, non-cancerous growths that can develop in the lining of the nose or sinuses. These growths can block the sinus passages, making it hard to breathe and leading to frequent infections. Surgery can remove these growths to open up the airways and reduce the feeling of congestion.

Urgent vs planned treatment

In most cases, sinus surgery is a planned procedure. This means it is scheduled in advance after you and your clinician have discussed your options and history. It is usually not an emergency. Instead, it is often considered after "maximal medical therapy," which is a period of time where you try various medicines to see if the condition improves without surgery.

While rare, there are times when a clinician might suggest more urgent treatment. This may happen if a sinus infection is very severe or if there is a concern that the infection could spread to nearby areas, such as the eyes or the brain. However, for the vast majority of patients, the surgery is a choice made to improve long-term quality of life rather than an immediate medical crisis.

Goals of treatment

The primary goal of this surgery is to improve how your sinuses drain. Your sinuses are air-filled spaces in the bones of your face that produce mucus to keep your nose moist. By clearing away small pieces of bone, polyps, or swollen tissue that block the pathways, your clinician aims to restore the natural flow of air and mucus.

Success in sinus surgery often means achieving several key goals:

• Better airflow: Making it easier to breathe through your nose by removing physical obstructions.
• Improved medication use: Opening the passages so that future nasal sprays and rinses can reach the sinus lining more effectively.
• Symptom relief: Reducing the frequency of sinus infections and lessening the pressure or pain you feel in your face.
• Sense of smell: Helping to restore or improve your ability to smell by clearing the pathways to the olfactory (smell) nerves.

Who may benefit

Sinus surgery is often a choice for people with chronic sinusitis, which is long-term swelling and irritation of the sinus linings. Your clinician may suggest this if your symptoms last for several months and do not get better with other treatments. It is also commonly used for people who have nasal polyps, which are small, non-cancerous growths that can block the nose and make it hard to breathe.

This procedure may also help if you have structural issues, such as a deviated septum (when the wall between your nostrils is crooked) or narrow sinus openings. The goal is usually to improve how air flows through your nose and to help your sinuses drain more easily, which can reduce the number of infections you get.

When it may not be the right option

Surgery is typically not the first step for sinus problems. Your care team will usually try "medical management" first. This includes using saltwater rinses, steroid nasal sprays, or antibiotics to clear up infections. If these treatments are working well to control your symptoms, surgery may not be necessary at this time.

It may also not be the right choice if your symptoms are caused by allergies that can be managed with lifestyle changes or allergy medications. Additionally, if you have certain underlying health conditions that make surgery or general anesthesia (medicine that puts you to sleep) risky, your clinician might recommend continuing with non-surgical treatments instead.

Questions to ask your care team

Deciding to have surgery is a big step. It is helpful to talk with your doctor about what to expect and how the procedure might change your daily life. You may want to bring a list of questions to your next appointment, such as:

• Why is surgery the best option for me right now?
• Are there any other medications or treatments we haven't tried yet?
• How much improvement should I expect in my breathing or sinus pressure?
• What are the risks of the procedure, and what happens if I choose not to have surgery?
• How long will it take for me to feel back to normal after the procedure?

In the procedure room

When you enter the procedure room, you will meet your surgical team, including the surgeon, nurses, and anesthesia providers. They will help you get settled comfortably on a padded table. The room is equipped with specialized tools, including a thin, lighted tube with a camera called an endoscope. This device allows the surgeon to see deep inside your nasal passages on a high-definition video monitor without making external cuts.

High-level steps

The surgeon carefully inserts the endoscope into your nostrils to view the sinus openings. Using very small, precise instruments, your clinician may remove blockages such as nasal polyps (soft growths), extra bone, or swollen tissue. The goal is to widen the natural pathways to improve airflow and help your sinuses drain more effectively.

Once the pathways are clear, the surgeon may wash out the sinuses with a saline solution. In some cases, they may place temporary packing or a small dissolvable spacer inside the nose. This material helps support the newly opened passages and controls minor bleeding while the area begins to heal.

Anesthesia and pain control

To ensure you are comfortable and pain-free, your clinician may use general anesthesia, which puts you into a deep sleep for the duration of the surgery. In some situations, they may use local anesthesia to numb the nose along with medicine to help you stay relaxed and drowsy. Your care team will discuss which option is safest and most appropriate for you. You should not feel any pain during the procedure itself.

Monitoring and safety steps

Your safety is monitored throughout the entire process. The surgical team uses sensors to constantly track your heart rate, blood pressure, and oxygen levels. The use of the endoscope provides the surgeon with a magnified, clear view of the anatomy, which allows for great precision. The team also follows standard safety checklists to confirm all details before the procedure begins.

Immediately after the procedure

After the surgery is finished, you will be moved to a recovery room where nurses will monitor you as you wake up. You may feel groggy or sleepy for a short time. It is common for your nose to feel very "stuffy" or full, similar to having a severe cold. This feeling is usually caused by internal swelling or the packing material placed inside the nose.

You might also notice some mild pressure or a dull ache in your nose and cheeks. Your clinician may provide medicine to help with any discomfort. Most patients are able to go home the same day once the anesthesia has worn off and they are feeling stable.

Typical procedure length

The length of the surgery depends on the complexity of your sinus issues and how many sinuses need to be treated. On average, the procedure takes between 1 and 3 hours. Your surgical team will provide a more specific estimate based on your individual treatment plan.

Common approaches (open vs minimally invasive)

Most sinus surgeries today are minimally invasive. This is often called Functional Endoscopic Sinus Surgery (FESS). In this approach, the surgeon uses a thin tube with a light and camera, known as an endoscope, to see inside your nose. Special instruments are used to gently remove blockages and widen the natural drainage pathways. Because the surgery is done through the nostrils, there are usually no visible cuts or scars on the face.

In rare cases, an open approach may be necessary. This is typically reserved for very complicated cases or when the infection is difficult to reach with an endoscope alone. This method may involve making a small incision (cut) on the skin or inside the mouth to access the sinus. Your doctor will recommend the safest approach based on your specific anatomy and CT scans.

Partial vs total

Sinus surgery is not "one size fits all." The procedure is often tailored to treat only the sinuses that are blocked or infected. This is why it is often called "functional" surgery—the goal is to restore normal function while keeping as much healthy tissue as possible. If you only have a blockage in one area, the surgeon will focus only on that spot.

However, if your condition is severe and affects all the sinus cavities (such as widespread nasal polyps), a more extensive procedure may be needed to open all the pathways. Your clinician will decide how much tissue or bone needs to be removed to help you breathe better and allow sinus rinses to reach the inflamed areas.

Revision or repeat procedures

For many people, one surgery significantly improves symptoms. However, chronic sinusitis is a long-term condition, and surgery does not always cure the underlying tendency for inflammation. In some cases, symptoms can return over time. This might happen if scar tissue forms during healing or if nasal polyps grow back.

If symptoms persist or return, a revision surgery (a repeat procedure) might be an option. This surgery is done to clear out new blockages or scar tissue. To lower the chance of needing a second surgery, it is important to follow all after-care instructions, such as using saline rinses and attending follow-up appointments to keep the nose clean while it heals.

Tests and imaging that may be done

To ensure you are healthy enough for anesthesia and the procedure, your clinician will likely schedule a pre-operative visit. This appointment usually takes place within 30 days of your surgery date. During this time, your care team will review your medical history and check your general health.

Common tests ordered before sinus surgery include:

• Physical exam: A general check-up to ensure your heart and lungs are ready for surgery.
• Blood work: Standard lab tests to check for clotting issues or infection.
• EKG (Electrocardiogram): A test that checks your heart rhythm, often required for patients over age 50 or those with heart conditions.
• CT Scan: Your surgeon may order a new CT scan to use as a map during the surgery (image guidance).

Medication adjustments

Certain medications and supplements can increase the risk of bleeding during and after surgery. Your surgical team will review everything you take and provide a specific schedule for stopping or changing them. Only stop medicines if your clinician instructs you.

Common adjustments may include:

• Pain relievers: You are often asked to stop taking aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) at least two weeks before surgery. Acetaminophen (Tylenol) is generally considered safe to use.
• Supplements: Herbal products such as Vitamin E, fish oil, ginkgo, ginseng, and garlic may need to be paused two weeks prior to your date.
• Pre-surgery prescriptions: Your doctor may prescribe antibiotics or oral steroids for you to take in the days leading up to the surgery. These help reduce swelling and infection before the procedure begins.

Day-before and day-of instructions

Strictly following the rules for the day of surgery is essential for your safety. If these instructions are not followed, the surgery may need to be cancelled.

• Fasting: Do not eat or drink anything after midnight the night before surgery. This includes water, coffee, gum, and mints. An empty stomach is necessary for safe anesthesia.
• Morning medications: If your doctor instructs you to take specific heart or blood pressure medication on the morning of surgery, take it with a very small sip of water.
• Clothing and items: Wear loose, comfortable clothing. Avoid wearing jewelry, makeup, nail polish, or contact lenses to the surgery center.
• Transportation: You will be under the effects of anesthesia and cannot drive yourself home. You must arrange for a responsible adult to pick you up. Most centers do not allow patients to take a taxi or rideshare service alone.

General surgical risks

Like any operation, sinus surgery carries some standard risks. Bleeding is possible, though it is usually minor and often stops on its own or with basic treatment. There is also a small risk of infection at the surgical site.

Most sinus surgeries are performed under general anesthesia. While reactions to anesthesia can occur, your medical team will review your health history beforehand to manage these risks and keep you safe during the procedure.

Procedure-specific complications

Because the sinuses are located near the eyes and the base of the brain, there are unique risks associated with this surgery. However, serious complications are rare.

• Scarring: Scar tissue (sometimes called synechiae) may form between the structures inside the nose as it heals.
• Recurrence: In some cases, sinus inflammation or nasal polyps can return after the procedure.
• Sensory changes: You may notice a temporary change or decrease in your sense of smell or taste.
• Rare risks: In very uncommon cases, there can be injury to the eye area or a leak of the fluid that surrounds the brain (cerebrospinal fluid).

How complications are treated

Your care team has specific plans to handle complications if they arise. If an infection develops, it is typically treated with antibiotics. Minor bleeding is often managed by keeping your head elevated or using specific nasal sprays recommended by your doctor.

To prevent scarring and assist healing, your clinician will likely instruct you to use saline (saltwater) rinses. During follow-up visits, the doctor may perform a procedure called debridement. This involves gently cleaning the nasal passages to remove crusts and keep the sinuses open.

In the rare event of a more serious issue, such as a fluid leak or injury to the eye, further treatment or a repair procedure may be necessary.

Pain control medicines

It is normal to feel some pressure or mild pain after sinus surgery. Your clinician may suggest using over-the-counter pain relievers, such as acetaminophen, to help you feel more comfortable. These are often the first choice for managing mild discomfort during the first few days of recovery.

In some cases, your clinician might prescribe a stronger pain medicine, often called a narcotic or opioid, for a short period. Because these can cause sleepiness or other side effects, they are usually used only when necessary. Your care team will tailor your pain plan based on your health history and any allergies you may have.

It is important to avoid certain pain relievers like ibuprofen or naproxen unless your doctor says they are okay. These medicines, known as NSAIDs (non-steroidal anti-inflammatory drugs), can sometimes increase the risk of bleeding after the procedure.

Antibiotics

Antibiotics are medicines used to treat or prevent infections caused by bacteria. Your clinician may prescribe a course of antibiotics to start before your surgery or immediately afterward. This helps ensure the sinus area heals properly and reduces the chance of an infection slowing down your recovery.

If you are given an antibiotic, it is important to take the medicine exactly as directed and to finish the entire prescription, even if you start feeling better quickly. Your clinician will choose an antibiotic that is safe for you, taking into account any drug allergies or previous reactions you have reported.

Blood thinners and clot prevention

To help prevent heavy bleeding during and after surgery, your clinician will likely ask you to stop taking medicines that thin the blood. These are substances that make it harder for your blood to clot. Common examples include aspirin, certain prescription heart medications, and even some herbal supplements like vitamin E or ginkgo.

You will usually be asked to stop these items about one to two weeks before your procedure. Your care team will provide a specific list of what to avoid and tell you exactly when it is safe to start taking them again after surgery. Never stop a prescription medication without talking to your clinician first, as they will help you balance your overall health needs with the safety of your surgery.

Emergency warning signs

While serious complications from sinus surgery are rare, certain symptoms require immediate medical attention to protect your health and vision. You should go to the emergency room if you experience sudden changes in your eyesight, such as double vision, loss of vision, or if an eye appears to be bulging.

Seek emergency care if you have a severe headache accompanied by a stiff neck and high fever, as this could be a sign of a serious infection. Additionally, if you have heavy, bright red bleeding from the nose that flows steadily and does not stop after using ice or pressure as directed, you need immediate help.

Call your surgeon or clinic if…

Your healthcare team will want to know about any signs of infection or unexpected fluid drainage. Contact your surgeon’s office if you notice:

• A fever higher than 101°F (38.3°C).
• Constant, clear, watery fluid dripping from one side of your nose.
• Pain or pressure that is not relieved by your prescribed medication.
• Significant swelling or redness around the nose or eyes.

Expected vs concerning symptoms

It is normal to feel like you have a bad head cold immediately after surgery. Most people experience nasal congestion, sinus pressure, and fatigue for several days. It is also expected to see some bloody discharge or dark, old blood draining from the nose as you heal.

However, fresh bleeding that is bright red and continuous is concerning. While thick or bloody mucus is common, a thin, watery drip that tastes salty or does not stop could be a sign of a fluid leak. If you are unsure whether a symptom is part of the normal healing process, it is always safer to call your clinic for guidance.

Non-surgical treatments

Before suggesting surgery, your clinician may recommend several medical treatments to manage sinus issues. The goal is to reduce inflammation (swelling) and help the sinuses drain more easily on their own. These treatments are often the first step in managing chronic sinusitis, which is a long-term swelling of the sinus passages.

• Nasal steroid sprays: These medications help shrink the lining of the nose and sinuses to improve airflow and reduce congestion.
• Saline rinses: Using a saltwater solution to wash out mucus and irritants from the nasal passages.
• Antibiotics: If a bacterial infection is present, your clinician may prescribe these to clear the infection.
• Oral medications: In some cases, pills like decongestants or steroids may be used for a short time to reduce severe swelling.

Watchful waiting

Watchful waiting means your care team monitors your symptoms closely without starting a new procedure or surgery right away. This approach is often used for mild or occasional sinus problems to see if they resolve with time or simple home care. It allows your body time to heal or for current medications to take full effect.

During this period, your clinician may ask you to keep track of your symptoms, such as facial pressure or nasal congestion. If your symptoms stay the same or get better, surgery may not be necessary. This step ensures that surgery is only used when it is the most appropriate option for your health.

When surgery becomes the best option

Surgery is usually considered when "maximal medical therapy" has not provided enough relief. This means you have tried various medications and rinses for several weeks or months, but your symptoms—like pain, pressure, or difficulty breathing—continue to affect your daily life. The main goal of surgery is to improve how the sinuses drain.

Your clinician may recommend surgery if they find physical blockages that medicine cannot fix. This might include nasal polyps (painless, soft growths on the lining of the nasal passages) or other structural issues that prevent the sinuses from clearing themselves. By removing these blockages and enlarging the natural openings of the sinuses, the procedure helps the sinuses stay clear and reduces the chance of future infections.

Hospital services that commonly perform this surgery

Sinus surgery is typically performed within a hospital's Ear, Nose, and Throat (ENT) department. This specialty is also known as Otolaryngology. Because most sinus procedures are minimally invasive, they are often done in outpatient surgery centers or ambulatory care units. This means you can usually return home the same day the procedure is finished.

These facilities are equipped with specialized technology, such as endoscopes (thin, flexible tubes with tiny cameras) and image-guidance systems. These tools allow your clinician to see clearly inside the nasal passages during the operation. The hospital will also have a dedicated anesthesia team to ensure you remain comfortable and safe throughout the process.

Patient resources and support services

Many hospitals provide educational resources to help you feel prepared before your procedure. This may include pre-surgery guides or classes that explain how to get your home ready for recovery. Your care team may also offer access to financial counselors who can help you understand insurance coverage and billing.

After surgery, support services often include:

• Nursing Support Lines: Many centers provide a phone number you can call to ask questions about your recovery or symptoms.
• Pharmacy Services: On-site pharmacies can help you coordinate the specific nasal sprays, rinses, or medications your clinician may recommend for healing.
• Follow-up Care: Support staff will help schedule your post-operative visits to ensure your sinuses are healing properly.

Questions for choosing where to have surgery

Choosing the right facility can help you feel more confident about your care. Your clinician may suggest a specific hospital or surgery center based on your needs. You might consider asking the following questions when choosing a location:

• Is the facility accredited and experienced in performing endoscopic sinus surgeries?
• Does the center use modern image-guidance technology for sinus procedures?
• What is the process for reaching a healthcare provider if I have questions after I go home?
• Are the pre-surgery testing and post-surgery follow-up appointments located in the same building?
• Does the facility provide clear, written instructions for my recovery at home?

Conditions commonly treated by this procedure

Sinus surgery is often considered when medical treatments, such as antibiotics or nasal sprays, do not provide enough relief. Your clinician may recommend this procedure to help open the sinus passages and improve how air and mucus move through the nose.

Common conditions that may be treated with this surgery include:

• Chronic Sinusitis: This is a long-term inflammation of the sinuses (the hollow spaces in the bones around your nose) that lasts for 12 weeks or more.
• Nasal Polyps: These are soft, noncancerous growths on the lining of the nasal passages or sinuses. They can block the airways and make breathing difficult.
• Recurrent Sinus Infections: Some people experience frequent infections that keep coming back despite regular medical care.
• Structural Issues: Problems like a deviated septum (when the wall between the nostrils is crooked) or enlarged turbinates (structures inside the nose that help warm and moisten air) may also be addressed to improve breathing.

Related symptoms people search for

People who are candidates for sinus surgery often experience a variety of symptoms that affect their daily life. These symptoms can vary from person to person and may be associated with different underlying sinus issues.

Commonly reported symptoms can include:

• Facial Pain or Pressure: A persistent feeling of fullness or aching around the eyes, cheeks, or forehead.
• Nasal Congestion: A constant "stuffy" feeling that makes it hard to breathe through the nose.
• Reduced Sense of Smell or Taste: Difficulty smelling scents or tasting food because the nasal passages are blocked.
• Post-Nasal Drip: The sensation of mucus dripping down the back of the throat, which can sometimes lead to a sore throat or a cough.

If you are experiencing these symptoms, your clinician can help determine if they are related to a sinus condition and discuss the best options for your care.

Evidence overview

Endoscopic sinus surgery is a widely accepted and standard treatment for chronic sinus issues that do not improve with medication. Medical experts typically recommend this procedure when treatments like antibiotics, nasal sprays, and allergy management have failed to provide lasting relief. The primary goal is to widen the natural drainage pathways between the sinuses and the nose, allowing mucus to drain effectively and air to circulate.

Because this surgery uses a thin tube with a light and camera (endoscope) inserted through the nostrils, it does not usually require incisions on the outside of the face. This minimally invasive approach is supported by extensive medical experience and is considered the standard of care for treating chronic sinusitis and nasal polyps.

Safety notes and individualized care

Sinus surgery is generally considered safe, but like all surgical procedures, it carries some risks. Your clinician will discuss potential complications with you, which may include bleeding, infection, or the return of sinus symptoms. Although rare, there are risks associated with the surgery being close to the eyes and the base of the brain. Your surgical team uses detailed imaging and specialized tools to navigate the sinuses carefully.

To ensure your safety, your doctor will create a care plan specific to your health needs. This often involves:

• Medication review: You may be asked to stop taking aspirin, ibuprofen, or certain supplements before surgery to reduce the risk of bleeding.
• Nasal irrigation: Rinsing the nasal passages with saline (salt water) after surgery is a critical part of healing. This keeps the area moist and clears away debris.
• Activity limits: You will likely need to avoid heavy lifting, straining, and nose blowing for a period of time to prevent bleeding and aid recovery.
• Follow-up care: Regular visits are necessary to clean the surgical area and monitor healing.

Sources used

The information provided in this section is based on patient education materials and clinical overviews from major academic medical centers and departments of otolaryngology (ear, nose, and throat) in the United States.