What is sinus surgery and when is it recommended for chronic sinus problems?

Sinus surgery is a procedure designed to restore normal drainage and function of the sinuses when medical treatment has failed. It is typically recommended for patients with persistent or recurrent sinusitis lasting more than 12 weeks despite appropriate use of medication such as nasal steroids, antibiotics, or saline irrigation.

Chronic rhinosinusitis affects approximately 10–12% of adults in the UK, and a subset of these patients develop structural blockage or inflammation that requires surgical intervention. The goal is not cosmetic but functional: improving airflow, reducing infection frequency, and relieving symptoms such as facial pressure and nasal obstruction.

How does sinus surgery work to improve breathing and reduce infections?

Sinus surgery works by widening the natural drainage pathways of the sinuses to allow mucus to clear effectively. Most modern procedures are performed using functional endoscopic sinus surgery (FESS), which involves inserting a thin camera through the nostrils without external incisions.

By removing small amounts of bone or inflamed tissue, the surgeon restores ventilation and drainage. Studies show that up to 80–90% of patients report significant symptom improvement following FESS, particularly in nasal blockage and facial pain.

Improved drainage reduces bacterial growth, which lowers the frequency of infections and dependence on antibiotics.

What symptoms indicate that sinus surgery may be necessary?

Persistent symptoms despite medical therapy are the main indicator for considering sinus surgery. These symptoms must typically last at least 12 weeks and significantly affect quality of life.

Common symptoms include:

• Nasal blockage or congestion
• Thick nasal discharge (often green or yellow).
• Facial pain or pressure.
• Reduced or lost sense of smell.
• Recurrent sinus infections (multiple episodes per year).

Patients with nasal polyps or anatomical abnormalities such as a deviated septum are more likely to require surgical management.

What are the risks and recovery expectations after sinus surgery?

Sinus surgery is generally safe, but it carries small risks such as bleeding, infection, or scar formation. Serious complications, including damage to surrounding structures like the eye or brain, are rare (occurring in less than 1% of cases).

Recovery usually takes 1–2 weeks for initial healing, although full internal healing may take several weeks. Patients often experience temporary congestion, mild discomfort, and nasal discharge during this period.

Post-operative care, including saline rinses and follow-up reviews, is essential to optimise outcomes and prevent recurrence.

How effective is sinus surgery for long-term symptom relief?

Sinus surgery provides long-term improvement in symptoms for most patients, particularly when combined with ongoing medical management. Evidence suggests that around 75–85% of patients maintain symptom control over several years.

However, surgery is not a cure for underlying inflammatory conditions. Conditions such as allergies or asthma must continue to be managed to sustain results.

What practical steps can patients take before and after sinus surgery?

Preparing and following aftercare instructions improves surgical outcomes and reduces complications.

Before surgery:

• Use prescribed nasal sprays consistently.
• Avoid smoking, as it delays healing.
• Inform your clinician of all medications.

After surgery:

• Perform daily saline nasal irrigation.
• Avoid strenuous activity for at least one week.
• Attend all follow-up appointments.

Adherence to these measures significantly improves healing and long-term symptom control.

When should you seek medical help for sinus problems?

Medical evaluation is necessary when sinus symptoms persist beyond 10 days without improvement or worsen after initial recovery. Chronic symptoms lasting over 12 weeks require specialist assessment.

Urgent medical attention is required if symptoms include swelling around the eyes, severe headache, visual changes, or high fever, as these may indicate complications.

Early referral to a specialist in rhinology can prevent disease progression and reduce the likelihood of repeated infections.

Sinus surgery is an effective treatment for chronic sinus conditions that do not respond to medical therapy, offering significant symptom relief and improved quality of life. Careful patient selection and proper aftercare are essential for long-term success.

If you are considering treatment for sinus surgery, consult with Mr Abbad Toma via his Top Doctors profile to discuss your symptoms and next steps.

References

• NHS. “Chronic sinusitis.”
• NICE Guidelines on Sinusitis Management
• Fokkens WJ et al. “European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS).”
• Hopkins C et al. “Outcomes of Endoscopic Sinus Surgery.” PubMed
• WHO. “Chronic respiratory diseases overview”