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You Don't Need Surgery for Every Sinus Problem: When Is FESS Actually Necessary?
Sinus has become an easy explanation for almost everything from a blocked nose and facial pressure to headaches and repeated colds. But not every blocked nose is sinusitis, and not every person with sinusitis needs surgery.
This is an important distinction because endoscopic sinus surgery (ESS/FESS) is not usually the first step in treating sinus disease. The decision depends on what is causing the problem, how long it has been present, how much it is affecting the person's life and whether appropriate medical treatment has helped. Current clinical guidance also stresses confirming the diagnosis before considering surgery. We spoke to Dr Ananth Chintapalli, Sr. Consultant -Advanced ENT, Head & Neck Surgery & Skull Base Surgery, KIMS - Arete Hospital, who shared insights on the same.
When medicines may be enough
Many people with sinus symptoms can be managed without an operation. Depending on the cause, treatment may include nasal saline irrigation, nasal steroid sprays, treatment for allergies and, in selected cases, antibiotics or other medicines.
"A short episode of sinusitis, for example, is very different from chronic rhinosinusitis that has been troubling someone for months. Surgery is generally not recommended simply because a person has had one or two episodes of sinus infection," said Dr Chintapalli.
This is also why repeatedly taking antibiotics for every episode is not a substitute for finding out what is actually happening.
When does FESS enter the picture?
FESS is considered mainly when a person has chronic rhinosinusitis or another structural problem involving the sinuses, and symptoms remain troublesome despite appropriate medical management.
"Patients with persistent nasal blockage, facial pressure, reduced sense of smell, nasal discharge or recurrent infections may be candidates, particularly when these symptoms are affecting sleep, work or day-to-day life," added Dr Chintapalli.
Nasal polyps are another serious situation. "They can block the normal drainage pathways of the sinuses and may require surgery when medical treatment does not adequately control the disease. Phenotyping the disease is quintessential in chronic rhinosinusitis coupled with planned surgery. FESS can also be considered in selected patients with recurrent acute sinusitis," highlighted Dr Chintapalli.
A CT scan is useful, but it shouldn't decide on its own
A common misconception is that a CT showing "blocked sinuses" automatically means surgery.
It does not.
"A CT scan is important when planning sinus surgery, but the scan has to be considered alongside the person's symptoms, examination and response to treatment. Current guidelines specifically caution against deciding the extent of surgery based only on how much mucosal thickening or sinus blockage appears on a scan," explained Dr Chintapalli.
This is particularly relevant because some people can have changes on a CT scan without having symptoms that warrant an operation.
What does FESS do?
FESS is performed through the nose using a small endoscope, so there are no external cuts on the face. The aim is to open the natural drainage pathways of the affected sinuses and remove diseased or obstructing tissue where necessary.
The goal is not simply to "clean out the sinuses". It is to restore drainage and ventilation and, in appropriate patients, make ongoing medical treatment more effective.
"It is also important to understand that, not always, surgery does not necessarily mean the sinus disease is gone forever. Conditions such as chronic rhinosinusitis and nasal polyps can recur, and sometimes the surgery is more for reducing the inflammatory load in the individual's airway before the medications can actually be optimized. Some patients, especially with reactive airway disorders, continue to need medication and follow-up after surgery," shared Dr Chintapalli.
Surgery should solve the right problem
The most important question is not "Can sinus surgery be done?" It is "Will surgery actually help this particular patient?"
"Someone with persistent symptoms, documented sinus disease and inadequate response to appropriate treatment may benefit considerably from FESS. Someone with an occasional sinus infection, allergy or a headache that has been labelled as sinus without proper evaluation may not," said Dr Chintapalli.
"A careful ENT assessment is therefore more important than rushing towards surgery. FESS can be extremely useful when it is done for the right indication, but having a sinus problem does not automatically mean needing an operation," he concluded.
Disclaimer: The information provided in this article is for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition.
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