Functional Endoscopic Sinus Surgery (FESS)
Duration
1-3 hours
Downtime
1 week
Lasts for
long-lasting
Setting
Outpatient
Insurance
Covered
Overview
Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure to open your blocked sinuses so they can drain and heal properly. Your surgeon uses small instruments to remove polyps, inflamed tissue, or bone blocking your sinus openings.
Understanding Your Condition
Your sinuses drain mucus through small openings along your nasal walls. When something blocks these openings, mucus builds up and causes headaches, difficulty breathing, poor sleep, and reduced sense of smell.
Common causes of blockage include chronic inflammation, nasal polyps, fungal or bacterial infections, bone overgrowth, and tumors.
FESS can successfully eliminate these causes and improve symptoms.
Candidates
You will need FESS if you have:
- Chronic sinus inflammation (> 12 weeks) that is persistent.
- Failed medical treatment with nasal sprays.
- Recurrent acute nasal inflammation (4 or more episodes per year).
- Nasal polyps.
- Bone overgrowth.
- Fungal ball.
- Tumors Homsi, M. T., & Gaffey, M. M. (2025). Sinus Endoscopic Surgery. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK563202/ hin, J. J., Wilson, M., McKenna, M., Rosenfeld, R., Ammon, K., Crosby, D., Fuchs, J. M., Hensler, J. B., Illing, E. A., Lam, K., Levine, C., Kmucha, S. T., McCoul, E. D., Miller, J., Rodriguez, K., Rowan, N. R., Sedaghat, A. R., Tan, B. K., Roy, E., & Dhepyasuwan, N. (2025). Clinical Practice Guideline: Surgical Management of Chronic Rhinosinusitis. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 172 Suppl 2, S1–S47. https://doi.org/10.1002/ohn.1287
Benefits
Your symptoms drop by half. Nasal obstruction, facial pressure, headaches, and sense of smell all improve significantly, most patients go from moderate-severe symptoms to only mild ones. Soler, Z. M., Jones, R., Le, P., Rudmik, L., Mattos, J. L., Nguyen, S. A., & Schlosser, R. J. (2018). SNOT-22 Outcomes after Sinus Surgery: A Systematic Review and Meta-analysis. The Laryngoscope, 128(3), 581–592. https://doi.org/10.1002/lary.27008
You sleep better. Patients report fewer sleep disruptions and better overall sleep quality after surgery. Jiang, R.-S., & Liang, K.-L. (2019). The Influence of Functional Endoscopic Sinus Surgery on Sleep Related Outcomes in Patients with Chronic Rhinosinusitis. International Journal of Otolaryngology, 2019, 7951045. https://doi.org/10.1155/2019/7951045
You rely less on medications. Most patients reduce or stop daily nasal sprays and other sinus medications. Smith, K. A., Orlandi, R. R., & Rudmik, L. (2015). Cost of adult chronic rhinosinusitis: A systematic review. The Laryngoscope, 125(7), 1547–1556. https://doi.org/10.1002/lary.25180
You miss less work. Patients take fewer sick days and report higher overall productivity. Rudmik, L., Smith, T. L., Mace, J. C., Schlosser, R. J., Hwang, P. H., & Soler, Z. M. (2016). Productivity Costs Decrease After Endoscopic Sinus Surgery for Refractory Chronic Rhinosinusitis. The Laryngoscope, 126(3), 570–574. https://doi.org/10.1002/lary.25656
Common Misconceptions
Surgery will change my nose shape or face.
FESS only treats the inside of your sinuses, it does not change how your nose or face looks.
They break bones and cut my face.
Your surgeon works entirely through your nostrils. No external cuts, no bone-breaking. They use a small camera and fine instruments to open your natural sinus drainage pathways.
I'll get black eyes and a swollen face.
Because everything happens through your nostrils, you won't develop bruising, black eyes, or facial swelling.
Nasal sprays and rinses should be enough.
Saline rinses, sprays, and steam provide real symptom relief and support your treatment. However, surgery showed superiority over medications as they cannot remove polyps, clear structural blockages, or resolve the deep inflammation driving your chronic sinusitis. Patel, Z. M., Thamboo, A., Rudmik, L., Nayak, J. V., Smith, T. L., & Hwang, P. H. (2017). Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: A systematic review and meta‐analysis. International Forum of Allergy & Rhinology, 7(2), 119–127. https://doi.org/10.1002/alr.21872
Risks
FESS is a safe procedure with minimal complications. The major complication rate is about 0.5-1%, and the minor complication rate is ~7%. Dhamija, R., Das, N., & Ding, P. (2025). Complication Rates Following Endoscopic Sinus Surgery for Chronic Sinusitis. American Journal of Rhinology & Allergy, 39(3), 197–204. https://doi.org/10.1177/19458924251315434 Krings, J. G., Kallogjeri, D., Wineland, A., Nepple, K. G., Piccirillo, J. F., & Getz, A. E. (2014). Complications of Primary and Revision Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis. The Laryngoscope, 124(4), 838–845. https://doi.org/10.1002/lary.24401 Ramakrishnan, V. R., Kingdom, T. T., Nayak, J. V., Hwang, P. H., & Orlandi, R. R. (2012). Nationwide incidence of major complications in endoscopic sinus surgery. International Forum of Allergy & Rhinology, 2(1), 34–39. https://doi.org/10.1002/alr.20101 Suzuki, S., Yasunaga, H., Matsui, H., Fushimi, K., Kondo, K., & Yamasoba, T. (2015). Complication rates after functional endoscopic sinus surgery: Analysis of 50,734 Japanese patients. The Laryngoscope, 125(8), 1785–1791. https://doi.org/10.1002/lary.25334 Vlastarakos, P. V., Fetta, M., Segas, J. V., Maragoudakis, P., & Nikolopoulos, T. P. (2013). Functional endoscopic sinus surgery improves sinus-related symptoms and quality of life in children with chronic rhinosinusitis: A systematic analysis and meta-analysis of published interventional studies. Clinical Pediatrics, 52(12), 1091–1097. https://doi.org/10.1177/0009922813506489
Minor Complications |
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Minimal bleeding |
Adhesions |
Reduced smell |
Chapter references
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