Sinus surgery is a procedure that opens blocked sinus passages to restore normal drainage, typically by removing small amounts of bone or tissue through the nostrils. It’s most commonly performed for chronic sinusitis that hasn’t responded to medications like antibiotics, steroids, or nasal sprays. The surgery is almost always outpatient, meaning you go home the same day, and it’s done under general anesthesia.
Why Sinus Surgery Is Recommended
The sinuses are air-filled cavities behind your forehead, cheeks, and eyes. When they become chronically inflamed, the narrow drainage openings swell shut, trapping mucus and creating a cycle of pressure, congestion, and infection. Chronic rhinosinusitis, the formal name for this condition, is defined by symptoms lasting 12 weeks or longer.
Surgery becomes an option when medical treatments haven’t brought adequate relief. Current clinical guidelines emphasize that there’s no fixed requirement for how long you need to try medications before surgery is appropriate. The decision is individualized based on how severe your symptoms are, what’s been tried, and what a CT scan shows about the extent of inflammation or structural blockage. Nasal polyps, a deviated septum blocking a sinus opening, or recurring infections that keep coming back despite treatment are all common reasons surgery gets recommended.
Types of Sinus Surgery
Functional Endoscopic Sinus Surgery (FESS)
FESS is the standard approach and the one most people are referring to when they say “sinus surgery.” A thin, lighted camera called an endoscope goes through your nostril, giving the surgeon a magnified view of your sinus anatomy on a screen. The core concept is removing only the tissue and thin bone that’s blocking the sinus drainage pathways while preserving healthy mucous membrane. Specialized instruments called microdebriders precisely remove diseased tissue without damaging the normal lining around it. There are no external incisions or visible scars.
Depending on which sinuses are involved, the surgeon may widen the natural opening of the maxillary sinus (behind the cheek), remove small honeycomb-like bone cells in the ethmoid sinuses (between the eyes), or open the frontal or sphenoid sinuses. For patients with nasal polyps, the polyps are removed during the same procedure.
Balloon Sinuplasty
Balloon sinuplasty is a less invasive alternative that works differently from FESS. Instead of removing tissue, a small balloon catheter is threaded into the blocked sinus opening and inflated. The inflation creates tiny microfractures in the surrounding bone, permanently widening the passage without destroying the mucous lining. Because no tissue is removed, balloon sinuplasty can’t address nasal polyps on its own. It works best for patients whose primary problem is narrowed sinus openings rather than widespread inflammation or polyp growth.
Image-Guided Surgery
Many surgeons now use a computer navigation system during FESS, similar in concept to GPS. Before surgery, a CT scan of your sinuses is loaded into the system, which creates a three-dimensional map. During the procedure, the system tracks the tip of the surgical instrument in real time against that map, showing the surgeon exactly where they are relative to critical structures like the eyes and brain.
This technology meaningfully reduces complications. A meta-analysis found that image-guided FESS cut the rate of reoperation due to postoperative bleeding roughly in half compared to conventional FESS, and reduced overall complication rates by about 34%. It’s particularly useful in revision surgeries where the normal anatomy has been altered, or in cases involving the sinuses closest to the skull base.
What Happens During the Procedure
You’ll be under general anesthesia for the duration, which typically ranges from one to three hours depending on how many sinuses need to be addressed. Everything is done through the nostrils. The surgeon works with the endoscope in one hand and instruments in the other, systematically opening each blocked sinus. Some surgeons place a small dissolvable stent inside the sinus at the end of the procedure. These stents slowly release anti-inflammatory medication directly into the tissue over about a month, then dissolve on their own. They help keep the sinus open during the critical early healing period and reduce the chances of scarring or inflammation that could close the passage back up.
Nasal packing may or may not be placed. Older techniques used non-absorbable packing that had to be physically pulled out at a follow-up visit, which was notoriously uncomfortable. Many surgeons now use absorbable packing materials that dissolve over days, or skip packing entirely. If your surgeon plans to use packing, it’s worth asking which type.
Recovery Week by Week
You’ll go home the same day. Expect significant nasal congestion, some bloody drainage, and mild to moderate facial pressure for the first several days. Pain is usually manageable with over-the-counter medication for most people.
During the first week, don’t blow your nose. Avoid bending over, straining, or lifting anything over 20 pounds. Light walking and normal household tasks are fine right away. Saline rinses, which your surgeon will instruct you on, become a daily routine to keep the healing sinuses clean and moist.
Plan to take about one week off work, and consider easing back with a half day on your first day back. After one week, you can return to exercise at about half your normal intensity. By two weeks, most people can resume full exercise. You’ll have one or more follow-up appointments where the surgeon uses the endoscope to clean out any crusting or early scar tissue forming inside the sinuses, a process called debridement. These visits aren’t optional. They’re an important part of making sure the surgical openings heal properly and stay open.
Full healing of the sinus lining takes several weeks to a few months. Your breathing and symptoms typically improve gradually over that period rather than all at once.
Success Rates and Revision Surgery
The majority of patients experience significant improvement in their symptoms after endoscopic sinus surgery. However, about 16% of patients will eventually need a revision surgery. That number varies considerably depending on the underlying condition. Patients without nasal polyps have a revision rate of roughly 10%, while those with nasal polyps face a much higher rate of about 30%. Polyps have a biological tendency to regrow, which is why ongoing medical management with nasal steroid sprays or other treatments remains important even after a successful surgery.
Among those who do need revision, most only require one additional procedure. Only about 4% of all sinus surgery patients end up needing two or more revisions.
Risks and Complications
Sinus surgery is considered safe, but the sinuses sit next to structures where complications carry real consequences. The sinuses share thin walls with the eye sockets and the base of the skull.
The most common issue is bleeding, occurring in roughly 2 to 2.5% of cases. This is usually manageable and rarely requires a return to the operating room. Cerebrospinal fluid leak, where the thin bone separating the sinuses from the brain cavity is breached, occurs in less than 1% of cases. Orbital (eye-related) injury is similarly rare. Both of these serious complications have become less frequent with the adoption of image-guided navigation. Scar tissue forming between surfaces inside the nose, called adhesions, is another potential issue that post-operative debridement visits are designed to catch early.
Temporary changes to your sense of smell are common during recovery. Permanent loss of smell is possible but uncommon. Numbness in the upper teeth or lip can occur when surgery involves the maxillary sinus but usually resolves over weeks to months.