Functional Endoscopic Sinus Surgery (FESS) is the most common procedure for treating chronic sinusitis, performed entirely through the nostrils. This minimally invasive technique opens the natural drainage pathways of the sinuses, allowing for better airflow and effective delivery of topical medications. Following the procedure, careful recovery is necessary to ensure tissues heal properly and prevent complications. Understanding the expected timeline and care routine is the first step toward a successful outcome.
The Immediate Aftermath
The first 24 to 48 hours following sinus surgery involve the most acute effects of the procedure and anesthesia. Patients may feel groggy and slightly nauseated after waking from general anesthesia, though this usually subsides quickly. Nasal congestion will be pronounced, feeling similar to a severe head cold due to internal swelling and any nasal packing used.
If non-dissolvable nasal packing was placed to control initial bleeding, mouth breathing is necessary until it is removed, typically within 24 to 48 hours. Mild to moderate pain or a dull ache in the facial areas is common, but it is manageable with prescribed pain medication. Resting with the head elevated, using a few pillows or a recliner, is important to minimize swelling and reduce bleeding.
Light, bloody drainage is expected during this initial period, often requiring a small gauze dressing, known as a “drip pad,” under the nose. This drainage is typically thin, pink, or blood-tinged mucus and should gradually decrease over the first few days. Patients should avoid suppressing a sneeze, instead letting it out through an open mouth to prevent pressure buildup in the nasal cavities.
Practical Recovery Management at Home
The cornerstone of post-operative sinus care is the consistent use of saline nasal irrigation, often started the morning after surgery. Using a nasal wash bottle system allows for a more thorough cleaning than a simple saline spray, flushing out old blood, mucus, and crusting. This washing process is performed multiple times a day—often two to four—and is crucial for preventing infection and scarring.
Prescribed pain medication should be taken as directed, often on a schedule during the first day or two to manage discomfort. Many surgeons advise against taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for the first week, as these increase the risk of bleeding. Simple acetaminophen is often recommended for milder pain relief instead.
A soft, bland diet may be preferred immediately following surgery, especially if the throat is sore from the breathing tube. Maintaining excellent hydration is important, and patients should avoid hot liquids, alcohol, and spicy foods for at least 48 hours. These items can promote blood vessel dilation and increase the risk of bleeding. Temporary changes to the sense of smell or taste, or numbness in the upper teeth, should resolve as swelling decreases over the following weeks.
Activity Restrictions and Recovery Timeline
Rest is paramount in the initial week of recovery. Patients must avoid activities that increase blood pressure in the head, which could trigger a nosebleed. This includes a strict restriction on bending over, straining, and lifting anything heavier than 10 pounds for the first seven to fourteen days. Light walking is encouraged soon after the procedure to promote circulation, but strenuous exercise, such as jogging, weightlifting, or swimming, must be avoided for two to four weeks.
The timeline for returning to work depends on the job’s nature. Those with sedentary roles can often return within a few days to one week. Jobs involving physical labor or significant exertion require a longer time off, typically two weeks or more, to ensure the surgical site is stable. Patients should also avoid air travel for at least one to two weeks after surgery, as changes in cabin pressure can cause pain or increase the risk of bleeding.
Do not blow the nose for the first one to two weeks after the procedure to prevent dislodging clots or causing a fresh bleed. Drainage should be gently wiped or sniffed back until the surgeon advises that gentle nose-blowing can begin. While initial healing occurs rapidly, the complete internal healing of the sinus lining can take four to eight weeks. Follow-up appointments are necessary to clean the surgical site and monitor progress.
Recognizing Normal vs. Concerning Symptoms
During the healing process, certain symptoms are expected and indicate the body is recovering appropriately. Normal signs include fatigue for the first week, minor intermittent bleeding or blood-tinged discharge, and a feeling of nasal stuffiness or pressure. The presence of thick mucus and crusting is also expected, particularly after the removal of any packing, which the saline rinses are intended to clear.
Some symptoms warrant immediate contact with the surgeon or emergency care. Patients should seek urgent medical attention if they experience persistent, heavy, bright-red bleeding that does not stop after applying gentle pressure for 15 minutes. Other concerning symptoms require immediate medical evaluation:
- A high fever (101°F or higher).
- Severe pain that is unrelieved by prescribed medication.
- Sudden, excessive swelling around the eyes.
- Vision changes, such as double vision or blurry sight.
- Clear, watery discharge that persistently drips from the nose, which could indicate a rare cerebrospinal fluid leak.