Sinusitis Treatment & Endoscopic Sinus Surgery (FESS)
Most sinus infections are viral and get better without antibiotics. When facial pressure, blockage and discharge have lasted more than twelve weeks and proper medical treatment has failed, endoscopic surgery opens the natural drainage pathways — through the nostrils, with no external cut and no scar.
- Cashless Insurance Support
- No-Cost EMI
- Free Pickup & Drop
- Dedicated Care Coordinator
- 24×7 Patient Support
- No Hidden Charges
Get Expert Surgical Guidance
Connect with our care team for treatment guidance.
What is Sinus?
The sinuses are air-filled cavities in the bones around the nose, lined with the same mucous membrane and connected to the nasal cavity by narrow openings. Mucus produced inside them is swept continuously towards those openings by microscopic hairs. Sinusitis happens when the lining becomes inflamed, the openings swell shut, and mucus that can no longer drain sits and stagnates.
The first thing worth stating clearly, because it drives an enormous amount of unnecessary antibiotic use: most acute sinusitis is viral. It follows a cold, it causes facial pressure and thick discharge, and it resolves on its own within seven to ten days. Thick yellow or green mucus is not proof of a bacterial infection — it reflects the immune cells present, and it occurs in ordinary viral illness too. Antibiotics are appropriate when symptoms last beyond ten days without improvement, when they worsen after initially improving, or when the illness is severe with high fever and marked facial pain. Taking them for every cold that settles in the sinuses drives resistance and does not shorten the illness.
Chronic rhinosinusitis is a different condition, defined by symptoms lasting more than twelve weeks. It is less an infection than a persistent inflammatory disease of the lining, and antibiotics are largely beside the point. The main division is between chronic sinusitis with nasal polyps — grape-like swellings of inflamed lining that block the nose and destroy the sense of smell — and without them. That distinction matters because polyp disease is a more inflammatory condition, responds well to steroids, and recurs readily if steroid treatment is stopped.
Surgery is not the first answer, and a surgeon who offers it before a proper medical trial is skipping a step that often works. The genuine first-line treatment is intranasal steroid spray used correctly and consistently for at least eight to twelve weeks, combined with daily saline irrigation. Most people use the spray wrongly — aimed at the septum instead of outwards towards the ear, and abandoned after ten days because "it did not work". Used properly for a proper duration, it resolves a substantial proportion of cases.
When medical treatment genuinely fails, FESS is highly effective. Working entirely through the nostrils with an endoscope, the surgeon opens the natural drainage pathways and removes polyps and diseased tissue, without cutting anything on the face. The important thing to understand is what it does and does not achieve: FESS restores drainage; it does not cure the underlying inflammation. Allergy, asthma and polyp disease continue, so the steroid spray and saline irrigation continue after surgery too. Patients who stop them are the ones whose polyps come back.
Treatment information
| Condition | Chronic Rhinosinusitis, with or without Nasal Polyps |
|---|---|
| Procedure | Functional Endoscopic Sinus Surgery (FESS) |
| Duration | 60 to 120 minutes |
| Treated by | ENT Surgeon |
| Anaesthesia | General anaesthesia |
| Success rate | 80–90% symptom improvement |
| Recovery time | 1 to 2 weeks |
| Hospital stay | Daycare to 1 day |
Signs you may need Sinus treatment
- Nasal blockage or congestion lasting more than twelve weeks
- Thick nasal discharge, or mucus running down the back of the throat
- Facial pain, pressure or fullness over the cheeks, forehead or between the eyes
- Reduced or absent sense of smell, and dulled taste with it
- Headache, often worse on bending forward
- Persistent cough, typically worse at night
- Bad breath
- Ear fullness or pressure
- Toothache in the upper teeth
- Fatigue and poor sleep quality
- Repeated courses of antibiotics that help briefly and then stop working
What causes it?
- Viral upper respiratory infection, which triggers most acute episodes
- Bacterial infection following a viral illness
- Allergic rhinitis, which causes persistent lining inflammation
- Nasal polyps blocking the drainage pathways
- A deviated nasal septum obstructing drainage on one side
- Anatomical variants such as concha bullosa narrowing the drainage channels
- Fungal sinus disease, including allergic fungal rhinosinusitis
- Dental infection spreading into the maxillary sinus
- Asthma and aspirin-exacerbated respiratory disease
- Immune deficiency, which causes recurrent infections
- Smoking and air pollution, which impair the lining's clearance mechanism
Who is more likely to be affected
- Allergic rhinitis or a strong allergic tendency
- Asthma — the two conditions frequently travel together
- A deviated nasal septum
- Nasal polyps, or a family history of them
- Smoking and exposure to second-hand smoke
- Living in a high-pollution city
- Occupational exposure to dust, fumes or chemicals
- Frequent swimming and diving
- Aspirin sensitivity
- Immune deficiency or immunosuppressive treatment
- Untreated dental infection in the upper jaw
When to see a doctor immediately
- Symptoms lasting more than ten days without any improvement
- Symptoms that improve and then clearly worsen again
- Severe facial pain with high fever
- Nasal blockage or discharge continuing beyond twelve weeks
- Loss of smell that is not recovering
- Four or more episodes of acute sinusitis in a year
- Repeated antibiotic courses with only brief relief
- Swelling or redness around the eye, visual disturbance, double vision, severe headache with neck stiffness or confusion — these need emergency care the same day
How it is diagnosed
Clinical history and symptom duration
The single most useful distinction is time. Under four weeks is acute; more than twelve weeks defines chronic rhinosinusitis, and the two are managed completely differently. Establishing which one you have prevents a chronic inflammatory condition being treated with repeated pointless antibiotic courses.
Nasal endoscopy
A thin telescope passed into the nose gives a direct view of the drainage areas, the back of the nose and the septum. It identifies polyps, pus draining from a specific sinus, and anatomical obstruction — none of which a torch-and-speculum examination reliably shows.
CT scan of the paranasal sinuses
The definitive imaging study and the roadmap for surgery. It shows which sinuses are affected, how thick the lining is, whether the drainage pathways are blocked, and the precise anatomy near the eye and skull base. Not needed for acute sinusitis, but essential before any operation.
Allergy assessment
Skin prick testing or specific IgE, since allergic rhinitis underlies a large proportion of chronic disease. Treating allergy properly addresses a driver that surgery cannot touch, and ignoring it is a common reason symptoms persist after an otherwise successful operation.
Nasal swab and culture
Guided endoscopic sampling of pus from the affected area, rather than a swab from the front of the nose, which mostly grows harmless resident bacteria. Useful in recurrent infections and in choosing an antibiotic sensibly.
Assessment for asthma and aspirin sensitivity
Nasal polyps, asthma and aspirin sensitivity form a recognised triad with a high recurrence rate after surgery. Identifying it changes expectations and treatment intensity, and it is worth knowing before rather than after.
Immune workup in selected cases
Immunoglobulin levels and, where indicated, further testing in patients with unusually frequent or severe recurrent infections.
How the options compare
| Feature | Medical Management | Endoscopic Sinus Surgery (FESS) |
|---|---|---|
| First-line treatment | Yes, always | Only after medical treatment has genuinely failed |
| Treats the inflammation | Yes | No — it restores drainage |
| Opens blocked drainage pathways | Only if swelling is the sole cause | Yes |
| Removes polyps | Shrinks them; large ones persist | Yes, removed directly |
| Duration of treatment | 8–12 weeks minimum, often ongoing | One procedure, then ongoing medication |
| Recovery time | None | 1–2 weeks |
| Recurrence | Symptoms return if stopped | Polyps return if medication is stopped |
| Risk | Minimal | Small but real — orbit and skull base |
Types of treatment
Medical management — always first
Intranasal steroid spray
The cornerstone of treatment, and the one most often used wrongly. Aim it outwards towards the ear on the same side, not at the septum, and use it every day for at least eight to twelve weeks before judging it. Most people stop after ten days and conclude it does not work. Used correctly for a proper duration, it resolves a large proportion of chronic cases.
Saline nasal irrigation
High-volume rinsing with a squeeze bottle clears mucus, crusts and allergens, and makes a steroid spray used afterwards considerably more effective. Cheap, safe and genuinely one of the highest-value treatments available for this condition.
Antibiotics, used properly
Appropriate for acute bacterial sinusitis — symptoms beyond ten days without improvement, worsening after initial improvement, or a severe illness with high fever. Largely ineffective for chronic inflammatory disease, where repeated courses do harm without benefit.
Oral steroids
A short course markedly shrinks polyps and reduces severe inflammation, often used before surgery to make the operation safer and cleaner. Not for long-term use, because of the systemic effects.
Allergy treatment
Antihistamines, allergen avoidance and, in selected patients, immunotherapy. Addressing the allergic driver is essential in anyone whose sinusitis sits on top of allergic rhinitis.
Biologic therapy
Injectable antibody treatments such as dupilumab for severe polyp disease that keeps recurring despite surgery and maximal medical treatment. Highly effective, expensive, and given long term — a genuine option for the small group who need it.
Surgical treatment
Functional endoscopic sinus surgery (FESS)
The standard operation. An endoscope passed through the nostril allows the natural drainage openings to be widened and diseased tissue and polyps removed, restoring ventilation and mucus clearance. No external incision and no facial scar. The word 'functional' matters: the aim is to restore normal drainage rather than to strip the sinuses out.
Image-guided (navigation) sinus surgery
A CT-based navigation system shows the instrument's exact position relative to the eye and skull base in real time. Particularly valuable in revision surgery, extensive polyp disease and distorted anatomy, where the usual landmarks are gone.
Balloon sinuplasty
A balloon catheter dilates the drainage opening without removing tissue. Less invasive with a faster recovery, and suited to limited disease without polyps. It is not appropriate for extensive polyp disease, despite being marketed broadly.
Polypectomy
Direct removal of nasal polyps, usually as part of FESS. It relieves blockage and frequently restores the sense of smell — but polyps regrow unless steroid treatment continues afterwards, and that is not optional.
Septoplasty and turbinate reduction
Frequently combined with FESS where a deviated septum or enlarged turbinates are obstructing access and drainage. Correcting them improves both the surgical access and the long-term result.
What happens, step by step
- 1
Assessment and medical trial
8 to 12 weeks- History, examination and nasal endoscopy to establish acute versus chronic disease
- A properly supervised trial of steroid spray and saline irrigation, with technique demonstrated rather than described
- Allergy assessment and treatment where relevant
- Surgery considered only if this genuinely fails
- 2
Pre-operative planning
1 to 2 weeks- CT scan of the sinuses to map the disease and the anatomy near the eye and skull base
- A short course of oral steroids where polyps are extensive, to reduce bleeding and improve visibility
- Blood tests, clotting studies, ECG and anaesthetic assessment
- Blood thinners reviewed and adjusted on medical advice
- 3
The operation
60–120 minutes- General anaesthesia; the nose is decongested to reduce bleeding
- An endoscope is passed through the nostril — nothing is cut on the face
- Natural drainage openings of the affected sinuses are identified and widened
- Polyps and diseased tissue are removed with a microdebrider
- Navigation is used where the anatomy is distorted or the case is a revision
- Septoplasty or turbinate reduction is performed in the same sitting if needed
- Dissolvable dressings are placed; traditional painful packing is usually avoided
- 4
Recovery and discharge
4 hours to 1 day- Observation as the anaesthetic wears off
- Blood-stained discharge for a day or two is expected
- Saline irrigation is started early, usually from day one or two as instructed
- Discharge the same evening or the next morning
- Endoscopic cleaning at follow-up, and the long-term spray regimen explained clearly
How to prepare
- Complete the full medical trial first — a proper eight to twelve weeks, not ten days
- Learn to use the steroid spray correctly: aim outwards towards the ear, never at the septum
- Get allergy assessed and treated before surgery is considered
- Have the CT scan done as advised; it is the surgeon's roadmap
- Stop smoking at least two weeks before — it directly impairs the lining's clearance mechanism
- Stop blood thinners, aspirin and fish oil only on medical instruction
- Treat any active chest or nasal infection before the date
- Fast for six to eight hours before general anaesthesia
- Buy saline irrigation supplies in advance; you will need them from day one
- Arrange someone to take you home and stay the first night
Why patients choose this procedure
Drainage is restored
Opening the natural pathways lets the sinuses ventilate and clear mucus normally again, which breaks the cycle of stagnation and repeated infection.
The sense of smell often returns
For patients with polyps, regaining smell after years without it is frequently the change they value most — and it brings taste back with it.
Facial pressure and headache improve
The heaviness over the cheeks and forehead, and the headache that worsens on bending forward, resolve for the great majority.
Fewer infections and fewer antibiotics
Breaking the cycle of blocked, stagnant sinuses reduces recurrent infections and the repeated antibiotic courses that come with them.
No external cut or scar
Everything is done through the nostrils with an endoscope. Nothing is cut on the face.
Medication works better afterwards
With the pathways open, steroid sprays and irrigations actually reach the sinus lining — which is why the medical treatment becomes more effective after surgery rather than unnecessary.
Possible risks and side effects
Recurrence of polyps
The commonest disappointment, and largely preventable. Polyps return in a significant proportion of patients, especially those with asthma or aspirin sensitivity, and the strongest predictor is stopping the steroid spray. Surgery opens the sinuses; medication is what keeps them open.
Bleeding
Some blood-stained discharge is expected for a day or two. Significant bleeding is uncommon and occasionally needs packing or a return to theatre.
Injury to the orbit
The eye socket sits directly beside the ethmoid sinuses, separated by paper-thin bone. Injury is rare, and can cause bruising around the eye, double vision or — very rarely — visual loss. This is precisely why the CT scan is studied carefully and navigation is used in difficult cases.
Cerebrospinal fluid leak
The roof of the ethmoid sinuses forms part of the skull base. A breach can allow clear fluid to leak from the nose and, rarely, lead to meningitis. Uncommon, usually repaired at the time, and a serious reason to choose an experienced surgeon.
Adhesions and scarring
Scar bands can form and re-narrow the pathways that were opened. Post-operative endoscopic cleaning and diligent saline irrigation are what prevent this, which is why follow-up visits are not optional.
Altered or lost sense of smell
Usually improves after surgery, but occasionally worsens, particularly where the disease was extensive and the smell area was already damaged.
Empty nose syndrome
A rare and difficult complication after excessive turbinate removal, in which the nose feels paradoxically blocked despite being wide open. It is the reason turbinate reduction should be conservative rather than aggressive.
Infection
Uncommon after surgery. Fever, severe headache, worsening pain or swelling around the eye needs immediate assessment.
What recovery looks like
Recovery after FESS needs the same expectation set as any nasal surgery: your nose will feel more blocked for the first week or two, not less. Swelling, crusting and dried blood cause that. The improvement becomes apparent from around week two and keeps refining for two to three months.
Days 0 to 2: blood-stained discharge, congestion and a dull headache. Sleep propped up on two pillows. Do not blow your nose. Start saline irrigation as instructed, usually from day one or two — this is the most important thing you do in the whole recovery.
Days 3 to 7: crusting is at its heaviest. Irrigate frequently, exactly as shown. Avoid hot drinks, spicy food, straining, bending forward and lifting. Most patients with desk jobs return to work at the end of the first week or during the second.
Week 2: the first endoscopic cleaning appointment, where crusts and any early adhesions are removed under vision. Patients often notice a distinct improvement immediately afterwards. Breathing and smell start to return.
Weeks 3 to 6: normal activity and exercise resume. Continue saline irrigation and restart the steroid spray as directed — and understand that this is now long-term treatment, not a course to finish. Avoid swimming and diving until your surgeon confirms healing.
Months 2 to 3: the sinuses have healed and the full benefit is apparent. Follow-up endoscopy confirms the pathways are open. Allergy treatment continues alongside.
Long term: steroid spray and saline irrigation continue indefinitely for most patients with polyp disease. The single strongest predictor of polyps returning is stopping them because you feel well.
Contact your care coordinator immediately for heavy bleeding that does not stop with ten minutes of pinching, clear watery fluid dripping steadily from one nostril, swelling or redness around the eye, double vision, severe headache with neck stiffness, or high fever.
What to eat and what to avoid
Recommended
- Plenty of warm fluids, which thin mucus and help it clear
- Vitamin C rich foods — amla, guava, citrus and capsicum
- Anti-inflammatory foods: turmeric, ginger, garlic and oily fish
- Protein at every meal for healing of the lining
- Probiotic curd, particularly while on antibiotics
- Zinc from pumpkin seeds, chana and nuts
- 2 to 3 litres of water daily
Best avoided
- Hot drinks, hot soup and spicy food for the first week after surgery
- Smoking and smoky environments — the most damaging single factor for the sinus lining
- Alcohol, which causes nasal congestion and increases bleeding risk
- Dairy in large amounts if you find it thickens your mucus, though the evidence is individual rather than universal
- Known food allergens, where allergy testing has identified them
- Straining at stool and heavy lifting in the first two weeks
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
Sinus treatment cost
₹60,000 – ₹1,60,000
The range depends on how many sinuses are opened, whether polyps are removed, whether a septoplasty is done in the same sitting, whether image guidance (navigation) is used, your city and the hospital. FESS for documented chronic rhinosinusitis is covered by most health insurance policies. Worth planning for separately: the medical treatment afterwards — steroid sprays and saline irrigation — is long-term and usually not covered, and stopping it is the commonest reason polyps return. Our insurance desk verifies eligibility before admission.
Inside the care journey
Sinus — your questions answered
Usually not. Most acute sinusitis is viral and resolves in seven to ten days without antibiotics. Thick yellow or green mucus is not proof of bacterial infection — it reflects immune cells and occurs in ordinary viral illness too. Antibiotics are appropriate when symptoms last beyond ten days without improving, when they clearly worsen after initially improving, or when the illness is severe with high fever and marked facial pain. Repeated unnecessary courses drive resistance and do not help.