Endoscopic Sinus Surgery: When Is It Considered?

Endoscopic sinus surgery uses a small camera and specialised instruments passed through the nostrils to reach selected sinus passages. The aim is to improve access to affected areas and, where appropriate, ventilation and drainage. It is used for selected sinus conditions; it is not a routine treatment for every episode of sinus pain or nasal congestion.

The operation does not remove every underlying cause of chronic inflammation. Some patients continue to need nasal treatments, management of associated conditions and follow-up after surgery. The possibility of persistent or recurring symptoms should be part of the decision-making process.

How suitability is assessed

Before surgery is considered, the ENT specialist reviews the symptom history, effect on quality of life, previous treatment and relevant health conditions. Nasal endoscopy may help assess inflammation, polyps and nasal anatomy. A sinus CT is commonly used for surgical planning when a patient is being considered for an operation, with the scan interpreted alongside symptoms and examination findings.

The decision depends on the specific disease pattern and the response to appropriate non-surgical care. A scan by itself does not determine that surgery is needed. The consultation should explain the reason for the proposed operation and whether other options remain appropriate.

What to review before deciding

• The duration and impact of symptoms, including blockage, discharge and reduced smell.
• Which medical treatments have been tried, for how long and with what result.
• Nasal endoscopy and sinus CT findings, if these investigations have been performed.
• Asthma, allergies, bleeding risks, other medical conditions and current medicines.
• Any previous sinus operation and the details of postoperative care.

Risks, recovery and long-term care

As with any operation, endoscopic sinus surgery has potential risks. Relevant risks depend on the extent of disease, anatomy and planned procedure, and should be discussed individually with the surgeon. Recovery instructions and follow-up are important because the operated area may need review and ongoing treatment while it heals.

Surgery may improve access for treatment and help selected patients with persistent disease, but it cannot guarantee that inflammation will never return. A realistic plan includes expected benefits, possible limitations, alternatives and maintenance care that may still be needed.

This information is general and does not replace an individual medical assessment or a personalised discussion of surgical risks.

Clinical reference: AAO-HNS Clinical Practice Guideline: Surgical Management of Chronic Rhinosinusitis.