Endoscopic Sinus Surgery

Endoscopic Sinus Surgery


What is Endoscopic sinus surgery?

Endoscopic sinus surgery, also known as Functional Endoscopic Sinus Surgery and FESS for short, is a minimally invasive operation to treat severe sinus conditions. Studies indicate that over 80% of patients feel this procedure alleviated their sinus issues.

The sinuses are small, air-filled spaces in the front of the skull, located behind the cheekbones and forehead. They are connected to the inside of the nose and produce mucus, which usually drains into your nose through these small channels. Sinusitis is an infection of the mucous membrane which becomes inflamed and swollen.


Symptoms of sinusitis include a blocked nose, reduced sense of smell, and a build-up of mucus at the back of your nose and throat, which can often be very painful. Depending on the cause, you may be prescribed antibiotics. Treatment of sinusistis with topical nasal steroid sprays or drops is essential to treat the condition. If it is allergy-related, you may be prescribed medication such as antihistamines and advised to avoid allergy triggers. Polyps in the sinus and nasal passage may also occur in patients with sinusitis.

Sufferers often experience repeated episodes of painful sinusitis that are not resolved with medication. Patients with chronic sinusitis often feel their nose and face is constantly congested and that their nose is persistently dripping. It can have a significant impact on quality of life.

At this point, ENT specialist Mr Annakan Navaratnam may recommend endoscopic sinus surgery to widen the passages between the sinus and your nose Not only would this improve symptoms from the surgery itself, it will also facilitate delivery of medical treatment to ensure symptoms do not return.

What happens during endoscopic sinus surgery?

Endoscopic sinus surgery is performed either under a general anaesthetic or local anaesthetic and sedation, depending on the extent of the procedure and usually takes between one and two hours.

Mr Navaratnam will make incisions inside the nose so there will be no visible scarring afterwards. Using a nasal endoscope, a thin tube with a light and a lens, he will examine the nasal passages. Then, with specially designed instruments, remove any polyps if required and widen the passages to allow for normal draining.


Nasal surgeon

At a glance

Surgery time

1 – 1.5 hours



Time off work

2 weeks

Hospital stay

Day case


After 1 day

Reasonable mobility

After 1 day


After 2 weeks

Sleeping on back

2 weeks

Full recovery

3 weeks


5 days


Mr Annakan Navaratnam

Annakan Navaratnam is Consultant Ear, Nose & Throat (ENT) Surgeon whose private practice is based at Harrow and One Welbeck Hospital in Central London and The Clementine Churchill Hospital in Harrow. In his NHS practice, he works at Royal National ENT Hospital, University College London Hospital (UCLH) and is an honorary consultant at Great Ormond Street Hospital.

He has a subspeciality interest in rhinology and facial plastic surgery with particular expertise in septorhinoplasty and nose reshaping surgery.

Annakan is excellently placed to manage general adult and paediatric ENT presentations and in particular is able to assess and treat complex problems related to the form and function of the nose. This includes endonasal (scarless) rhinoplasty, revision septorhinoplasty as well as advanced endoscopic sinus surgery.

What to expect

Here you will find some essential information to help you prepare for surgery and the arrangements you should make to ensure you have the support you need and that everything runs smoothly on the day. However, we are on hand to answer any questions you may have.

The first stage is always a comprehensive consultation and pre-operative assessment with your surgeon Mr Annakan Navaratnam.

During the consultation, he will listen carefully to your concerns and desired outcomes, and recommend whether surgery is appropriate at this time. The potential risks, post-surgery expectations, and recovery details of the specific procedure will also be discussed. A detailed medical history will be obtained to ensure your fitness for surgery.

Examination of the nose will be performed during the consultation to assess the nasal structures and to evaluate for any presence of nasal disease. This will often involve a procedure called nasoendoscopy to examine the nasal passages and sinus openings.

A CT scan is often required as part of the assessment to help guide treatment and plan surgery

A two-week reflection period follows the initial consultation, during which you can return for additional consultations free of charge.

If you decide to proceed, you’ll receive guidance on preparing for surgery. Pre-surgery tests may be required.

Mr Navaratnam will advise you on stopping smoking as far in advance of surgery as possible due to its impact on healing, infection risks, and complications during anaesthesia. Guidance on discontinuing blood-thinning medication and fasting before surgery will be provided

Upon arrival at hospital, you’ll be escorted to a private room, and vital signs will be assessed. Your surgeon will finalise markings, and the anaesthetist will visit you. Clinical photography will document the pre-op and post-op phases.

The procedure is typically performed under general anaesthesia, followed by recovery in a specialist recovery room. Surgery can be performed as a day case so once you have recovered sufficiently you will be discharged into the care of a friend or family member.

Post-surgery pain varies for each individual, but most patients find it minimal and can be managed with over-the-counter painkillers. It typically subsides within the first week or so along with any bruising.

A comprehensive recovery guide, including follow-up appointment dates. Our team will be on hand if you have any concerns.

Frequently asked questions

The main symptoms of sinusitis include:

  • A sinus headache – typically you’ll experience pain and tenderness around the cheeks, eyes or forehead, which often worsens when you lie down
  • Discharge which can be yellow or green
  • Nasal congestion
  • Reduced sense of smell
  • Bad breath
  • Toothache
  • Ear congestion

Functional endoscopic sinus surgery may be recommended if you are experiencing repeated sinus infections or have persistent symptoms of nasal congestion and a runny nose due to chronic sinusitis. Most patients find their symptoms dramatically improve following surgery and the correct medical treatment. If you have been struggling with sinus issues for a long time, this procedure typically has a hugely positive impact on patient wellbeing.

Typically, the nose can feel blocked after the operation and this feeling of congestion can last a few weeks. You will be advised not to blow your nose for at least a week afterwards.

Mr Navaratnam will prescribe you with a course of antibiotics to reduce the risk of infection.

As with any surgical procedure there are some risks, but these are rare. These can include complications associated with the anaesthesia, pain, bleeding. Specific to endoscopic sinus surgery, you may experience an infection of the sinuses, but you will be prescribed a course of antibiotics. Serious, but very rare, complications include damage to the eye and a leaking of fluid from the brain.

Studies suggest that FESS has a very high success rate in treating patients suffering from sinusitis, with or without polyps, with improvements in symptoms such as nasal obstruction, headache and decreased sense of smell.