Functional Endoscopic Sinus Surgery (FESS) in Singapore

What Is Functional Endoscopic Sinus Surgery?

Functional endoscopic sinus surgery (FESS) is a minimally invasive procedure performed through the nose that opens blocked sinuses and sinus drainage pathways.

The sinuses, or sinus cavities, are air-filled spaces around the nose, cheeks, forehead and eyes. They make mucus that drains through narrow openings into the nose. When these openings are blocked by swelling, infection, nasal polyps or an abnormal anatomy, mucus can accumulate, leading to nasal congestion, sinus pressure and recurrent or prolonged symptoms.

FESS uses a small camera called an endoscope and fine instruments to work inside the nose. The aim is to remove blockages, improve drainage and help medicines, such as saline rinses and nasal steroid sprays, reach the sinus lining more effectively. There are usually no external cuts, no visible facial scars and no need to break bony structures in standard cases.

Why Is Functional Endoscopic Sinus Surgery Done?

Functional endoscopic sinus surgery is done when sinus disease remains troublesome despite appropriate medical treatment.

FESS is most often used to treat chronic sinusitis, which means inflammation lasting 12 weeks or longer. Symptoms may include a blocked nose, nasal congestion, thick mucus, postnasal drip, facial pain, facial pressure, a reduced sense of smell, cough, tiredness, and recurrent infections.

The surgery treats a range of sinus conditions and chronic sinus issues:

• Recurrent acute sinusitis
• Chronic sinus infections
• Nasal polyps
• Fungal sinus disease
• Mucoceles
• Select sinus cysts
• Obstructed drainage pathways
• Some benign growths

In some cases, endoscopic sinus surgery may help remove sinus tissues for laboratory testing or provide access to deeper areas in the sinus cavity.

 In Singapore, year-round exposure to house dust mites, environmental allergens, haze, and air-conditioned indoor environments may contribute to persistent nasal and sinus irritation. Non-surgical treatment is usually tried first. This may include saline rinses, intranasal steroid sprays, allergy treatment, antibiotics when bacterial infection is suspected, and treatment of triggers such as allergic rhinitis.

Surgery becomes an appropriate treatment option when symptoms remain significant, scans show ongoing sinus problems, or complications or growths need surgical treatment for other sinus conditions.

When to See an ENT Specialist

You should see an ENT specialist if sinus symptoms last more than 12 weeks, keep returning or do not improve with the usual treatment.

An ENT review is helpful when nasal obstructions, nasal congestions, thick discharges, facial pressure, difficulty breathing, a reduced sense of smell or postnasal drips affect sleep, work or daily comfort. It is also important if the symptoms keep recurring despite repeated courses of medication.

Prompt assessment is needed if sinus symptoms are one-sided, accompanied by swelling around the eye, severe headache, double vision, forehead swelling, confusion, high fever, or neck stiffness.

How to Prepare for a FESS Procedure

Preparation for functional endoscopic sinus surgery includes confirming the diagnosis, reviewing scans, planning the anaesthesia and reducing bleeding or healing risks.

• Before surgery, Dr Barrie Tan will review your symptoms, medical history, allergy history, medication use and previous treatments.
• Nasal endoscopy is usually performed to examine the nasal passages, nasal cavity, drainage areas, and any polyps, pus, swelling, or discharge.
• A CT scan of the nasal sinuses and sinus cavities is commonly used for surgical planning. It shows which cavities are affected, where the natural drainage pathways are blocked, and whether there are anatomical variations that need careful attention during your surgery.
• Patients should tell the clinic about all their medicines, supplements, allergies, and medical conditions. Blood thinners, aspirin, anti-inflammatory medicines and some supplements may need to be stopped or adjusted before surgery, but only with medical advice.
• Smoking should be stopped before and after surgery because it can slow healing and irritate the nasal lining and nasal mucosa.
• Fasting instructions will be given if general anaesthesia or sedation is planned, and patients may need to avoid eating or drinking after midnight before surgery.
• Arrange for someone to take you home after surgery.

FESS is often an outpatient procedure, so most patients can go home the same day, but some may need admission depending on the extent of surgery, medical conditions, bleeding risk or whether other procedures are performed.

What Happens During Functional Endoscopic Sinus Surgery?

During functional endoscopic sinus surgery, the ENT surgeon uses an endoscope and small instruments to open blocked sinus pathways from inside the nose.

1. This surgical procedure is usually done under general anaesthesia. Local anaesthesia with sedation may be suitable in selected, limited cases. General anaesthesia is common when the surgery is more extensive or when several sinuses need treatment.
2. The surgeon gently passes a small endoscope, a thin tube and flexible tube, through the nostril to view the nasal cavity and openings.
3. Decongestant and local numbing medicines may be used in the nose to reduce swelling and bleeding.
4. Swollen tissue, thin bone partitions, polyps, scar tissue, fungal material or infected material may then be removed.
5. The natural openings and sinus passages are widened so mucus can drain more freely, helping to remove blockages.
6. Bleeding points are controlled with cautery, nasal packing, or absorbable materials as needed.
7. Image guidance may be used in complex cases, revision surgery or disease near the eye or skull base.
8. Tissue may be sent for laboratory testing if polyps, fungal material, unusual tissue or a growth is removed.

FESS may be combined with septoplasty for a deviated septum, turbinate reduction or nasal polyp removal if these also contribute to obstruction. This surgical procedure typically lasts about 2 to 3 hours, depending on the extent of the disease.

What to Expect After FESS and the Recovery Timeline

Functional endoscopic sinus surgery recovery usually involves temporary congestion, mild bleeding, crusting, follow-up visits and regular saline irrigations.

• Immediately after surgery, patients are monitored in the recovery room while the anaesthetic wears off.
• The nose may feel blocked due to swelling, blood clots, dressings or crusting.
• Nasal packing may be used to reduce the bleeding and may stay in place for 24 to 48 hours.
• Some blood-stained discharge is common, especially during the first week.
• Pain is usually mild to moderate and is often managed with prescribed or recommended pain medicine.
• Regular saline irrigations are commonly advised to keep the nose moist, clear the crusting and support healing.
• Some patients may be given antibiotics, nasal sprays or oral steroids depending on the condition being treated.

Many patients return to desk work, school or their normal routine within a week. Strenuous exercise, heavy lifting, swimming, forceful nose blowing and flying are usually avoided during early recovery. The patient is advised to sneeze with the mouth open to reduce nasal pressure.

Follow-up care is an important part of the FESS procedure. The ENT specialist may clean crusts, remove dried blood or mucus, check healing and adjust medicines. Most patients notice significant improvement as swelling settles and the sinus lining recovers over weeks to months.

Risks and Possible Complications from FESS

Functional endoscopic sinus surgery risks and complications include bleeding, infection, scar tissue or adhesions inside the nose, ongoing nasal blockage, a reduced sense of smell, recurrence of polyps or inflammations, and the need for further treatment.

Most patients recover well after FESS surgery, but all surgery has risks. Common early effects include congestion, crusting, bloodstained mucus, mild pain, and a temporary reduction in the sense of smell. These usually improve as healing progresses.

Extremely rare risks include:

• Injury to the eye socket
• Double vision
• Excessive tearing
• Tear duct injury
• Leakage of cerebrospinal fluid from a skull base breach
• Meningitis
• Changes in vision

Sinus disease can return, especially in patients with nasal polyps, asthma, aspirin sensitivity, fungal disease, allergy or long-term inflammatory sinus disease. Revision functional endoscopic sinus surgery may be needed if symptoms recur, scarring blocks drainage, polyps return, or disease was too extensive to fully control with one operation.

Seek urgent medical care after surgery if there is heavy bleeding, worsening severe headache, high fever, neck stiffness, confusion, eye swelling, vision changes, clear watery fluid from the nose, chest pain or breathing difficulty.

How Barrie Tan ENT Can Help

Barrie Tan ENT Head & Neck Surgery can assess whether FESS is suitable and guide patients through safe treatment and recovery.

At Gleneagles Hospital in Singapore, Dr Barrie Tan sees patients with chronic sinusitis, recurrent sinus infections, polyps, fungal sinus disease, blocked nasal breathing and persistent postnasal drips. If sinus symptoms keep returning, affect your breathing or sense of smell, or have not improved despite appropriate treatment, contact Barrie Tan ENT for a consultation.

FAQs about FESS

Is functional endoscopic sinus surgery a major surgery?

FESS is usually considered minimally invasive because it is performed through the nostrils without external cuts. It is still surgery and requires proper assessment, anaesthesia planning, recovery care and follow-up.

How painful is functional endoscopic sinus surgery?

Most patients describe FESS as uncomfortable rather than very painful. Nasal blockage, pressure, crusting and mild soreness are common. Pain is usually manageable with medication recommended or prescribed by the doctor.

Is functional endoscopic sinus surgery worth it?

FESS may be worthwhile when chronic sinusitis, recurrent infections, or nasal polyps persist despite appropriate medical treatment. It can improve drainage, breathing, smell and access for nasal medicines. Results depend on the underlying condition and ongoing care.

How much does functional endoscopic sinus surgery cost in Singapore?

The cost of FESS in Singapore varies, ranging from about S$17,000 to more than S$30,000. FESS may be MediSave-claimable when it is medically indicated. Insurance coverage depends on the patient’s policy, medical necessity, deductible, co-insurance, rider terms and insurer approval.  A consultation and CT review are needed before a personalised estimate can be given.