Endoscopic Sinus Surgery
in Austin, TX
Advanced, minimally invasive sinus surgery using 3D image-guided technology for patients with chronic sinusitis and recurrent sinus infections. Outpatient procedure with excellent long-term outcomes.
What is endoscopic sinus surgery?
Endoscopic sinus surgery (FESS) is an outpatient procedure that uses a thin lighted scope passed through the nostrils to open blocked sinus passages and remove diseased tissue. It's performed under general anesthesia in an outpatient surgical setting and typically takes 1–3 hours. There are no external incisions and no facial bruising. It's used to treat chronic sinusitis or recurrent sinus infections when medications and minimally invasive procedures like balloon sinuplasty haven't provided lasting relief.
Amazing surgical advances over the last decade allow our skilled ENT doctors to perform cutting-edge sinus surgery for patients with severe sinus disease. Endoscopic sinus surgery can now be performed without the pain and complications of previous sinus surgeries.
The goal of endoscopic sinus surgery is to remove blockages in the sinuses that cause pain and breathing problems. Removing blockages will help the sinuses drain, improve airflow through the nasal passages, and reduce the number and severity of sinus infections.
Symptoms of chronic sinusitis:
- Nasal congestion
- Facial pressure
- Runny nose
- Postnasal drip
- Decreased sense of smell
How Endoscopic Sinus Surgery Works
Endoscopic sinus surgery uses a small instrument with a camera and light at the end, allowing the surgeon to view the sinuses and determine what is causing the blockages, then safely and effectively remove them through the nostrils.
Watch this video to learn more about how the procedure is performed at Capital ENT.
Schedule a Sinus ConsultationWhen Is Endoscopic Sinus Surgery the Right Choice?
Doctors recommend FESS only after a stepwise approach confirms that surgery is necessary. Understanding how that decision is made helps you know what to expect in a consultation.
The stepwise approach
Per the AAO-HNS Adult Sinusitis Clinical Practice Guideline, endoscopic sinus surgery is appropriate for patients with chronic rhinosinusitis who have had an adequate trial of medical therapy without satisfactory improvement. An adequate trial typically includes 8–12 weeks of intranasal corticosteroid sprays (Flonase, Nasacort), daily saline nasal rinses, appropriate antibiotic courses for bacterial episodes, and allergy treatment when applicable. A CT scan of the sinuses confirms which sinuses are involved and how severely.
When balloon sinuplasty is enough
For patients whose sinuses are significantly narrowed but structurally normal, balloon sinuplasty can widen the sinus openings without cutting tissue and often achieves excellent results with a faster, in-office recovery. If your CT scan shows disease that balloon sinuplasty cannot address, or if prior balloon sinuplasty didn't provide lasting relief, FESS becomes the appropriate next step.
The consultation and CT scan
Before surgery is scheduled, your Capital ENT physician will review your symptom history, examine the nasal passages with an office endoscope, and review a CT scan of the sinuses. The CT is the roadmap for surgery: it shows exactly which sinuses are affected, how thick the disease is, and what anatomy is present so the surgical plan is tailored to your specific case. If you don't have a recent CT scan, one can be obtained at Capital ENT using our in-house low-radiation scanner with results available in minutes.
Conditions that require FESS over conservative treatment
Endoscopic sinus surgery is indicated when:
- Nasal polyps are present (endoscopic surgery removes polyps; balloon sinuplasty cannot)
- Fungal sinusitis is diagnosed, requiring surgical debridement that medication cannot provide
- Multiple sinuses are fully opacified on CT scan, indicating extensive disease
- Appropriate medical management and prior procedures have not provided lasting relief
At your consultation, your surgeon will review your CT scan and symptom history and give you a clear, honest recommendation. Many patients referred for FESS consultation turn out to be good candidates for balloon sinuplasty; others will need the more thorough clearing that only FESS provides. The goal is the right procedure for your specific anatomy and disease, not the most complex one.
Endoscopic Sinus Surgery: Step by Step
Step 1: Outpatient Procedure
Traditional endoscopic sinus surgery is typically performed as an outpatient procedure in the hospital or surgery center under general anesthesia. You go home the same day.
Step 2: Endoscopic Visualization
Using a nasal endoscope (a small instrument with a camera and light at the end), the sinus surgeon can view the sinuses and determine what is causing the blockages.
Step 3: Blockage Removal
The doctor inserts specialized instruments into the nostrils to safely and effectively remove sinus blockages, including polyps, diseased tissue, and any other obstructions preventing proper drainage.
Your FESS Procedure Day with Capital ENT
Knowing what will happen on the day of surgery reduces anxiety and helps you arrive prepared. Here is a detailed walkthrough.
Before surgery: preparation
Your surgeon will give you specific pre-operative instructions at your pre-op appointment. General guidelines include: nothing to eat or drink after midnight the night before, shower the morning of surgery, and stop NSAIDs (ibuprofen, naproxen, aspirin) at least 7 days before the procedure because of their blood-thinning effects. Fill any prescriptions before surgery day (typically saline rinse solution, a short oral steroid course, and an antibiotic) so they are waiting for you when you get home.
Arrival and pre-op
Plan to arrive 60 to 90 minutes before your scheduled start time. A pre-op nurse will take your vital signs, start an IV, review your medications, and answer any final questions. You will meet with the anesthesiologist, who will review your medical history and explain the anesthesia plan. Your surgeon will confirm the surgical plan with you and mark the relevant anatomy if needed. A responsible adult must be available to drive you home; you will not be permitted to drive after general anesthesia.
In the operating room
Once anesthesia is administered, you will be comfortable and asleep throughout the procedure. The surgical team prepares your nasal passages with vasoconstricting medication to minimize bleeding. Your surgeon introduces the endoscope through one nostril at a time and navigates to the affected sinuses under direct visualization, with real-time 3D image guidance confirming anatomy throughout. The procedure typically takes 1 to 3 hours depending on how many sinuses are involved, whether polyps need excision, and whether concurrent procedures (septoplasty, turbinate reduction) are performed at the same time.
Recovery room
After surgery you spend 1 to 2 hours in the recovery room while the anesthesia wears off. You will feel congested and may notice light bloody drainage from the nose; this is normal and expected. Mild nausea after anesthesia is common; the nursing team manages this before discharge. Your vital signs are monitored throughout, and you are discharged once you are stable, comfortable, and alert.
Going home: the first 48 hours
Most patients are surprised by how manageable the first day is. Rest with your head elevated; do not lie flat. Apply a cold compress loosely over the nose and cheeks to help with swelling. Light bloody drainage is expected for the first 24 to 48 hours. Begin your saline nasal rinses as directed, typically starting the day after surgery. Do not blow your nose for 2 weeks; if you need to sneeze, sneeze with your mouth open to avoid pressure in the sinuses.
Call the office or our after-hours line right away if you experience heavy bleeding that does not slow with gentle pressure, a fever above 101.5 degrees Fahrenheit, sudden severe headache, or any change in vision. These are uncommon but warrant prompt evaluation. Your first post-operative appointment, which includes in-office debridement of the sinuses, is typically scheduled within 5 to 7 days of surgery.
Weeks 1 through 4
Most patients return to desk work and light activity within 5 to 7 days. Avoid strenuous exercise, heavy lifting, and air travel for 2 weeks. The congestion and reduced sense of smell that is common in the first 1 to 2 weeks after surgery improves steadily as the sinus lining heals. Full benefit (clearer breathing, improved smell, fewer infections) typically develops over 4 to 6 weeks as swelling resolves and the sinuses normalize.
3D Image-Guided Surgery
We frequently perform 3D image-guided sinus surgery, which uses real-time CT imaging to guide our surgeons during your procedure. The images move on the screen with the surgeon's hand movement, which allows for unmatched precision and a reduced risk of complications during and after your procedure, as well as improved patient outcomes.
Combined with rotating suction instruments to remove nasal polyps, powered sinus washing devices to treat infection, and instruments to straighten the septum and reduce the size of the turbinates if necessary, endoscopic sinus surgery is highly successful in treating patients that have experienced lifelong sinus issues.
- Real-time 3D CT imaging during surgery
- Rotating suction instruments for polyp removal
- Powered sinus washing to treat infection
- Endoscopic guided cultures for targeted antibiotics
- Septoplasty and turbinate reduction when needed
Quicker Recovery With Advanced Techniques
With the advanced techniques employed by the physicians at Capital ENT, the procedure typically takes 1–3 hours and most patients go home the same day as an outpatient procedure.
Our surgeons also use endoscopic guided cultures to enable utilization of culture-specific antibiotics, meaning your post-operative care is targeted precisely to your specific infection for faster healing and better results.
- Procedure typically takes 1–3 hours
- Same-day discharge: go home the same day
- Culture-specific antibiotics for faster healing
- Most patients return to normal activities within 1–2 weeks
Recovery Timeline
What to expect after your procedure
Day of Surgery
Go home the same day. Rest with head elevated; light bleeding and congestion is normal.
Days 2–7
Mild congestion and fatigue. Follow-up visit with your surgeon; targeted antibiotic therapy begins.
Week 2
Most patients return to work and normal daily activities.
Long-Term Outcomes: What the Research Shows
Endoscopic sinus surgery has one of the strongest evidence bases in otolaryngology. Long-term data consistently show that the majority of patients experience durable, meaningful improvement in symptoms and quality of life.
Documented symptom improvement
The AAO-HNS Clinical Practice Guideline on Adult Sinusitis cites evidence that endoscopic sinus surgery produces significant patient-reported improvement, including less facial pain, reduced congestion, easier breathing, and restored sense of smell, in the majority of patients with chronic rhinosinusitis who have failed medical management. Studies following patients for 5 to 10 years after FESS show that most maintain these improvements without requiring repeat surgery, particularly when they continue post-operative nasal care including saline rinses and intranasal corticosteroids.
Managing nasal polyps long-term
Nasal polyps have a higher rate of recurrence than non-polyp chronic sinusitis because they are driven by an underlying inflammatory tendency rather than anatomy alone. Surgery removes the existing polyp burden and opens the sinus passages, but polyps can regrow in patients with untreated allergic or eosinophilic disease. The modern approach to managing polyp disease after surgery combines multiple strategies:
- Daily saline rinses with dissolved corticosteroids (budesonide rinses) to bathe the sinus lining directly
- Intranasal corticosteroid sprays to maintain local anti-inflammatory control
- Allergy evaluation and immunotherapy, since many polyp patients have untreated allergic sensitization that fuels recurrence
- Biologic medications (dupilumab/Dupixent) for severe recurrent polyposis, now FDA-approved specifically for nasal polyp disease
Capital ENT coordinates between our sinus surgeons and our in-house allergy team so that surgical and ongoing medical management work as a unified plan, not separate tracks.
Smell recovery
Among the most gratifying outcomes for patients with anosmia (absent or severely reduced sense of smell), FESS can restore or substantially improve smell in many cases. Recovery depends on how long the olfactory nerves have been suppressed by inflammation and whether any permanent nerve injury has occurred. Shorter-duration smell loss tends to recover more fully. Improvement continues for several months after surgery as inflammation fully resolves; patients are typically counseled not to judge their smell recovery until at least 3 to 6 months post-operatively.
When surgery is not a permanent cure
Chronic sinusitis is a chronic disease. FESS treats the current disease burden but does not eliminate the underlying inflammatory tendency in patients with allergic, eosinophilic, or aspirin-sensitive disease. Patients who continue post-operative medical management and attend regular follow-up appointments experience the best long-term results. If significant symptoms return, repeat evaluation can determine whether polyp regrowth, a secondary sinus involvement, or a new area of disease is responsible and whether additional treatment is warranted.
The good news is that the vast majority of patients who need revision procedures have a defined, treatable reason for their recurrence rather than a surgical failure. At Capital ENT, we view post-operative care as part of the procedure itself, not an afterthought, and our follow-up protocol is designed to catch problems early when they are most manageable.
Insurance & Cost Information
Endoscopic sinus surgery is a medically necessary procedure for patients with chronic sinusitis that hasn't responded to medication. Our team handles insurance verification and authorization so you know your coverage before surgery is scheduled.
- Covered by most major insurance plans when medically necessary
- Prior authorization and benefits verified before scheduling
- Often combined with septoplasty or turbinate reduction in one surgery
- HSA and FSA accounts accepted
- Flexible financing available through CareCredit for out-of-pocket costs
Schedule a Sinus Consultation
Our board-certified sinus surgeons will evaluate your condition and discuss the best treatment path. Same-day and next-day appointments often available.
Schedule an AppointmentWhy Austin Has Higher Rates of Chronic Sinusitis
Austin's unique environment makes chronic sinusitis more common here than in most U.S. cities, and treating the underlying cause is essential to getting durable results after surgery.
The allergy-sinusitis connection
The sinuses drain through small openings called ostia that connect to the nasal passages. When the nasal lining swells with allergic inflammation, these openings narrow or close, trapping mucus inside the sinuses. Bacteria thrive in trapped mucus, causing infections. With repeated infections, the sinus lining thickens and can develop polyps. Over years, this cycle produces structural changes that medication alone cannot reverse.
Cedar pollen, oak pollen, mold spores, and grass pollen all drive this cycle in Austin. The near-year-round allergen exposure here means the nasal lining rarely has a chance to fully recover between seasons. In cities with shorter pollen seasons, the same patient might manage with medication alone. In Austin, the persistent allergen load makes sustained remission significantly harder for patients with polyps or significantly diseased sinuses.
Who is most affected
Many Capital ENT patients who moved to Austin with no prior sinus history develop chronic rhinosinusitis within a few years of arriving. Cumulative allergic sensitization builds up over time, and Austin's botanical diversity (Ashe juniper, live oak, Bermuda grass, and mold year-round) means transplants acquire new sensitivities faster than in most U.S. cities. By the time they present for evaluation, they often have a combination of untreated allergic rhinitis, recurrent sinus infections, and early polyp disease.
Why allergy treatment matters after sinus surgery
Allergy evaluation is a routine part of the pre-operative workup at Capital ENT because treating the underlying allergy is critical to long-term surgical success. Even after excellent FESS that clears the sinuses completely, a patient who remains untreated for allergic rhinitis faces a higher risk of disease recurrence. Ongoing allergic inflammation is the engine that drives polyp regrowth and sinus re-obstruction in many Central Texas patients.
Immunotherapy (allergy shots or sublingual drops) is the only treatment that modifies the underlying immune response rather than managing symptoms. For patients whose chronic sinusitis is driven by allergic sensitization to cedar, oak, or other Austin allergens, completing a course of immunotherapy after surgery dramatically reduces the risk of needing revision surgery in the future.
Coordinated sinus and allergy care
Capital ENT offers both endoscopic sinus surgery and in-house allergy testing and immunotherapy, which means your post-operative care plan can include allergy evaluation and treatment without being referred to a separate practice. This integrated approach is particularly important for Central Texas patients whose chronic sinusitis has an allergic component, and in Austin that is the majority of surgical candidates. Your surgeon and our allergy team communicate directly to design a unified plan: surgery to clear the disease, immunotherapy to prevent it from returning.
Endoscopic Sinus Surgery FAQ
Other Nasal & Sinus Solutions
Balloon Sinuplasty
A minimally invasive, in-office alternative to traditional sinus surgery. Capital ENT was the first practice in Austin to perform balloon sinuplasty (more than 15 years ago), and our team has collectively completed 10,000+ sinus surgeries.
Learn more →Septoplasty
Surgical correction of a deviated septum to improve nasal airflow and reduce sinus issues. Often performed alongside endoscopic sinus surgery.
Learn more →Turbinate Reduction
A procedure to reduce the size of enlarged turbinates, improving nasal breathing and airflow through the nasal passages.
Learn more →Polypectomy
Removal of nasal polyps that obstruct the sinuses and nasal passages, often performed as part of endoscopic sinus surgery.
Learn more →Ready to Breathe Freely Again?
Our board-certified sinus surgeons have performed thousands of endoscopic sinus procedures. Same-day and next-day consultation appointments are often available at our four Central Texas locations.