Routine advice says to try one more spray or another short steroid burst. For many with persistent obstruction, that approach delays the inevitable. When medical therapy fails to control symptoms, I consider nasal polyps surgery to restore airflow, reduce infection risk, and protect smell. Here is a clear, stepwise guide to the operative options, the process, and how recovery really looks in practice.

Types of Nasal Polyps Surgery

1. Functional Endoscopic Sinus Surgery (FESS)

I use FESS when polyps recur despite maximal medical therapy. The goal is not only nasal polyp removal. It is also to reopen sinus drainage pathways and preserve healthy mucosa. As the Pakistan Journal of Medical Sciences reported, outcomes exceed 90% success with low recurrence when technique and follow up are sound. That figure aligns with what I see in well-selected cases.

The method is minimally invasive. I work through the nostrils using a telescope and fine instruments. No external cuts. In recurrent disease, I expand the sinus openings to restore ventilation. This is why FESS sits at the centre of modern endoscopic sinus surgery.

• Primary aims: drainage, ventilation, and mucosal preservation.

• Typical setting: day case under general anaesthesia.

• Who benefits most: patients with diffuse polyposis or asthma and frequent infections.

FESS works. But it works best when integrated with long term topical therapy and careful follow up.

2. Polypectomy Procedure

Simple polypectomy is focused nasal polyp removal without wide sinus work. I reserve this for isolated, accessible polyps or for symptom relief in high risk surgical candidates. It is quick and targeted. However, it does not address underlying sinus ventilation. Recurrence risk is therefore higher, particularly in diffuse disease.

• Pros: shorter procedure, limited tissue manipulation.

• Cons: does not treat sinus outflow, higher probability of return.

• Use case: solitary antrochoanal polyp or as a bridge before comprehensive surgery.

In practice, I often pair limited polypectomy with medical optimisation and review. Right problem, right tool.

3. Image-Guided Surgery

For complex anatomy, prior operations, or polyps near critical structures, I add navigation. Think of it as a 3D map that synchronises instruments with preoperative scans. As Bangkok Hospital Pattaya explains, this technology functions like surgical GPS and reduces the risk to nearby tissues. It improves confidence when anatomy is distorted and when precision must be absolute.

• When I use it: revision surgery, skull base proximity, or congenital variations.

• Benefit: enhanced precision with less collateral trauma.

• Outcome: safer dissections and fewer intraoperative surprises.

This is not a crutch. It is a safety and accuracy layer that matters most in difficult cases.

4. Balloon Sinuplasty with Polyp Removal

Balloon sinuplasty dilates selected sinus openings with a catheter mounted balloon. I sometimes combine it with limited nasal polyp removal when anatomy allows. The intent is conservative remodelling, not tissue excision. It is particularly appealing for frontal sinus access or for patients who require a gentle approach.

• Ideal candidate: localised disease with mild to moderate inflammation.

• Advantage: less bleeding and faster early recovery.

• Limitation: not suited for extensive, diffuse polyposis that needs formal FESS.

Balloon work is a tool in the kit. It is not a universal solution, and expectations must match anatomy.

5. Revision Surgery Options

Revision procedures address recurrent polyps or persistent blockage after earlier operations. I start by reviewing imaging and endoscopy to understand whether scarring, residual partitions, or persistent inflammation drives symptoms. I then plan targeted corrections that preserve functioning pathways.

• Common tasks: scar lysis, ostial enlargement, and careful removal of inflamed tissue.

• Adjuncts: navigation, drug-eluting stents, and structured postoperative care.

• Decision point: if medical control is insufficient, revision FESS can re-establish airflow.

Revision is precision surgery. The goal is to solve defined problems, not to repeat the first operation.

Surgical Procedure Steps and Preparation

Pre-Surgery Medical Evaluation

Preparation is methodical. I confirm the diagnosis with endoscopy and imaging, review medication history, and assess for comorbid asthma or aspirin sensitivity. Blood tests and anaesthetic assessment follow. I also adjust steroids and start saline irrigation preoperatively to reduce mucosal oedema.

• Allergy and respiratory review to tailor perioperative steroids.

• Medication reconciliation, including stopping anticoagulants when appropriate.

• Expectation setting, including how nasal polyps surgery fits into long term management.

A clear plan prevents avoidable complications. It also streamlines recovery.

Anaesthesia Administration Process

Most cases proceed under general anaesthesia. The airway is protected and the surgical field remains stable. In minor polypectomy, a local anaesthetic approach may be feasible, but I prefer general anaesthesia for comprehensive FESS. It reduces patient movement and bleeding risk. It also allows deliberate, unhurried dissection.

I coordinate with the anaesthetist to maintain controlled hypotension and to minimise intraoperative sneezing and coughing. Small adjustments here yield large gains in visibility.

Endoscope Insertion Technique

Endoscopic access is through the nostrils. The endoscope provides lighting and magnified vision. As the Cleveland Clinic outlines, diagnostic nasal endoscopy uses a slender scope, usually after topical decongestant and anaesthetic, and takes about one to five minutes. In surgery, the principle is the same, though instruments and purpose differ.

• Topical preparation to reduce swelling and improve corridor space.

• Systematic progression from the nasal cavity into targeted sinus areas.

• Constant suction and mucosal care to maintain a clean view.

Good endoscopy is calm, deliberate, and anatomical. Vision drives every move.

Polyp Removal Methods

I remove polyps using a microdebrider, through-cutting instruments, or powered shavers. The method depends on polyp size, attachment, and adjacent structures. In FESS, I also enlarge natural ostia to re-establish ventilation. This is the part that separates endoscopic sinus work from simple nasal polyp removal.

• Microdebrider: controlled shaving with simultaneous suction.

• Through-cutting forceps: precise excision at the base.

• Adjunct cautery: selective haemostasis without thermal injury to healthy mucosa.

Technique choice is tactical. The aim is clean removal with minimal trauma and optimal sinus function.

Post-Operative Monitoring

In recovery, I observe for bleeding, pain, and nausea. I confirm airway stability and review early irrigation instructions before discharge. Most patients go home the same day, with a contact pathway for any concerns. The first dressing change or debridement is scheduled within the first week.

• Vital sign checks and haemostasis confirmation.

• Pain control strategy and antiemetic plan.

• Clear instructions for saline rinses and activity limits.

Early attention to detail prevents small issues from becoming setbacks.

Risks and Potential Complications

Bleeding and Infection Risks

Bleeding is the most common intraoperative event. I mitigate this with preoperative decongestion, meticulous technique, and postoperative packing if required. Infection risk is low after nasal polyps surgery when irrigation and topical care are consistent. I prescribe antibiotics selectively, guided by findings and patient risk factors.

• Typical bleeding: minor oozing for two to three days.

• Warning signs: large clots, persistent bright bleeding, or fever.

• Preventive measures: saline rinses, avoidance of nose blowing, and head elevation.

Most issues settle with local care. Escalation is rare but must be prompt.

Damage to Surrounding Structures

The sinuses border the orbit and skull base. Injury risk exists, particularly in revision cases or distorted anatomy. This is where navigation and measured dissection matter. I proceed with constant awareness of landmarks and with a low threshold to pause and reassess.

• Orbital injury: bruising or double vision in severe cases.

• CSF leak: very uncommon, managed with targeted repair.

• Septal or turbinate trauma: usually minor, but avoidable with care.

The principle is simple. Preserve function, protect boundaries, and respect variation.

Anaesthesia-Related Complications

As with any procedure under general anaesthesia, adverse events can occur. These include nausea, sore throat, or cardiovascular events in high risk patients. Preoperative optimisation and experienced teams keep rates low. I discuss these risks in detail so consent is informed and proportionate.

Recurrence of Nasal Polyps

Polyps can return. Disease biology, allergy load, and adherence to topical therapy influence the timeline. Even after excellent endoscopic sinus surgery, recurrence remains a possibility. I frame success as symptom control and function over the long term, often with maintenance sprays or biologic therapy when indicated.

• Higher risk groups: asthma, aspirin-exacerbated respiratory disease, extensive eosinophilic inflammation.

• Mitigation: daily saline irrigation and nasal steroids, early management of flares.

• Intervention: office debridement or targeted revision if obstruction redevelops.

Control, not cure, is the realistic goal in many chronic cases.

Loss of Smell or Taste

Smell can improve when inflammation is cleared and airflow returns. It can also worsen temporarily due to postoperative swelling. Persistent loss is uncommon but not impossible, particularly in severe disease. I manage expectations carefully and start olfactory training when appropriate.

• Typical course: temporary reduction for one to two weeks.

• Support: steroid rinses, careful debridement, and smell training exercises.

• Prognosis: best when swelling resolves and polyps remain controlled.

Smell is delicate. Gentle handling and stable mucosa offer the best chance of recovery.

Recovery Timeline and Aftercare

First 24-48 Hours Post-Surgery

The first two days focus on comfort, bleeding control, and rest. I advise head elevation, cold compresses, and prescribed analgesia. Saline irrigation starts as soon as bleeding subsides. Light blood-tinged discharge is common. It looks dramatic on tissues. It usually is not.

• Medication: paracetamol based analgesia, avoid NSAIDs unless cleared.

• Irrigation: isotonic saline, several times daily.

• Red flags: heavy bleeding, severe pain, or visual changes.

Early calm is key. Small steps make a noticeable difference.

Week 1 Recovery Milestones

By the end of week one, most patients breathe more freely through at least one side. I usually perform a gentle debridement to clear crusts and maintain openings. Fatigue is common but easing. Work from home is often possible for desk roles.

• Symptoms: mild congestion and low grade pressure.

• Activities: short walks, avoid heavy lifting and bending.

• Clinic: first review for cleaning and progress check.

Momentum matters. A clean cavity heals faster and with fewer adhesions.

Nasal Care and Cleaning

Saline irrigation is non negotiable after nasal polyps surgery. I recommend large volume rinses to reduce crusting and flush inflammatory debris. Topical steroid sprays or rinses follow once the mucosa is ready. This routine supports long term control, not just early healing.

• Irrigation frequency: two to four times daily for the first fortnight.

• Technique: head over sink, mouth open, let saline flow without force.

• Steroid timing: start when I confirm healing of raw surfaces.

Consistency beats intensity. Regular care prevents relapse and protects surgical gains.

Activity Restrictions

For two weeks, I advise avoiding strenuous exercise, nose blowing, and dusty environments. Travel by air is better delayed if possible. Sleep with head elevation and keep hydration steady. These are conservative measures. They reduce bleeding and aid mucosal recovery.

• Allowed: light walks and gentle stretching.

• Avoid: swimming, heavy lifting, or hot yoga during early healing.

• Return to baseline: usually from week two to three, depending on progress.

Simple rules. Measurable benefits.

Follow-Up Appointments Schedule

I schedule reviews at one week, three to four weeks, and at three months. Timing adjusts for disease severity and healing pace. Endoscopic cleaning during these visits prevents scar bands and keeps sinus openings patent.

Visit	Purpose
1 week	Debridement, review irrigation, check haemostasis
3-4 weeks	Assess mucosal healing, start or adjust steroids
3 months	Evaluate function, optimise long term therapy

Appointments are not just check-ins. They are part of the treatment plan.

Long-Term Management Strategies

Chronic rhinosinusitis with polyps needs ongoing care. I build a maintenance programme that blends saline, steroids, and trigger control. In select cases, biologics reduce polyp burden and improve smell. I also plan seasonal reviews for patients with strong allergy patterns.

• Core routine: daily saline and steroid spray or rinse.

• Adjuncts: antihistamines, leukotriene modifiers, and allergen management.

• Escalation: consider biologics when symptoms persist despite optimal regimen.

Long term success is a partnership. Surgical precision supported by consistent medical therapy.

Making an Informed Decision About Nasal Polyps Surgery

The decision to proceed depends on symptom burden, response to medicine, imaging, and personal goals. I weigh airflow, smell, sleep quality, and infection frequency. If medical care falls short, surgery offers structural change that medicine alone cannot achieve.

• Clear indications: obstruction, recurrent infection, and impaired quality of life.

• Realistic outcomes: improved breathing and smell, fewer infections, better sleep.

• Commitment: postoperative care and long term control to limit recurrence.

Some ask about endoscopic sinus surgery versus limited polypectomy. The answer depends on disease extent and objective findings. If the sinuses are blocked, definitive FESS is usually the more durable pathway. I also discuss practicalities, including hospital stay, time off work, and nasal polyps surgery cost considerations for budgeting and insurance claims.

Good decisions respect evidence and the individual context. That balance is the whole task.

Frequently Asked Questions

How long does nasal polyps surgery take?

Simple polypectomy may take 20 to 40 minutes. Comprehensive FESS often ranges from 60 to 120 minutes depending on anatomy and extent. Revision or image-guided cases can run longer. I schedule adequate time to ensure careful haemostasis and thorough cleaning before closure.

What is the typical nasal polyps surgery cost in India?

Hospitals vary by city, facility level, and insurance arrangements. The nasal polyps surgery cost typically reflects surgeon fees, anaesthesia, operating room time, disposables, and navigation technology when used. I advise patients to request an itemised estimate from the hospital finance team. That breakdown clarifies what insurance covers and what remains out of pocket.

Can nasal polyps return after endoscopic sinus surgery?

Yes, recurrence is possible. Biology and ongoing inflammation drive the risk. Endoscopic sinus surgery changes airflow and access for topical therapy, which lowers recurrence to an extent, but it does not eliminate risk. Regular irrigation, steroid use, and targeted follow up slow regrowth and protect results.

When can I return to work after nasal polyp removal?

For desk work, most return within five to seven days if symptoms are controlled. Roles involving heavy lifting or exposure to dust may require two to three weeks. I tailor advice to the workplace environment and to the extent of surgery. A brief phased return is often sensible.

Is nasal polyps surgery performed under general anaesthesia?

Most definitive procedures are under general anaesthesia for safety and precision. Limited polypectomy can be performed under local anaesthetic in select cases. I decide with the patient after discussing extent, tolerance, and procedural goals. Stable operating conditions produce better outcomes and fewer complications.

What are the success rates of endoscopic sinus surgery for polyps?

Success rates are high when surgery is paired with long term care. Published data show strong symptom improvement and sustained control for most patients. Results vary with disease severity and adherence to maintenance therapy. My practice mirrors that pattern, with meaningful gains in airflow, smell, and infection reduction.