Nose Blocked Since Last Winter? When Sinus Surgery (FESS) Helps and When It Doesn’t

 

Every October, as Delhi’s air turns grey, a familiar story walks into my clinic in Vasant Vihar. The nose has been blocked since last winter. Sprays, steam and a few courses of antibiotics later, it still hasn’t cleared, and the question finally comes: do I need an operation?

Sometimes the answer is yes, and the operation is usually FESS, short for functional endoscopic sinus surgery. Often the answer is no. Here is how an ENT tells the difference, what the surgery involves, and what to try before it comes to that.

Is it really sinusitis?

A nose that stays blocked for months is not always sinusitis. The usual causes are a deviated septum (the wall between the nostrils is bent), swollen turbinates, allergic rhinitis, nasal polyps, or a mix of these. They can feel the same but are treated very differently.

Doctors call it chronic rhinosinusitis when symptoms last 12 weeks or more. That means a blocked or running nose, often with facial pressure or a weaker sense of smell, plus changes an ENT can see on endoscopy or a CT scan. This definition comes from EPOS 2020, a widely used European guideline on sinus disease.

There is also a trap many people fall into: the decongestant spray that opens the nose within minutes. Sprays like xylometazoline and oxymetazoline are meant for a few days at a time. Used for weeks or months, they can cause rebound blockage called rhinitis medicamentosa, a common problem in ENT clinics.

Why Delhi’s winter air is hard on the sinuses

Delhi’s air gets roughly twice as bad in October as in September. Averaged over 2021 to 2025, the city’s AQI rose from about 100 in September to 212 in October, as reported by NewsBytes. Across 2025, Delhi averaged 82.2 µg/m³ of PM2.5, the worst of any capital city in IQAir’s report.

Research now links these fine particles to sinus disease. A US study covering about 4 billion outpatient visits found that each 1 µg/m³ rise in PM2.5 predicted a 10% higher rate of chronic sinusitis visits. The average exposure in that study was 8.9 µg/m³, less than a ninth of Delhi’s yearly average.

Another study looked at 308 patients having sinus surgery. Those exposed to more PM2.5 in the preceding year had more inflammation and more eosinophils in their sinus lining. Pollution is rarely the only cause, but it can keep that lining inflamed.

How an ENT finds out: endoscopy and a CT scan

Two tests answer most of the questions: a nasal endoscopy and a CT scan of the sinuses. The endoscopy takes a few minutes in the clinic. After a numbing spray, a thin camera shows the septum, the turbinates, any polyps, and pus around the sinus openings.

A CT scan shows what the camera cannot reach: whether the sinuses themselves are blocked, and how their drainage channels are shaped. It also becomes the surgeon’s map if an operation is needed. The scan is most useful after a proper trial of medicines, because a recent cold can make healthy sinuses look blocked for a few weeks.

Not everyone needs surgery, and these two tests are how you find out. If sinus surgery is advised without an endoscopy and a CT scan, it is fair to ask why, or to get a second opinion.

Try the right medicines first

Most people with chronic sinusitis should start with medicines, not surgery. EPOS 2020 puts two treatments first: daily saline rinses and a steroid nasal spray, used properly for several weeks. A steroid spray is not the same as the decongestant sprays above, and it is safe for long-term use under an ENT’s guidance.

Saline rinses are cheap and they help, though modestly. In a UK trial of 871 adults with recurring sinus symptoms, daily rinsing improved symptoms, while steam eased headaches but little else. If allergy is driving the symptoms, treating the allergy often settles the nose as well.

Antibiotics have a place when there is a bacterial flare-up. Course after course for a nose that has been blocked for months rarely fixes the cause. If two or three months of the right treatment hasn’t helped, that is the time to discuss surgery.

What FESS actually involves

FESS opens the blocked sinuses from inside the nose, through the nostrils. Using a thin camera called an endoscope, the surgeon widens the sinuses’ drainage channels and removes polyps or thick mucus. Nothing is cut on the face, so there is no scar and the nose keeps its shape.

It is usually done under general anaesthesia and takes one to two hours, depending on how many sinuses need work. If a bent septum is part of the blockage, it is often straightened in the same sitting. Most patients go home the same day or the next morning.

The aim is not to remove the sinuses but to let them drain and breathe again. Rinses and sprays also reach the sinus lining far better once the channels are open, so they continue after surgery. There is more on the procedure on our FESS page at MedFirst ENT Centre.

Recovery, and the honest risks

Recovery is usually quicker than people expect. For the first week or two the nose feels blocked and crusty, with some blood-stained discharge. Most people with desk jobs return to work in about a week, but heavy lifting, bending and hard exercise should wait about two weeks.

Follow-up visits matter as much as the surgery itself. The surgeon cleans crusts from the operated area under the endoscope, and you keep up saline rinses and steroid sprays at home. Skipping this raises the chance of scarring inside the nose and of symptoms coming back.

Like any operation, FESS has risks, and you should hear them before you agree. Bleeding and infection are the usual ones, and polyps can grow back, especially in people with allergy or asthma. Serious problems involving the eye or the lining of the brain are rare in experienced hands.

Warning signs that shouldn’t wait

Some symptoms need an ENT or an emergency department the same day. Swelling or redness around the eye, double vision or blurred vision can mean a sinus infection has spread toward the eye. A severe headache, swelling over the forehead, high fever with a stiff neck, or confusion are just as urgent.

A blockage on only one side also deserves a prompt look, especially with bleeding, crusting or a foul smell. The cause is usually harmless, but it should be examined rather than treated with sprays. EPOS 2020 lists all of these as alarm signs.

References

1. Fokkens WJ, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology.
2. Zucker SM, Barton BM, McCoul ED. Management of rhinitis medicamentosa: a systematic review. Otolaryngol Head Neck Surg.
3. Yang et al. Ambient particulate matter and frequency of outpatient visits for chronic rhinosinusitis in the United States. Int Forum Allergy Rhinol.
4. Lubner et al. Particulate matter exposure is associated with increased inflammatory cytokines and eosinophils in chronic rhinosinusitis. Allergy.
5. Little P, et al. Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care.
6. India is sixth most polluted country (IQAir World Air Quality Report 2025). The Wire, 24 March 2026.
7. Every October, Delhi’s AQI more than doubles compared with September. NewsBytes, 29 September 2026.

About the author

Dr. (Major) Rajesh Kumar Bhardwaj is a senior ENT surgeon with more than 35 years of clinical and surgical experience. He earned his MS in ENT at AFMC Pune with a silver medal and also holds a DNB. He served 15 years in the Indian Army Medical Corps and is Professor Emeritus at TMU, Moradabad.

He leads MedFirst ENT Centre in Vasant Vihar, South Delhi. The centre covers ENT surgery, general ENT care, an allergy clinic, a vertigo clinic with specialised vestibular testing, and hearing aid fitting with audiometry. To book a sinus check, visit entdelhi.com.