Understanding the Risks of Endoscopic Sinus Surgery: What You Need to Know

If you’ve been dealing with chronic sinus infections, persistent nasal congestion, or sinus-related breathing difficulties, your doctor may have recommended endoscopic sinus surgery (ESS). It’s natural to have concerns—surgery is a big decision, and understanding the risks and benefits is essential.

ESS is a minimally invasive procedure performed through the nostrils, with no external incisions. It’s designed to open up blocked sinuses, improve drainage, and reduce inflammation. For many patients, it brings significant relief. However, like any surgical procedure, it comes with potential risks. Let’s go over them in a way that’s easy to understand.

Common risks: What You Should Expect

1. Mild Bleeding (Normal)

After surgery, some light bleeding is common for a few days. It usually stops on its own, and nasal saline irrigation helps keep things clean. However, in rare cases, excessive bleeding may require additional treatment.

What you can do: Avoid aspirin, ibuprofen, and blood-thinning supplements before surgery (unless instructed otherwise by your doctor).

2. Temporary Nasal Congestion and Crusting

Right after surgery, it’s common to feel like your nose is still blocked. That’s because of postoperative swelling and crust formation inside the nasal passages. This improves as the healing process progresses.

What you can do: Regular saline rinses will help speed up healing and prevent excessive crust buildup.

3. Scarring Inside the Nose

Some patients may develop small scar bands (adhesions) inside the nasal passages, which could partially block sinus drainage again. This is why follow-up visits with your doctor are important—they can check for scarring and remove it if necessary.

What you can do: Attend all scheduled post-op follow-ups to ensure your nose is healing properly.

Rare risks

1. Changes in Your Sense of Smell

Because the sinuses are close to the olfactory nerves (which control smell), some patients experience temporary smell disturbances. Permanent loss is rare but can happen in severe cases.

What you can do: Most of the time, smell returns as inflammation subsides. If you notice persistent changes, let your doctor know.

2. Cerebrospinal Fluid (CSF) Leak

The sinuses are located near the base of the skull, where a thin layer of bone separates them from the brain. In very rare cases, this barrier may be accidentally breached, causing a leak of cerebrospinal fluid (CSF). This requires further treatment, sometimes including another surgery to repair it.

What you can do: If you experience clear, watery nasal drainage that won’t stop after surgery, contact your doctor immediately.

3. Eye-Related Issues (Extremely Rare)

The sinuses are very close to the eyes, so in rare cases, complications such as bruising, excessive tearing, or even vision changes can occur. These risks are very low, especially when surgery is performed by an experienced specialist.

What you can do: If you notice sudden vision problems or severe eye pain, seek medical attention right away.

Who Should Be Extra Cautious?

Some people may be at higher risk for complications, including:
✅ Patients with previous sinus surgeries – Scar tissue can make the procedure more complex.
✅ People with blood clotting disorders – Higher risk of excessive bleeding.
✅ Severe sinus disease cases – More extensive surgery may be needed.

Is ESS Worth the Risk?

For most patients, the benefits of ESS far outweigh the risks—especially if you’ve been struggling with chronic sinus infections, severe nasal obstruction, or recurrent acute sinusitis that doesn’t respond to medication. The procedure is designed to improve your quality of life, enhance breathing, and reduce the frequency of sinus infections. However, it’s not a cure-all, and proper postoperative care is just as important as the surgery itself. By choosing a qualified ENT specialist and following post-op instructions carefully, you can significantly reduce the chances of complications. If you’re still unsure whether ESS is right for you, don’t hesitate to ask your doctor. A personalized discussion based on your medical history and symptoms will help you make the best decision.

Wirach Chitsuthipakorn