Sinus Surgery in Singapore — FESS & Image-Guided Surgery

What is Sinus Surgery?

"Sinus surgery" today almost always refers to Functional Endoscopic Sinus Surgery (FESS) — a minimally invasive technique performed entirely through the nostrils using a high-definition endoscope. There are no external incisions, no facial scars, and no need to break any bones in the face. Instead, fine instruments are used to widen the natural drainage openings of the paranasal sinuses, remove polyps and inflamed tissue, and restore the ability of the sinuses to ventilate and clear mucus on their own.

FESS has been the international gold standard for chronic sinus disease since the late 1980s. In Singapore, with its high prevalence of allergic rhinitis and seasonal haze exposure, sinus surgery is one of the most common ENT operations. At CENTAS we offer FESS, image-guided FESS, and balloon sinuplasty — choosing the most appropriate technique based on your CT scan findings and disease severity.

When is Sinus Surgery Needed?

Surgery is never the first option. The vast majority of sinusitis is managed successfully with medical therapy. Sinus surgery is considered when one or more of the following apply:

• Chronic rhinosinusitis — symptoms persisting for more than 12 weeks (blocked nose, facial pressure, post-nasal drip, reduced smell) despite a complete course of maximum medical therapy with intranasal steroids, saline irrigation, antibiotics, and treatment of any underlying allergy
• Nasal polyps causing nasal obstruction, anosmia (loss of smell), or polyps so large they are visible at the nostril
• Recurrent acute sinusitis — four or more episodes per year requiring antibiotics
• Mucocele — a slowly expanding mucus-filled cyst that erodes surrounding bone
• Fungal sinusitis — either a fungal ball (typically maxillary) or allergic fungal rhinosinusitis with thick eosinophilic mucin
• Complications of sinusitis — orbital cellulitis, intracranial spread, or sinus disease threatening the eye or brain
• Failed previous sinus surgery with persistent or recurrent disease (revision FESS)

Read more about chronic sinusitis and nasal polyps, the two most common reasons we recommend surgery.

Types of Sinus Surgery Offered

Functional Endoscopic Sinus Surgery (FESS)

The cornerstone procedure. A 4 mm rigid endoscope is introduced through the nostril, projecting a magnified high-definition image onto a monitor. Working alongside the endoscope, fine instruments and a powered debrider are used to:

• Open the natural drainage opening (ostium) of each affected sinus
• Remove polyps, inflamed mucosa, fungal debris, and any cysts
• Preserve healthy mucosal lining wherever possible — the operation is "functional" because it restores normal physiology rather than stripping the sinus
• Take tissue samples for histology and microbiology when relevant

FESS is typically performed under general anaesthesia and takes 1 to 2 hours. Most patients are discharged the same day.

Image-Guided FESS

Image guidance overlays your pre-operative CT scan onto the surgical field in real time, working much like a GPS for the sinuses. A tracked instrument is shown on three CT planes simultaneously, so the surgeon can confirm exactly where the tip is sitting relative to the eye socket, the brain, and the carotid artery — structures that lie only millimetres from the operative field.

Image guidance is particularly valuable for:

• Revision sinus surgery, where normal anatomy and landmarks have been altered by previous operations
• Frontal and posterior ethmoid disease, where the sinuses sit closest to the brain and orbit
• Polyposis with distorted anatomy
• Skull base lesions and cerebrospinal fluid leak repair

Dr Pang established the Image Guided Surgery Program at the National University Hospital, where the technology was first introduced into routine sinus practice in Singapore. The same standard of intra-operative navigation is offered at Mt Elizabeth.

Balloon Sinuplasty

A less invasive option in selected patients. A flexible catheter with a small balloon at its tip is guided into the natural sinus opening; inflating the balloon dilates the opening without removing any tissue. Balloon sinuplasty is suitable for mild to moderate disease in the maxillary, frontal, or sphenoid sinuses without significant polyposis. It is not appropriate for the ethmoid sinuses, severe polyposis, fungal sinusitis, or revision cases — FESS remains the better option in these settings.

Concurrent Procedures

Sinus surgery is often combined with:

• Septoplasty — to straighten a deviated septum that is blocking surgical access or contributing to obstruction
• Turbinate reduction — to address coexisting enlarged turbinates

What Happens on the Day of Surgery?

• Admission to Mt Elizabeth Hospital in the morning, fasted from midnight
• Surgery under general anaesthesia, typically 1 to 2 hours depending on the extent of disease
• Light dissolvable nasal packing inserted to control any oozing
• Most patients are discharged the same day or after one night, depending on the procedure

Recovery After Sinus Surgery

• Days 1–3: nasal congestion, light blood-tinged discharge, mild headache. Begin saline rinses from day 3.
• Week 1: rest at home, sleep with the head elevated, avoid bending and heavy lifting
• Week 2: return to office work for most patients; first endoscopic clinic debridement to remove crusts and check healing
• Weeks 3–4: sense of smell and breathing improve steadily as the mucosa heals
• Weeks 4–6: full recovery. Avoid swimming, contact sports, and scuba diving until cleared at follow-up.

Long-term follow-up with intranasal steroid sprays and nasal irrigation is essential. Treating any underlying allergic rhinitis — for which Dr Pang offers SLIT immunotherapy — significantly reduces the risk of polyp recurrence.

Risks of Sinus Surgery

FESS is a safe operation in experienced hands. Recognised risks include:

• Bleeding — the most common issue; usually minor and self-limiting, occasionally requiring repacking
• Infection — uncommon and treated with antibiotics
• Recurrence of polyps or sinus disease, particularly without long-term medical treatment
• Synechiae (scarring) requiring division at follow-up
• Very rare: cerebrospinal fluid leak, orbital injury, double vision, change in vision. Image-guided surgery is specifically designed to minimise these risks.

Cost of Sinus Surgery in Singapore

FESS at Mt Elizabeth typically costs S$10,000–S$20,000 inclusive of surgeon, anaesthetist, hospital, and theatre fees. The total varies with disease extent, whether image guidance and concurrent septoplasty/turbinate surgery are needed, and length of hospital stay. Sinus surgery is Medisave-claimable, and most Integrated Shield Plan insurance covers the procedure (subject to your individual policy). Our clinic team will provide a detailed quotation, assist with insurance pre-authorisation, and submit Medisave claims on your behalf.

Why Choose Dr Pang for Sinus Surgery?

• Established the Image Guided Surgery Program at NUH — pioneered the routine use of intraoperative 3D navigation for sinus surgery in Singapore
• Former Senior Consultant and Clinical Director, NUH Department of Otolaryngology
• Over 20 years of ENT practice across the United Kingdom, United States, and Singapore
• Sub-specialty interest in allergy, sinus, and snoring — combined treatment of the underlying allergic rhinitis (including SLIT immunotherapy) reduces the risk of polyp recurrence after surgery
• FESS, image-guided FESS, balloon sinuplasty, and revision sinus surgery all performed at Mt Elizabeth Medical Centre
• Medisave-claimable, with insurance pre-authorisation handled by the clinic team

Frequently Asked Questions