Background Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition of the nasal cavity and paranasal sinuses characterized by symptoms persisting for more than 12 weeks, resulting in substantial impairment of quality of life. Functional endoscopic sinus surgery (FESS) is the established surgical treatment for patients who fail to respond to conservative medical management. Methods This prospective analytical study included 50 patients with medically refractory CRS who underwent FESS between April 2025 and March 2026. Four principal symptoms - nasal obstruction, facial pain, post-nasal drip, and anosmia - were scored preoperatively and at six months postoperatively using a four-point ordinal symptom severity scale (0 = absent, 1 = mild, 2 = moderate, 3 = severe). The Wilcoxon signed-rank test was used to compare preoperative and postoperative severity scores, with effect size calculated as r = Z/√N. Results The cohort comprised 32 males (64%) and 18 females (36%), with a mean age of 37.66 ± 13.95 years. Preoperative symptom prevalence was as follows: nasal obstruction in 92%, facial pain in 86%, anosmia in 74%, and post-nasal drip in 68%. Statistically significant reductions in mean severity scores were observed for nasal obstruction (2.40 to 1.66; p < 0.001, r = 0.99), facial pain (2.28 to 1.54; p < 0.001, r = 1.00), and post-nasal drip (1.54 to 1.24; p < 0.001, r = 1.00). Anosmia showed a non-significant trend toward improvement (1.58 to 1.44; p = 0.071, r = 0.47), with four patients demonstrating postoperative worsening. No patient experienced worsening of nasal obstruction, facial pain, or post-nasal drip. The complication rate was low, with minor bleeding in four (8%) patients and synechiae in three (6%) patients; no major complications were recorded. Conclusions FESS produced statistically significant and clinically meaningful improvements in nasal obstruction, facial pain, and post-nasal drip in patients with medically refractory CRS. Anosmia did not reach statistical significance, and its management in CRS warrants further investigation. The procedure was associated with a low complication rate, supporting its role as a safe and effective surgical intervention.
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