Chronic Sinusitis: Managing Allergies, Infections, and When Surgery Helps

For many people, a stuffy nose that won’t go away isn’t just annoying-it’s exhausting. If you’ve had nasal congestion, facial pressure, or a dull sense of smell for more than three months, despite trying decongestants or antibiotics, you might be dealing with chronic sinusitis. This isn’t a bad cold that’s dragging on. It’s a persistent inflammation deep in your sinuses, and it affects nearly 1 in 10 people worldwide. The good news? We now understand it better than ever, and there are real, effective ways to take control.

What Exactly Is Chronic Sinusitis?

Chronic sinusitis, also called chronic rhinosinusitis, means your sinuses-the hollow spaces in your forehead, cheeks, and nose-are swollen and blocked for 12 weeks or longer, even with treatment. Unlike acute sinusitis, which usually clears up in a few weeks, chronic sinusitis doesn’t follow the pattern of a typical infection. It’s not just bacteria hanging around. It’s your body’s own inflammatory response gone rogue.

The American Academy of Otolaryngology defines it by two or more key symptoms: blocked nose, thick nasal discharge (either dripping out or down the back of your throat), facial pain or pressure, and reduced or lost sense of smell. If you’ve had two of these for over three months, it’s time to look beyond cold remedies.

Doctors confirm the diagnosis with a nasal endoscopy-a thin, flexible scope inserted into the nose to see inside-or a CT scan that shows swollen tissue or fluid buildup. You don’t need a scan for every case, but if symptoms don’t improve, it’s a critical tool to rule out polyps or structural issues.

Why It Happens: Allergies, Infections, and Structural Triggers

There’s no single cause. Chronic sinusitis is a mix of factors, and knowing which ones apply to you changes your treatment path.

Allergies are a major player. If you have hay fever, pet dander sensitivity, or mold allergies, your nasal lining is constantly irritated. This swelling blocks drainage, traps mucus, and creates the perfect environment for inflammation to stick around. People with allergies are 2.5 times more likely to develop chronic sinusitis.

Nasal polyps-soft, noncancerous growths inside the nose-are found in about 1 in 4 people with chronic sinusitis. These aren’t visible without an endoscope, but they physically block airflow and drainage. Polyps are often linked to asthma and aspirin sensitivity, a combination known as Samter’s triad. In those cases, the inflammation is especially stubborn.

Structural problems like a deviated septum or narrow sinus openings can trap mucus even if there’s no infection. Think of it like a clogged sink-the water doesn’t drain because the pipe is bent, not because there’s dirt in it.

And yes, bacteria can play a role-but less than you think. Studies show that in 70% of chronic cases, there’s no active bacterial infection. Common bugs like Streptococcus pneumoniae or Haemophilus influenzae are more typical in short-term infections. In chronic cases, it’s the body’s ongoing immune reaction that’s the problem, not lingering germs.

First-Line Treatment: Saline and Steroid Sprays

Before you think about pills or surgery, start with the basics. The most effective, evidence-backed first step is daily nasal saline irrigation combined with intranasal corticosteroid sprays.

Saline rinses flush out allergens, mucus, and irritants. You can use a neti pot, squeeze bottle, or nasal spray. Studies show consistent use reduces symptoms in over 80% of people within 4 to 8 weeks. It’s simple, cheap, and safe for long-term use.

Corticosteroid sprays like fluticasone (Flonase), mometasone (Nasonex), or budesonide (Rhinocort) target inflammation directly in the nasal lining. They don’t work overnight. You need to use them every day for at least 6 to 8 weeks to see results. About 60-70% of users get significant relief. The key? Don’t stop too soon. Many people quit because they don’t feel immediate results-but that’s when persistence pays off.

One big problem? Adherence. Only about 60% of patients stick with nasal sprays long-term. The spray can feel weird at first. Some report mild nosebleeds or dryness. But these side effects are minor compared to the relief it brings. If you’re struggling, talk to your doctor about switching brands or trying a different delivery method.

When Allergies Are the Main Culprit

If your sinusitis flares up with pollen season or around pets, allergies are likely driving it. Antihistamines like loratadine (Claritin) or cetirizine (Zyrtec) can help reduce sneezing and runny nose-but they don’t fix the swelling in your sinuses. That’s why they’re used alongside steroid sprays, not instead of them.

For severe allergic sinusitis, allergists may recommend allergy shots (immunotherapy). Over time, this retrains your immune system to stop overreacting to triggers like dust mites or ragweed. It takes months to years, but for some, it’s the only way to get lasting relief.

And if you have Samter’s triad-asthma, nasal polyps, and aspirin sensitivity-your doctor might suggest aspirin desensitization. This involves slowly increasing your aspirin dose under medical supervision. It sounds risky, but for 70-80% of eligible patients, it reduces polyp growth and improves breathing dramatically.

Biologic Therapies: A Game Changer for Polyps

If you’ve tried everything-saline, steroids, antihistamines-and still have large polyps and trouble breathing, biologic drugs are now an option.

Dupilumab (Dupixent), approved by the FDA in 2019, is the first biologic specifically for chronic sinusitis with nasal polyps. It’s an injectable medication that blocks key inflammatory signals. In clinical trials, patients saw a 50-60% reduction in polyp size and a 30-40% improvement in symptoms. Many regain their sense of smell, something that’s often lost for years.

Other biologics like omalizumab (Xolair) and mepolizumab (Nucala) are also being used off-label or in specific cases, with 35-55% effectiveness in reducing polyp-related symptoms. These aren’t cures, but they can dramatically reduce the need for repeated surgeries.

They’re expensive, and not everyone qualifies. But for those with severe, persistent polyps, they’ve changed lives. Insurance often requires proof that you’ve tried at least 12 weeks of high-dose steroid sprays and oral steroids first.

Surgery: When Medical Treatment Isn’t Enough

If symptoms persist after 12 weeks of consistent medical treatment, surgery is the next step. It’s not a last resort-it’s a logical progression when inflammation and blockages don’t respond to medication.

Functional Endoscopic Sinus Surgery (FESS) is the gold standard. An ENT specialist uses a thin camera and tiny instruments to remove blockages, open up narrowed sinus passages, and clear out polyps. It’s done through the nose-no external cuts. Recovery takes about a week. Most people return to normal activities within 7 to 10 days. Success rates? Between 75% and 90% for long-term symptom improvement.

Balloon sinuplasty is a less invasive option. A tiny balloon is inflated inside the blocked sinus to widen it. Recovery is faster-often just 3 to 5 days-and there’s less bleeding. But it’s not as effective for large polyps or complex blockages. It works best for people with mild structural narrowing and no polyps.

Polypectomy removes visible polyps. It’s often done during FESS. While 85% of patients feel better right after, polyps come back in 40-50% of cases within 18 months if medical treatment isn’t continued. That’s why surgery isn’t a one-and-done fix-it’s part of a long-term plan.

If you have a deviated septum contributing to your symptoms, a septoplasty may be done at the same time. About 65-75% of patients report major improvement in breathing after this combined procedure.

What You Can Do at Home

Medications and surgery help, but daily habits make a huge difference.

• Use a humidifier in dry weather-especially in winter. Dry air irritates nasal passages.
• Avoid smoke, strong perfumes, and chemical fumes. These are triggers for 35% more cases.
• Stay hydrated. Thin mucus drains better.
• Wash your bedding weekly in hot water to reduce dust mites.
• Check your home for mold, especially in bathrooms and basements.

Some people find relief with probiotics. Early research from Johns Hopkins suggests certain strains may reduce inflammation in 30-40% of patients when used with other treatments. It’s not a replacement, but it could help.

What Happens If You Don’t Treat It?

Most people won’t develop serious complications. But untreated chronic sinusitis can lead to ongoing fatigue, trouble sleeping, poor concentration, and even depression from the constant discomfort.

In rare cases-less than 0.5%-infection can spread to the eyes, bones, or even the brain. That’s why persistent symptoms need attention, not just waiting it out.

The bigger risk? Living with it for years thinking it’s "just allergies" or "a bad cold." You don’t have to. There are proven paths forward.

Getting the Right Care

Chronic sinusitis often needs a team. Your GP can start you on saline and steroid sprays. But if you’re not improving, see an ENT specialist. If allergies are suspected, an allergist can test for triggers. For severe polyps or biologic therapy, you’ll likely need both.

Studies show patients who get coordinated care from both an ENT and allergist have 35-45% better outcomes than those seeing just one specialist.

Don’t settle for temporary fixes. If you’ve been living with this for months, it’s not normal. There’s a way to feel better-and it starts with knowing exactly what’s going on inside your sinuses.