Chronic Sinusitis: Managing Allergies, Infections, and When Surgery Might Help

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 lost sense of smell for more than three months, you’re not just dealing with a bad cold. You might have chronic sinusitis. Unlike acute sinusitis, which clears up in a couple of weeks, chronic sinusitis lingers. And it’s more common than you think: about 9% of people worldwide deal with it every year. In the U.S. alone, 31 million people are diagnosed annually. Most of them aren’t sick because of a lingering infection. They’re stuck in a cycle of inflammation, blocked drainage, and irritation that won’t resolve with antibiotics alone.

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 inflamed for 12 weeks or longer, even with treatment. It’s not one disease. It’s a group of conditions with similar symptoms but different causes. The main ones are: chronic sinusitis without nasal polyps, chronic sinusitis with nasal polyps, and allergic fungal rhinosinusitis. Each needs a slightly different approach.

Doctors diagnose it when you have at least two of these symptoms for 12 weeks or more: 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. A physical exam might show pus or polyps. But the real confirmation comes from a nasal endoscopy (a thin camera inserted into your nose) or a CT scan that shows thickened sinus lining.

Why Do You Get It? Allergies, Irritants, and Structural Issues

Most people assume chronic sinusitis is caused by a bacterial infection. It’s not. Only about 30% of cases involve active bacteria. The rest? It’s inflammation.

Allergies are a big trigger. If you have hay fever, pet dander sensitivity, or dust mite allergies, your risk of chronic sinusitis goes up by 2.5 times. Asthma makes it even worse-people with asthma are 3 to 4 times more likely to develop it. That’s because your airways, from your nose to your lungs, share the same inflammatory pathways.

Nasal polyps-soft, noncancerous growths inside your nose-are present in 25-30% of chronic sinusitis cases. They’re like little balloons of swollen tissue that block airflow and mucus drainage. And if you have polyps plus asthma and sensitivity to aspirin (called Samter’s triad), your case is often harder to treat.

Environmental irritants matter too. Smoking, secondhand smoke, air pollution, and even dry air can worsen inflammation. One study found that exposure to tobacco smoke increases your risk by 35%. If you live in a dry climate like parts of Australia or the U.S. Southwest, low humidity can dry out your nasal passages, making them more prone to irritation.

Structural problems play a role too. A deviated septum, narrow sinus openings, or enlarged turbinates can physically block drainage. These aren’t always obvious without imaging. That’s why a CT scan is often needed-not to find an infection, but to see if your anatomy is working against you.

First-Line Treatment: Saline and Steroids

Before you think about surgery or strong medications, start with the basics. The most effective first step for almost everyone is daily nasal saline irrigation. It’s cheap, safe, and works. You use a neti pot or squeeze bottle with sterile saltwater to flush out mucus, allergens, and irritants. Studies show this alone improves symptoms in up to 70% of people.

Next comes intranasal corticosteroid sprays. These aren’t the same as the steroids athletes use. These are local, targeted anti-inflammatories. Brands like Flonase (fluticasone), Rhinocort (budesonide), and Nasonex (mometasone) reduce swelling in your sinuses. They don’t work overnight. It takes 4 to 8 weeks of daily use to see real improvement. But once they kick in, 60-70% of patients get significant relief.

Here’s the catch: most people stop using them too soon. Only about 60% stick with the spray long-term because of the initial burning sensation or because they don’t feel better right away. But skipping doses or quitting early is why so many people end up thinking their treatment “didn’t work.” Consistency is everything.

What About Allergies and Antibiotics?

If allergies are driving your sinusitis, antihistamines like loratadine (Claritin) or cetirizine (Zyrtec) can help. They’re not a cure, but they reduce the allergic response that triggers swelling. Studies show they cut symptoms by 45-60% in allergic patients.

Antibiotics? Don’t expect much. The American Academy of Allergy, Asthma & Immunology says antibiotics usually don’t help in chronic cases because bacteria aren’t the main problem. If you’ve had a flare-up with thick yellow-green mucus and fever, your doctor might try a 21-28 day course of amoxicillin-clavulanate. But if symptoms return after finishing the antibiotics, it’s not an infection-it’s inflammation. Keep using your steroid spray.

When Medication Isn’t Enough: Biologics for Severe Cases

If you’ve tried nasal sprays, saline, and antihistamines for months and still can’t breathe, smell, or sleep, you might be a candidate for biologic therapy. These are injectable drugs that target specific parts of your immune system.

Dupilumab (Dupixent) was approved by the FDA in 2019 specifically for chronic sinusitis with nasal polyps. In clinical trials, it reduced polyp size by 50-60% and improved breathing and smell in 30-40% of patients. It’s not cheap-it’s given as a shot every two weeks-but for people who’ve failed everything else, it’s life-changing.

Other biologics like omalizumab (Xolair) and mepolizumab (Nucala) are also being used off-label with 35-55% success rates. These are typically reserved for patients with severe polyps, asthma, or Samter’s triad. They’re not for mild cases. But for those who qualify, they can mean avoiding surgery entirely.

Surgery: When and What Kind?

Surgery isn’t the first option. It’s the next step if you’ve tried at least 12 weeks of medical treatment and still have severe symptoms. The gold standard is Functional Endoscopic Sinus Surgery (FESS). During this procedure, an ENT surgeon uses a thin camera and small instruments to remove blockages, open up narrowed sinus passages, and clear out polyps. Success rates are high: 75-90% of patients report lasting improvement.

Recovery is quicker than you might think. Most people go back to work in 7-10 days. There’s no external cutting. Everything is done through the nose.

Another option is balloon sinuplasty. It’s less invasive. A tiny balloon is inflated inside the blocked sinus to widen it. Recovery is faster-3 to 5 days-but long-term results aren’t as strong as FESS. It works best for people with mild blockages and no polyps.

If you have nasal polyps, a polypectomy (removing the polyps) is often done during FESS. But here’s the reality: even after surgery, polyps come back in 40-50% of cases within 18 months if you don’t keep using your steroid spray. Surgery fixes the structure, but you still need the medication to keep inflammation down.

For those with a deviated septum, a septoplasty can be done at the same time. It improves airflow and helps other treatments work better. About 65-75% of patients report major improvement after this combined approach.

Lifestyle Changes That Actually Help

Medication and surgery aren’t the whole story. Daily habits make a big difference.

• Use a humidifier in dry weather. Dry air irritates your sinuses. In places like Sydney, where winter air can get dry, a humidifier in your bedroom cuts symptoms for about 40% of users.
• Avoid smoke, strong perfumes, and air pollution. If you can’t avoid them, wear a mask.
• Stay hydrated. Water keeps mucus thin and easier to drain.
• Wash your pillowcases weekly. Dust mites are a major trigger.
• If you have allergies, try to identify your triggers. Allergy testing can help you avoid what’s making things worse.

What Happens If You Ignore It?

Most people with chronic sinusitis don’t develop serious complications. But untreated inflammation can lead to deeper problems. In less than 0.5% of cases, the infection can spread to the eyes, bones, or even the brain. That’s rare-but it’s why persistent symptoms need attention.

More commonly, it just wears you down. You’re tired. You can’t sleep. You lose your sense of smell and taste. You miss work. You feel like you’re always fighting a cold. That’s why managing it isn’t optional-it’s about your quality of life.

What’s Next? The Future of Treatment

Research is moving fast. Scientists are looking at the sinus microbiome-the bacteria that live in your nose. Early studies suggest certain probiotics might reduce inflammation. Clinical trials are underway to see if adding them to your routine helps.

For people with Samter’s triad, aspirin desensitization is becoming more common. It involves slowly increasing doses of aspirin under medical supervision. About 70-80% of those who complete the process see major improvement in polyps and breathing.

By 2027, experts predict biologics will treat 25-30% of severe chronic sinusitis cases. That means fewer surgeries and better outcomes for people who’ve struggled for years.

Final Thoughts: It’s Manageable

Chronic sinusitis isn’t a death sentence. It’s not something you just have to live with. But it does require patience. You can’t fix it with one pill or one surgery. It’s a long-term plan: saline rinses, steroid sprays, avoiding triggers, and sometimes biologics or surgery. The key is working with your doctor to figure out which subtype you have-and sticking with the treatment that fits.

If you’ve been told it’s just allergies or a bad cold, and nothing’s helped, it’s time to ask for a nasal endoscopy or CT scan. You don’t have to keep breathing through your mouth. You don’t have to lose your sense of smell. There’s a path forward. You just need the right plan.