Chronic Sinusitis: Symptoms, Diagnosis and Treatment

Overview

Chronic sinusitis is inflammation of the sinuses lasting 12 weeks or longer, despite treatment attempts. It differs from an occasional cold or acute sinus infection in its persistence and often requires a different diagnostic and treatment approach.

Chronic sinusitis can occur with or without nasal polyps (soft, painless growths on sinus/nasal lining), and this distinction significantly affects treatment choice. It's often driven by a combination of factors: structural issues (deviated septum, narrow sinus passages), allergies, immune dysfunction, and sometimes underlying conditions like asthma or aspirin sensitivity (in a specific subset called AERD — aspirin-exacerbated respiratory disease).

While often viewed as a minor annoyance, chronic sinusitis can significantly impact quality of life through persistent congestion, facial pain, disrupted sleep, and reduced smell/taste — and can require ongoing, sometimes escalating management.

Symptoms

Nasal congestion or blockage lasting 12+ weeks
Thick, discolored nasal discharge or postnasal drip
Facial pain, pressure, or fullness, particularly around the eyes, cheeks, or forehead
Reduced or lost sense of smell
Cough, often worse at night (from postnasal drip)
Fatigue
Ear pressure or pain
Headache
Bad breath
Sore throat from persistent drainage

Diagnosis

Symptom criteria — at least 2 of the core symptoms (congestion, discharge, facial pain/pressure, reduced smell) for 12+ weeks
Nasal endoscopy — a thin scope allows direct visualization of the nasal passages and sinuses, checking for inflammation, polyps, or structural issues
CT scan of the sinuses — provides detailed imaging of sinus anatomy and the extent of inflammation, especially important if surgery is being considered
Allergy testing — since allergies frequently contribute to or worsen chronic sinusitis
Additional testing — for recurrent or severe cases: immune function testing, testing for aspirin sensitivity (AERD) if asthma and polyps are also present

An otolaryngologist (ENT) typically confirms diagnosis via endoscopy and imaging.

Treatments

Nasal corticosteroid sprays — first-line treatment, used consistently (not just during flares) to reduce inflammation
Saline nasal irrigation — regular rinsing (neti pot or squeeze bottle) helps clear mucus and allergens
Oral corticosteroids — short courses for significant flares or before surgery
Antibiotics — only when a bacterial infection is superimposed; not effective for the underlying chronic inflammation itself
Biologics — newer injectable medications (dupilumab, omalizumab, mepolizumab) for chronic sinusitis with nasal polyps that hasn't responded to standard treatment, particularly effective for allergic/eosinophilic subtypes
Allergy management — treating underlying allergies can significantly improve sinus symptoms
Endoscopic sinus surgery — for cases not responding to medical treatment, to open blocked sinus passages and remove polyps; often improves both symptoms and effectiveness of subsequent medical treatments
Balloon sinuplasty — a less invasive procedure to open narrowed sinus passages in select cases

Medical Resources

Your Care Plan

A step-by-step guide to navigating your condition, from finding the right doctors to advocating for the care you deserve.

Step 1: Doctors to See

Start with: Your primary care physician or an allergist if allergies seem to be a major contributor.

Then seek: An otolaryngologist (ENT), especially if symptoms persist despite initial treatment, or if nasal polyps are suspected.

Build your team:

Allergist/immunologist — for allergy testing and management, and evaluation for biologic therapy candidacy
ENT surgeon — if surgery is being considered
Pulmonologist — if you also have asthma, particularly with the AERD (aspirin-sensitive) subtype

Step 2: Advocate for Yourself

If you've had congestion, facial pressure, or reduced smell for more than 12 weeks despite treatment, ask specifically for a referral to an ENT for endoscopy — don't just keep cycling through short courses of antibiotics for what may not be a bacterial problem at all. If you have both asthma and nasal polyps, specifically ask about aspirin-exacerbated respiratory disease (AERD) and whether you should avoid aspirin/NSAIDs. If standard nasal sprays and rinses aren't controlling your symptoms and you have polyps, ask about biologic therapy — this is a significant treatment advance that's not yet universally offered as a first option.

Step 3: Your Action Plan

Track your symptoms — congestion, discharge, facial pain, smell loss — and their duration.
See your primary doctor or allergist for initial evaluation and allergy testing if relevant.
If symptoms persist 12+ weeks, get an ENT referral for nasal endoscopy.
Start consistent nasal corticosteroid spray use and saline irrigation.
Get a CT scan if recommended, particularly if surgery might be considered.
If nasal polyps are present and symptoms are severe, ask about biologic therapy options.
Consider endoscopic sinus surgery if medical treatment alone isn't sufficient.
Address underlying allergies as part of your long-term management plan.

Important: This report is educational information, not medical advice. Always consult a qualified healthcare professional for diagnosis and treatment decisions.