A blocked nose that never seems to clear, constant postnasal drip, facial pressure, or a reduced sense of smell can be more than just another cold. When these symptoms continue for weeks, they may be linked to chronic sinusitis, also called chronic rhinosinusitis.

Unlike a short-term sinus infection, chronic sinusitis involves ongoing inflammation of the nose and sinuses. Understanding what causes it, how it is diagnosed, and which treatments can help may make it easier to manage the condition and know when to see a doctor.

What Is Chronic Sinusitis?

Chronic sinusitis is a long-lasting inflammation of the lining of the nose and sinuses. It is generally defined by symptoms that continue for 12 weeks or longer. The inflammation can interfere with normal mucus drainage, leading to congestion and difficulty breathing through the nose.

The condition is also known as chronic rhinosinusitis because it affects both the nasal passages and the sinuses.

Chronic sinusitis can occur with or without nasal polyps, which are soft, non-cancerous growths that can develop inside the nose or sinuses.

Common Symptoms of Chronic Sinusitis

The symptoms can vary from person to person. Some may have mainly nasal congestion, while others experience facial pressure or problems with their sense of smell.

Common symptoms include:

  • Persistent nasal congestion or a blocked nose
  • Thick mucus or a runny nose
  • Mucus draining down the back of the throat, known as postnasal drip
  • Pressure, tenderness or pain around the cheeks, nose, forehead or eyes
  • Reduced sense of smell or taste
  • Headache
  • Cough or sore throat
  • Bad breath
  • Tiredness
  • Ear pressure or discomfort

These symptoms can affect sleep, concentration and everyday activities when they continue for a long time.

What Causes Chronic Sinusitis?

There is not always one clear cause. Chronic rhinosinusitis is a complex inflammatory condition, and different factors can contribute to persistent symptoms.

Some possible causes and contributing factors include:

Nasal Polyps: Nasal polyps can block normal drainage from the sinuses and make it harder to breathe through the nose. They are commonly associated with chronic rhinosinusitis.

Allergies: Allergic rhinitis can cause ongoing inflammation and swelling inside the nose. If allergies are not well controlled, nasal symptoms may persist or worsen.

Structural Problems: A deviated nasal septum or other changes in the structure of the nose can interfere with drainage and contribute to persistent symptoms.

Infections and Inflammation: Viral or bacterial infections can sometimes trigger or worsen sinus inflammation. However, chronic sinusitis is not simply a long-lasting bacterial infection. It is primarily an inflammatory condition, so antibiotics are not automatically needed for every person with chronic symptoms.

Other factors, including cigarette smoke, air pollution, dental infections and certain medical conditions, may also contribute to chronic sinus problems.

How Is Chronic Sinusitis Diagnosed?

If you have constant nasal congestion or other sinus symptoms lasting 12 weeks or more, a doctor may evaluate you for chronic rhinosinusitis.

Diagnosis usually involves:

  • Reviewing your symptoms and medical history
  • Examining the nose and face
  • Nasal endoscopy, which allows a doctor to look inside the nasal passages
  • CT scanning, when imaging is needed to assess the sinuses and identify structural or inflammatory changes
  • Allergy testing when allergies may be contributing to symptoms

A diagnosis is generally based on both symptoms and objective evidence of inflammation or disease, such as findings on nasal endoscopy or imaging.

Chronic Sinusitis Treatment Options

Treatment depends on the underlying cause, symptoms, presence of nasal polyps and how well the condition responds to initial treatment. The goal is to reduce inflammation, improve drainage, ease symptoms and improve quality of life.

1. Saline Nasal Rinses: Saline irrigation can help clear mucus and irritants from the nasal passages. It may be recommended as part of regular symptom management.

If you use a neti pot or squeeze bottle, use distilled, sterile or appropriately boiled and cooled water, rather than untreated tap water.

2. Nasal Corticosteroids: Nasal steroid sprays help reduce inflammation and swelling inside the nose. They are commonly used in the medical management of chronic rhinosinusitis and may be particularly helpful when nasal polyps are present.

They generally need to be used regularly as advised by a healthcare professional rather than only when symptoms become severe.

3. Treatment for Allergies: If allergies are contributing to your symptoms, controlling them may help reduce nasal inflammation. Depending on the cause, treatment may include allergy medicines, avoiding known triggers or allergy immunotherapy.

4. Other Medicines: Some people may need additional medicines depending on their symptoms and the underlying cause. Oral corticosteroids may occasionally be used for severe inflammation, particularly in people with nasal polyps, but they are generally used selectively because of their potential side effects.

Antibiotics may be prescribed when there is evidence of a bacterial infection, but they are not routinely required simply because sinus symptoms have lasted a long time.

5. Biologic Medicines: For some people with severe chronic rhinosinusitis with nasal polyps that remains uncontrolled despite standard treatment, biologic medicines may be considered by a specialist. These medicines target specific parts of the inflammatory response and are prescribed based on individual factors.

6. Endoscopic Sinus Surgery: When appropriate medical treatment does not provide adequate or lasting relief, an ENT specialist may consider endoscopic sinus surgery.

The procedure uses an endoscope and specialised instruments to improve drainage and address diseased tissue or other blockages. Surgery is not required for everyone with chronic sinusitis. The decision depends on symptoms, examination and imaging findings, quality of life, and previous treatment.

How Can You Manage Chronic Sinusitis at Home?

Along with your prescribed treatment, some everyday habits may help:

  • Avoid cigarette smoke and other nasal irritants
  • Keep allergies under control
  • Stay adequately hydrated
  • Follow your nasal spray or rinse routine as advised
  • Keep saline-rinsing equipment clean
  • Avoid using nasal decongestant sprays for longer than recommended
  • Attend follow-up appointments if symptoms continue or return

When Should You See a Doctor?

Consider seeing a doctor if:

  • Nasal congestion or sinus symptoms continue for 12 weeks or longer
  • Symptoms keep returning
  • Treatment is not providing adequate relief
  • You have persistent problems with your sense of smell
  • You have significant facial pain or pressure
  • You have symptoms that interfere with sleep or daily activities

Seek urgent medical attention for symptoms such as swelling or redness around the eyes, vision changes, severe headache, confusion or a stiff neck, as these can indicate a rare but serious complication.

How PB Health Can Support You

Persistent sinus symptoms can sometimes require evaluation by an ENT specialist, especially when they do not improve with routine treatment. PB Health can help patients understand their symptoms, explore appropriate care options and connect with the right healthcare professionals when needed.

Conclusion

Chronic sinusitis is more than a stuffy nose that refuses to go away. Persistent inflammation can affect breathing, sleep, smell and everyday comfort. Treatment may include saline rinses, nasal corticosteroids, allergy management and, for selected patients, biologic medicines or surgery.

If you have chronic nasal congestion, facial pressure, postnasal drip or reduced sense of smell lasting 12 weeks or more, speak with a healthcare professional for an appropriate evaluation. Finding the underlying cause can help guide the right treatment.