Chronic Sinusitis: Symptoms, Causes and Treatments That Work When It Won't Go Away
Written by Naurah Gaspard, DNP, FNP-C, FNP-BC · Medically reviewed by Cherlie Joseph, MSN, FNP-BC · Updated November 2026
Chronic sinusitis (chronic rhinosinusitis) is ongoing inflammation of the sinuses that lasts 12 weeks or longer, even with treatment. It is usually driven by inflammation, not a lingering infection, so repeated antibiotics rarely fix it. Daily saline rinses and a nasal steroid spray are the foundation of treatment, with biologic medicines or surgery for people who need more.
In this guide
What counts as chronic sinusitis
Providers diagnose chronic rhinosinusitis when you have had at least two of these four symptoms for 12 weeks or more:
- A blocked or stuffy nose
- Thick drainage from the front of the nose or down the back of the throat
- Pain, pressure or fullness in the face
- A reduced sense of smell
Many people also notice tiredness, bad breath, ear fullness, a nagging cough or poor sleep. Symptoms usually feel steady and grinding rather than sudden. That's different from recurrent acute sinusitis, where you get several separate sinus infections a year but feel fine in between.
There are two main types. Chronic sinusitis with nasal polyps involves soft, painless growths of swollen tissue inside the nose, which often cause a stronger loss of smell. Chronic sinusitis without nasal polyps is more common and often causes more facial pressure.
Common causes and triggers
There's rarely one single cause. Instead, several factors keep the sinus lining inflamed and drainage blocked:
- Allergies, including Florida's long pollen seasons, dust mites and indoor mold
- Asthma, which often travels with nasal polyps
- Aspirin-exacerbated respiratory disease, a combination of asthma, polyps and reactions to aspirin or NSAIDs
- Structural issues such as a deviated septum
- Smoking or secondhand smoke
- A weakened immune system or, less often, conditions like cystic fibrosis
- Dental infections in the upper teeth, which can spread into the sinus above
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Symptoms alone aren't enough. The 2025 adult sinusitis guideline from the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) strongly recommends confirming chronic sinusitis with objective signs of inflammation. That usually means a nasal endoscopy (a thin camera in the nose, done in an ear, nose and throat office) or a CT scan of the sinuses. This step matters because allergies, migraines and other conditions can mimic sinus symptoms.
A primary care nurse practitioner can review your history, start first-line treatment and refer you to an ear, nose and throat specialist (ENT) or allergist for endoscopy, imaging or allergy testing when needed.
Treatment options, step by step
| Treatment | Role | Notes |
|---|---|---|
| Saline irrigation | First line | High-volume rinses daily; use distilled, sterile or boiled-then-cooled water |
| Nasal steroid spray | First line | Used every day for months, not just during flares |
| Treating allergies or asthma | Supportive | Better control often means fewer sinus symptoms |
| Short course of oral steroids | Selected cases, mainly polyps | Not for long-term use because of side effects |
| Biologic injections | Nasal polyps not controlled by other care | Prescribed by specialists; not routinely used without polyps |
| Endoscopic sinus surgery | When medicines aren't enough | Opens drainage paths; rinses and sprays continue afterward |
Antibiotics: The AAO-HNS guideline advises against routinely prescribing antibiotics for chronic sinusitis unless there is a separate acute bacterial flare. It also recommends against antifungal medicines. Many people with chronic symptoms have been through several antibiotic courses without lasting relief, because the problem is inflammation rather than infection.
Biologics for nasal polyps: Several injectable medicines that target the immune pathways behind polyps are FDA-approved for chronic sinusitis with nasal polyps, including dupilumab (Dupixent), omalizumab (Xolair), mepolizumab (Nucala) and, since October 2025, tezepelumab (Tezspire). They are typically prescribed and managed by an ENT or allergist. Costs and insurance coverage vary, so check with your plan and the manufacturer's site.
Living with it day to day
- Be consistent. Rinses and steroid sprays work best as a daily habit. Stopping when you feel good often leads to a flare.
- Use proper spray technique. Tilt your head slightly down and aim toward the outer side of each nostril to reduce nosebleeds.
- Control your home environment. Run AC or a dehumidifier to limit mold, and wash bedding weekly in hot water if dust mites are a trigger.
- Quit smoking and avoid secondhand smoke.
- Keep track of symptoms, flares and what helps, so your provider can see patterns.
Get in-person care or call 911 if you have:
- Swelling, redness or pain around the eye, or double vision
- A severe headache, stiff neck or confusion
- Swelling of the forehead
- Symptoms on only one side with bloody drainage or numbness of the face (see an ENT promptly)
Frequently asked questions
Can chronic sinusitis be cured?
For many people it is a long-term condition that can be well controlled rather than cured. Daily rinses and steroid sprays, treating allergies, and in some cases surgery or biologics can greatly reduce symptoms.
Why do antibiotics not work for my chronic sinusitis?
Chronic sinusitis is mainly an inflammatory condition. Antibiotics only help during a true bacterial flare, which is why guidelines advise against using them routinely.
When should I see an ENT for chronic sinusitis?
Consider a specialist if symptoms last beyond 12 weeks despite daily rinses and steroid sprays, if you have nasal polyps or a reduced sense of smell, or if you have several sinus infections a year.
Sources
- AAO-HNS: Clinical Practice Guideline: Adult Sinusitis Update (2025) summary
- American Family Physician: Chronic Rhinosinusitis
- Amgen: FDA Approves Tezspire for Chronic Rhinosinusitis With Nasal Polyps (October 2025)
Keep reading
- How long does a sinus infection last?
- Sinus pressure relief: 9 ways to feel better
- Amoxicillin for sinus infection
- Browse all conditions and treatments A to Z
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Naurah Gaspard, DNP, FNP-C, FNP-BC
Board-certified family nurse practitioner licensed in Florida, New Mexico, Oregon and Washington, caring for adults online at OurTopClinic. Meet our providers.
This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.
