Chronic Sinusitis: How Allergies, Infections, and Surgery Affect Your Breathing

For millions of people, breathing through the nose isn’t just inconvenient-it’s impossible. If you’ve had a stuffy nose, facial pressure, or loss of smell that won’t go away 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, this condition lingers. And it’s not caused by one simple thing. It’s a mix of inflammation, allergies, structural issues, and sometimes, stubborn infections.

What Exactly Is Chronic Sinusitis?

Chronic sinusitis, also called chronic rhinosinusitis, means your sinuses-the hollow spaces in your skull around your nose, eyes, and forehead-are swollen and blocked for 12 weeks or longer, even with treatment. It’s not just congestion. You might feel heavy pressure in your face, have thick nasal discharge, or struggle to smell your food. Some people lose their sense of smell entirely.

The American Academy of Otolaryngology defines it by symptoms, not just imaging. You need at least two of these for 12+ weeks: nasal blockage, thick nasal discharge, facial pain or pressure, or reduced smell. A doctor will confirm it with a nasal endoscopy or a CT scan showing inflamed tissue or fluid buildup.

It’s more common than you think. About 9% of people worldwide deal with it every year. In the U.S., roughly 31 million people are diagnosed annually. It’s one of the top reasons people visit their primary care doctor.

Why Does It Happen? Allergies, Infections, and More

There’s no single cause. Chronic sinusitis is usually the result of multiple factors working together.

Allergies are a major trigger. If you have hay fever, dust mite allergies, or pet dander sensitivity, your nasal lining gets inflamed and swells up. This blocks the tiny openings that let mucus drain. People with allergies are 2.5 times more likely to develop chronic sinusitis. And if you also have asthma? Your risk jumps to 3-4 times higher. That’s because the same inflammatory pathways affect your lungs and sinuses.

Nasal polyps are soft, noncancerous growths inside the nose or sinuses. They’re found in 25-30% of chronic sinusitis cases. These polyps don’t hurt, but they physically block airflow and mucus drainage. Once they form, they tend to come back unless you keep treating the inflammation behind them.

Structural problems like a deviated septum, narrow sinus openings, or enlarged turbinates can trap mucus and create a breeding ground for irritation. These aren’t always obvious without imaging.

And while people often think bacteria are the main culprit, that’s not usually true in chronic cases. Only about 30% of chronic sinusitis cases involve active bacterial infection. The usual suspects-Streptococcus pneumoniae, Haemophilus influenzae-are more common in short-term infections. In chronic cases, it’s the body’s own inflammation that’s the problem. That’s why antibiotics often don’t help.

Environmental irritants like cigarette smoke, pollution, or dry air make things worse. Smoking increases your risk by 35%. Dry climates without humidity can dry out nasal mucus, making it thicker and harder to clear.

Medical Treatment: The First Line of Defense

Before you even think about surgery, doctors start with medical management. And it works-for most people.

Nasal saline irrigation is the foundation. Rinsing your nose with salt water clears out mucus, allergens, and irritants. It’s cheap, safe, and backed by strong evidence. People who do it daily see better results than those who skip it.

Intranasal corticosteroid sprays are next. These are not the same as oral steroids. They’re targeted, low-dose anti-inflammatory sprays that reduce swelling right where it’s happening. Brands like Flonase (fluticasone), Nasonex (mometasone), and Rhinocort (budesonide) are first-choice treatments. Studies show 60-70% of patients improve within 4-8 weeks of consistent use. But here’s the catch: you have to use them every day. Only about half of people stick with them because the relief isn’t instant.

Allergy medications like loratadine or cetirizine help if allergies are driving your symptoms. They won’t fix structural issues, but they can reduce swelling and mucus production. For people with allergic fungal sinusitis, avoiding mold exposure and using antifungal rinses under a doctor’s supervision can help.

Biologics are a game-changer for severe cases with nasal polyps. Dupilumab (Dupixent), approved by the FDA in 2019, is an injectable drug that blocks specific inflammatory signals. In clinical trials, it reduced polyp size by 50-60% and improved breathing and smell in 30-40% of patients. Omalizumab (Xolair) and mepolizumab (Nucala) are also used off-label for resistant cases. These aren’t cures, but they can dramatically cut down on flare-ups and the need for repeated surgeries.

Surgery: When Medical Treatment Isn’t Enough

If you’ve tried 12 weeks of daily nasal sprays, saline rinses, and allergy control-and you’re still struggling-surgery may be the next step. It’s not a last resort. It’s a targeted fix for physical blockages.

Functional Endoscopic Sinus Surgery (FESS) is the gold standard. An ENT surgeon uses a thin camera (endoscope) to look inside your nose and remove blocked tissue, open narrowed passages, and clear out infected areas. It’s done through the nostrils-no external cuts. Recovery takes about a week. Success rates? 75-90% of patients report long-term improvement in breathing and smell.

Balloon sinuplasty is a less invasive option. A tiny balloon is inflated inside the blocked sinus to widen the opening. It’s quicker, with recovery in 3-5 days, and less bleeding. But it’s not for everyone. It works best for people with isolated blockages, not widespread polyps or complex anatomy. Long-term results aren’t as strong as FESS.

Polypectomy is the removal of nasal polyps. It’s often done during FESS. The procedure gives quick relief-85% of patients feel better right away. But polyps come back in 40-50% of cases within 18 months if inflammation isn’t controlled afterward. That’s why surgery alone isn’t enough. You still need steroid sprays and regular follow-ups.

Septoplasty fixes a crooked septum. If your nasal passage is twisted, it can block drainage and worsen sinusitis. Combining septoplasty with FESS improves outcomes. About 65-75% of patients see major improvement after this combo.

What You Can Do at Home

Surgery and medications help, but daily habits make a big difference.

Use a humidifier, especially in dry climates or during winter. Moist air keeps mucus thin and flowing. One study found 40% of patients in dry regions improved just by adding humidity.

Avoid smoke, strong perfumes, and air pollution. These irritate your nasal lining and trigger inflammation.

Stay hydrated. Drinking enough water keeps mucus from thickening.

If you have Samter’s triad (asthma, nasal polyps, and aspirin sensitivity), aspirin desensitization under medical supervision can reduce polyp recurrence by 70-80%.

And don’t ignore your allergies. Keep your home clean, use HEPA filters, and consider allergy testing if you haven’t had it done.

What Happens If You Don’t Treat It?

Most people manage chronic sinusitis with ongoing care. But if left untreated, it can lead to complications.

In rare cases (less than 0.5%), the infection can spread to nearby areas: the eyes, bones, or even the brain. That’s why persistent symptoms-especially fever, vision changes, or severe headaches-need immediate attention.

More commonly, it just wears you down. Sleep suffers. Concentration drops. You feel tired all the time. Studies show 65% of patients say it interferes with daily life, work, or social activities.

The good news? With the right plan, most people get their quality of life back.

What’s Next? The Future of Treatment

The understanding of chronic sinusitis has changed dramatically. It’s no longer seen as an infection problem. It’s an inflammation problem.

Biologics are expanding. By 2027, experts predict these drugs will treat 25-30% of severe cases, cutting down on surgeries by 15-20%.

Researchers are also looking at the sinus microbiome-the bacteria that live in your nose. Early studies suggest certain probiotics might help reduce inflammation. While not ready for prime time, it’s a promising area.

Multidisciplinary care is becoming the norm. The best outcomes come when allergists, ENTs, and immunologists work together. One Cleveland Clinic study showed 35-45% better results when patients had coordinated care instead of seeing just one specialist.

When to See a Doctor

See a doctor if:

• Your symptoms last more than 12 weeks
• You’ve tried OTC decongestants and antihistamines with no improvement
• You have facial pain, swelling around the eyes, or vision changes
• Your sense of smell is gone or significantly reduced
• You have asthma or allergies and your sinus symptoms keep coming back

Don’t wait until you’re miserable. Early diagnosis and consistent treatment make all the difference.