In United States, chronic Sinusitis is managed by ents. Chronic sinusitis, now classified as chronic rhinosinusitis (CRS), is persistent inflammation of the nasal lining and paranasal sinuses lasting longer than 12 weeks despite usual treatment. It affects roughly 11.6% of adults in the United States and 10.9% in Europe per EPOS 2020, making it one of the most common chronic inflammatory diseases of any organ system.
Chronic sinusitis (ICD-10: J32; J32.9 chronic sinusitis unspecified, J32.0-J32.4 by sinus site) is defined by EPOS 2020 and the AAO-HNS guideline as symptomatic inflammation of the paranasal sinuses and nasal cavity persisting for 12 weeks or longer, with objective evidence of inflammation on nasal endoscopy or CT imaging. The clinical syndrome requires at least two of four cardinal symptoms — nasal obstruction or congestion, anterior or posterior mucopurulent discharge, facial pain or pressure, and reduction or loss of smell — plus endoscopic or radiologic confirmation of mucosal disease. CRS is split into two main phenotypes that drive treatment selection: chronic rhinosinusitis with nasal polyps (CRSwNP), which is typically a type-2 eosinophilic inflammation overlapping with asthma and aspirin-exacerbated respiratory disease (AERD), and chronic rhinosinusitis without nasal polyps (CRSsNP), which is more heterogeneous and often non-type-2. Allergic fungal rhinosinusitis (AFRS) is a distinct severe phenotype driven by a hypersensitivity reaction to fungal antigens in the sinus mucus, presenting with thick eosinophilic mucin and bone remodeling on CT.
The key symptoms of Chronic Sinusitis are: Persistent nasal blockage or congestion present most days for at least 12 weeks, often worse on lying down or in the morning, and not relieved fully by decongestants., Thick nasal discharge that may be clear, yellow, or green, plus postnasal drip producing throat clearing, chronic cough, or a bad taste in the mouth., Facial pressure, fullness, or dull pain over the cheeks, forehead, between the eyes, or around the upper teeth, typically worse on bending forward or with air-pressure changes., Reduced or completely lost sense of smell (hyposmia or anosmia), which is the most predictive symptom of nasal polyposis and present in 60-80% of CRSwNP patients., Diminished sense of taste, since most flavor perception depends on intact olfaction; food can feel bland or one-dimensional., Chronic cough, particularly at night, driven by postnasal drip and upper-airway inflammation, often misdiagnosed as bronchitis or asthma., Ear fullness, popping, or muffled hearing due to eustachian tube dysfunction from contiguous mucosal swelling..
Diagnosis is clinical, confirmed by objective evidence of inflammation. Both the EPOS 2020 and AAO-HNS 2015/2023 adult chronic rhinosinusitis guidelines require symptoms lasting at least 12 weeks (at least two of nasal obstruction, anterior or posterior discharge, facial pressure, or smell loss) plus either endoscopic findings — purulent mucus, polyps, edema in the middle meatus — or CT findings of mucosal disease. Symptom history alone is insufficient because the symptom set overlaps with allergic rhinitis, migraine, and dental disease. The first office step is anterior rhinoscopy followed by nasal endoscopy with a 4 mm rigid scope, which directly visualizes polyps, purulence, and anatomic narrowing. A non-contrast CT of the paranasal sinuses (low-dose protocol) is the imaging study of choice and is scored using the Lund-Mackay system (0-24); a score of 4 or above is considered abnormal. CT is best performed after 4-6 weeks of intranasal steroid plus saline to avoid imaging transient post-viral changes. Allergy testing (skin prick or specific IgE) is recommended when atopy is suspected. Total serum IgE, blood eosinophil count, and where indicated specific IgE to Aspergillus help phenotype CRSwNP and identify AFRS. Sweat chloride or CFTR testing is reserved for early-onset or pediatric pansinusitis. Microbiology is rarely useful from a routine nasal swab, but endoscopically guided cultures help in refractory disease and immunocompromised patients. Sinonasal malignancy, granulomatosis with polyangiitis, and invasive fungal disease must be excluded in unilateral, atypical, or rapidly progressive presentations — biopsy any suspicious lesion. Patient-reported outcome measures (SNOT-22, with a clinically important difference of 8.9 points) anchor follow-up.
With consistent medical therapy, most CRSsNP patients achieve durable symptom control on saline plus intranasal steroids alone, with surgery needed in roughly 5-15% over a decade. CRSwNP is a chronic relapsing disease — polyps recur in 40-60% of patients within 18 months of FESS without ongoing medical control, rising above 80% in AERD. Modern biologics shift these numbers substantially: in SINUS-52, two years of dupilumab kept 75% of patients out of repeat surgery, and patients on continuous topical steroid plus biologic therapy can often avoid revision indefinitely. Smell typically improves over 3-12 months with effective treatment; severe long-standing anosmia may not fully recover even after polyp removal. Quality of life on validated measures returns close to general-population norms in well-controlled patients, but lapses in maintenance therapy reliably trigger relapse. Mortality is not directly increased by CRS itself, but uncontrolled severe disease worsens asthma control, sleep, and productivity, with measurable economic impact (direct US costs estimated at USD 13 billion per year, EPOS 2020).
An otolaryngologist should be involved when symptoms persist beyond 12 weeks despite saline plus intranasal steroids, when nasal polyps are visible or smell loss is severe, when the disease is unilateral or atypical, when imaging shows complications, when oral steroid bursts are needed more than twice yearly, or when biologic therapy or surgery is being considered. An allergist or immunologist should be involved when atopy, AERD, biologic candidacy, or immunodeficiency is suspected.
Find specialists →Saline plus intranasal steroid yields measurable benefit by 4-8 weeks. Oral steroid bursts shrink polyps within 3-7 days but benefit fades over 3-6 months. Biologics typically show smell and congestion improvement at 4-12 weeks, with maximum benefit by 24 weeks. After FESS, nasal crusting and mild bleeding last 1-2 weeks, normal activity resumes at 1-2 weeks, and full mucosal healing takes 2-3 months — symptom improvement is usually obvious by 4-6 weeks. Long-term maintenance with saline plus intranasal steroid is required indefinitely; stopping after recovery from any treatment phase consistently leads to relapse within months.
Moderate aerobic exercise improves nasal congestion via sympathetic-mediated vasoconstriction and supports asthma and weight control. Build to 150 minutes per week of activity such as walking, swimming, or cycling. Avoid heavy outdoor exertion on high-pollen or high-pollution days for atopic patients. Wear a mask in cold dry air if exercise triggers congestion. Resume light activity within a week after FESS; avoid heavy lifting, nose blowing, and contact sports for 2-3 weeks post-operation.
Look for an ENT with subspecialty interest in rhinology — fellowship training in rhinology and skull-base surgery is ideal for complex disease. Confirm access to in-office nasal endoscopy, low-dose CT, and biologic infusion. For CRSwNP and asthma, choose a center with combined ENT and pulmonology or allergy clinics. Ask the surgeon's annual FESS volume and revision rate — high-volume rhinologists (over 50 cases annually) consistently report better outcomes.
Medically reviewed by AIHealz Medical Editorial Board · May 12, 2026
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