Sinusitis is called chronic when symptoms last 12 weeks or longer, and recurrent when you get four or more separate attacks a year. In most chronic cases the problem is long-running inflammation rather than a long infection, often linked to nasal polyps, allergies, asthma or the shape of the inside of your nose, so the fix is daily long-term treatment and, if that fails, an ENT specialist’s help rather than course after course of antibiotics.
If you have a sinus infection that started in the last few weeks, our guide on how to treat sinusitis at home covers acute sinusitis. This article is for people whose sinus trouble won’t go away or keeps coming back.
Chronic or recurrent: which do you have?
The American Academy of Otolaryngology’s patient site ENThealth and Cleveland Clinic use these definitions:
| Pattern | What it means | What usually drives it |
|---|---|---|
| Chronic sinusitis | Symptoms that last at least 12 weeks, without clearing in between | Ongoing inflammation of the sinus lining, often with polyps, allergies or asthma |
| Recurrent acute sinusitis | Four or more separate sinus infections in one year, with no symptoms between them | Risk factors include colds, allergies, structural problems such as polyps, smoking and a weak immune system |
ENThealth adds that for a firm diagnosis of chronic sinusitis, an ENT doctor needs to see signs inside the nose (polyps, pus or thick mucus) or confirm it on a CT scan. Symptoms alone aren’t enough.
What chronic sinusitis feels like
The symptoms are the same as acute sinusitis, but lower-grade and longer-lasting:
- a blocked nose that never fully clears
- thick mucus running from the front of the nose or down the back of the throat
- a dull ache or pressure around the cheeks, eyes or forehead
- a reduced sense of smell or taste
- bad breath or a cough
Why it keeps coming back
ENThealth notes that the exact cause of chronic sinusitis isn’t always known, but these are the usual contributors.
Nasal polyps
Polyps are soft, painless swellings of the nasal lining. The NHS lists a blocked or runny nose, mucus down the throat, loss of smell or taste, and snoring as typical signs, and says that unlike a cold, polyps won’t get better unless they’re treated. People with asthma and people who react badly to aspirin are more likely to get them. They’re rare in children.
Allergies and asthma
The CDC lists seasonal allergies as a risk factor for sinus infections, and ENThealth names allergies and asthma among the conditions that keep sinusitis going unless they’re treated too. Cleveland Clinic says a doctor may test for allergies if you have chronic sinusitis, because treating the allergy can calm the sinuses. Our overview of asthma symptoms and precautions covers the chest side.
A deviated septum
The septum is the wall between your nostrils. Cleveland Clinic says about 8 out of 10 people have one that’s slightly off-centre, usually with no symptoms. A badly bent septum, though, can block one side, cause snoring and nosebleeds, and contribute to chronic sinusitis. If loud snoring is part of the picture, see our article on snoring.
Smoke and weak immunity
The CDC lists smoking, second-hand smoke and a weak immune system (or medicines that weaken it) as risk factors.
How an ENT specialist investigates
- Nasal endoscopy: a thin lighted tube passed into the nose in the clinic to look for polyps, pus or a bent septum.
- CT scan of the sinuses: not needed for a simple sinus infection, but useful when symptoms are prolonged or keep coming back, or complications are suspected.
- Allergy tests: to find triggers that may be keeping the inflammation going.
Long-term treatment that works
ENThealth says salt-water nasal irrigation and steroid nasal sprays are the main treatments for chronic sinusitis. They’re meant to be used every day, including on days when your nose feels fine.
- Salt-water rinses: the NHS describes a rinse made with 1 level teaspoon of salt and 1 of bicarbonate of soda in about a pint (568 ml) of boiled water that has cooled. Never use unboiled tap water, and the NHS says this home rinse isn’t suitable for children.
- Steroid nasal sprays or drops: used every day, often for a long time. Your doctor will tell you how long to continue.
- Steroid tablets: sometimes given for severe polyps, usually for up to 2 weeks according to the NHS.
- Allergy treatment: antihistamines or montelukast if allergies are part of the problem, as Cleveland Clinic describes.
- Antibiotics: ENThealth says they may sometimes help, but they don’t fix the underlying inflammation, so repeated courses without a diagnosis aren’t the answer.
- Biologic injections: for nasal polyps that aren’t controlled by other treatment, specialists can prescribe injectable medicines such as dupilumab, which MedlinePlus lists as a treatment for chronic rhinosinusitis with nasal polyps.
Avoid over-the-counter decongestant sprays for long-term use. Cleveland Clinic warns against using them more than three days in a row because the blockage rebounds.
When surgery is an option
ENThealth says surgery is considered when chronic sinusitis can’t be controlled with medicines. The main operations are:
- Endoscopic sinus surgery: uses a thin telescope inside the nose to widen the sinus drainage channels; polyps can be removed at the same time.
- Balloon sinus dilation: a newer option that opens blocked sinus openings with a small balloon.
- Septoplasty: straightens a deviated septum. Cleveland Clinic notes it’s usually delayed in children until the nose stops growing, typically in the mid-teens.
Surgery isn’t always the end of treatment. The NHS says polyps often grow back, usually within a few years, so most people keep using a steroid spray afterwards to slow their return. The NHS also suggests surgery for polyps may be offered if there’s no improvement after about 12 weeks of medicine.
When to see a doctor, and when to call 112
See your doctor, and ask about an ENT referral, if:
- symptoms have lasted 3 months despite treatment, or you keep getting sinus infections (both NHS reasons for referral)
- symptoms are only on one side of your face or nose, which the NHS also lists as a reason to see a specialist
- your sense of smell has changed
- you have trouble breathing through your nose or your symptoms are getting worse
Call 112 or go to an emergency department straight away for:
- swelling or redness around one eye, a bulging eye, pain when moving the eye, or double or blurred vision. A 2023 review in the Indian Journal of Ophthalmology describes orbital cellulitis, often spreading from the sinuses, as an emergency needing hospital admission and IV antibiotics, with a risk of vision loss
- a severe headache with fever, a stiff neck, confusion or drowsiness, which can signal infection spreading inside the skull
Frequently asked questions
Can chronic sinusitis be cured permanently?
Many people get long-term control rather than a one-time cure. Daily rinses and steroid sprays, treating allergies, and sometimes surgery can keep symptoms away, but polyps in particular tend to return, so ongoing care is usual.
Is chronic sinusitis an infection?
Mostly not. ENThealth says it’s usually caused by prolonged inflammation rather than a long-lasting infection, which is why antibiotics alone rarely fix it.
How long can I use a steroid nasal spray?
Steroid sprays are designed for long-term daily use under a doctor’s supervision, unlike decongestant sprays, which shouldn’t be used for more than a few days. Ask your doctor how long to continue.
Will straightening my septum stop sinus infections?
It can help if a badly deviated septum is blocking drainage, but most off-centre septums cause no problems. An ENT exam and sometimes a CT scan show whether it’s the real cause.
Do I need a CT scan?
Not for a simple sinus infection. A CT scan is useful when symptoms keep coming back or last a long time, when complications are suspected, or when surgery is being planned.
This article is for general information and is not a substitute for advice from a doctor. If you have symptoms or a health condition, please consult a qualified healthcare professional.
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