Chronic sinusitis

What chronic sinusitis feels like

A blocked nose, drainage down the throat or from the nose, reduced smell and facial pressure can overlap. Some people feel congested every day; others notice flares on top of their usual symptoms. Poor sleep and the effort of managing symptoms can become as bothersome as the drainage itself.

Those symptoms alone do not establish the diagnosis. Allergies, nonallergic rhinitis, repeated colds and headache disorders can feel similar. Distinct infections with clear periods of recovery are considered separately as recurrent acute sinusitis.

Putting the symptoms and findings together

Dr. Fewins starts with the history and nasal examination. Endoscopy can show inflammation, drainage or polyps. CT is useful when the pattern or extent of disease needs clarification, and when surgery is being considered.

A small cyst or a mild change in the lining is not automatically the cause of persistent symptoms. Dr. Fewins reviews the images with the clinical picture and compares his assessment with the radiologist’s report. If the evidence points elsewhere, the next step changes accordingly.

What happens during an evaluation.

Treatment usually starts with the lining

Saline irrigation and topical nasal corticosteroids are common foundations of care. The medication, delivery method and duration depend on the pattern of disease and your response. Allergy treatment is added when allergy contributes. Antibiotics have a role in selected bacterial infections; they are not an automatic treatment for every chronic flare.

Review how you use sprays or rinses, not only which products you have tried. Technique and consistency can matter. Use distilled, sterile, or previously boiled and cooled water for nasal irrigation. A treatment plan should include a point to reassess rather than repeating the same prescription indefinitely.

When nasal polyps are part of the problem

Nasal polyps are growths of inflamed lining that can obstruct breathing, interfere with sinus drainage and reduce smell. Treatment may involve topical medication, endoscopic surgery or a biologic, depending on the findings and previous response.

Dr. Fewins treats polyp disease with a plan for both current symptoms and longer-term control. Explore nasal polyp evaluation, surgery and medication options.

When an operation becomes useful

Surgery is considered when the expected improvement in quality of life exceeds what nonsurgical care alone is likely to provide. The pattern on examination and CT helps determine the extent of treatment. Limited disease may sometimes be treated with balloon dilation; polyps or more extensive disease may need endoscopic surgery.

Your goals matter. Fewer flare-ups, improved nasal breathing, better sleep or less drainage are concrete things to discuss. The plan should say what is likely to improve, what remains uncertain, and what care continues afterward.

A plan that can adapt

Chronic sinus disease reflects anatomy, environment and inflammation. Treatment can improve daily life without controlling every one of those factors. Dr. Fewins sets expectations early, follows the response and adjusts the plan as needed.

If symptoms return, that is a reason to reassess. It does not automatically mean another antibiotic or another operation.

Common questions