Chronic Sinusitis Treatment: When to Consider Sinus Surgery

In-Office Procedures

January 30, 2026

Chronic Sinusitis Treatment: When to Consider Sinus Surgery

49 minutes

Chronic Sinusitis Treatment: When to Consider Sinus Surgery

Why “Chronic Sinusitis Treatment” Sometimes Includes Surgery

Chronic sinusitis is ongoing inflammation of the sinus and nasal lining that lasts 12 weeks or longer, often causing recurring or persistent symptoms even when you’re trying to manage them. Many people improve with a consistent, non-surgical plan—such as nasal rinses, steroid sprays, and treating triggers—but some don’t. In those cases, chronic sinusitis treatment may include a discussion about sinus surgery, especially when physical blockage prevents normal drainage. (Source: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667)

A simple way to picture it: if your sinuses are like rooms that need airflow and a working “drain,” medication can calm swelling, but it can’t always fix a structural bottleneck. When mucus can’t move out well, symptoms often keep looping—congestion, pressure, drainage, then another flare.

This guide explains:

- Symptoms and patterns that suggest chronic sinusitis (not just a temporary cold)

- Why some causes respond to medication while others may need a procedural fix

- Signs it may be time to discuss surgery

- How ENT specialists evaluate surgical candidacy (endoscopy + CT)

- Common procedure types and what recovery often involves

- FAQs patients ask when deciding what to do next

If you’d like background on the condition itself, you can also visit our Chronic Sinusitis page (https://sleepandsinuscenters.com/chronic-sinusitis).

When medication can’t overcome a physical blockage, adding a procedure may be part of a comprehensive plan.

Chronic Sinusitis Symptoms: When It’s More Than a “Stuffy Nose”

Common symptoms

Chronic sinusitis can show up differently from person to person, but common symptoms include:

- Nasal blockage/congestion

- Thick nasal drainage or postnasal drip

- Facial pressure or pain

- Reduced sense of smell or taste

- Fatigue, cough, or bad breath

(Source: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667)

Many patients describe it as more than “just being stuffed up.” For example, you might breathe fine for a day or two, then wake up congested again with pressure around the cheeks or between the eyes. Or you may notice that your sense of smell is “muted” for weeks—especially during flare-ups—despite using over-the-counter products.

For a deeper overview, see our page on symptoms of sinus problems (https://sleepandsinuscenters.com/symptoms-of-sinus-problems).

Red-flag patterns that suggest chronic sinusitis may be persistent

A few patterns can suggest that inflammation and drainage problems are becoming chronic rather than temporary:

- Symptoms continue despite weeks of consistent treatment routines

- Symptoms improve briefly but keep returning (frequent flare-ups)

- Congestion contributes to sleep disruption and persistent daytime fatigue

(Source: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667)

A practical self-check: if you’ve been treating what feels like “the same cold” for months—or if you keep bouncing between partial relief and relapse—this is often the point where an ENT evaluation starts to make sense.

If symptoms last beyond 12 weeks or keep recurring, it’s more than a cold and may warrant ENT evaluation.

What Causes Chronic Sinusitis? (And Why Some Causes Need a Surgical Fix)

Inflammation vs. drainage sink analogy showing small flow and partially plugged drain

Inflammation vs. blockage: the big idea

A helpful way to think about chronic sinusitis is inflammation + drainage. Long-term inflammation can narrow the pathways where sinuses drain. When drainage is restricted, mucus can build up, creating more pressure and making infections or flare-ups more likely.

An analogy many clinicians use is a kitchen sink: reducing swelling is like turning down the faucet, but if the drain is clogged or too narrow, water still backs up. Chronic sinusitis often improves most when both sides of the equation are addressed—calming inflammation and restoring drainage.

Common contributors

Chronic sinus inflammation may be influenced by:

- Allergies and ongoing nasal lining irritation

- Recurrent infections

- Irritant exposure (smoke, pollution, strong fragrances)

- Immune-related issues in select cases

(Source: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667)

Because allergies can mimic or worsen sinus symptoms, an underlying allergy component is often part of the conversation. Some people notice their “sinus” symptoms spike during pollen seasons, after dust exposure, or around pets—clues that treating triggers may be just as important as treating the sinuses themselves. Learn more about allergy testing and how it can support a complete care plan (https://sleepandsinuscenters.com/allergy-testing).

Structural/anatomical causes

Sometimes, anatomy is a major reason symptoms linger—because even good medications can’t fully overcome a physical bottleneck. Common structural contributors include:

- Deviated septum

- Enlarged turbinates

- Nasal polyps

- Naturally narrow sinus openings

(Source: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667)

When structure is a major driver, patients often say things like: “Rinses help for an hour, then it’s blocked again,” or “I can only breathe through one side.” These symptoms can have multiple causes, but they commonly relate to impaired airflow or drainage. If a deviated septum is part of the picture, our deviated septum relief resource explains typical symptoms and treatment options (https://sleepandsinuscenters.com/deviated-septum-relief).

Most people do best with a plan that calms inflammation and restores drainage, tailored to the specific drivers of their symptoms.

First-Line Chronic Sinusitis Treatment: What “Adequate Medical Therapy” Usually Means

Adequate medical therapy kit: saline, steroid spray, pill bottle, daily calendar

Before surgery is considered, most care pathways emphasize a structured, consistent medical plan. In many cases, chronic sinusitis treatment starts with reducing inflammation, improving mucus clearance, and addressing triggers.

One important distinction: “adequate therapy” usually means daily, consistent use as prescribed by your healthcare provider or ENT—not just using a spray for a few days when symptoms are at their worst. That consistency helps an ENT determine whether symptoms are truly resistant to medical therapy or whether the plan needs to be optimized.

Typical non-surgical treatment plan

A non-surgical plan commonly includes:

- Saline nasal irrigation (used consistently, often daily)

- Intranasal steroid sprays

- Short courses of oral steroids for selected patients (when appropriate)

- Antibiotics only when bacterial infection is suspected (not every case requires them)

- Trigger management, such as allergy control, reflux management, and irritant avoidance

Sources: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667, https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis

For an overview of options we commonly discuss with patients, visit Chronic Sinusitis Treatment (https://sleepandsinuscenters.com/chronic-sinusitis-treatment).

Why medical treatment sometimes doesn’t work

Even with a solid routine, symptoms can persist when:

- Obstruction traps mucus, such as from polyps or septal deviation

- Inflammation remains high despite sprays/rinses

- Related conditions (like allergies or asthma) aren’t addressed alongside sinus care

A common scenario is “partial responders”—people who do some things right, get some relief, but never feel fully clear. That’s often where imaging and endoscopy are helpful, because they can show whether lingering symptoms match a drainage blockage that medication can’t fully overcome.

Start with consistent, supervised medical therapy; if symptoms persist, objective testing can clarify next steps.

When to Consider Sinus Surgery for Chronic Sinusitis

Before/After drainage cutaway showing improved airflow post-surgery

Surgery isn’t the first step for most people. However, it can be worth discussing when symptoms continue and testing suggests blockage that prevents normal drainage—especially if quality of life is taking a real hit. The goal of surgery is typically to improve ventilation and drainage so ongoing medical care can work better.

Many ENTs frame it this way: surgery is rarely a “replacement” for medical therapy. Instead, it can be a way to make daily treatments—like rinses and sprays—more effective by improving access to the sinus pathways. Sources: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667, https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis

5 key signs surgery may be worth discussing

1) Symptoms persist despite adequate medical treatment

Ongoing congestion, drainage, facial pressure, or smell changes—despite a consistent plan—may prompt a surgical conversation.

Sources: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667, https://www.gregdavismd.com/blog/when-to-consider-surgery-for-chronic-sinusitis

2) Anatomical blockage prevents sinus drainage

Significant polyps, a deviated septum, or narrow sinus openings can limit drainage and keep symptoms cycling.

Sources: https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis, https://www.hillsentinstitute.com/sinusitis-and-surgical-intervention-when-is-it-time-to-consider-surgery

3) Recurrent sinus infections that don’t resolve or keep returning

If infections rebound soon after treatment or don’t respond as expected, it may signal an underlying drainage problem.

Sources: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667, https://www.hillsentinstitute.com/sinusitis-and-surgical-intervention-when-is-it-time-to-consider-surgery

4) Frequent sinus headaches/facial pain linked to blockage

Facial pressure that correlates with congestion (often worse with bending forward) can be associated with impaired sinus airflow and drainage.

Sources: https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis, https://www.gregdavismd.com/blog/when-to-consider-surgery-for-chronic-sinusitis

5) Quality of life is significantly affected

Poor sleep, missed work/school, fatigue, and reduced ability to exercise can be a major reason people explore procedural options as part of chronic sinusitis treatment.

If you’re unsure where you fall, you can start with our sinus symptom quiz (https://sleepandsinuscenters.com/sinus-symptom-quiz) and then decide whether an ENT evaluation makes sense.

Situations where surgery may be more urgent

Severe complications from sinus disease are uncommon, but urgent evaluation is often recommended when symptoms suggest spread beyond the sinuses—such as eye swelling/vision changes, high fever with severe illness, or neurological symptoms. (Source: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667)

Surgery is considered when symptoms persist and testing shows blockage; it’s a complement to—not a replacement for—ongoing medical care.

How ENTs Decide If You’re a Surgical Candidate

ENT evaluation tools: sinus CT on tablet, endoscope wand, checklist card

The evaluation process

An ENT evaluation typically focuses on matching symptoms with objective findings and confirming what treatments have already been tried. Common steps include:

- A detailed symptom history and “what have you used consistently, as prescribed?” checklist

- Nasal endoscopy (an in-office look inside the nose/sinus drainage areas)

- CT scan of the sinuses to confirm inflammation or blockage and map anatomy

Patients often find this part reassuring because it turns a vague, frustrating pattern (“I’m always congested”) into clearer answers (“this area is blocked,” or “there’s swelling but no major obstruction”). That clarity helps you and your clinician weigh whether more medical therapy is likely to help—or whether anatomy is limiting progress.

What a sinus CT can reveal

CT imaging can help show:

- Blocked sinus openings, polyps, and thickened sinus lining

- A deviated septum or narrow anatomy that supports a surgery discussion

Objective findings on endoscopy and CT—combined with your symptom history—guide whether surgery is likely to help.

Types of Sinus Surgery (Patient-Friendly Overview)

Functional Endoscopic Sinus Surgery (FESS)

FESS is designed to open natural drainage pathways and remove obstructive tissue (such as polyps) when needed. It’s often paired with continued medical therapy afterward to keep inflammation controlled.

If you’ve heard someone say, “They cleaned out my sinuses,” they’re often describing this general approach—creating more space for airflow and drainage while preserving normal anatomy as much as possible.

Balloon Sinuplasty

Balloon sinuplasty uses a small balloon to gently widen sinus openings in select patients. It typically involves less tissue removal and may be appropriate for specific sinus patterns and anatomy.

You can read more on our Balloon Sinuplasty page (https://sleepandsinuscenters.com/balloon-sinuplasty).

Surgery for contributing anatomy

When airflow and access are limited, sinus procedures may be combined with:

- Septoplasty (to address a deviated septum)

- Turbinate reduction (to reduce internal nasal blockage)

The “right” procedure depends on your anatomy and disease pattern—your ENT will match the approach to your findings.

Benefits, Risks, and Realistic Expectations

Potential benefits

For appropriately selected patients, surgery may lead to:

- Fewer infections and flare-ups

- Improved drainage and nasal breathing

- Better delivery of ongoing treatments (rinses/sprays may reach deeper)

- Improved sleep and daily quality of life

Sources: https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis, https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667

A realistic “win” many patients report is simply feeling less blocked and less pressured day to day—so they can sleep, exercise, and focus without constantly managing symptoms.

Possible risks/downsides

As with any procedure, there can be downsides such as bleeding, infection, scarring, and (in some cases) the need for revision surgery. Also, surgery is not always a permanent “end point” because inflammation can still require long-term management. Sources: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667, https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis

What surgery can and can’t do

- Can: improve airflow, drainage, and access for topical therapies

- Can’t: eliminate allergies or guarantee inflammation won’t return—maintenance care is often still part of chronic sinusitis treatment

Set realistic goals: surgery can improve airflow and access for therapies, but maintenance care remains important.

Recovery and Aftercare: How to Get the Best Result

What recovery commonly looks like

Recovery varies by procedure and individual, but many patients experience:

- Temporary congestion and crusting early on

- Follow-up visits to monitor healing and clear debris if needed

- Short-term restrictions (activity limits, nose blowing guidance, etc.), based on the surgeon’s plan

It can help to plan ahead for a brief “recovery window” where you may not feel instantly clear. Early on, patients often feel stuffy before they feel better—more like healing from inflammation than flipping a switch.

Post-surgery chronic sinusitis treatment plan

After surgery, ongoing care often includes:

- Saline irrigation (often even more important after surgery)

- Nasal steroid sprays and/or steroid rinses as directed

- Trigger control (allergies, irritants), plus hydration and sleep support

Expect temporary congestion during healing, and follow your post-op plan closely to protect your results.

Lifestyle Tips That Support Chronic Sinusitis Treatment (With or Without Surgery)

Daily habits can help reduce flare-ups and make your medical plan more effective:

- Use saline rinses consistently

- Consider humidification if dry air worsens symptoms

- Avoid smoke and strong irritants/fragrances

- Reduce allergy exposure (filters, cleaning, and keeping windows closed during high pollen days)

Because nasal blockage often feels worse at night:

- Some people find that slight head elevation helps with nighttime congestion

- If nasal obstruction disrupts sleep regularly, an ENT evaluation can help clarify whether inflammation, anatomy, or both are contributing

Small, consistent habits can lower baseline inflammation and support both medical and surgical care.

FAQs: Chronic Sinusitis Surgery Questions Patients Ask

How do I know if I’ve tried enough medical treatment?

In general, “enough” tends to mean: a consistent daily regimen (not just occasional use), appropriate prescriptions when indicated, trigger management (like allergies/irritants), and enough time to judge response. An ENT visit can help organize what’s been tried and what’s missing. (Source: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667)

Will sinus surgery cure chronic sinusitis?

Many people improve significantly, but chronic sinusitis often has an inflammatory component. Surgery can improve drainage and make treatments work better, but ongoing maintenance may still be needed. Sources: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667, https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis

Is balloon sinuplasty the same as “sinus surgery”?

It’s considered a type of sinus procedure, but it’s different from endoscopic sinus surgery because it typically widens openings with less tissue removal. Candidacy depends on anatomy and disease pattern. (Source: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667)

Do I need a CT scan before surgery?

Often, yes. A CT scan helps confirm where inflammation or blockage is located and helps plan the safest approach. Sources: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667, https://nyulangone.org/conditions/chronic-sinusitis/treatments/surgical-treatment-for-chronic-sinusitis

When should I see an ENT instead of trying more OTC meds?

Many people consider an ENT evaluation when symptoms last more than 12 weeks, infections keep returning, congestion is severe, or sleep and daily function are consistently affected. Sources: https://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/diagnosis-treatment/drc-20351667, https://www.hillsentinstitute.com/sinusitis-and-surgical-intervention-when-is-it-time-to-consider-surgery, https://www.gregdavismd.com/blog/when-to-consider-surgery-for-chronic-sinusitis

If you still have questions after trying consistent care, an ENT can personalize these general guidelines to your situation.

Conclusion + Next Step

Most people with chronic sinus symptoms improve with a structured, non-surgical plan. But surgery becomes a reasonable option when symptoms persist despite adequate therapy, anatomy blocks drainage, infections recur, or quality of life suffers. A step-by-step evaluation—often including nasal endoscopy and a CT scan—can help clarify whether a procedural approach should be part of your chronic sinusitis treatment plan.

If you’re exploring next steps, Sleep and Sinus Centers of Georgia can help guide a structured evaluation and review both medical and surgical options based on your specific findings. To book an appointment, visit: https://www.sleepandsinuscenters.com/

A stepwise evaluation can clarify whether surgery should be part of your plan—and how to get the best results from it.

Medical disclaimer: This article is for educational purposes only and is not medical advice. Please consult a qualified healthcare provider for diagnosis and treatment. If you have severe symptoms (such as vision changes, significant eye swelling, high fever, or neurological symptoms), seek urgent medical care immediately.

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