Chronic Rhinosinusitis
A blocked, runny nose with facial pressure or a lost sense of smell for 12 weeks or more. It’s long-term inflammation, not a lingering infection, so antibiotics rarely fix it. Daily rinses and a steroid spray, used properly, are the backbone.
Symptoms (for 12 weeks or more)
- Blocked or congested nose, and/or discharge down the front or back of the throat
- Facial pain or pressure
- Reduced or lost sense of smell, a strong clue to nasal polyps
- Some have nasal polyps (soft, grape-like swellings); others don’t
See a doctor urgently for swelling around the eye, double vision, a severe headache, confusion or a stiff neck. A one-sided blocked nose with bleeding also needs checking.
What helps
Most people improve with steps 1–3 used every day for at least 2–3 months.
- Step 1 · Self-careHigh-volume saltwater rinsesA squeeze bottle or neti pot, once or twice a day, with boiled or distilled water.
- Works
- Reduces symptoms in trials, and helps sprays reach the lining
- Cost
- About $15–25 for a kit
- How long
- Ongoing
- Watch for
- Use boiled-and-cooled or distilled water and clean the bottle.
Feels like drowning the first time. Feels like breathing by day three.
- Step 2 · PharmacySteroid nasal spray every daye.g. mometasone, fluticasone, budesonide. Aim slightly outwards, away from the middle.
- Works
- Improves blockage and shrinks polyps; works best used daily for weeks
- Cost
- About $15–30
- How long
- Ongoing; reassess at 8–12 weeks
- Watch for
- Nosebleeds or dryness; aim away from the middle of the nose.
- Step 3 · GPShort course of prednisolone for nasal polypsShrinks polyps and brings smell back for a while.
- Works
- Helps for weeks to months, not permanently
- Cost
- Low cost
- How long
- 1–3 weeks
- Watch for
- Repeated courses add up: bones, sugar, mood and sleep.
- Step 4 · GPTreat allergies, stop smoking, check for asthmaAntihistamines help only if you have allergies. Asthma often comes with polyps.
- Works
- Better control of the nose often improves asthma too
- Cost
- Varies
- How long
- Ongoing
- Watch for
- Step 5 · SpecialistSinus surgery (endoscopic)Opens the sinus drainage and removes polyps, so rinses and sprays reach inside.
- Works
- Most people improve; polyps can come back, so sprays continue
- Cost
- Medicare rebate; private gap
- How long
- Day surgery, 1–2 weeks recovery
- Watch for
- Bleeding, rare eye or brain-lining injury.
- Step 6 · SpecialistBiologic injections for severe polypse.g. dupilumab, for severe polyps despite surgery and steroids.
- Works
- Large improvements in polyps, blockage and smell in trials
- Cost
- Specialist-prescribed; PBS-subsidised for some
- How long
- Long term
- Watch for
- Eye irritation, injection-site reactions.
Costs are rough Australian prices and vary by pharmacy and provider. PBS co-payment: $25, or $7.70 with a concession card. Results are typical figures from trials, not promises.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Repeated antibiotic coursesChronic rhinosinusitis is mostly inflammation, not infection. Antibiotics help only flare-ups with signs of bacterial infection.
- Decongestant sprays for more than 5 daysOxymetazoline and similar sprays cause rebound blockage (rhinitis medicamentosa).
- Antihistamines without allergiesThey don’t reduce sinus inflammation unless allergy is part of the problem.
Weird but true
- Some people with polyps and asthma react to aspirin and anti-inflammatories with wheeze and a streaming nose. It’s called aspirin-exacerbated respiratory disease (Samter’s triad).
Common questions
What is chronic rhinosinusitis?
Inflammation of the nose and sinuses lasting 12 weeks or more, causing blockage, discharge, facial pressure or reduced smell, with or without nasal polyps.
Do antibiotics cure chronic sinusitis?
Usually not. It’s mainly inflammation, so daily saltwater rinses and a steroid nasal spray are the mainstays. Antibiotics are kept for flare-ups with signs of bacterial infection.
When is sinus surgery needed?
When symptoms persist despite at least 2–3 months of daily rinses and steroid spray, or with large polyps. Surgery opens the sinuses so treatment can reach inside.
Helpful resources
- ASCIA: Allergic rhinitis and sinusitisAustralasian allergy information. Free.
Evidence and more information
- EPOS 2020: European position paper on rhinosinusitis and nasal polyps
- Cochrane: Saline irrigation for chronic rhinosinusitis (2016)
maladywise.com/chronic-rhinosinusitis/