Everything To Know About Chronic Rhinosinusitis (2025)

Chronic rhinosinusitis is inflammation of the sinuses and nasal passages that lasts at least 12 weeks. It causes ongoing symptoms, such as stuffy nose and facial pain or pressure.

Although the exact cause of chronic rhinosinusitis isn't always clear, it likely develops from several factors, including allergies and structural issues with the nose, such as a deviated septum. About 5-12% of all people have chronic rhinosinusitis.

Treatment usually involves a combination of approaches, including medications, lifestyle changes, and sometimes surgery. Treatment can help most people relieve their symptoms.

Healthcare providers may classify chronic rhinosinusitis based on whether or not you have nasal polyps (soft tissue growths in the lining of your nasal cavity). The condition may also be classified based on whether allergies play a role.

Knowing the type helps your healthcare provider develop an effective treatment plan.

Chronic Rhinosinusitis Without Nasal Polyps (CRSsNP)

Chronic rhinosinusitis without nasal polyps (CRSsNP) is long-term inflammation of the sinuses and nasal passages. As the name suggests, nasal polyps aren't present. It's the most common form of chronic rhinosinusitis, especially among people with immune-related conditions.

Chronic Rhinosinusitis With Nasal Polyps (CRSwNP)

Chronic rhinosinusitis with nasal polyps (CRSwNP) is long-term inflammation of the sinuses and nasal passages, along with polyps.

Your sinuses and nasal cavities are lined by a mucus layer that protects your body from inhaling irritants. In people with this type, inflammation changes the structure of the sinuses and nasal tissue, which leads to nasal polyps forming.

Allergic Fungal Rhinosinusitis

Allergic fungal rhinosinusitis is a form of chronic rhinosinusitis with nasal polyps associated with a fungal infection and allergies. It accounts for 5-10% of all chronic rhinosinusitis cases. It most commonly affects people with asthma or allergies who live in warm, humid climates, where fungi are likely to thrive.

Symptoms

Symptoms of chronic rhinosinusitis last for 12 weeks or more. They can range from mild to severe and may worsen after exposure to triggers such as air pollution, cigarette smoke, or pollen. Common symptoms include:

• Stuffy nose
• Runny nose
• Facial pressure or pain
• Decreased sense of smell
• Postnasal drip (mucus running down the back of your throat)

You may also have additional symptoms, such as:

• Headaches
• Pain in your upper teeth
• Snoring
• Poor sleep
• Ear pain or pressure
• Cough
• Bad breath

Chronic rhinosinusitis develops when the tissue that lines your nasal passages and sinuses becomes inflamed.This inflammation prevents your sinuses from draining properly, causing mucus buildup and symptoms like congestion and facial pressure. Long-lasting inflammation can sometimes damage tissues and cause the growth of nasal polyps, which can worsen symptoms.

The exact cause of inflammation in this condition is not fully understood. Experts believe a combination of risk factors contributes to inflammation.

Risk Factors

Several factors can increase the risk of chronic rhinosinusitis. These include:

• Infections: Recurring sinus infections or colds can lead to chronic inflammation, increasing your risk of chronic rhinosinusitis. These infections may be bacterial or viral.
• Family history: A history of chronic rhinosinusitis or other sinus conditions in your family may increase your risk.
• Age: This condition can affect people of all ages, but it's more common in adults who are 50-60.
• Allergies: People with allergies, especially to pollen or dust mites, are more likely to develop chronic rhinosinusitis.
• Structural abnormalities: Existing nasal polyps or a deviated septum can contribute to sinus problems and increase the risk.
• Environmental factors: Exposure to irritants such as cigarette smoke, air pollution, or chemical fumes can increase your risk.
• Weakened immune system: Conditions that affect your immune system, such as autoimmune diseases, can make you more susceptible to chronic rhinosinusitis.
  

Diagnosis

Your healthcare provider will review your medical history and symptoms. You must have at least two of the four main symptoms of chronic rhinosinusitis for at least 12 weeks to receive a diagnosis. These symptoms include:

• Facial pain or pressure
• Reduced or lost sense of smell
• Nasal obstruction (stuffy nose)
• Nasal drainage(runny nose)

You can also expect your healthcare provider to perform a physical examination and order diagnostic tests. During the physical exam, they will look at your nasal passages for signs of inflammation, swelling, mucus buildup, polyps, or facial tenderness.

Diagnostic tests that can help confirm a diagnosis include:

• Nasal endoscopy: This involves inserting an endoscope (a long, flexible tube) into your nose to look inside your nose and sinuses.
• Computed tomography (CT) scan: This imaging test uses X-rays to create 3D images of your nose and sinuses to look for polyps, blockages, and inflammation.
• Allergy testing: Your healthcare provider may order allergy testing to determine whether any allergens may be triggering symptoms.

Treatment may help reduce inflammation, relieve symptoms, and improve quality of life. Treatment plans typically involve a combination of medications and at-home remedies. Surgery may be necessary when other treatments don't work or your symptoms are severe.

Lifestyle Changes

Staying hydrated throughout the day can help thin nasal mucus and make breathing easier. During flare-ups, warm compresses on your face can help ease facial pain, pressure, and congestion.

Living with chronic rhinosinusitis may require lifestyle adjustments, such as avoiding allergens and irritants like cigarette smoke. Tracking your symptoms and potential triggers can help you identify symptom patterns and determine the most effective treatments.

Nasal Saline Irrigation

This at-home procedure helps clear your nose and sinuses, reducing symptoms like nasal congestion and pressure.

Nasal saline irrigation involves flushing your nasal cavity with a saltwater solution. You can use a spray or squirt bottle, a neti pot, or a nebulizer. You typically put the solution into one nostril and allow it to drain out the other. Your healthcare provider can show you how to perform this process at home.

Corticosteroid Nasal Spray

Corticosteroid nasal spray is a medication you spray directly into your nose to help you breathe more easily. It can help decrease swelling, mucus production, and other symptoms.

Healthcare providers typically recommend daily use for the best results. Using the spray as prescribed can help you feel better during the day and sleep more comfortably at night. It may take up to two weeks of use to notice improvements.

Other Medications

Your healthcare provider may prescribe other medications, such as:

• Fluticasone with exhalation delivery system (EDS): This corticosteroid medication helps treat nasal polyps and common allergy symptoms like runny nose and sneezing. You deliver it through a breath-powered device. The force of your breath carries the medication into your nasal passages to reduce inflammation.
• Oral corticosteroids: For more severe inflammation, your healthcare provider may prescribe a short course of corticosteroids that you take by mouth.
• Biologics: These injectable medications may help reduce nasal congestion and polyp size. Examples include Dupixent (dupilumab), Xolair (omalizumab), and Nucala (mepolizumab).
• Antibiotics: If a bacterial infection contributes to your chronic rhinosinusitis, your healthcare provider will likely prescribe antibiotics to kill the bacteria.

Surgery

Surgery may be necessary when other treatments haven't worked. Surgery helps open your sinuses, allowing for better drainage and airflow. The goal is to remove blockages and enlarge your sinus openings.

Surgery may significantly improve your symptoms and overall quality of life, but it's not a cure. After surgery, you may still need ongoing treatments to reduce inflammation in your nasal passages and sinuses.

Prevention

There is no guaranteed way to prevent chronic rhinosinusitis, but managing allergies and avoiding irritants may help reduce the frequency and severity of flare-ups.

For example, treating underlying allergic rhinitis can help prevent flare-ups associated with pollen or dust mites. It's also important to limit exposure to air pollution, cigarette smoke, and other irritants that can aggravate inflammation in your nose.

People with chronic rhinosinusitis are more likely to experience some related conditions. These include:

• Allergic rhinitis: This condition causes inflammation of the nasal passages caused by allergens such as pollen, dust, or pet dander.
• Asthma: Chronic rhinosinusitis and asthma often occur together, especially in people with nasal polyps. Inflammation in the nose can contribute to or worsen asthma symptoms.
• Obstructive sleep apnea: Difficulty breathing through the nose can contribute to sleep apnea. Sleep apnea may also be associated with worse chronic rhinosinusitis.
• Autoimmune and immunodeficiency disorders: People with immune system disorders are more prone to developing chronic rhinosinusitis.
• Cystic fibrosis: Most people with cystic fibrosis develop chronic rhinosinusitis. The condition causes thick and sticky mucus to clog the sinuses, which can lead to blockage and inflammation.

Living With Chronic Rhinosinusitis

Chronic rhinosinusitis is a long-term condition. While a cure isn't always possible for some people, treatment is important.

Untreated chronic rhinosinusitis may sometimes lead to more serious infections, but most people can relieve their symptoms and maintain a fulfilling, active life with treatment.