Chronic obstructive nasal and sinus disease

Also called Chronic rhinosinusitis, Sinusitis

Inflammation of the sinuses lasting months. Common, miserable, and antibiotics are usually the wrong answer.

What it is

Chronic rhinosinusitis means inflammation of the nose and sinuses lasting more than twelve weeks. It affects around one in ten adults.

The reason it is here is that it is treated badly and often. People receive repeated courses of antibiotics for a condition that is usually inflammatory rather than bacterial, and the underlying inflammation goes untreated.

The effective treatment is unglamorous: nasal saline irrigation and topical steroid spray, used correctly and for long enough. Most people do neither correctly.

Nasal polyps, allergy and asthma all travel with it, and treating one usually helps the others.

Signs you might notice

A blocked nose, for months.

Thick nasal discharge, or mucus running down the back of the throat.

Facial pain or pressure, and a reduced sense of smell.

Poor sleep, tiredness, and reduced concentration, which people rarely connect to their nose.

Symptoms on one side only, bleeding, or severe pain with visual change needs urgent assessment.

How it can affect day-to-day life

Loss of smell has a substantial impact on quality of life and on safety, and it is dismissed as trivial by almost everybody except the person experiencing it.

Sleep disruption from nasal blockage feeds daytime fatigue and low mood.

Repeated antibiotic courses drive resistance without treating the problem.

Supporting someone well

Learn the steroid spray technique. Head slightly forward, spray with the opposite hand aiming outward towards the ear, and do not sniff hard. Most people spray straight at the septum, which does nothing and causes nosebleeds.

Use saline irrigation daily. A proper rinse bottle, not a spray. It works, and it is cheap.

Use the steroid spray for at least three months before judging it. It is not a decongestant and it does not work in a day.

Treat allergy alongside it.

Do not accept repeat antibiotics as a management plan.

Ask for ENT referral if it is not controlled, since surgery helps a subset, particularly with polyps.

Where to get help

A GP or pharmacist can start treatment and check technique.

Ask for ENT referral for persistent symptoms or polyps.

Severe pain with swelling around the eye, visual change or confusion is an emergency.