Quick answer: Chronic sinusitis may need surgery when symptoms have lasted more than 12 weeks and cannot be controlled with medical treatment such as saline rinses and steroid nasal sprays. Surgery is not the first step and does not suit everyone. An ENT specialist first confirms the diagnosis, looks for causes such as nasal polyps, allergy or a blockage, and checks that treatment has been used correctly and for long enough.
Emirates European Hospital provides sinusitis treatment in Sharjah for acute and chronic sinus conditions. Seeing an ENT specialist does not mean you will need an operation. Many people improve once the cause is clear and treatment is used properly, and surgery is one option among several.
What Is Chronic Sinusitis?
The sinuses are hollow spaces in the bones around the nose. They connect to the nose through small, narrow channels. Sinusitis, also called rhinosinusitis, means the lining of the sinuses is inflamed. The swelling can stop mucus from draining properly, which leaves you feeling blocked.
A diagnosis of chronic sinusitis requires symptoms that last longer than 12 weeks. Unlike a short sinus infection, it is usually caused by prolonged inflammation rather than a long infection. This is why antibiotics alone often do not solve it.
How Is Chronic Sinusitis Different from Acute Sinusitis?
- Acute sinusitis: Symptoms last less than 4 weeks. Most cases are caused by a virus and clear up without antibiotics.
- Recurrent acute sinusitis: Four or more separate sinus infections in a year, with no symptoms in between.
- Chronic sinusitis: Symptoms last longer than 12 weeks, and inflammation is usually the main problem.
What Are the Symptoms of Chronic Sinusitis?
You might have chronic sinusitis if you have at least two of these symptoms for at least 12 weeks:
- A stuffy, congested or blocked nose
- Pain, pressure or fullness in the face, head or around the eyes
- Thick nasal drainage
- Loss of smell
Symptoms alone are not enough for a firm diagnosis. An ENT specialist also needs to see polyps, pus or thick mucus inside the nose, or find changes on a CT scan.
What Causes Chronic Sinusitis?
The exact cause cannot always be found. For some people, the nose and sinuses seem to overreact as if there were an infection. Several factors can contribute or make symptoms harder to control:
- Allergies, including allergic rhinitis
- Nasal polyps
- A deviated nasal septum or a bone spur that blocks drainage
- Asthma
- Problems with the body's ability to fight infection
When these conditions are present, they usually need treating too, or the sinusitis can keep returning.
Could It Be Something Other Than Sinusitis?
Yes. Migraine and tension headaches can cause pain or pressure that feels like a sinus problem. If you have "sinus headaches" without colored nasal drainage, ask your doctor whether migraine could be the cause. Inflammation in the nose can also cause congestion and drainage without involving the sinuses.
How Do ENT Specialists Diagnose Chronic Sinusitis?
Consultation and examination
Your doctor will ask how long symptoms have lasted, which treatments you have tried and how you used them, and whether you have allergies or asthma. The doctor will then look inside your nose for polyps, swelling or pus.
Nasal endoscopy
Nasal endoscopy uses a thin scope to look closely at the inside of the nose and the sinus drainage areas. It helps assess nasal obstruction, chronic sinus symptoms, polyps and structural problems.
CT scan
X-rays and CT scans are not needed to diagnose uncomplicated sinusitis. A CT scan of the sinuses may be needed if your doctor suspects a complication, or if you have repeated episodes or prolonged symptoms. Surgeons also use it to plan an operation.
Allergy assessment
If allergy may be playing a part, allergy testing for ENT conditions can help identify triggers so they can be treated or avoided.
What Treatment Should Be Tried First?
Chronic sinusitis is treated differently from acute sinusitis. Because it is driven by inflammation, treatment aims to control that inflammation over time.
- Saline nasal rinses: Salt water irrigation is one of the main treatments. Use sterile or previously boiled and cooled water, and follow your doctor's instructions.
- Steroid nasal sprays or drops: These reduce swelling in the sinuses. You may need them for a few months, and they work better when used regularly with the correct technique.
- Antihistamines: These may help if an allergy is causing your symptoms.
- Antibiotics: These may sometimes help but not always, because infection is usually not the main cause.
- Avoiding triggers: This includes not smoking and avoiding things that trigger your allergies.
Treatment takes time. If a spray has not helped, ask your doctor to check your technique before you decide it has failed.
When Should I See an ENT Specialist?
You should see an ENT specialist if:
- You still have sinusitis after 3 months of treatment
- You keep getting sinusitis
- You only have symptoms on one side of your face
When Is Sinus Surgery Needed?
For chronic sinusitis, surgery is an option when symptoms cannot be controlled with medicines and other treatments. Your ENT specialist will usually consider it when:
- Symptoms continue and still affect your daily life after a proper course of treatment
- Examination, endoscopy or a CT scan confirm the disease
- A blockage, such as polyps or a structural problem, is stopping the sinuses from draining
- You understand what surgery can and cannot achieve
Surgery is not usually recommended for acute sinusitis. The rare exception is an infection that spreads to the eye, face or brain, which is an emergency.
What Is Functional Endoscopic Sinus Surgery (FESS)?
The most common operation for the sinuses is functional endoscopic sinus surgery, or FESS. The surgeon uses an endoscope, a thin scope passed through the nose, to see inside and guide the operation. It is carried out under general anesthesia, so you will be asleep.
The aim is to widen the natural drainage pathways between the sinuses and the nose. This lets mucus drain, lets air in, and helps sprays and rinses reach the sinuses better afterward. The surgeon may do this by removing blocked tissue. Another technique inflates a tiny balloon in the blocked opening, but this does not suit every type of chronic sinusitis, so ask your surgeon which approach is planned for you.
What Are the Risks of Sinus Surgery?
Every operation has risks. Your surgeon will explain how they apply to you. These are general published estimates, not figures for any one hospital:
- Common (more than 1 in 20): Pain or discomfort, blood-stained discharge for a few days, symptoms that continue, a need for further treatment, and symptoms returning over time.
- Less common (fewer than 1 in 20): Significant bleeding that may need further treatment.
- Rare (fewer than 1 in 100): A leak of the fluid around the brain, damage to the eye, infection in the sinuses after surgery, and loss of or change in the sense of smell.
- Very rare: Meningitis, loss of vision, and permanent loss of smell.
Will Surgery Cure My Sinusitis?
Surgery can improve drainage and make treatment work better, but it is not always a permanent cure. Many patients still need medicine after surgery to control the condition and keep it from returning. Your sense of smell may not improve. Symptoms can come back over the months or years that follow, and about 1 in 8 patients may need a further sinus operation.
What Should I Expect During Recovery?
Most patients can go home the same day, although some need to stay overnight. Your surgeon will tell you what to expect, but general advice includes:
- Rest for about 1 to 2 weeks, depending on your surgeon's advice
- Expect some blood-stained watery drainage for a few days
- Expect your nose to feel blocked for a few weeks
- Do not blow your nose until your surgeon says you can, which may be around 1 week
- Do not pick at scabs in your nose, because this can cause bleeding
- Avoid swimming and diving for about 2 weeks
- Use your rinses, sprays and any medicines exactly as prescribed
- Arrange for someone to take you home, and do not drive yourself
When Do Sinus Symptoms Need Urgent Care?
Most sinus problems are not emergencies, but get urgent medical help if you have:
- Severe swelling or redness around the eye
- Any change in your vision
- A severe headache that pain relief does not help
- A fever and you feel very unwell
- Symptoms that are getting worse, or a weakened immune system
After surgery, contact your surgical team quickly if you have heavy bleeding, worsening pain, swelling around the eye, or changes in your vision.
Questions to Ask Your ENT Specialist
- Is this definitely chronic sinusitis, or could it be something else?
- Do I have polyps, an allergy, or a structural problem?
- Am I using my spray and rinses correctly?
- Do I need a CT scan?
- What could surgery improve in my case, and what will it not change?
- Which risks matter most for me?
- What treatment will I need after surgery?
Sinus Assessment at Emirates European Hospital
Dr. Ammar Al Farhan is an ENT Specialist at Emirates European Hospital with more than 20 years of experience. The EEH profile lists clinical expertise that includes Functional Endoscopic Sinus Surgery (FESS).
If sinus symptoms have lasted more than 12 weeks, keep returning, or affect only one side of your face, you can book an appointment at Emirates European Hospital or call 06 561 9444. The right next step may be nasal endoscopy, allergy assessment, a change in medical treatment, or a discussion about surgery.
This article provides general educational information and does not replace an ENT examination, diagnostic tests, surgical assessment, or personalized medical advice.
