Chronic Sinusitis That Won't Go Away: When to See an ENT Specialist
You finished the antibiotics. You tried the nasal sprays, the steam showers, the neti pot. And yet here you are, weeks or months later, still dealing with the same facial pressure, congestion, and fatigue. If that sounds familiar, you're not alone.
Chronic sinusitis affects roughly 1 in 8 adults in the United States each year. When sinus symptoms drag on for 12 weeks or longer, it's no longer just a stubborn cold or a sinus infection that needs one more round of amoxicillin. It's chronic sinusitis, and it has an underlying cause that standard antibiotics aren't reaching.
The good news: once that cause is identified, effective chronic sinusitis treatment exists. Options range from targeted medication adjustments to in-office procedures like balloon sinuplasty and minimally invasive endoscopic sinus surgery. The first step is figuring out why your sinus infection won't go away after antibiotics.
This article walks through the differences between acute and chronic sinusitis, the most common reasons antibiotics fail, what to expect from an ENT evaluation, and the treatment options that can finally get you lasting relief.
Acute vs. Chronic Sinusitis—What's the difference?
Not all sinus infections are the same, and knowing which type you're dealing with changes what you should do about it.
Acute sinusitis
Acute sinusitis lasts less than four weeks. It usually starts with a viral cold that leads to bacterial infection, causing congestion, facial pain, and thick nasal discharge. Most cases respond well to a course of antibiotics and supportive care like saline rinses and rest.
Chronic sinusitis
When symptoms persist for 12 weeks or longer despite treatment, the diagnosis shifts to chronic sinusitis. At this stage, the problem is often ongoing inflammation rather than active infection. Structural issues, immune factors, or allergies are frequently driving the cycle, and another round of antibiotics won't fix them.
Recurrent acute sinusitis
Some people recover fully between episodes but keep getting sick. Four or more separate sinus infections per year qualifies as recurrent acute sinusitis. Even though each individual episode resolves, the pattern itself signals something deeper going on.
Many patients bounce between primary care and urgent care visits for months or years without anyone looking past the surface. That's not a failure of those providers. It's just that an ENT evaluation is built to go deeper, using tools like nasal endoscopy and CT imaging to find what's actually causing the problem.
Why Your Sinus Infection Won't Respond to Antibiotics
If you've been through two or three rounds of antibiotics without lasting relief, the problem likely isn't bacterial, or at least not only bacterial. Here are the most common reasons antibiotics fall short.
Underlying inflammation, not just infection
Chronic sinusitis is often driven by persistent inflammation in the sinus lining rather than an active bacterial infection. Antibiotics kill bacteria, but they do nothing to reduce swollen tissue, shrink polyps, or reopen narrowed drainage pathways. The inflammation stays, mucus keeps building up, and symptoms return.
Structural problems blocking drainage
Your sinus anatomy may be working against you. A deviated septum can narrow or block sinus openings. Enlarged turbinates restrict airflow. Nasal polyps physically obstruct drainage. A less well-known issue called concha bullosa, an air-filled middle turbinate, can crowd the sinus passages and trap mucus. No antibiotic will fix any of these.
Allergies and immune factors
Untreated allergies cause chronic swelling of the nasal mucosa, which traps mucus and creates a breeding ground for repeated infection. Some patients have underlying immune deficiencies that make them unusually infection-prone. Fungal sinusitis, which doesn't respond to standard antibiotics at all, is another diagnosis that sometimes gets missed.
Biofilms
Bacteria can form protective colonies called biofilms on sinus tissue. These biofilms act like a shield, making the bacteria inside them highly resistant to standard antibiotic therapy. Treating biofilms often requires direct intervention through surgery or specialized irrigation protocols.
When the root cause is structural, inflammatory, or immune-related, antibiotics alone will never deliver lasting results. That's the point where an ENT specialist becomes necessary.
When to See an ENT Specialist
Most sinus infections resolve with basic treatment. But when they don't, there's a clear set of signs that it's time to move beyond primary care.
You should see an ENT if:
Your symptoms have persisted beyond 12 weeks despite medical treatment
You've completed two or more courses of antibiotics without resolution
You experience four or more sinus infections per year
You have nasal polyps or a history of nasal surgery
You've lost your sense of smell
Facial pain or pressure won't go away
Your primary care doctor has recommended further evaluation
Any one of these is reason enough to schedule an appointment. If you're checking off several, you're overdue.
What to expect at your first ENT visit
The visit starts with a detailed history of your symptoms, how long they've been going on, and what treatments you've already tried. From there, your ENT will perform a nasal endoscopy, a thin camera gently passed into the nose to get a direct look at your sinus openings, any polyps, and structural issues like a deviated septum.
Your doctor will also discuss whether a CT scan is needed. At Dr. Feinstein's Tarzana office, an in-office cone beam CT scanner provides same-day sinus imaging, so there's no need for a separate radiology appointment. That means answers faster and fewer visits before starting treatment.
How an ENT Diagnoses Chronic Sinusitis
A proper diagnosis is the single most important step in treating chronic sinusitis. Without it, you're guessing, and guessing is how patients end up on their fifth round of antibiotics with nothing to show for it.
Nasal endoscopy
This is usually the first thing your ENT will do. A thin, flexible camera is gently inserted into the nose to give a direct view of your sinus openings, the condition of your nasal lining, any polyps, and structural abnormalities. It takes only a few minutes, is done right in the office, and most patients find it painless.
CT scan of the sinuses
A sinus CT scan is the gold standard for imaging chronic sinusitis. It shows your sinus anatomy in detail, reveals the extent of disease, and identifies issues like a deviated septum, polyps, or blocked drainage pathways that endoscopy alone can't fully capture. Dr. Feinstein has an in-office cone beam CT machine in Tarzana, which means results are available the same day as your visit.
Additional testing when needed
In some cases, further workup is necessary. A sinus culture can identify the specific bacteria involved, which is especially useful when infections keep coming back or don't respond to standard antibiotics. Allergy testing, either through a blood panel or skin testing with an allergist, can reveal whether chronic allergic inflammation is fueling the cycle. If recurrent infections suggest an immune deficiency, your ENT may order immune function labs as well.
Chronic sinusitis has multiple potential causes, and they often overlap. The goal of a thorough evaluation, like those performed by ENT sinus specialists, is to identify every contributing factor so treatment can be matched to what's actually going on.
Chronic Sinusitis Treatment Options—From Conservative to Surgical
Treatment for chronic sinusitis isn't one-size-fits-all. What works depends on the cause, the severity, and how your body has responded to prior therapy. Your ENT will build a plan around your specific situation.
Medical management (first-line)
Most patients start here. Saline nasal irrigation clears mucus and inflammatory debris from the sinuses. Nasal corticosteroid sprays reduce mucosal swelling over time. For significant inflammation or polyps, a short course of oral steroids can help knock things back. When infection is confirmed, targeted antibiotics guided by culture results are far more effective than the empiric prescriptions you may have gotten from urgent care. And if allergies are part of the picture, antihistamines or immunotherapy can address that chronic trigger at its source.
In-office procedures
Balloon sinus ostial dilation ("balloon sinuplasty")
For patients who want relief without the operating room, balloon sinuplasty is performed right in the office with topical anesthesia and light sedation. A small balloon catheter is guided into the blocked sinus opening and gently inflated, widening the drainage pathway. There's no cutting and no tissue removal. Most patients return to normal activities within a day or two. Centers offering comprehensive sinus care have seen high patient satisfaction with this approach for mild to moderate disease.
Minimally invasive endoscopic sinus surgery
When disease is more extensive, polyps are present, or structural issues need correction, endoscopic sinus surgery is the next step. Performed under general anesthesia, specialized instruments open the sinuses, remove polyps, and correct problems like a deviated septum or enlarged turbinates, all in the same procedure. An endoscopic camera guides every step for precision. Recovery times have shortened considerably with modern techniques, and most patients are back to their routines within one to two weeks.
Treating the nose to treat the sinuses
Nasal obstruction often contributes directly to chronic sinusitis. If a deviated septum or enlarged turbinates are restricting airflow and blocking drainage, fixing the nose can be just as important as treating the sinuses themselves. Vivaer nasal airway remodeling is an in-office procedure that reshapes the nasal valve without any cutting. Turbinate reduction and septoplasty restore proper airflow and help the sinuses drain the way they're supposed to.
The right treatment depends on your anatomy, your disease, and what you've already tried. That's why the ENT evaluation discussed earlier matters so much.
Balloon sinuplasty vs. endoscopic sinus surgery: which is right for you?
This is one of the most common questions patients ask, and the honest answer is that it depends on what's happening inside your sinuses.
Balloon sinuplasty is an in-office procedure performed under local anesthesia. It works best for mild to moderate chronic sinusitis with limited structural disease. There's no cutting or tissue removal involved. A small balloon is threaded into the blocked sinus passage, inflated to widen the opening, and removed. Most patients are back to normal activities within a day or two. The tradeoff: it may need to be repeated over time, and it can't address polyps or correct structural problems like a deviated septum.
Endoscopic sinus surgery is a more involved procedure performed in an operating room under general anesthesia. It's better suited for moderate to severe disease, particularly when nasal polyps, extensive inflammation, or multiple structural issues need to be corrected at the same time. Recovery typically takes one to two weeks, but the results tend to be more durable. When performed by an experienced surgeon, revision rates are low. For advanced chronic sinusitis, endoscopic surgery remains the gold standard treatment option.
How Dr. Feinstein decides which approach to recommend
Some patients benefit from a combination of both techniques in the same setting. Dr. Feinstein evaluates each patient's CT imaging and nasal endoscopy findings individually and recommends the approach that matches their specific anatomy and disease pattern. The goal is always the least invasive option that will actually solve the problem long term. Experienced sinus treatment centers typically offer both procedures so patients aren't steered toward one option by default.
What Happens If You Don't Treat Chronic Sinusitis?
Chronic sinusitis isn't just a quality-of-life nuisance. Left untreated, it can cause real problems that go well beyond a stuffy nose.
Day to day, untreated chronic sinusitis wears people down. Persistent fatigue, poor sleep, and difficulty concentrating are among the most common complaints. Studies have shown that the quality-of-life impact of chronic sinusitis is comparable to that of heart disease and chronic back pain, which surprises most people when they hear it.
Loss of smell is another risk, and the longer it goes untreated, the more likely it becomes permanent. For some patients, this also dulls their sense of taste, affecting everything from appetite to enjoyment of food.
In rare but serious cases, infection can spread beyond the sinuses to surrounding structures, leading to complications like orbital cellulitis, meningitis, or brain abscess. These are uncommon, but they underscore why chronic sinusitis shouldn't be shrugged off indefinitely.
There's also a well-established link between chronic sinusitis and asthma. Ongoing sinus inflammation can trigger or worsen asthma symptoms, creating a cycle that's harder to control when either condition is left unmanaged. Depression and reduced productivity are part of the picture too.
Finding a treatment that works isn't just about comfort. It's about protecting your long-term health.
Frequently Asked Questions
Why won't my sinus infection go away after antibiotics?
Chronic sinusitis is often driven by inflammation, structural blockages, polyps, or allergies rather than bacteria alone. Antibiotics treat infection but don't address these underlying causes. An ENT evaluation with nasal endoscopy and a sinus CT scan can identify the true source of the problem and guide treatment that actually works.
How long does chronic sinusitis last?
By definition, chronic sinusitis lasts 12 weeks or longer. Without proper treatment, it can persist for months or years. With targeted treatment, whether medical, in-office, or surgical, most patients experience significant improvement. The key is matching the treatment to the specific cause.
Is balloon sinuplasty painful?
Most patients report only mild pressure during the procedure. Balloon sinuplasty is performed in the office with topical anesthesia and optional sedation. There's no cutting involved, and most people return to normal activities within a day or two.
Can chronic sinusitis be cured permanently?
Many patients achieve long-term or permanent relief with the right approach. Success depends on identifying and addressing every contributing factor, including structural issues, inflammation, allergies, and immune problems. Patients with nasal polyps may need ongoing maintenance therapy, but even in those cases, symptoms can be well controlled with proper management.
Take the Next Step Toward Lasting Relief
If your sinus infection won't go away despite antibiotics, there's a reason. And it can be found. Chronic sinusitis has treatable causes, from structural blockages and polyps to unmanaged allergies and persistent inflammation. Modern treatments range from in-office balloon sinuplasty to minimally invasive endoscopic sinus surgery, and the right choice starts with a thorough ENT evaluation.
Dr. Aaron Feinstein sees patients with chronic sinusitis at his Tarzana, Los Angeles office. With in-office cone beam CT scanning, nasal endoscopy, and both in-office and surgical treatment options available, he can help identify what's driving your symptoms and build a plan to fix it. Schedule a consultation today.