Most people recognise the pattern. A cold arrives, the worst of it passes within a week or so, and yet the blocked nose, the pressure behind the cheeks and the thick drip down the back of the throat linger on for weeks. As the autumn cold and flu season builds, many adults find themselves several weeks in, having tried a pharmacy shelf of sprays and sometimes a course of antibiotics, with no lasting relief.
When symptoms persist for 12 weeks or more, the explanation is often chronic rhinosinusitis. This is persistent inflammation of the lining of the nose and sinuses, which is a different problem from a lingering infection. It is common, frequently missed and treatable, but effective chronic sinusitis treatment depends on an accurate diagnosis. That usually requires a look inside the nose that a routine GP appointment cannot provide.
Patients who come to see a sinus specialist in London are often several months into the problem and have already tried the standard remedies. Our rhinology service assesses people whose nasal symptoms have outlasted first-line treatment, using endoscopy to see the sinuses directly. Knowing what to look for, and when to stop waiting, can save months of ineffective treatment.
A cold that never clears deserves a proper diagnosis.
Cold, sinus infection or chronic sinusitis?
Duration is the first clue. A cold typically improves within 7 to 10 days. Acute sinusitis, which usually follows a viral cold, can last up to 12 weeks and is mostly viral too. Chronic sinusitis is diagnosed when symptoms continue for 12 weeks or longer. The key chronic sinusitis symptoms are:
Nasal blockage: a persistently stuffy nose, often worse on one side or at night
Discharge: thick mucus from the nose or running down the back of the throat
Facial pressure: a dull ache or fullness around the cheeks, forehead or between the eyes
Reduced sense of smell: food tasting bland, or smells fading or disappearing
A diagnosis normally requires at least two of these, one of which must be blockage or discharge. Fever, tooth pain and feeling generally unwell are more typical of an acute infection than of the chronic form.
The difference between a sinus infection and chronic sinusitis matters because the treatment differs. An acute infection is a short event, whereas chronic sinusitis is an ongoing inflammatory condition that flares and settles but rarely disappears without the right treatment. Allergic and non-allergic rhinitis can also look almost identical, and the two often coexist. Our guide to hayfever versus rhinitis explains how those conditions differ, and our hayfever and allergic rhinitis service covers testing and treatment.
Why antibiotics and over-the-counter sprays often fail
Antibiotics treat bacteria, but the inflammation behind chronic sinusitis is rarely driven by a simple bacterial infection. For that reason a course of antibiotics may bring brief, partial improvement at best, and the symptoms return as soon as it ends. Repeated courses add side effects and contribute to antibiotic resistance without addressing the underlying problem.
Over-the-counter decongestant sprays have a different limitation. They shrink the swollen lining of the nose for a few hours, but using them for more than about a week can cause rebound congestion, leaving the nose more blocked than before. Steroid sprays are far more appropriate for long-term inflammation, but they only work if the spray actually reaches the sinus openings. Poor technique, or a nose blocked by polyps or a deviated septum, can prevent the medication from getting there.
Structural causes are another reason first-line treatment fails. Nasal polyps, a deviated septum, enlarged turbinates and narrow sinus drainage channels can all trap mucus and sustain inflammation. No spray will correct them. If you have tried the usual remedies and a persistent block remains, our article on why a nose stays blocked despite antihistamines describes the other causes worth considering.
What a specialist assessment involves
An assessment begins with a detailed history: how long symptoms have lasted, what makes them better or worse, which treatments you have tried, and whether you have asthma, allergies or a reduced sense of smell. This is followed by an examination of the nose. A GP can usually see only the front of the nasal passages, and much of the disease sits further back.
The key step is nasal endoscopy. A thin, flexible camera is passed gently into the nose after a topical anaesthetic spray. It takes a few minutes, and it allows a specialist to see the sinus drainage pathways, identify polyps, assess the septum and look for infected mucus. This is the direct view that explains why a cold has not gone away.
Imaging is not needed for everyone. A CT scan of the sinuses is considered when the diagnosis is uncertain, when medical treatment has not worked, or when surgery is being planned, because it maps the anatomy precisely. It is not a routine first test, since sinus scans can look abnormal in people with no symptoms. Where the picture points to chronic rhinitis rather than sinusitis, with a runny nose and no sinus disease, a different approach applies. Treatments such as ClariFix target the nerve supply behind chronic rhinitis and are not a treatment for sinusitis, which is why getting the diagnosis right comes first.
Chronic sinusitis treatment, from medical therapy to when surgery is considered
Treatment is staged, and most patients begin with medical therapy. The main options are:
Saline irrigation: regular rinsing clears mucus and allergens and helps medication reach the lining
Intranasal steroid sprays or drops: the cornerstone of long-term control, used daily with correct technique
Short courses of oral steroids: used selectively, particularly where polyps are present
Allergy treatment: managing coexisting allergic rhinitis reduces ongoing inflammation
Antibiotics: reserved for confirmed bacterial flares, not used as routine treatment
Biologic medicines: considered in selected patients with severe polyp disease that has not responded to other treatment
If medical therapy has been used properly for several months and symptoms persist, surgery may be considered. Functional endoscopic sinus surgery opens blocked drainage pathways through the nostrils, with no external cuts, so that the sinuses can ventilate and drain again. Correcting a deviated septum or reducing enlarged turbinates is sometimes combined with this when anatomy is part of the problem. Candidates are typically people with confirmed disease on endoscopy or CT, a clear impact on quality of life and an inadequate response to medication. Most people return to light activity within a week or two, although full healing and the post-operative care of the nose take longer.
The private cost depends on what you need. It reflects the consultation and endoscopy, any imaging, and, if surgery is recommended, the surgical, anaesthetic and hospital fees. Once your assessment is complete, you receive a clear plan and a transparent quote before any decision. If your symptoms have lasted beyond 12 weeks, an early specialist assessment can establish whether treatment, or surgery, is likely to help.
Frequently asked questions about chronic sinusitis
How long before a cold counts as chronic sinusitis?
A cold usually settles within 7 to 10 days. If blockage, discharge, facial pressure or loss of smell continue for 12 weeks or more, the condition is classed as chronic sinusitis. If symptoms last beyond three to four weeks with no sign of improvement, it is reasonable to seek assessment.
Do I need antibiotics?
Usually not. Chronic sinusitis is mainly an inflammatory condition, and antibiotics give limited and temporary benefit. They are used when there is clear evidence of a bacterial flare, typically alongside saline irrigation and steroid treatment.
Do I need a CT scan?
Not always. Diagnosis usually begins with examination and nasal endoscopy. A CT scan is advised when the diagnosis is unclear, when medical treatment has failed, or when surgery is being planned.
Can sinusitis affect smell or cause blocked ears?
Yes to both. Swelling or polyps in the nose can block airflow to the smell receptors and reduce the sense of smell. Inflammation near the back of the nose can also affect the eustachian tube, causing a sensation of blocked or full ears.
Is chronic sinusitis the same as hay fever?
No, although they overlap. Hay fever is an allergic reaction in the nasal lining, whereas chronic sinusitis involves persistent inflammation of the sinuses and can occur with or without allergy. Many people have both, which is why a full assessment looks at each.
How much does private sinus treatment cost in London?
The cost depends on the assessments and treatments you need. A consultation comes first, followed by nasal endoscopy and imaging if required, and surgery is quoted separately after the plan is agreed.
Do I need a GP referral to see a sinus specialist?
No, there is no need for a GP referral before booking a consultation.
Book a consultation at Hillser Clinic
We offer expert evaluation of chronic sinusitis and persistent nasal symptoms at Hillser Clinic, with specialist nasal endoscopy and a full range of modern sinus treatments, including endoscopic sinus surgery. To arrange a consultation, please contact our team.
