A sinus infection that will not go away can be frustrating, especially when symptoms continue for weeks or keep returning after a brief improvement. A blocked nose, facial pressure, mucus and a reduced sense of smell can affect sleep, energy levels and day-to-day comfort.
Sometimes, what feels like a lingering infection is actually persistent sinusitis, also known as chronic rhinosinusitis. This is longer-term inflammation of the lining of the nose and sinuses. It may begin after a cold or infection, but ongoing symptoms are not always caused by bacteria.
Most short-term sinus infections improve within two to three weeks and often clear without antibiotics. If symptoms continue, recur regularly or affect one side of the face, it is sensible to seek medical advice.
Why will my sinus infection not go away?
A sinus infection that will not go away may be caused by ongoing inflammation, allergies, nasal polyps or a nasal blockage affecting sinus drainage. While an infection can start the problem, persistent symptoms are not always due to bacteria. This is why repeated antibiotics may not resolve the underlying cause.
The sinuses are air-filled spaces behind the cheeks, forehead and around the eyes. They connect to the inside of the nose through small drainage channels. When the lining becomes swollen, mucus cannot drain as freely. This can lead to congestion and pressure.
How long does sinusitis last?
Acute sinusitis usually improves within two to three weeks, although some symptoms may take up to four weeks to settle. Symptoms that last for 12 weeks or longer may be classed as chronic sinusitis, particularly when there is ongoing nasal blockage or discharge alongside facial pressure or a reduced sense of smell.
Chronic rhinosinusitis is defined as two or more symptoms lasting for at least 12 weeks. One symptom should be nasal blockage or nasal discharge. Other symptoms can include facial pain or pressure, or a reduced sense of smell.
What is chronic sinusitis?
Chronic sinusitis is long-term inflammation of the nose and sinuses. It does not necessarily mean you have a constant bacterial infection.
Symptoms can vary from day to day. You may have periods where you feel relatively well, followed by flare-ups of congestion, thicker mucus, facial discomfort or loss of smell. This can make sinusitis that keeps coming back feel like a series of separate infections.
Common symptoms of persistent sinusitis include:
- A blocked or congested nose
- Mucus from the nose or down the throat, known as post-nasal drip
- Facial pressure or discomfort around the cheeks, eyes or forehead
- A reduced or lost sense of smell
- Coughing, particularly at night
- Headaches or a feeling of pressure in the ears
- Tiredness caused by poor sleep or ongoing symptoms
Yellow or green mucus can occur with sinus inflammation, but colour alone does not confirm a bacterial infection or mean that antibiotics are needed. It can be difficult to distinguish viral and bacterial sinusitis based on symptoms alone.
For general information, read our guide on how to recognise a sinus infection and what to do next.
What causes recurring sinusitis?
Recurring sinusitis can mean different things. Some people have repeated acute episodes with clear symptom-free periods between them. Others have one ongoing problem with symptoms that improve and worsen but never fully settle.
Several factors can contribute.
Ongoing inflammation after an infection
A cold or viral infection can trigger swelling in the nose and sinuses. In some people, inflammation continues after the original infection has passed. The swollen lining narrows the drainage channels and makes mucus more difficult to clear.
Allergies and irritants
Allergic rhinitis, often known as hay fever, can cause continuing inflammation inside the nose. Pollen, dust mites, mould and animal dander may all contribute. Smoke, air pollution, strong fragrances and workplace dust can also irritate the nasal lining.
Nasal polyps or structural blockage
Nasal polyps are soft, non-cancerous swellings inside the nose. A deviated septum, where the wall between the nostrils is not central, may also affect airflow and drainage. These issues can make symptoms more persistent for some people.
Other health conditions
Asthma can occur alongside chronic sinusitis, particularly where nasal polyps are present. Less commonly, immune problems, cystic fibrosis or conditions affecting mucus clearance can contribute to difficult or recurring symptoms.
Why antibiotics may not resolve persistent sinusitis
Antibiotics can be appropriate for selected bacterial infections, but they do not treat every cause of sinus symptoms. Most acute sinusitis follows a viral infection, and many cases improve without antibiotics.
If chronic sinusitis is driven by inflammation, allergy, polyps or a structural problem, antibiotics alone are unlikely to provide lasting relief. Repeated courses can also cause side effects and should not replace a review of the underlying cause.
A careful assessment can help establish whether your symptoms are more likely to be inflammatory, allergic, infective or related to nasal anatomy.
Treatment options for chronic sinusitis
Treatment for persistent sinusitis depends on your symptoms, examination findings and whether there are contributing factors such as allergies or nasal polyps.
A clinician may recommend:
- Saline nasal rinses to help clear mucus and irritants
- Steroid nasal sprays or drops to reduce inflammation. These may need to be used consistently over several weeks or months
- Treatment for allergies where appropriate
- Short courses of other medicines for selected patients, following an individual assessment
- Review of triggers, including smoking, workplace exposure and allergy symptoms
If symptoms remain despite appropriate medical treatment, further assessment may include nasal endoscopy. This uses a thin camera to examine the inside of the nose. A CT scan may also be needed to assess the sinuses and plan treatment.
For some people with confirmed blockage or ongoing disease, Functional Endoscopic Sinus Surgery (FESS) may be considered. This procedure aims to improve sinus drainage by opening blocked pathways. It is not suitable for everyone, and the decision should follow a full discussion of the potential benefits, limitations and risks with your ENT specialist.
Can chronic sinusitis be cured?
There is not one single cure for every type of chronic sinusitis. However, many people can achieve better symptom control with the right combination of treatment, trigger management and follow-up.
The aim is to reduce inflammation, improve drainage and lessen the effect symptoms have on your life. Where a structural blockage or polyps are contributing, treatment directed at that cause may be helpful.
It is important to use prescribed nasal treatment as advised, even if symptoms fluctuate. Chronic sinusitis often needs a longer-term approach rather than treatment only during flare-ups.
When does sinusitis need a specialist?
It is sensible to arrange a specialist assessment if sinus symptoms have lasted more than 12 weeks, keep coming back or have not improved with appropriate treatment.
An ENT assessment cam be particularly helpful if you have:
- Persistent nasal blockage, facial pressure or loss of smell
- Repeated episodes of sinusitis
- Symptoms on one side of the face or nose only
- Nasal polyps or suspected structural blockage
- Asthma alongside ongoing sinus symptoms
- Ongoing symptoms despite consistent use of recommended nasal treatment
- Several courses of antibiotics without lasting improvement
NHS guidance advises referral to an ENT specialist for sinusitis that continues after three months of treatment, keeps returning or affects one side of the face.
When to seek urgent medical help
Serious complications from sinusitis are uncommon, but urgent assessment is needed if you develop swelling or redness around an eye, double vision, reduced vision, a severe frontal headache, confusion, a stiff neck or new neurological symptoms.
Call 999 or attend A&E if you have severe symptoms or signs of a potentially serious complication. NICE advises urgent hospital referral for eye-related complications, signs of meningitis, swelling over the forehead or focal neurological symptoms.
Getting help for persistent sinusitis
Persistent sinusitis can be difficult to live with, but ongoing symptoms do not need to be dismissed as repeated colds. A clear diagnosis can help distinguish chronic inflammation from recurring short-term infections and identify factors that may be keeping symptoms going.
The ENT Consultancy can assess persistent nasal and sinus symptoms, investigate possible causes and discuss an appropriate management plan.
Get in touch today to book an appointment with a specialist.
Frequently asked questions
- Why do I keep getting sinusitis?
Recurring sinusitis may be linked to allergies, nasal polyps, ongoing inflammation, smoke exposure or a structural blockage affecting mucus drainage. Some people have separate acute episodes, while others have chronic symptoms that fluctuate without fully resolving.
- Is a sinus infection lasting more than three weeks serious?
Not necessarily, but symptoms that do not improve after around three weeks should be reviewed. Symptoms lasting 12 weeks or longer may indicate chronic sinusitis and are worth assessing.
- Can chronic sinusitis affect your sense of smell?
Yes. Ongoing swelling in the nose and sinuses can reduce the ability of odours to reach the smell receptors high in the nose. Loss of smell is a common symptom of chronic sinusitis.
- Does chronic sinusitis always need surgery?
No. Many people are managed with nasal rinses, steroid nasal treatment and management of contributing factors such as allergies. Surgery may be considered where symptoms continue despite appropriate treatment and investigations show a blockage that could be addressed.
- Is chronic sinusitis the same as a chronic sinus infection?
Not always. Chronic sinusitis usually describes long-term inflammation of the nose and sinuses. Infection may trigger symptoms or cause occasional flare-ups, but bacteria are not always the main cause of persistent symptoms.
