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Chronic rhinosinusitis (CRS) is a persistent inflammation of the sinuses lasting 12 weeks or more, which does not resolve with standard treatments. The condition is often driven by a complex mix of underlying inflammation, anatomical blockages, or resilient bacterial biofilms, which is why first-line therapies can fail.

• Primary Symptoms: The four classic signs are nasal congestion, facial pain or pressure, thick nasal discharge, and a reduced sense of smell.
• Complex Causes: CRS is not a simple infection. It is a chronic inflammatory condition often linked to allergies, structural issues like a deviated septum, or bacterial biofilms that resist antibiotics.
• Advanced Treatment: When optimised medical treatments fail, Functional Endoscopic Sinus Surgery (FESS) is a minimally invasive option to open the natural sinus drainage pathways.

This guide explores what chronic rhinosinusitis really is, why it becomes a persistent problem, and what advanced treatment options are available when first-line therapies are not enough.

Understanding Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a persistent inflammation of your sinuses. These are the air-filled cavities in your skull. The inflammation lasts for 12 weeks or longer, even with attempts at treatment. It affects a surprising number of people. Studies show that 10-15% of Australian adults live with the condition.

Unlike acute sinusitis, which is a temporary infection that usually clears up in a few weeks, CRS is a more complex inflammatory condition. It can be broadly divided into two main types. CRS with nasal polyps and CRS without nasal polyps. Understanding which type you have is a key step towards finding the right treatment.

Recognising the Symptoms and Impact on Quality of Life

The symptoms of CRS are persistent and draining. The four classic signs that ENT specialists look for are:

• Nasal congestion or a constantly blocked nose.
• Facial pain, pressure, or a feeling of fullness around your eyes, cheeks, and forehead.
• Thick nasal discharge or a sensation of post-nasal drip down your throat.
• A reduced or complete loss of your sense of smell.

Beyond these, many people also struggle with chronic fatigue, headaches, poor sleep, and a persistent cough. The constant battle with these symptoms can significantly impact your work, social life, and overall mental wellbeing.

Why Has Your Sinusitis Become Chronic

If you have been dealing with this for months or even years, you have probably asked, “Why will this not go away?”. The answer is usually a combination of factors that create a cycle of inflammation.

The main drivers behind chronic rhinosinusitis include:

• Underlying Inflammation: Conditions like allergic rhinitis or aspirin-exacerbated respiratory disease can cause ongoing inflammation in your sinus lining.
• Anatomical Blockages: A deviated septum or naturally narrow sinus drainage pathways can trap mucus. This prevents your sinuses from clearing properly.
• Bacterial Biofilms: Sometimes, bacteria form protective communities called biofilms. These are incredibly resistant to standard antibiotics, which helps explain why conventional treatments often fail.

What Tests Might You Need for Diagnosis

A thorough diagnosis is the foundation for an effective treatment plan. Simply describing your symptoms is not enough. We need to see exactly what is happening inside your nose and sinuses.

Your journey to a clear diagnosis will typically involve:

• A Detailed Discussion: We will talk about your symptoms, what treatments you have tried, and how the condition is affecting your life.
• Nasal Endoscopy: This is a crucial in-clinic procedure. I use a very thin, flexible camera with a light to look directly inside your nasal passages and at the sinus openings. It sounds uncomfortable, but it is quick and well-tolerated. We use a topical anaesthetic spray first, so you will only feel a sense of pressure. This gives us a real-time view of any inflammation, polyps, or structural issues.
• CT Scan: If we are considering surgery, a CT scan of your sinuses is the gold standard. It provides a detailed map of your unique sinus anatomy. It also shows the extent of the disease, allowing for precise surgical planning.
• Allergy Testing: If allergies are a suspected trigger, we can arrange testing to identify the specific culprits.

Optimising Non-Surgical Treatments

Before we consider surgery, the goal is always to maximise medical therapies. A truly optimised medical plan involves more than just an occasional spray. It includes:

• Nasal Corticosteroid Sprays: These are the cornerstone of treatment, used daily to reduce inflammation.
• Saline Irrigation: High-volume rinsing with a sinus rinse bottle is essential. It physically washes away mucus, allergens, and inflammatory debris. It also helps your nasal sprays work more effectively.
• Targeted Oral Medications: Depending on the cause, this might include a long-term, low-dose antibiotic for its anti-inflammatory effects or short courses of oral steroids to manage severe flare-ups.

What are Indications for Surgery

Surgery is not usually the first resort for most cases of chronic rhinosinusitis. It is a considered option when you have given optimised medical therapy a fair trial for at least three months, and your symptoms still severely impact your quality of life. Surgery up front may be considered for sinusitis with suspicious lesions in the nasal cavity, presentations with complications, severe disease or other patient or disease factors.

Surgery is typically recommended if you have:

• Failed appropriate medical therapy.
• Nasal polyps that are physically blocking your nose.
• Anatomical blockages like a deviated septum that prevent your sinuses from draining.
• Recurrent acute infections or complications related to your CRS.

What to Expect with Functional Endoscopic Sinus Surgery (FESS)

The modern standard for sinus surgery is Functional Endoscopic Sinus Surgery, or FESS. This is a minimally invasive procedure performed entirely through the nostrils, with no external incisions. Using a high-definition endoscope for a magnified view, the surgery focuses on carefully removing blockages and opening the natural drainage pathways of your sinuses. The extent of the surgery is tailored precisely to your anatomy and what we see on your CT scan.

Potential Complications and How They are Minimised

While sinus surgery is a very safe procedure, any surgery has risks. Minor issues like minor bleeding or crusting are common and manageable.

Serious complications are rare. They occur in less than 1% of cases and can include bleeding that requires intervention or injury to the structures around the sinuses, like the eye or brain. To maximise safety, Dr Nguyen uses advanced image-guided surgery technology. This system acts like a GPS for your sinuses. It allows him to navigate your unique anatomy with the highest level of precision.

Take Control of Your Chronic Sinusitis

If you have been struggling with chronic sinus problems and feel like you have hit a wall with standard treatments, it is time to explore advanced options. A thorough assessment is the first step toward breathing easier and reclaiming your quality of life.

If you are ready to find a lasting solution, schedule a consultation today to discuss your symptoms and create a personalised treatment plan.