Don’t Rush into Surgery for Chronic Sinusitis — Start with Medication and Lifestyle Adjustments

Q: Doctor, hello. I’m 41 years old and have been troubled and worried about my sinusitis symptoms.

Over the years, I’ve seen many doctors—both Chinese and Western—but the condition keeps recurring.

Back in 2019, I had severe nasal congestion and went to see a Western doctor. After many questions, the doctor diagnosed me with sinusitis.

I asked about the cause, and the doctor said it might be related to my working environment.

At that time, I worked as an accounts clerk for 15 years in a small windowless room filled with piles of paper files.

The doctor said prolonged exposure to paper dust could lead to sinusitis. He prescribed a nasal spray and oral medication.

Whenever the weather changed suddenly, I would develop flu-like symptoms that made me very uncomfortable.

By 2024, my nose became severely blocked again. I thought it was just due to the weather.

One day, while meeting a client with a friend, we talked about sinusitis. The client said his condition was so severe that he needed oxygen to sleep at night. That really frightened me.

When I got home, I checked my nose and found a small white lump blocking one side of the nasal passage. I went to see a doctor the next day.

The doctor said long-term use of nasal spray and oral medication could improve the condition and that surgery was unnecessary.

However, with recent changes in weather, my sinusitis relapsed again. The same white lump blocked my airway once more.

Several times in the middle of the night, I woke up suddenly feeling like I was suffocating. It was terrifying — I worried that one day I might stop breathing in my sleep.

The next day, I went back to the doctor, who said that if medication no longer worked, surgery might be necessary.

Therefore, I would like to ask:

1. Can sinusitis be treated without surgery?
2. Are there any effective ways to completely cure sinusitis?
3. Will long-term use of nasal sprays and oral medicine cause side effects?

I’m afraid of surgery — especially the sight of knives and blood. I hope the doctor can help me understand my condition better and suggest suitable treatment options. Thank you. — Chen, Otolaryngology (ENT)

Doctor’s Response:

I understand your pain and anxiety caused by chronic sinusitis. The feeling of “almost suffocating” is indeed frightening, and it’s completely natural to fear surgery. Let’s address your concerns one by one.

1. Can sinusitis be treated without surgery?

Yes. Chronic sinusitis can often be managed without surgery.

Surgery is usually the last resort—only considered when other treatments fail.

The main goal of non-surgical treatment is to reduce inflammation, clear the nasal passages, and prevent recurrence.

Common non-surgical treatments include:

• Nasal corticosteroid sprays: The mainstay of treatment. These sprays reduce swelling and inflammation, improving drainage and breathing.
• Saline nasal irrigation: Using a neti pot or squeeze bottle to flush the nasal passages helps clear mucus, allergens, and irritants — an easy and effective way to keep the nose clean.
• Oral medications: Short-term use of oral steroids can reduce severe inflammation, and antibiotics may be prescribed if bacterial infection is present. If the symptoms are allergy-related, antihistamines can help.
• Avoiding triggers: As your doctor mentioned, paper dust might be a trigger. It’s also important to avoid other irritants such as smoke, allergens, and strong chemicals that may worsen the condition.

Lifestyle and Environmental Adjustments:

• Humidity: Use a humidifier to keep indoor air moist, especially in dry environments, to prevent nasal dryness and blockage.
• Hydration: Drink plenty of water to help thin mucus.
• Elevate your head while sleeping: Using higher pillows helps drainage and may reduce the “choking” feeling you described.
• Steam inhalation: Inhaling steam or taking a hot shower can loosen mucus and relieve nasal congestion.

The “white lump” you mentioned may be an enlarged nasal turbinate — a common cause of nasal blockage among those with allergic rhinitis or chronic sinusitis.

Medication can shrink the turbinate, but it may grow back, which is why the doctor mentioned the possibility of surgery.

If surgery is required, I would recommend radiofrequency (RF) turbinate reduction.

This method is gentler than laser surgery because RF energy operates at about 60°C — much lower than the 400°C of laser procedures — so it doesn’t cause the same “burning” effect.

RF surgery results in minimal bleeding and usually doesn’t require nasal packing afterward.

In contrast, traditional turbinate removal involves more bleeding and painful nasal packing after surgery. RF reduction is much less invasive and better tolerated.

Are Long-Term Sprays and Oral Medications Safe?

The risk of side effects depends on the type of medication and how it’s used.

Nasal sprays (corticosteroids): Generally safe for long-term use since they are low-dose and act locally in the nasal cavity, causing minimal systemic effects.

Possible minor side effects include irritation, dryness, or mild nosebleeds. Always follow your doctor’s instructions.

Oral steroids: Usually prescribed short-term to control severe flare-ups. Long-term use may cause weight gain, high blood pressure, and osteoporosis.

Oral decongestants: Effective short-term, but long-term use may cause high blood pressure, palpitations, or insomnia.

Some nasal decongestant sprays, if overused, can cause “rebound congestion,” making symptoms worse.

Antibiotics: Prolonged or frequent use may lead to resistance and disrupt the body’s natural bacterial balance.

The most important thing is to work closely with your doctor to balance effective symptom control and minimal side effects.

When doctors suggest “long-term use,” they usually refer to nasal sprays, as these are much safer than oral medications for managing chronic sinusitis.

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