What is Chronic Rhinosinusitis?
Chronic rhinosinusitis (CRS) is a medical condition in which the spaces behind your nose, cheeks, and forehead become inflamed for 12 weeks or longer. For the condition to be considered chronic, the swelling lasts for at least 12 weeks (about three months), even if you are taking medicine for it.
At a Glance: Chronic Rhinosinusitis (CRS)
- CRS defined: Inflammation of the nasal passages and sinuses persist for 12 weeks or longer, even with medical care.
- Primary triggers: CRS is often connected to a family history of the condition. It can be caused by allergens, pollution, smoke and dust.
- Coexisting conditions: CRS frequently presents alongside asthma and allergies.
- CRS treatment: CRS may require daily commitment to medications, nasal rinses, and specialized allergy care.
- Beyond the nose: Long-term inflammation of nasal passages can result in systemic issues like fatigue. It can also impact mental health.
- Prevalence: CRS is one of the most common chronic diseases in the United States. It affects all age groups.
- Keys to management: Success often depends on a consistent treatment plan and a strong partnership with a healthcare provider.
CRS affects approximately 6-12% of adults in the United States. This makes CRS one of the most common chronic inflammatory conditions affecting the airways. It can lead to significant healthcare costs.
CRS can take a significant toll on daily life. People with CRS may struggle with a constant “leaky faucet” of nasal drainage, congestion, and intense sinus and facial pressure. This can escalate into severe migraines and fatigue. Some may feel self-conscious at social gatherings because of the stigma associated with “sounding sick.”
With the right diagnosis and treatment plan, many people with CRS can achieve better symptom control and improve their quality of life.
What is the Difference Between Chronic Rhinosinusitis and Chronic Sinusitis?
You might hear the term “chronic sinusitis” used to describe your long-lasting sinus problems. And you may find it easier to explain your symptoms to family, friends and co-workers as a “sinus problem” or “sinusitis.”
In general, these terms refer to the same thing. Healthcare professionals now prefer the more accurate term “chronic rhinosinusitis,” or CRS for short.
Why is the newer term better? The passages in your nose and your sinuses (air-filled spaces behind your nose) are connected. They work together as one system. When inflammation occurs in the sinuses, it almost always affects the nose. And when inflammation happens in the nose, it usually affects the sinuses. So the term “chronic rhinosinusitis” is more precise because it identifies both the nasal passages and the sinuses involved in long-term inflammation.
When healthcare providers use the term “chronic rhinosinusitis,” they are describing what is happening in your whole nasal and sinus system, rather than just focusing on the sinuses alone.
Who is at risk for chronic rhinosinusitis?
CRS can affect anyone, but certain factors increase the risk.
Structural differences. Having a deviated septum, narrow sinus passages, or previous nasal surgery may increase risk.
Age. Adults are more likely to be affected than children, especially those between 30-60 years old.
Environmental exposures. Frequent exposure to pollen, mold, air pollution, cigarette smoke, or workplace irritants can increase risk.
Allergies or asthma. People with a history of allergies or asthma are more likely to develop CRS.
Immune system differences. Problems can occur when the immune system reacts too strongly to triggers. This can lead to your body not being able to fight infections easily.
Chronic Rhinosinusitis vs. Sinus Infection
Many people use the terms “chronic rhinosinusitis” and “sinus infection” interchangeably. However, they are not the same condition. Understanding the differences can help you get the right diagnosis, treatment, and long-term symptom relief.
| Feature | Acute | Chronic |
|---|---|---|
| Severity | Symptoms are often more intense | Symptoms are milder but persistent |
| Cause | Often viral or bacterial infection | Often due to structural issues, allergies, or chronic inflammation |
| Treatment | Short-term (e.g., rest, antibiotics) | Long-term management or surgery |
| Duration | Less than 4 weeks | 12 weeks or longer |
Symptoms of acute sinusitis often resolve quickly. CRS symptoms typically persist and may worsen over time.
What are the Types of Chronic Rhinosinusitis?
Healthcare professionals group CRS into two distinct types.
- Chronic rhinosinusitis (no nasal polyps)
- Chronic rhinosinusitis with nasal polyps (CRSwNP)
CRS involves primarily sinus symptoms. People with CRS may have nasal blockage or discharge, facial pain or pressure, fatigue and a reduced sense of smell and taste.
CRSwNP involves sinus symptoms but also has nasal polyps. These are soft, benign, painless, teardrop-shaped growths inside the nose. The polyps block airflow and drainage. The condition is often linked to Type 2 inflammation and asthma.
Eosinophilic sinusitis is sometimes linked to CRS and CRSwNP, but it’s a separate condition. It involves the presence of eosinophils, a type of white blood cell. These cells help protect the body, but sometimes they are overactive and build up in the nose and sinuses. This can cause swelling, congestion, and nasal polyps.
Two subtypes of CRSwNP are:
- Aspirin-Exacerbated Respiratory Disease (AERD) is a chronic disease involving asthma, recurrent nasal polyps, and sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). AERD develops in adulthood, usually between the ages of 20 and 50. Many people with the condition have chronic sinus problems and a loss of sense of smell.
- Allergic Fungal Rhinosinusitis (AFRS) involves an increase in sinus inflammation due to mold or fungus in the environment. When people with AFRS breathe in the tiny particles of mold of fungus, their immune system overreacts. It creates a very thick, sticky kind of mucus that can get trapped in sinus cavities. Over time, the mucus can act like a plug, causing pressure to build up. This can make it very hard for the sinuses to drain.
What are the Symptoms of Chronic Rhinosinusitis?
Understanding CRS symptoms and your triggers is the first step toward relief. Usually, it is a mix of your environment and your body’s natural makeup.
The four main symptoms of chronic rhinosinusitis
- Nasal obstruction or blockage. This is a feeling of being “stuffed up.” It can be hard to breathe through your nose, which might force you to breathe through your mouth.
- Nasal discharge. You may have a runny nose with thick mucus. This mucus can also drip down the back of your throat. This is postnasal drip, and it can cause a cough or a sore throat.
- Facial pain and pressure. You might feel a dull ache or heavy pressure in your cheeks, your forehead, or around your eyes. Some people even feel this pain in their teeth.
- Reduced sense of smell and taste. You may find it hard to smell things like food, flowers, or smoke. Because smell and taste are linked, your food might also seem flavorless.
Additional symptoms of CRS may include constant fatigue, headache (migraines), ear pain and poor concentration. Some patients report bad breath, or a sour smell to their breath.
Ear pressure and Eustachian tube symptoms with CRS
Chronic rhinosinusitis, especially CRS without nasal polyps, can sometimes affect the ears. Swelling and thick mucus in the back of the nose and sinuses can block the Eustachian tubes. These small tubes connect your ears to the back of your nose and help keep pressure balanced.
When the tube does not function properly, people may experience:
- Ear pressure or fullness
- Popping or crackling sounds
- Muffled hearing
- A feeling of fluid in the ears
These symptoms are often mistaken for ear infections. However, they are actually caused by persistent nasal and sinus inflammation. Treating the underlying sinus inflammation often improves Eustachian tube-related symptoms.
How chronic rhinosinusitis affects your whole body
Chronic rhinosinusitis does not just stay in your nose and sinuses. Because your body is working hard to fight the swelling, you may feel other symptoms, such as:
- Tiredness. Many people with CRS feel very worn out or exhausted.
- Sleep problems. Being stuffed up makes it hard to get a good night’s rest.
- Inability to focus. You might find it difficult to concentrate or think clearly.
- Headaches. Sinus pressure can lead to frequent headaches, including migraines.
Common triggers
Triggers are things that make your symptoms flare up or get worse. People with CRS have different triggers, but some of the most common ones include:
- Allergies. Dust mites, pet dander, pollen, and mold can cause more swelling in your nasal cavity.
- Air pollution and smoke. Cigarette smoke or dirty air can irritate the lining of your sinuses.
- Infections. Getting a common cold, the flu or a bacterial infection can make your chronic symptoms much worse.
- Dry air. Very dry air can dry out the inside of your nose. This makes it harder for your sinuses to clear out mucus.
If you have had these symptoms for more than three months, talk to a healthcare provider. Avoiding your triggers and following a treatment plan can help you feel much better.
Practical tips to help you manage CRS
- Nasal hygiene. Saline sprays or rinses can help remove allergens and mucus daily.
- Reduce allergen exposure (if allergies are causing symptoms). Limit time outside when pollen counts are high. Address sources of moisture by fixing leaks and cleaning areas prone to mold growth. Regularly wash your bedding, vacuum, and filter indoor air to reduce dust mites and pet dander.
- Avoid smoking and pollutants. Limit exposure to cigarette smoke and harsh chemicals.
- Stay hydrated. Drinking enough water can help thin mucus.
What Causes Chronic Rhinosinusitis?
CRS is usually caused by ongoing inflammation and not a single infection. In many people, the lining of the nose and sinuses becomes stuck in an inflamed state. This blocks normal mucus drainage and allows symptoms to persist.
Common causes include:
- Chronic inflammation: An overactive immune response that keeps the nasal lining swollen.
- Allergies: Long-term exposure to allergens can contribute to sinus symptoms.
- Environmental irritants: Air pollution, smoke, chemicals, or workplace exposures.
- Structural problems: A deviated septum or narrow sinus openings that prevent proper drainage.
- Chronic infections: Frequent viral infections can damage the sinus lining over time.
- Immune system: It’s not working properly (an immunodeficiency). For example, it may under-produce antibodies to fight an infection.
- Biofilms: Communities of bacteria that stick to sinus surfaces and resist treatment.
In many cases, CRS develops from a combination of factors, not just one cause.
The role of the environment and genetics
Your surroundings play a huge role. Air pollution, cigarette smoke and allergens can damage the lining of your nose. This damage stops your nose’s natural cleaning system from working correctly. It can lead to infection and swelling.
However, not everyone reacts the same way. Your genetics (traits you inherited from your parents) can decide how your body fights back. Some people may have genes that make their immune system react more strongly to pollen or mold.
How is Chronic Rhinosinusitis Diagnosed?
Diagnosing CRS involves more than just describing symptoms. A healthcare provider looks at how long symptoms last, what they look like, and what’s happening inside the nose and sinuses.
Symptom history
To diagnose CRS, symptoms must last 12 weeks or longer. Healthcare providers look for at least two of the following:
- Nasal congestion or blockage
- Nasal drainage (runny nose or post-nasal drip)
- Facial pain or pressure
- Reduced or lost sense of smell
Physical examination
Your healthcare provider will examine the inside of your nose to look for swelling, mucus or nasal polyps.
Nasal endoscopy
In some cases, a thin camera is used to look deeper into the nasal passages and sinus openings. This can help identify inflammation, nasal polyposis (polyps), or drainage problems.
Imaging
A CT scan of the sinuses may be ordered if symptoms are severe or not improving. CT scans show sinus blockage and inflammation and help guide treatment decisions.
Allergy or immune testing
If allergies or immune conditions are suspected, testing may help identify triggers. Allergies and immune conditions can worsen sinus symptoms.
Treatment and Management of Chronic Rhinosinusitis
Treating CRS focuses on reducing inflammation. This includes preventing flare-ups and improving drainage. Most people need ongoing daily care, not short-term treatment.
Common treatments
- Saline nasal rinses: Wash out mucus, allergens, and irritants.
- Nasal corticosteroid sprays: Reduce inflammation inside the nose.
- Oral corticosteroids: Used short-term for severe inflammation or nasal polyps. (These pills come with a risk of adverse side effects, so they should be taken sparingly and as prescribed by your doctor.)
- Antibiotics: Only used when a bacterial infection is confirmed or strongly suspected.
- Allergy treatments: Nasal corticosteroid sprays, antihistamines, avoidance strategies, or immunotherapy.
- Biologic medications: Used for moderate to severe CRS with nasal polyps driven by Type 2 inflammation.
- Sinus surgery: Considered when medical treatment does not provide relief.
Medication Safety Tips
- Nasal corticosteroids: Usually safe, but they can cause nose dryness or irritation. Follow directions carefully.
- Oral corticosteroids: Effective for a flare-up of symptoms. They can have side effects if used long-term. These include weight gain, bone thinning, mood changes, and increased blood pressure.
- Biologics: Target specific inflammation pathways. May cause injection-site soreness as a side effect.
- Antibiotics: Only use if prescribed, mostly for CRS impacted by a bacterial infection. Unnecessary use can cause side effects and antibiotic resistance.
Always discuss risks and benefits of medications with your healthcare provider. Keep in mind your treatment plan may change over time, depending on symptoms, triggers, and your response to therapy.
Factors that can influence how well treatment works
| Factor | Why it Matters |
|---|---|
| Allergies | Exposure to allergens like pollen or mold can keep inflammation going. |
| Comorbidities | Related conditions like asthma or sleep apnea can make CRS worse. Treating all conditions together leads to better results. |
| Mental Health | Anxiety and depression can make pain feel worse and make it harder to stick to a medication schedule. |
| Genetics | Your family history can help indicate your level of inflammation, as well as how your body responds to certain medications. |
Sticking to your CRS treatment plan
The most important factor in feeling better from CRS? Taking your medicine exactly as prescribed. If you skip doses or stop treatment early, the inflammation often comes back.
- Consistency is key. Daily sprays or nasal saline irrigation work best when used every day.
- Mental Health. Feeling down or anxious can make it hard to keep up with your routine. If you are struggling with motivation, talk to your doctor.
The role of allergy treatments
Are allergies triggering your CRS? Treatment with a corticosteroid nasal spray or other allergy medicine can address your allergies – and sometimes clear up sinus symptoms.
Your healthcare provider may suggest allergen immunotherapy. This approach retrains your immune system to build tolerance and stop overreacting to allergic triggers.
- SCIT (subcutaneous immunotherapy): Allergy shots given in a clinic.
- SLIT (sublingual immunotherapy): Drops or tablets placed under the tongue at home.
Both methods help calm the immune system. Allergen immunotherapy can help reduce your allergy symptoms and improve your overall energy and health.
CRS is a complex condition involving your environment, immune system, and overall health. When you understand its complexity, you can work more effectively with your doctor to find long-term relief.
When to Seek Urgent Medical Care
See your doctor or go to the hospital, ER or urgent care clinic if you experience these symptoms:
- High fever
- Swelling around eyes
- Vision changes
- Severe headache
- Confusion
These symptoms may indicate a serious complication that requires immediate evaluation.
Coexisting Conditions with Chronic Rhinosinusitis
Healthcare providers now take a whole-person approach to your health, looking beyond the sinuses. They check for comorbidities – other conditions you might have at the same time as CRS.
These include:
- Asthma: Inflammation in the sinuses can worsen asthma symptoms. Treating CRS often improves asthma control.
- Allergies (allergic rhinitis): Ongoing allergic inflammation.
- CRSwNP: A type of CRS. It’s marked by soft growths in the nasal passages caused by ongoing inflammation.
- Obstructive sleep apnea: Nasal blockage can make breathing during sleep more difficult.
- AERD:A condition involving asthma, nasal polyps, and reactions to aspirin or NSAIDs.
- GERD (Gastroesophageal Reflux Disease): Acid reflux can irritate the upper airway and worsen nasal inflammation.
CRS rarely exists in a vacuum. Treating related conditions is vital for managing CRS symptoms.
Quick facts on comorbidities and chronic rhinosinusitis
Coexisting conditions often overlap with CRS. This may influence symptom severity and treatment response.
- People with CRS often have worsening of other health conditions. Asthma and allergic rhinitis are common comorbidities. CRS can worsen symptoms, and vice versa.
- CRS can be influenced by systemic diseases, including cystic fibrosis and immunodeficiency disorders.
- People with CRS and asthma may experience a higher rate of flare-ups. They may have more severe symptoms.
- Dental infections or tooth infections can lead to CRS. This can occur when the infection spreads from the upper teeth to the sinuses.
How Does Chronic Rhinosinusitis Affect Mental Health?
Ongoing CRS inflammation and symptoms can have a significant impact on your mental and emotional well-being. This can happen for a couple of reasons:
- Physical stress. CRS often causes chronic pain and poor sleep. When your body is tired and hurting, your brain cannot work at its best.
- Emotional stress. Dealing with a long-term illness can leave you frustrated, drained, and less able to concentrate or remember things. It can also lead to depression.
Some people become self-conscious about frequent coughing, throat clearing, or “sounding sick.” They may feel like they are a “downer” for other people, leading them to avoid social situations.
Healthcare providers for CRS may screen for anxiety and depression. They may ask how CRS is affecting sleep, work performance, relationships, or overall quality of life.
By reducing CRS inflammation and gaining control of symptoms, you can improve your sleep, clear up your thinking, and boost your mood and energy levels.
10 ways to support your mental health after a CRS diagnosis
Seek professional mental health support. Consult a therapist or counselor to address symptoms of depression, anxiety, or chronic stress.
Focus on good sleep hygiene. Improve sleep quality to reduce fatigue, enhance cognitive function, and stabilize mood.
Follow your CRS treatment plan. When you control CRS symptoms, you can improve sleep, energy levels, and mood.
Actively manage chronic pain and discomfort. Address persistent facial pain, pressure, or headaches. This can lessen mental health burden and improve concentration.
Engage in shared decision-making with your healthcare team. Participate in treatment choices to foster a sense of control over your health.
Understand the interconnections of your conditions. Learn how CRS relates to comorbidities like asthma or allergies. This can help enhance your treatment plan.
Manage allergies effectively. Reduce allergic inflammation to ease symptoms. It can also improve sleep, and positively impact mood and well-being.
Practice stress reduction techniques. Use strategies like mindfulness or relaxation to cope.
Maintain regular physical activity. Engage in regular exercise to enhance physical and mental well-being. It can also improve your mood.
Connect with support systems. Engage with family, friends, or support groups to combat feelings of isolation. Share experiences, too.
Questions & Answers (Q&A) About Chronic Rhinosinusitis
Here are some frequently asked questions about CRS. If you have a question that is not answered here and you’d like to see covered, please email our editor.
July 2026
Reviewed by:
Anju Peters, MD, is Professor of Medicine and Otolaryngology-Head & Neck Surgery and Director of Clinical Research, Division of Allergy-Immunology, at Northwestern University Feinberg School of Medicine in Chicago. She is a board-certified allergist and immunologist who practices at the Sinus and Allergy Center of Northwestern University. Her specific interest is in treating chronic rhinosinusitis patients with and without nasal polyps and associated conditions of asthma and immunodeficiencies.
