Surgery, not antibiotics, might be the best way to treat chronic rhinosinusitis, a condition that leaves people with a permanently blocked or runny nose and a reduced sense of smell
By Carissa Wong
28 August 2025
The sinuses become inflamed in people with chronic sinusitis
Science Photo Library/Alamy
Surgery is typically a last resort for people with a chronically blocked or runny nose. But in some cases, it may actually work better than the antibiotics that are routinely prescribed to treat the condition.
Chronic sinusitis affects about 9 per cent of people worldwide and occurs when the mucus-producing cavities – sinuses – around the nose become inflamed. Common symptoms include a blocked or runny nose, a reduced sense of smell and facial pain, with these persisting for more than 12 weeks. The cause of the condition is usually unclear but may involve viral infections or a change to the nose microbiome.
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The first line of treatment involves anti-inflammatory nasal sprays and flushing saline solution through the nose daily. But if symptoms persist, doctors often prescribe a three-month course of the antibiotic clarithromycin. This is used for its anti-inflammatory properties rather than its bacteria-killing properties, says Carl Philpott at the University of East Anglia in the UK.
As a last resort, people can undergo surgery to widen the sinuses and remove any benign nasal growths, or polyps, which form and worsen symptoms in about 5 per cent of cases. Yet no prior study has directly compared surgery with antibiotics.
To fill this gap, Philpott and his colleagues recruited more than 500 adults with chronic rhinosinusitis. In surveys, the participants rated the severity of 22 symptoms, such as facial pain and how runny their nose was, with an average score of 55 out of 110.