Chronic Sinusitis in Black Adults: Care You Are Owed

Chronic rhinosinusitis, often called chronic sinusitis or CRS, is inflammation of the sinuses and nasal lining that lasts at least 12 weeks. The hallmark symptoms are nasal congestion or blockage, facial pain or pressure, thick drainage front or back, and a reduced or absent sense of smell. You need two or more of these, plus a doctor seeing inflammation on exam or a scan, to make the diagnosis. This is not a long cold. CRS lowers daily quality of life on par with chronic conditions like diabetes and heart failure, and it affects roughly 12 percent of U.S. adults.

Acute sinusitis lasts under four weeks and usually follows a cold. Most acute cases are viral and clear on their own. Chronic sinusitis runs 12 weeks or longer and is driven by ongoing inflammation, not a one-time infection. That difference changes everything about treatment.

Doctors split chronic sinusitis into two types: with nasal polyps and without. Polyps are soft, noncancerous growths in the nasal lining that block airflow and crush your sense of smell. Polyp disease tends to be more stubborn and is the form most linked to asthma. Your clinician should look in your nose, often with a thin scope, to confirm whether polyps are present, because the answer steers which medicines and procedures will help.

The nose, sinuses, and lungs share one continuous lining, so inflammation in one tends to show up in the others. Clinicians call this the unified airway. That is why allergic rhinitis and asthma travel with chronic sinusitis so often. Among people who have CRS with nasal polyps, somewhere between 30 and 70 percent also have asthma, and polyps grow more common as asthma gets more severe.

The practical lesson is that you cannot treat the sinuses in isolation. If your allergies are uncontrolled or your asthma is flaring, your sinuses will keep flaring too. Getting allergy testing, using allergy medication consistently, and keeping asthma well controlled are part of sinus treatment, not separate from it. If you are managing childhood asthma in your family, the same triggers and control principles apply, which we cover in our guide to asthma triggers and control in Black children.

Most chronic sinusitis is not a bacterial infection, so antibiotics usually do not fix it. The 2025 adult sinusitis guideline from the American Academy of Otolaryngology advises clinicians not to routinely prescribe antibiotics for chronic sinusitis. They are reserved for a true acute bacterial flare, and even then only when there is purulent discharge on exam. Repeated antibiotic courses for chronic symptoms expose you to side effects and resistance without treating the underlying inflammation.

The evidence-based core is simple and you can start most of it today:

• Saline nasal irrigation. Rinsing with a saltwater solution, using distilled or boiled-then-cooled water, clears mucus and inflammatory debris. Guidelines recommend it as a first-line measure.
• Intranasal corticosteroid spray. A daily steroid nasal spray reduces the inflammation that causes the symptoms. Used correctly and consistently, it is the workhorse of CRS care, not a quick fix.
• Treat the allergies and asthma. Allergy control and asthma control directly lower sinus inflammation through the shared airway.

When rinses, steroid sprays, and allergy or asthma control are not enough, two escalation paths exist. Endoscopic sinus surgery opens blocked sinuses and removes polyps so that rinses and sprays can reach the lining. Biologic medications are injectable drugs that calm the type of inflammation behind polyp disease. In two large randomized trials, the biologic dupilumab shrank nasal polyps and improved congestion and sense of smell compared with placebo, and it also improves asthma in people who have both. Biologics are reserved for severe polyp disease, usually after surgery or when surgery is not the right option.

The gap is documented. A 2025 systematic review in OTO Open found that non-Hispanic Black patients with chronic sinusitis present with more severe disease at their first specialist visit, report worse symptom scores, and yet receive fewer follow-up appointments and less surgical or antibiotic treatment than white patients. They are also more likely to delay care because of cost.

Access drives much of it. A New York study of people undergoing sinus surgery found that those treated at a public hospital, who were far more likely to be non-white, had symptoms for longer before surgery, were more likely to have polyps, and waited longer for the operation than patients at the private hospital. Insurance status tracks with more severe sinus tissue inflammation in other studies too. Black and lower-income patients are also referred to allergy and immunology specialists less often, which is the gateway to advanced treatments like biologics. None of this reflects a different disease. It reflects a different path through the system.

What this means for you: weeks of congestion and facial pressure are not something to wait out. If a clinician keeps handing you antibiotic courses without examining your nose or discussing a steroid spray, saline rinses, allergy workup, or a referral, that is a signal to push for an ear, nose, and throat or allergy referral. Bring your symptom timeline and ask directly whether polyps have been ruled in or out.

Start with a primary care visit and bring the specifics: how many weeks of symptoms, which symptoms, what you have already tried, and your allergy and asthma history. Ask for a steroid nasal spray and saline rinse plan, an allergy evaluation if it has not been done, and a referral to ENT or allergy if you are past 12 weeks or have polyps. If finding a clinician who listens has been the hard part, you can find a Black ENT or allergist in our provider directory who serves Black patients and takes your concerns seriously.