Chronic sinusitis: 10.9% of Europeans report it, 3% to 6% are confirmed

How many people are affected, and how many really are

This is the only specialty in this file where the prevalence figure depends entirely on the definition used. That gap is not a statistical detail, it is the subject.

Requiring objective confirmation divides prevalence by three to five. In other words, between half and four fifths of the people who believe they have chronic sinusitis do not meet the criteria for the disease. What they have is real, but it is not necessarily this, and the treatment is therefore not the same.

The GA2LEN study, still the European reference, covered 57,128 respondents across 19 centres in 12 countries. It also found one clear risk factor: smoking, with an odds ratio of 1.7 (95% CI 1.6 to 1.9).

The abnormal scan trap

This is the central mechanism of overdiagnosis, and it comes down to two figures.

The Norwegian HUNT study scanned 982 adults aged 50 to 66, drawn at random from a public health survey, with no medical indication. Two thirds had sinus opacification. One third had polyps or retention cysts.

The consequence is direct: an abnormal sinus scan in someone with a headache does not show that the headache comes from the sinuses. It shows that this person resembles two thirds of the population. That is why the 2015 American guideline advises against imaging in acute rhinosinusitis meeting diagnostic criteria: it adds doubt, not certainty.

What medical treatment achieves, and what it does not

Before any surgical discussion, two treatments are supposed to have been run properly. Here is what the Cochrane reviews say about them, without a favourable rounding.

Two things deserve to be said plainly. First, the effect of nasal steroids is real and modest: 0.26 points on a scale that runs to 3. Second, the evidence base for saline irrigation amounts to two randomised trials and 116 participants in total, with 23% adverse effects in the irrigation arm. These are two treatments rightly recommended, on evidence thinner than their popularity suggests.

What surgery delivers, measured

The scale used everywhere is the SNOT-22, from 0 to 110, where a high score means substantial burden. Its minimal clinically important difference was set at 8.9 points on a prospective cohort of 3,128 patients operated in 87 UK hospitals.

Three readings follow. Surgery works, and MACRO demonstrates it cleanly, on 514 patients randomised into three arms, all on background medical treatment. Prolonged antibiotics, meanwhile, do no better than placebo, which ends a widespread practice.

But improvement is not cure. In the English national audit, the mean SNOT-22 at five years remains 28.2, about 14 points better than baseline, and that level has been stable since month three. Surgery moves the dial once, it does not move it twice.

Finally, one operated patient in five is operated again within five years, and one in four where there are polyps. That is not a failure rate, it is the nature of the disease: it is inflammatory and chronic, surgery opens the cavities, it does not switch off the inflammation.

Biologics, what they change in nasal polyposis

An 82.6% reduction in the need for surgery is a substantial result, and it is the figure that changed the discussion over ten years. It comes from a pooled analysis of the two SINUS trials, in severe patients, on a background nasal steroid.

Two caveats frame it. The first is access: in the United Kingdom, NICE restricts dupilumab to adults with a SNOT-22 of at least 50 and at least one previous sinus operation, inadequately controlled despite systemic corticosteroids or surgery. The second is cost. European prices are covered by confidential agreements and are not published; the only real spending data available are American and concern privately insured patients in 2022. We do not transpose them to Europe, and we do not compare prices.

Antibiotics, the commonest prescription and the least useful

Sinusitis is the leading reason for antibiotic prescribing in the United States, at 56 prescriptions per 1,000 population per year. Across all acute respiratory conditions, 221 prescriptions per 1,000 population are issued and only 111 are estimated appropriate, roughly half of them unnecessary (Fleming-Dutra, JAMA, 2016).

The 2018 Cochrane review, 15 trials and 3,057 participants, gives the order of magnitude of the benefit in acute rhinosinusitis: without antibiotics, 46% of patients are cured at one week and 64% at fourteen days. Antibiotics add 5 to 11 cures per 100 patients, and 13 more patients per 100 experience an adverse effect. The authors’ conclusion is unambiguous: there is no place for antibiotics in uncomplicated acute rhinosinusitis.

What the studies do not allow anyone to claim

The revision surgery rate at ten years is not reliably established. The only prospective figure at about eleven years, 17% overall and 25% with polyps, rests on 59 patients. The robust figure stops at five years, at 19.1% across 1,459 respondents.

The available work absence data are American and cover 27 patients. We do not quote them as a European order of magnitude, and no comparable European source exists.

The often-repeated quality of life comparison, according to which chronic sinusitis weighs more heavily than heart failure or angina, comes from a 1995 study using the generic SF-36 scale on the bodily pain and social functioning dimensions. It does not use the SNOT-22, which cannot be administered to cardiac patients. The two scales should not be merged.

Finally, the proportion of chronic rhinosinusitis treated with antibiotics without indication is not known. The figures above concern the acute form and sinusitis in the broad sense.

What delay adds

In England, 594,546 people were waiting for ENT care in June 2026, and only 59.0% were treated within 18 weeks. In Ireland, on 30 July 2026, 46,124 patients were waiting for a first ENT outpatient appointment, 5,277 of them for more than twelve months.

In this specialty the effect of delay is particular. The disease is not dangerous, it is wearing, and the MACRO trial showed that well-conducted medical treatment does part of the work. What delay costs is not a lost chance, it is time spent with a high SNOT-22 score, and one more antibiotic prescription at every flare.

In practice, if this concerns you

Three questions decide, in this order. Is the diagnosis confirmed by nasal endoscopy, not by a scan alone. Has background medical treatment been run properly, daily nasal steroid and irrigation, for long enough. Are there polyps, because that is what opens the discussion on biologics.

Noria Health arranges a full ENT work-up in Brussels within 24 to 48 hours: nasal endoscopy, SNOT-22 scoring, and imaging only where the endoscopy and examination justify it. The report is issued within 24 hours, and surgery is considered only around day 10 if it is needed, with structured follow-up at D14, D30 and D90. What Noria Health does not do: operate on the strength of a scan. Two thirds of adults have an abnormal sinus image, and the vast majority of them have nothing that needs operating.

Further reading

• Hearing: 430 million people need hearing care
• Snoring and sleep apnoea, a cardiovascular risk worth testing for
• Tinnitus: 14.4% of adults worldwide

Sources

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See also: all our articles on ENT.

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