Surgery is generally considered a last option for those suffering from chronic nasal blockages or persistent runny noses. However, it may prove to be more effective than the commonly prescribed antibiotics for this condition in certain circumstances.

Chronic sinusitis affects 9% of the global population. It arises when the sinuses—the cavities that produce mucus—become inflamed. Typical symptoms include nasal blockage or discharge, a diminished sense of smell, and facial pain lasting over 12 weeks. The specific cause is often unclear, although it can stem from viral infections or alterations in the nasal microbiome.

The primary treatment typically starts with anti-inflammatory nasal sprays and daily saline rinses. If symptoms persist, doctors may prescribe a three-month course of clarithromycin, utilized more for its anti-inflammatory effects than its antibacterial action, according to Carl Philpott from the University of East Anglia, UK.

As a last resort, patients may undergo surgery to enlarge their sinuses or to remove benign growths, such as polyps. This approach is needed in approximately 5% of cases. Nonetheless, no prior studies have directly contrasted the outcomes of surgery with those of antibiotics.

To address this gap, Philpott and his team enrolled over 500 adults with chronic sinusitis. Participants evaluated the severity of 22 symptoms, including facial pain and nasal congestion, averaging a score of 55 out of 110.

Participants were then randomly assigned to either a three-month regimen of clarithromycin, placebo pills, or surgical intervention. All were also instructed to use nasal sprays and conduct saline rinses.

Six months later, those on clarithromycin or placebo reported a symptom severity reduction of around 10 points compared to their baseline scores. According to Claire Hopkins from King’s College London, the improvement was noted in both the antibiotic and placebo groups, indicating it was likely due to nasal spraying and rinsing.

Conversely, the surgical group experienced a symptom improvement of approximately 30 points compared to their pre-surgery state, suggesting that such procedures should be prioritized over antibiotics, Hopkins believes.

However, there are significant factors to consider. Around 80% of the participants had nasal polyps and might have been at risk of contracting coronavirus during the study, as it was conducted amid the Covid-19 pandemic. Hopkins states that this type of inflammation often leads to polyps. More research is required to determine if the findings apply to those without polyps, who may experience different inflammation types.