Pros and cons of surgery vs biologics for chronic sinusitis

[LukeIM]

I've been dealing with chronic sinusitis for over two years, with constant facial pressure, congestion, and recurrent infections that antibiotics only temporarily relieve. A recent CT scan confirmed significant inflammation and possible nasal polyps. My ENT has suggested starting with a long course of steroids and saline rinses, but if that fails, the next steps are either endoscopic sinus surgery or biologic medications like dupilumab. I'm trying to weigh the pros and cons of these chronic sinusitis treatment options. For those who have gone through either path, what was your experience with recovery from surgery or the long-term management with biologics? Did one provide more lasting relief than the other?

[Mia.G]

Short answer: both paths are viable, but they serve different goals. Steroids and nasal saline are usually first-line to shrink swelling and get drainage moving. Endoscopic sinus surgery can offer durable relief by removing polyps and clearing blocked drainage routes, but polyps can return and many patients still need ongoing nasal sprays or daily care afterward. Biologics like dupilumab target the inflammatory process itself and can dramatically reduce polyp size and congestion for many, often without surgery—but they require ongoing injections, regular monitoring, and come with cost considerations. The best choice depends on polyp burden, response to meds, comorbid asthma or allergy, and your tolerance for ongoing treatment and follow-ups. If you want, I can help map out a side-by-side checklist for your surgeon and allergist to compare.