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Chronic sinusitis (medically: chronic rhinosinusitis) is inflammation of the sinus lining lasting twelve weeks or more, not a stubborn cold that refuses to clear.
If your nose has been blocked for three months, your face still feels heavy after a course of antibiotics, or you have lost your sense of smell and not got it back, it may be appropriate to reassess whether further evaluation is needed. In Dr Gan's practice as an ENT specialist at Mount Elizabeth Novena Hospital, chronic sinusitis is one of the more commonly assessed conditions.
This guide is written for three groups of readers. The first is the patient who has been suffering quietly for months, often pushed to come in by a partner who can no longer sleep through the snoring or the constant nose-blowing. The second is the patient who has done their reading, knows their GP has done what a GP can do, and now wants to understand whether specialist review is the appropriate next step. The third is the patient who has already been through ENT treatment somewhere, sometimes including surgery, and whose symptoms have come back.
This guide walks through what chronic sinusitis is, when it is time to escalate from GP care to ENT specialist review, what an ENT consultation actually involves, the treatment options available in order from least to most invasive, and what is realistic to expect after surgery. It also discusses the limitations and uncertainties of treatment, which are important parts of informed decision-making.
The twelve-week threshold separates a lingering cold from a chronic condition that needs a different kind of treatment.
Not sure whether you need a specialist at all? See GP vs ENT Specialist Singapore: When to Escalate.
What Chronic Sinusitis Means, and Why the 12-Week Mark Matters
The sinuses are air-filled spaces inside the bones of the face that connect to the nasal passages through small openings. When the lining becomes inflamed and drainage pathways narrow, mucus clearance may be impaired and symptoms can become persistent. Acute sinusitis is usually the tail end of a viral cold and resolves within four weeks. Chronic rhinosinusitis is different in kind, not just degree.
The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020), which most ENT specialists in Singapore use as a working reference, defines chronic rhinosinusitis as nasal inflammation lasting twelve weeks or longer, with at least two of the following four cardinal symptoms: nasal blockage, nasal discharge (running forward or down the throat), facial pain or pressure, and reduced sense of smell.
Within that definition, two patterns matter clinically. The table below sets them side by side.
| Feature | CRSsNP (without polyps) | CRSwNP (with polyps) |
|---|---|---|
| Prevalence | More common pattern | Less common, often more severe |
| Hallmark symptoms | Facial pressure, post-nasal drip, blocked nose | Pronounced smell loss, persistent nasal obstruction |
| Polyps | Absent | Soft, non-cancerous swellings blocking sinus drainage |
| Associated conditions | Often isolated | Frequent overlap with asthma, aspirin sensitivity and type-2 inflammation |
| Typical management | Medical therapy works for many patients | Often combined medical and surgical; biologic therapy in selected cases |
Table 1. Chronic rhinosinusitis without polyps (CRSsNP) vs with polyps (CRSwNP). For more detail on polyp disease specifically, see our service page on nasal polyps.
Chronic Rhinosinusitis in Singapore: What the Evidence Says
A 2023 narrative review of chronic rhinosinusitis in Asia, led by researchers at the NUS Yong Loo Lin School of Medicine, reported that CRS prevalence across Asian populations ranges from 2.1% to 28.4%, broadly similar to Western populations but with notable differences in disease phenotype, including lower levels of certain type-2 inflammatory markers in some Asian cohorts compared with European and North American data.
across Asian populations
defining chronic disease
for diagnosis (EPOS 2020)
In practical terms for Singapore patients, this means two things. The condition is common enough to be a public-health-relevant problem, and the inflammatory biology of CRS here is not identical to what international guidelines describe by default. The clinical implication is that assessment and treatment may need to be individualised rather than relying solely on broad international patterns.
When Your Symptoms Have Crossed the Line
If two to three appropriately prescribed courses of treatment from your GP have not given lasting relief, an ENT specialist review may then be appropriate.
The most common question patients ask at first consultation is some version of: "Is my problem actually serious enough that I should be here?" Many patients who attend an ENT consultation have already experienced persistent or recurring symptoms affecting daily life. But for those still deciding, here is a practical framework.
There is also a quieter scenario worth acknowledging. If you have been told by a partner or family member that your sleep, your mood or your concentration has changed because of how you are breathing and feeling, take that seriously. Patients often discount what they have come to accept as normal. Family members or partners may sometimes notice these changes earlier than the patient does.
ENT Specialist or Rhinology Subspecialist: Which Is Appropriate?
ENT is a broad specialty. Rhinology is the subspecialty focused specifically on the nose, sinuses and anterior skull base. The most appropriate assessment pathway depends on the complexity of the problem.
Otolaryngology (ENT) covers the ear, the nose and sinuses, the throat and voice box and the head and neck more generally. An ENT specialist in Singapore is trained across that full spectrum. Within ENT, rhinology is the subspecialty focused on the nose, sinuses and the front part of the skull base. A rhinologist is an ENT specialist who has completed an additional fellowship in that subspecialty area.
For many straightforward sinus problems, assessment by a general ENT specialist is appropriate. The cases where subspecialty rhinology training is specifically relevant are these:
Revision Cases
Disease that has not responded to a first round of surgery, where the anatomy has already been altered.
Extensive Polyposis
Extensive nasal polyposis, particularly with asthma or aspirin-exacerbated respiratory disease.
Fungal Sinusitis
Fungal sinusitis, which behaves differently from bacterial disease and needs careful surgical clearance.
Skull Base Proximity
Sinus disease that sits close to the eye socket, the base of the skull or the optic nerve, plus patients focused on preserving natural nasal anatomy and function.
The table below sets out the practical differences in training, focus and typical case mix.
- Dr Gan Eng Cern completed his rhinology and skull base surgery fellowship at St Paul's Sinus Centre, University of British Columbia, Vancouver, Canada.
- The fellowship was funded by the Health Manpower Development Programme (HMDP) Award from the Ministry of Health, Singapore.
- Before entering private practice, Dr Gan served as Deputy Director of the Rhinology Service at Changi General Hospital (2013 to 2017).
- He is a Senior Clinical Lecturer at the NUS Yong Loo Lin School of Medicine and has published in peer-reviewed international ENT journals.
For broader guidance on choosing any ENT specialist in Singapore, see How to Choose an ENT Specialist in Singapore.
What to Expect at Your First Consultation
A focused 30 to 45 minute consultation built around three steps: history, nasal endoscopy and (where needed) CT imaging.
A consultation with Dr Gan typically runs between thirty and forty-five minutes, depending on the complexity of the history. The format is consistent.
Detailed History
Symptom duration, triggers, treatments tried, asthma/allergies, home and work environment
Nasal Endoscopy
Thin scope under topical decongestant and local anaesthetic spray to examine the lining and drainage
CT if Needed
Bony anatomy and disease extent, scored with the Lund-Mackay system where surgery is considered
Plan Agreed
Findings explained, options discussed; surgery decisions are not rushed in the same visit
First, Dr Gan takes a detailed history. This covers how long your symptoms have lasted, what makes them better or worse, what treatments you have tried and how you responded, whether you have asthma or allergies, and what your home and work environment is like. Clinical history often provides important diagnostic clues.
Second, the inside of the nose is examined. A thin, flexible or rigid nasal endoscope is used to look directly at the nasal passages, the drainage openings of the sinuses and the back of the nose. This is done in the clinic under topical decongestant and local anaesthetic spray. The examination looks at the appearance of the lining, whether there are polyps, where mucus is coming from and whether there are any anatomical issues such as a deviated septum.
Third, if the picture is not yet clear, or if surgery is being considered, a CT scan of the sinuses is arranged. CT shows the bony anatomy and the extent of disease in a way that endoscopy alone cannot. The findings are scored using a system called the Lund-Mackay score, which provides a structured radiological assessment of disease extent.
Where allergy is in the picture, allergy testing may also be arranged. Where biologic therapy is being considered, blood tests for markers of type-2 inflammation (such as IgE and eosinophil counts) help guide the decision.
At the end of the consultation, Dr Gan explains the findings, walks through the options and agrees a plan with the patient. The aim is for patients to leave with a clearer understanding of the likely diagnosis, what the next steps are and what to expect. If surgery is on the table, Dr Gan does not ask patients to make that decision in the same consultation; he would rather they go home, think it through and come back with questions.
- A concise symptom timeline: onset, how symptoms have changed, triggers, and how they affect sleep, work and daily function.
- All prior imaging: CT sinus scans, MRI if applicable, endoscopy images, in originals or encrypted digital copies.
- Surgical records: operation notes and histology reports from any prior ENT procedures.
- Medication history: current medications, intranasal steroid use, frequency and dose of antibiotic and oral steroid courses, and any biologic therapy trialled.
- Allergy and respiratory testing: skin prick tests, specific IgE (RAST), spirometry and sleep study results where relevant.
- Your written questions: outcomes you want, recovery expectations, constraints on time off work, alternatives to surgery.
The Treatment Ladder: How Dr Gan Approaches Chronic Sinusitis
Start with the least invasive treatment that has a reasonable chance of working, and only escalate when the clinical evidence indicates the need to.
Step 1: Optimised Medical Therapy
This forms the foundation of treatment, and some patients achieve satisfactory control without surgery.
- Large-volume saline nasal irrigation, used correctly, twice a day. Many patients may not previously have used large-volume saline irrigation techniques consistently or correctly.
- An intranasal corticosteroid spray, used daily, with the correct head position. Improvement is gradual and may take six to eight weeks to be obvious.
- Allergy control where allergy is contributing. This may involve antihistamines, allergen avoidance or in selected cases immunotherapy.
- A short course of oral steroids in selected situations, for example to shrink polyps before surgical planning or to settle a severe flare. These are not prescribed casually because of their wider side-effect profile.
- Culture-directed antibiotics where there is a documented bacterial infection, rather than repeated empirical courses.
Step 2: Advanced Medical Options
For patients with CRSwNP who do not respond adequately to standard medical therapy, biologic therapy targeting type-2 inflammation is a further option. These are injectable medications that require careful patient selection. They are an ongoing commitment in both time and cost. Selecting appropriate candidates and monitoring response requires subspecialty familiarity, particularly for patients with overlapping nasal polyposis and asthma. Specific products, indications and any reimbursement considerations are discussed in consultation.
Step 3: Surgery
Surgery is indicated when maximal medical therapy has not delivered enough relief, when structural narrowing contributes to impaired drainage, when polyps need to be removed to allow medications to reach the sinus lining, or in cases of complications such as fungal disease, mucocele or impending orbital involvement.
Most primary sinus surgery cases at Dr Gan's practice are day-surgery procedures. Post-operative care matters as much as the surgery itself: continued saline irrigation, topical steroid use and follow-up debridement appointments support the longer-term result of the surgery.
In general, initial healing is associated with some nasal congestion and crusting, and the inside of the nose continues to heal for several weeks beyond that. Return-to-work timing depends on the nature of the work and how a patient is healing, and is discussed at the post-operative review. Strenuous exercise and air travel are also reviewed at that visit.
FESS vs Balloon Sinuplasty
Two endoscopic approaches are commonly discussed. The right procedure depends on what your CT scan and endoscopy show.
| Feature | FESS | Balloon Sinuplasty |
|---|---|---|
| What it does | Opens the natural drainage pathways and removes diseased tissue | Dilates the sinus openings without removing tissue |
| Best suited to | The full spectrum of chronic rhinosinusitis, including polyp disease and fungal disease | A narrower group of patients with limited disease and no polyps |
| Tissue removal | Yes — diseased tissue and obstruction addressed directly | No — openings are widened rather than tissue excised |
| Recovery profile | Timing depends on the work and healing; reviewed at the post-operative visit | Timing depends on the work and healing; reviewed at the post-operative visit |
Table 3. FESS vs balloon sinuplasty. Recovery timing is individualised and confirmed at the post-operative review rather than fixed in advance.
When Previous Treatment Has Failed: Revision Sinus Surgery
A second operation is not always the right answer. Altered post-operative anatomy and mucosal scarring make revision planning fundamentally different from a first-time procedure.
A meaningful portion of Dr Gan's practice involves patients who have already had sinus surgery, sometimes more than once, and whose symptoms have returned. The consultation conversation is genuinely different. The first step is to review everything: the original operation notes if available, the previous CT scans, the post-operative course and what medical treatment has been tried since.
Patients in this situation are often highly informed about their condition and prior treatment history. That knowledge is taken seriously and built upon rather than starting from scratch.
The reasons sinus disease comes back after surgery are not always failures of the original procedure. They include:
- Underlying inflammation that was always going to need ongoing medical management, regardless of how well the surgery was done.
- Polyp regrowth in patients with the inflammatory phenotype that predisposes to it.
- Scarring or anatomical narrowing of the openings that were created.
- New disease in sinuses that were not addressed in the first procedure.
- Inadequate post-operative care, which is more common than people realise.
Where revision surgery is appropriate, the planning needs more care. Landmarks may have been removed or altered by the first operation, and image-guided navigation is more often warranted. The realistic goals also need to be discussed openly: revision surgery can improve symptoms and reduce reliance on medication, but it does not undo the underlying biology that caused the original problem.
If you are reading this section because it describes your situation, bringing prior records and imaging can help streamline the consultation. Operation notes from your previous surgeon, the pre-operative and post-operative imaging from the previous procedure, and a clear timeline of what medications you have used and how you responded will shorten the road considerably.
Sinus Symptoms That Will Not Settle?
Singapore's Environment and Your Sinuses
Year-round humidity and indoor allergen exposure mean environmental control is part of the prescription, not separate lifestyle advice.
Patients sometimes ask whether what they read about sinusitis in international sources really applies here. For the medicine, the answer is yes; the environmental side is genuinely different. The relevant local factors discussed with patients are sustained high indoor humidity (which favours dust mite proliferation and mould growth), dust mite exposure in mattresses, bedding and soft furnishings (a leading driver of allergic rhinitis that in turn perpetuates chronic sinusitis), recirculated air-conditioning (which can dry and irritate the nasal lining), and periodic transboundary haze (which acutely worsens symptoms in patients with existing inflammation).
The practical measures that tend to make the biggest difference for patients are:
- Encasing the mattress and pillows in dust mite-proof covers.
- Washing bedding weekly at a sufficiently high temperature, or sun-drying thoroughly.
- Reducing soft furnishings and carpets in the bedroom where possible.
- Using a HEPA-filtered air purifier sized appropriately to the room.
- Avoiding indoor plants in the bedroom and ventilating damp areas like bathrooms.
- During haze episodes, wearing an N95 mask outdoors and increasing the frequency of saline irrigation.
These are not substitutes for medical treatment. They are adjuncts. But in patients with allergy-driven sinusitis, they may influence how well medical treatment controls symptoms over time.
- Swelling around the eye, double vision or pain on eye movement (possible orbital involvement).
- A severe headache with confusion, neck stiffness or visual changes.
- High fever that is not settling with antibiotics after 72 hours.
- Recurrent heavy nosebleeds from one side, particularly with a blocked nose on the same side that has been worsening.
- Clear watery fluid leaking from one side of the nose after any head injury or prior sinus surgery (possible CSF leak: same-day review required).
If in doubt, present to the emergency department at Mount Elizabeth Novena Hospital or call the clinic directly.
Costs, Medisave and Insurance in Singapore
Medisave covers up to $3,600 for FESS as day surgery. Total bill range at private facilities is $17,767 to $34,335 based on MOH 2023 transacted bills.
limit (TOSP 5C)
hospital charge
for FESS as day surgery
Medisave
Medisave can be used for the surgical component of approved ENT procedures, subject to MOH-set withdrawal limits. For FESS, the Medisave surgical limit is $2,770 under TOSP Table 5C. Day surgery adds up to $830 for the daily hospital charge, bringing the potential Medisave total to $3,600 for FESS as day surgery. Routine outpatient consultations, allergy testing and biologic therapy are not Medisave-claimable.
Source: CPF MediSave Withdrawal Limits, live limits page (current as of May 2026).
Total Surgery Costs
Based on MOH published hospital bill size data (SM714S), the typical total bill for FESS at private facilities ranges from $17,767 to $34,335, depending on complexity, length of stay and the specific facility. This includes the surgeon's fee, anaesthesia, operating theatre charges, consumables and medications.
Source: MOH SM714S bill sizes (2023 transacted bills, inclusive of GST, 25th to 75th percentile) · Surgeon fees: MOH Fee Benchmarks, effective 1 January 2025.
Consultation Fee
A consultation with Dr Gan at Mount Elizabeth Novena Hospital is SGD $196.20 (inclusive of GST) for a consultation within 30 minutes. Diagnostic tests (nasal endoscopy, CT scans, allergy testing) are billed separately based on what is needed at the visit.
Integrated Shield Plans
Most Integrated Shield Plans cover medically necessary inpatient and day surgery costs subject to deductibles, co-insurance and exclusions.
- New riders sold from 1 April 2026 cannot fully cover the minimum IP deductibles set by MOH (S$1,500 to S$3,500 per policy year, depending on ward class).
- The annual minimum co-payment cap has been raised from S$3,000 to S$6,000 per year (excluding the minimum deductible). The minimum 5% co-payment requirement is unchanged.
- Existing riders purchased before 27 November 2025 generally continue under the previous framework until insurer-set transition, no later than the next policy renewal after 1 April 2028.
- Confirm the current status of your specific IP rider with your insurer, including any panel doctor or pre-authorisation requirements, before proceeding with a procedure.
The clinic can assist with insurance documentation and e-filing processes where applicable. See Billing & Payment.
Get a Written Estimate
Always request a written, itemised estimate before confirming any procedure. The clinic team can provide this and confirm your insurance panel status. For a full breakdown of ENT specialist consultation fees, diagnostic costs and all Medisave claim limits, see How Much Does an ENT Specialist Cost in Singapore?
Need Medical Advice from an ENT Specialist?
No referral is required. Whether you are seeking a diagnosis, treatment advice or a second opinion, Dr Gan provides specialist assessment and personalised treatment planning.
Contact UsQuestions Patients Should Ask Before Sinus Surgery
If a surgeon is recommending an operation, you should leave the consultation able to answer the following ten questions.
| # | Question to Ask |
|---|---|
| 1 | What exactly is the operation intended to achieve in my case, and what symptoms are most likely to improve? |
| 2 | What are the realistic limits of what surgery can do for my specific pattern of disease? |
| 3 | What is the risk profile, including the rarer but more serious complications? |
| 4 | How many of these procedures does the surgeon perform each year, and how many of those are revision cases? |
| 5 | Will image-guided navigation be used, and why or why not? |
| 6 | What is the post-operative care plan, including how many follow-up visits are anticipated? |
| 7 | What medications will I still need to take after surgery, and for how long? |
| 8 | What is the expected timeline for returning to work, exercise and air travel? |
| 9 | What is the total estimated cost, broken down by surgeon's fee, anaesthesia, hospital fee and follow-up? |
| 10 | What is the plan if symptoms recur in the future? |
Patients should feel comfortable asking these questions as part of informed decision-making, and should feel they have had sufficient opportunity to ask questions and understand the proposed plan.
Frequently Asked Questions
- Chronic sinusitis is inflammation of the sinus lining lasting twelve weeks or more, with two or more of: nasal blockage, nasal discharge, facial pressure or reduced sense of smell.
- An ENT review may be considered if symptoms persist beyond twelve weeks of guideline-directed therapy, you have had four or more sinus infections in a year, prior sinus surgery did not work, or imaging shows nasal polyps or complex anatomy. (Source: EPOS 2020)
- CRS prevalence across Asian populations ranges from 2.1% to 28.4%, similar to Western populations but with notable phenotypic differences. (Source: Chee J et al. Clin Otolaryngol 2023)
- For most straightforward sinus problems a general ENT specialist is appropriate. Rhinology subspecialty experience is most relevant for recurrent, polyp-related, fungal, complex anatomic, or revision cases.
- Treatment follows a stepped approach: saline irrigation and intranasal steroids first, allergy control where relevant, advanced medical options (including biologic therapy for CRSwNP) next, and surgery only when maximal medical therapy has not delivered enough relief.
- FESS is appropriate for the full spectrum of chronic rhinosinusitis. Balloon sinuplasty is appropriate for selected patients with limited disease and no polyps.
- Singapore's climate makes environmental control (dust mite covers, HEPA filtration and haze masking) a core part of treatment, not optional lifestyle advice.
- Medisave covers up to $3,600 for FESS as day surgery ($2,770 TOSP 5C + $830 day surgery charge). Total bill range at private facilities is $17,767 to $34,335 based on MOH 2023 transacted bills. Always request a written itemised estimate. (Sources: CPF Board; MOH SM714S)
- No referral required. Contact the clinic on +65 6253 7296 or WhatsApp +65 9058 2480.
Medical Reviewer: Dr Gan Eng Cern
This article is medically reviewed by Dr Gan Eng Cern, an ENT specialist and fellowship-trained rhinologist practising at Mount Elizabeth Novena Hospital in Singapore.
Dr Gan's subspecialty focus is rhinology (nose and sinus conditions) and endoscopic skull base surgery. He completed his rhinology fellowship at St Paul's Sinus Centre, University of British Columbia, Vancouver, Canada, funded by the Health Manpower Development Programme (HMDP) Award from the Ministry of Health, Singapore. Before entering private practice, he served as Deputy Director of the Rhinology Service at Changi General Hospital (2013 to 2017).
He holds an MBBS (University of New South Wales), MRCS (Edinburgh), MMed in ENT (NUS) and FAMS. He has numerous publications in peer-reviewed international ENT journals and textbook chapters, and was a Senior Clinical Lecturer at the NUS Yong Loo Lin School of Medicine.
| Detail | Information |
|---|---|
| Subspecialty | Rhinology (nose & sinus) · Endoscopic skull base surgery |
| Location | 38 Irrawaddy Road, #08-45, Mount Elizabeth Novena Hospital, Singapore 329563 |
| Consultation Fee | SGD $196.20 (inclusive of GST) within 30 minutes |
| Clinic Hours | Mon–Fri: 9:00am to 5:00pm · Sat: 8:30am to 12:00pm |
| Languages | English, Hokkien, Malay, Mandarin (limited) |
| Referral Required? | No, direct consultation available |
| Medisave | Accredited, eligible procedures claimable |
| Insurance Panels | NTUC Income (IncomeShield) · Singlife (Singlife Shield) · MHC Network · Allianz Care · Alliance Medinet · iXchange · Parkway Shenton |
For Dr Gan's full profile, qualifications, research, teaching appointments and publications, visit About Dr Gan Eng Cern.
Consult Dr Gan Eng Cern
ENT Specialist & Rhinologist · Mount Elizabeth Novena Hospital
Contact the clinic
Call 6253 7296 during clinic hours or WhatsApp +65 9058 2480 at any time. No referral letter required.
Discuss costs upfront
The clinic team can provide written estimates, confirm Medisave eligibility and assist with insurance pre-authorisation and Letters of Guarantee. See Billing & Payment.
Visit the clinic
38 Irrawaddy Road, #08-45, Mount Elizabeth Novena Hospital, Singapore 329563. Directly connected to Novena MRT (NS20). Bring your NRIC or passport, any medical reports or scans and insurance details.
Medical Disclaimer: This article is for general informational and educational purposes only. It is not intended as a substitute for professional medical advice, diagnosis or treatment. Always consult a qualified healthcare provider regarding any medical condition or treatment. Information is current as of the date of publication and may not reflect the most recent developments. This information has been prepared in accordance with the Healthcare Services (Advertisement) Regulations 2021 and Ministry of Health Singapore guidelines for healthcare information. drganent.com · Mount Elizabeth Novena Hospital, Singapore.
Last updated: May 2026 · © Dr Gan Eng Cern ENT Clinic
Sources:
1. Fokkens WJ et al. EPOS 2020. Rhinology. 2020;58(Suppl S29):1–464. 12-week guideline-directed therapy threshold, definition of chronic rhinosinusitis. pubmed.ncbi.nlm.nih.gov/32077450
2. Chee J, Pang KW, Wong KL, Loh WS, Charn TC. Epidemiology and aetiology of chronic rhinosinusitis in Asia — A narrative review. Clinical Otolaryngology 2023;48(2):305–312. Asian CRS prevalence 2.1% to 28.4%, phenotypic differences from Western populations. pubmed.ncbi.nlm.nih.gov/35997660
3. CPF MediSave for Hospitalisation, live limits page. FESS TOSP 5C: $2,770; day surgery daily charge: $830. www.cpf.gov.sg
4. MOH Hospital Bill Sizes SM714S (2023 transacted bills, incl. GST, 25th to 75th percentile). $17,767 to $34,335 typical total FESS bill range. www.moh.gov.sg
5. MOH Fee Benchmarks, effective 1 January 2025. Surgeon fee benchmarks inclusive of GST. go.gov.sg
6. SMC Register of Medical Practitioners. Credential verification. www.healthprofessionals.gov.sg/smc
