Symptoms of chronic sinusitis include facial pain, rhinorrhea and malaise. Infection, allergies and vasomotor rhinitis/ sinusitis are the usual causes. Physical examination, laboratory results and routine radiologic findings are often minimal. Computed tomographic scanning, however, may show pathology that is not apparent on standard radiographs. Nonpharmacologic treatments should be considered first. Increased exercise and nasal steam inhalation may help. Dietary restrictions or a change in environment are occasionally quite beneficial. Intranasal corticosteroids and brief courses of local decongestants are frequently appropriate. Systemic therapy, including decongestants, anti-inflammatory agents, antibiotics and, occasionally, antihistamines, offers treatment directed at the causes of chronic sinusitis. When aggressive medical treatment is unsuccessful, nasal surgery, particularly endoscopic surgery, directed at abnormalities of the ostiomeatal unit, may offer significant benefit for selected patients.