There are about 14 physiologic factors (maybe more) related to the intricate and ideal functioning of the sinuses, if one or more of these finely tuned systems is off, then tendency for recurrent sinusitis (sinus inflammation, but not necessarily infection) can be the result. A discussion of subacute/recurrent/chronic sinusitis is beyond the scope of this medium so I'll focus on acute sinusitis. The defining feature of ALL sinusitis is the production of irritating, thick and copious mucous created within the malfunctioning sinus system and then draining out. As a quick aside, head pressure and pain without this copious mucous is almost never sinusitis. It is usually migraine or some other primary headache variant. Sinus headaches, i.e. head pain originating form the sinuses but with NO congestion/mucous is not a true condition (or is exceedingly rare). Treating such head pain with sinus medicines in this day and age is not justified. Anyway, back to sinusitis. Discussing sinusitis means discussing mucous. Sinus mucous drainage out a frontal pathway eventually leads to the nose where mucous irritates the nasal tissue, worsens nasal swelling and often requires blowing/sneezing to clear out. The rear passageway for mucous drainage is via the throat (so called "post nasal drip"). Many persons with sinusitis will drain from both places simultaneously, hence a feeling of head fullness and pressure. Healthy humans (adults) produce about 1-2 cups of thin, clear and very healthy mucous per day. This mucous drains through these same places in a pleasant and largely unnoticed fashion, this mucous maintains proper humidity within the respiratory system, forms a protective coat against pathogens, keeps pH in the respiratory and even GI system within proper ranges and does many other wonderful and under-recognized/appreciated things for healthy humans. When normal sinus mucous drainage is impeded (as in most viral upper respiratory illnesses) this leads to a profound change in mucous viscosity and consistency. This altered mucous is what we notice and are bothered by. The goal of a properly executed sinus treatment plan is to flush out the unhealthy mucous, open up all normal drainage pathways and re-establish normal and healthy mucous flow. Normal mucous is NOT our enemy and does not need to be killed or eradicated as some commercials imply, a major goal of treatment is to re establish healthy mucous flow. Coming back to your problem, the "thick chunks" are likely the end product of a poorly draining sinus system with trapped mucous inspissating into thick, unpleasant consistencies causing further blockage and a possible vicious cycle. Proper use of a sinus irrigation system to clean out unhealthy mucous and a nasal steroid to reduce swelling and allow for better sinus drainage are excellent first steps (both of these are now OTC- neilmed irrigation kit and nasacort spray). Using these devices optimally takes a lot of experience and instruction, using them incorrectly may make matters worse (It is regrettable that most directions on nasal steroid sprays' package inserts have incorrect directions on them!). Antibiotics are almost never needed for basic sinusitis, but are a kind of short cut that is often effective because most antibiotics have inherent anti-inflammatory properties that reduce swelling and achieve some of the goals I have described. In terms of benefit/harm ratios, I think antibiotics have no role in acute sinus problems as they can lead to future resistant bacteria, GI upset/flora disruption and many other well known problems associated with antibiotic overuse. Well done studies have demonstrated that about 97%% of acute sinusitis (symptoms less than 7-10 days) is caused by viral infection and antibiotics do NOT kill viruses, though they may relieve some swelling. It is also well proven that about 99%% of cases of acute upper respiratory infection with associated sinusitis will spontaneously improve with supportive care only (fluids, rest, motrin, etc). Chicken broth (2-3 cups/day) and honey (2 tbsp 3-5 times per day) have shown promise in relieving virally induced mucous production and attendant symptoms. It is cases lasting more than 14 days (sub-acute to chronic sinusitis) that require stronger interventions. Such cases, IMHO, should get specialty attention. Most allergists should be non-surgical sinus experts able to provide optimal medical management for your problems (as a bonus, recurrent sinusitis is often influenced by allergy which they can also help with). Unfortunately many allergists are terrible at treating non-allergic chronic sinusitis, the majority of persons with chronic sinusitis. Allergists (I am one BTW), usually do their testing and put persons with positive testing on shots. Unfortunately, studies of persons with sinusitis show a majority of such persons have negative or irrelevant allergy testing results. ENT doctors are a good option although they are primarily surgeons, for them medical management of sinusitis is often a prelude to sinus surgery (treatment begins with antibiotics+oral steroids+ct scan - if not better in 2 weeks then schedule surgery). There are notable exceptions to my awful generalizations in both specialties and certainly some primary docs also know what they are doing with regard to these situations. My basic advice is if the doctor immediately goes to allergy shots, antibiotics or a cat scan for symptoms that have lasted less than 10 days (unless they are extremely severe), I'd go elsewhere. Ideally, find someone who specializes in the treatment of non-allergic, non-surgical sinus disease which is the description that best fits the majority of persons who have your symptoms. I wish you good health. Aslam Lateef, MD