Could My Immune System Be Causing My Sinus Infections?

Dr. Franklyn R. Gergits, DO, MBA, FAOCO · Board-Certified Otolaryngologist · Fellowship-Trained Otolaryngic Allergist · 30+ Years of Experience · Clinical Focus in Rhinology and Airway Disorders

Short answer: It is worth asking, and it gets asked too rarely. When a patient has been through multiple antibiotics and is still sick, I go back to the beginning — I look at the lining of the nose and sinuses again, I send a sample to the lab to find out what is actually growing, and I revisit the imaging. What moves my thinking toward the immune system is a history of infections somewhere else. Pneumonia. Bronchitis. Ear infections. Recurrent stomach or intestinal infections. If the pattern is infections everywhere rather than only in the sinuses, that is a different problem, and there are straightforward blood tests that start answering it.

These patients arrive discouraged, and they have earned it.

Several rounds of antibiotics. Steroids. Maybe a surgery. Still sick. Somewhere in there they started wondering whether anyone actually knows what is wrong with them.

So here is what I do before anyone talks about another procedure.

I Go Back to the Beginning

Three things, in order.

I re-examine the lining. I want to look at the nasal and sinus mucous membranes myself and assess the tissue for infection. Not read a report from six months ago. Look.

I get a sample to the lab. This is the step that gets skipped most, and it is the one that changes management most often. I want to know what is actually causing the infection rather than treating a guess. Antibiotic after antibiotic without knowing the organism is how a year goes by.

I revisit the imaging. And if the CT shows obstructive findings, I will always recommend a conservative option first. Always. Finding a blockage is not the same as needing an operation.

What Makes Me Think About the Immune System

The clue is usually not in the nose.

What I listen for is a history of other infections elsewhere. Pneumonia. Bronchitis. Ear infections. Recurrent stomach or intestinal infections. Sometimes skin infections, which point to a different kind of immune problem.

A patient who gets sinus infections has a sinus problem. A patient who gets sinus infections and pneumonia and ear infections and gut infections may have something broader going on. The sinuses are just where it shows up loudest.

That distinction is the whole reason to ask the question.

There is a second route worth knowing about, and it has nothing to do with how you were born. Some medications suppress the immune system. Rituximab and other drugs used for autoimmune disease. Long-term oral steroids. If you are on one of those and your sinuses will not settle, the two may be connected, and that is a conversation worth having with whoever prescribed it.

How Common Is This?

More common than most patients expect, and more common than it gets tested for.

The 2025 adult sinusitis guideline from the American Academy of Otolaryngology pooled data from 13 studies. Twenty-three percent of patients with difficult-to-treat chronic sinus disease had low antibody levels, along with 13 percent of those with recurrent infections.

That is far above the rate in the general population, which is the whole reason it is worth checking.

A 2011 study in the American Journal of Rhinology & Allergy reviewed 129 patients whose sinus disease had failed medical therapy. Ninety-three of them — 72 percent — had low baseline antibody levels against pneumococcus, one of the bugs that causes sinus and chest infections. Fifteen met full criteria for a specific antibody deficiency once their vaccine response was measured.

A 2010 study in the same journal gave the pneumococcal vaccine to 51 patients and measured their response. Sixty-seven percent of them failed to mount an adequate antibody rise — meaning their immune systems were not answering the vaccine the way a healthy system does.

You may notice those two studies landed on very different numbers. They did, and the reason is worth knowing. The rate varies a great deal depending on how sick the group was and how the researchers defined an adequate response.

Either way, it is a meaningful share of the people sitting in sinus clinics who have a findable, treatable reason that nobody has looked for.

What Blood Work I Order

The panel is straightforward and most of it is ordinary lab work.

A complete blood count with differential. Basic, and it tells me about the cell populations that fight infection.

Immunoglobulin levels. These are the antibodies your body makes. If they are low, that is a direct finding.

Pneumococcal antibody titers, before and after a vaccine. This is the most useful one and the least familiar. We check your antibody level. We give you the vaccine. Then we check again about four to six weeks later. A healthy immune system answers by making more antibody. If yours does not answer, that tells us something the first number could not.

One detail matters here and patients rarely know it. The test uses the polysaccharide pneumonia vaccine, Pneumovax 23. That is a different vaccine from the newer pneumonia shots most adults now receive — Prevnar 20, Capvaxive, or Vaxneuvance. They are not interchangeable for this purpose.

So bring your vaccine record. Which shot you had, and when, changes how we read the result. Some people on one of the newer routes have already had Pneumovax as part of the series, which matters too.

And a few more that widen the net. A sedimentation rate and C-reactive protein, both of which measure inflammation in the body generally. An ANA, which screens for autoimmune conditions. And an ANCA, which looks for a specific group of autoimmune diseases that can attack the nose and sinuses directly — worth checking in anyone whose sinus disease behaves strangely.

Those last three do not test for immune deficiency. They ask a wider question. Is something inflammatory going on in this person beyond the sinuses? Sometimes that answer changes everything.

Does This Mean Something Is Wrong With Me?

I want to address this directly because patients brace for it, and in my experience the reaction is usually the opposite.

Most patients want a reason. They want the root cause. If I can give them answers, they are happy.

Think about what they have been living with. Years of treatment and no explanation. Another prescription. Wondering privately whether they are doing something wrong.

Finding an immune deficiency is not bad news in that context. It is the first explanation anybody has offered — and unlike most of what came before it, it points somewhere.

Who Treats It?

If the testing shows an immune deficiency, I refer to an allergist and immunologist. We have a few we recommend.

That is their specialty and it should be. My job is the airway. Theirs is the immune system, and the treatments for antibody deficiency are theirs to manage.

What I will say is that this is a referral after we have actually done something, not a handoff. By the time you see them, we will know what is growing in your sinuses and what your anatomy looks like. That is useful information for them to have.

Then What Is Surgery For?

This is the question that matters most, and it deserves a careful answer.

Surgery does help resolve the symptoms. That part is real.

But if you are dealing with an immune deficiency, surgery is not going to fix the deficiency. It cannot. The immune system is not something an operation reaches.

And the reverse is also true, which is worth saying plainly. Immune treatment helps, but it does not always settle the sinuses on its own. In one large study of patients with a serious antibody deficiency, antibody replacement sharply reduced pneumonia and ear infections — but chronic sinus disease often persisted. A more recent study found that most patients had far fewer sinus infections, and needed surgery far less often, once treatment started.

Both findings point the same way. The immune treatment and the sinus care work best together.

So here is how I think about my role in that situation.

My goal is to optimize your anatomy. Optimal rinse efficiency, so the topical treatments actually reach the tissue they need to reach. No polyps. No scar tissue. And knowing the organisms.

Then the immunologist can work their magic.

I am setting the table. I am making your sinuses a place where treatment can succeed, and handing your immunologist a clear picture of what they are dealing with. That is a different job from curing you, and it is an honest one.

Patients throughout Scottsdale, Phoenix, and Maricopa County have sometimes been through several procedures before anyone asked this question. The procedures were not wasted. They just were not the whole answer.

What If the Testing Is Normal?

That happens, and it is not a wasted trip.

A normal immune panel rules out a whole category. It tells us the problem is in your sinuses rather than in your defenses, and that narrows what we do next.

It also means we stop wondering. Patients who have been sick a long time carry a question in the back of their mind about whether something bigger is going on. Closing that door is worth something on its own.

And we still have the culture. We still have fresh imaging. We still know what your lining looks like today rather than last year. None of that disappears because one panel came back clean.

People Also Ask

How many sinus infections per year is too many?
There is no single number that settles it. What matters more is the pattern — whether infections are happening in other places too, whether they clear completely between episodes, and whether appropriate treatment is working. Recurrent infections at multiple sites is the finding that makes me look further.

Does it matter which pneumonia vaccine I have had?
Yes, and it is worth bringing the record. The antibody test uses the polysaccharide vaccine, Pneumovax 23. Most adults now get one of the newer shots instead — Prevnar 20, Capvaxive, or Vaxneuvance — and having had one changes how your results are read.

Will a regular blood test show an immune deficiency?
Not usually. A standard panel will not include immunoglobulin levels or pneumococcal antibody titers, and the titer test requires two draws with a vaccine in between. It has to be ordered specifically.

Why do I need a culture if I have already had antibiotics?
Because the antibiotics may have been aimed at the wrong organism. Knowing what is actually growing changes what we treat with, and it is information your immunologist will want if testing points that direction.

If I have an immune deficiency, is surgery pointless?
No, but its purpose changes. Surgery cannot correct an immune deficiency. What it can do is open the anatomy so rinses and topical medications reach the tissue, remove polyps and scar tissue, and give the immunologist a clear starting point.

References

1. Carr TF, Koterba AP, Chandra R, et al. Characterization of specific antibody deficiency in adults with medically refractory chronic rhinosinusitis. American Journal of Rhinology & Allergy. 2011;25(4):241–244. doi:10.2500/ajra.2011.25.3653

2. Alqudah M, Graham SM, Ballas ZK. High prevalence of humoral immunodeficiency patients with refractory chronic rhinosinusitis. American Journal of Rhinology & Allergy. 2010;24(6):409–412. doi:10.2500/ajra.2010.24.3532

3. Payne SC, McKenna M, Buckley J, et al. Clinical Practice Guideline: Adult Sinusitis Update. Otolaryngology–Head and Neck Surgery. 2025;173(Suppl 1):S1–S56. doi:10.1002/ohn.1344

4. Schwitzguébel AJ, Jandus P, Lacroix JS, Seebach JD, Harr T. Immunoglobulin deficiency in patients with chronic rhinosinusitis: Systematic review of the literature and meta-analysis. Journal of Allergy and Clinical Immunology. 2015;136(6):1523–1531.

Want to Understand More

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About the Author

Dr. Franklyn R. Gergits, DO, MBA, FAOCO is a Board-Certified Otolaryngologist and Fellowship-Trained Otolaryngic Allergist with a Clinical Focus in Rhinology and Airway Disorders and over 30 years of clinical experience, first at Northeast Ear Nose and Throat Associates in Berwick and Bloomsburg, Pennsylvania, and now at the Sinus and Allergy Wellness Center of North Scottsdale. He performs in-office balloon sinuplasty, turbinate reduction, NEUROMARK® posterior nasal nerve ablation (Neurent Medical, FDA-cleared radiofrequency ablation system), and Eustachian tube dilation under local anesthesia. He performed the first balloon sinuplasty in Pennsylvania and earned dual Entellus Centers of Excellence certifications. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis — a testable clinical framework proposing pepsin-mediated posterior nasal mucosal injury as an upstream driver of chronic rhinosinusitis. His narrative review of the framework, “Posterior Sinonasal Syndrome: Pepsin-Mediated Posterior Nasal Mucosal Injury as a Proposed Upstream Driver of Chronic Rhinosinusitis,” has been accepted for publication in the European Archives of Oto-Rhino-Laryngology (2026). Preprints available at Preprints.org (PSS: DOI 10.20944/preprints202603.0858.v1 · Mucosal Liquid Layer: DOI 10.20944/preprints202605.0727.v1). ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. Immune evaluation requires individualized assessment, and the tests described here are ordered based on a specific clinical picture rather than routinely. If you are experiencing recurrent infections at multiple sites, that is worth raising with your physician. Please consult a qualified physician for individualized recommendations.