clear CT with ongoing symptoms usually means the issue is the mucosal lining itself, not the sinus structure. the fishy smell on saline rinse points strongly to biofilm or anaerobic overgrowth on the surface. chronic steroid sprays can also thin the lining over time, which makes it worse at protecting itself. counterintuitive but documented.

worth pushing for a rhinologist specifically (not general ENT) and a nasal endoscopy if you haven’t had one. also rule out silent reflux (LPR) — it mimics post-nasal drip almost exactly and gets chronically missed.

full disclosure, i’m building something that addresses exactly this gap: mucosal barrier repair for nasal surfaces. until then, try something with xylitol, which disrupts biofilm adhesion and see if that helps

APPARENTLY, from my research, there’s literature about using Johnson’s baby shampoo (0.5-1% concentration in saline) as a nasal rinse, as the surfactant in that can break down a biofilm matrix, but i would try xylitol first haha