@ajoutwest-Hi. What you are experiencing is being “felt” in the sinuses, however it is not sinus related. Most “sinus headaches” are not sinus headaches at all. It is an inflammatory response that happens in the gut/intestinal lining and presents in the sinus/nasal cavity. This is the reason why sprays/rinses did not work for you.
The main cause of gut disbiosis is stress. Stress in the form of regular life/emotional stress, environmental and foods. If you go to the ENT, they will not educate you on this as for one, they are highly uneducated on exactly why inflammation happens in the sinus/nasal cavity to begin with. They only have one way of thinking and that is either bacterial or external allergens. They are also surgeons, so if you have nothing of interest structural to them that they can cut into, then they will give you some pamphlet about allergies and tell you to be on your way.
You working in a healthcare system, knows how this works. It’s not that this is strange per se, it’s just that these specialists can’t bill insurance or code for something that is not billable, like patient education. Your nasal/sinus lining is the same lining that lines your throat all the way down to your stomach. If your gut does not have the proper foods/enzymes to keep a healthy environment, inflammation begins. Such as acid reflux/silent reflux which can all back up into the sinus lining, especially while sleeping. This is why if someone drinks milk, they can feel congestion. Or as you mentioned alcohol, red wine and sugary drinks. This all causes congestion. Congestion is a natural response to your gut not agreeing with acidity/high inflammatory foods. The good news is,you sound like you know your body very well and how it responds. I would stay out of the health care system and work with someone like a Functional med/Natural path doctor to better understand you as an entire system and not just separate parts. They can help you understand which foods cause high acidity/glycemic index/inflammation and help you get your gut/microbiome in balance. There are many things that can help. Too many to list. But to start you can look into the relationship between the small intense and sinusitis. Do not put anymore things in your nose, which is only compromising your healthy natural bacteria in there.
ENTs would have empty offices if more people knew how the rest of their body effects sinuses. Hope this helps.