Objective To investigate the efficacy of nasal endoscopic surgery and glucocorticoid therapy on chronic rhinosinusitis (CRS) and influence on nasal mucociliary clearance rate, inflammation level and olfactory function. Methods A total of 106 patients with CRS received in department of otorhinolaryngology of the hospital from January 2022 to January 2025 were divided into control group (nasal endoscopic surgery, n=53) and observation group (nasal endoscopic surgery+ glucocorticoid, n=53) according to the random number table method. The clinical efficacy, nasal mucociliary function (nasal mucociliary clearance rate), olfactory function (olfactory threshold, olfactory recognition threshold, olfactory recognition ability), serum inflammatory factors [eosinophil count, interferon-γ (IFN-γ), interleukin-5 (IL-5)] and complications were compared between the two groups. Results At 2 months after treatment, the total effective rate in observation group was higher than that in control group (P<0.05). The nasal mucociliary clearance rate in observation group at 2 months after treatment was better than that in control group (P<0.05). The olfactory threshold in observation group was lower at 2 months after treatment while the olfactory recognition threshold and olfactory recognition ability were higher than those in control group (P<0.05). The levels of eosinophil count, IFN-γ and IL-5 in observation group were lower compared to control group at 2 months after treatment (P<0.05). The incidence rates of complications in observation group were lower than those in control group within 2 months after surgery (P<0.05). Conclusion The application of nasal endoscopic surgery combined with glucocorticoid for CRS can improve the nasal mucociliary clearance rate, enhance the olfactory ability, and reduce the levels of inflammatory factors, with good safety.