Sorry about your difficult congestion, makes me think I've got an easy problem.
I looked and see the prescription generic I use is Fluticasone but it doesn't help me much. But I have no problem getting the spray into the sinus area, as far as I know. I can also get a netipot irrigation through whatever sinus that passes through. Still, the difficulty I have breathing at nigh sometimes brings on enough panic I have to get up, but I am always able to breat through my mouth.
Let us know how you solve your problem. Disappointing just to read that surgery didn't help.
I have a bit of a history with sinus congestion problems that resulted in 2 different sinus surgeries. I have problems with nasal polyps getting so big they put pressure and block off air flow. I have tried quite a few different nasal sprays in the past but none seemed to help. All they would do is go up the nose and straight down the throat. Becuase of this problem my ENT had be use a nebulizer that emits a continuos stream into the sinus in hopes that the medication would reach up into the sinus cavities. But none of our attempts worked.
I would definitely suggest seeing an ENT. That way you wil be able to get more indept information
I respond in part due to the fact I have trouble with nasal congestion too. Mine is limited mostly to sleep-time, that is when I am lying down. I have discussed and been examined only by general practice (primary care) doctors and have been given and used a prescription nasal spray that helps a little. I forget what I am using, but it is a generic form of one seen on TV commercials (haven't see lately) where a bumble bee is the main character.
To your question I can only say I agree you should expect some improvement, but I base that on general medical experience, not on the steps you have taken.
Does the over-the-counter nasal sprays (e.g,. Afirin) help? In my case these sprays are very effective, but I can not use them on a regular basis. I will check further with my PC doctor and perhaps get a recommendation on an ENT.
I look forward to reading on your progress to a cure.