The primary goal when treating sinusitis is to decrease the inflammation in the nose and sinus openings to improve sinus drainage. This may include a combination of medical treatments. Your healthcare provider will treat an infection, if present, and try to reduce the symptoms of a runny or congested nose. The management of acute sinusitis is different than the management of chronic sinusitis, but may utilize many similar medications. Here a few recommended treatments:
A saltwater, or saline, nasal wash helps remove mucus and bacterial from the nose and sinuses. This can temporarily reduce symptoms of nasal congestion and postnasal drip. It also helps to clear out environmental triggers from the nasal lining. We often recommend doing a nasal wash before using medicated nasal sprays. After doing a nasal wash, wait until the draining stops; then use your nasal spray as prescribed by your health care provider. Learn more.
Steroid Nasal Spray
A prescription steroid nasal spray can decrease nasal inflammation and mucus production. This will decrease symptoms of nasal congestion and improve sinus drainage. A steroid nasal spray does not provide immediate relief of symptoms and may require several weeks of routine use to be effective. If you have chronic sinusitis, you may benefit from continued daily use of this medication. If you have occasional sinusitis episodes, you may only require periodic use.The combination of nasal wash and nasal steroid sprays can be highly effective for many patients with nasal and sinus problems. Several steroid nasal sprays are available and include:
- Flonase®, Veramyst® (fluticasone)
- Nasacort AQ®, Nasacort® (triamcinolone)
- Nasarel® (flunisolide)
- Nasonex® (mometasone)
- Rhinocort® (budesonide)
- Zetonna® (ciclesonide)
- Qnasl® (beclomethasone)
When used properly, steroid nasal sprays are safe and effective, however, nasal dryness and bleeding are possible side effects when using these medications. We recommend trying to spray the medication towards the sidewalls of the nose (laterally), rather than along the nasal septum in the center.
Antibiotics are medicines designed to treat bacterial infections. In some cases of sinusitis, but certainly not all, the underlying cause will be a bacterial infection. Such an infection can be difficult to treat because the bacteria thrive in the warm, moist and dark areas of the sinus cavities. These infections usually respond to antibiotic treatment, however, you may need to continue treatment for one to three weeks or longer. The choice of antibiotic depends on several factors such as: drug allergies, past use of antibiotics and your symptoms. In some cases, your healthcare provider can collect mucus from your nose and send it to the laboratory for culture to confirm the presence of bacteria. This test can also help in the selection of the proper antibiotic to fight the infection.
The majority of episodes of sinusitis (upper airway infection) are successfully treated without the use of antibiotics by treatments directed at the nasal inflammation and specific symptoms. Inappropriate use of antibiotics can lead to bacterial resistance and side effects, thus these medications must be used carefully and thoughtfully.
These medicines, available as tablet, syrup or nasal spray, may help unblock the openings of the sinuses and temporarily reduce symptoms of nasal congestion. Common over the counter decongestants include Sudafed® and Dimetapp® (pseudoephedrine). Combination decongestant/antihistamine medicines are available over the counter. Read the label to see what is in the over the counter medicine you are buying and discuss the medicine with your healthcare provider. Topical nasal decongestants (sprays) can be highly effective in the immediate shrinking of swollen nasal tissue. However these sprays should be used only for 2 to 3 consecutive days because more prolonged use can cause rebound nasal congestion with increased symptoms. Systemic decongestants have the same effect of decreasing the swelling of the lining of the nose and promoting drainage of the sinuses. However, since higher concentrations are present in the bloodstream, systemic decongestants are more likely to cause side-effects. These may include high blood pressure, anxiety, sleeplessness, prostate problems in men, and the "jitters". You should always discuss the use of these medications with your physician.
Antihistamines are medicines designed to counter the actions of histamine, the main chemical produced in the body in allergic reactions. Antihistamines in spray, tablet or syrup form may help reduce the allergic symptoms of sneezing, itchy eyes and nose, and may reduce nasal stuffiness and mucus production. Your healthcare provider may elect to add this type of medicine to your treatment, particularly if allergies are present. Common over-the-counter antihistamines include:
- Claritin® (loratadine)
- Chlor-Trimeton (chlorpheniramine)
- Benadryl (diphenhydramine)
Newer classes of prescription antihistamines do not cause drowsiness. They include:
- Clarinex® (desloratadine)
- Allergra® (fexofenadine)
- Zyrtec® (cetirizine)
Topical nasal spray antihistamines include:
- Astepro® (azelastine)
- Patanase® (olopatadine)
Leukotrienes cause inflammation in the nose, sinuses, lungs, eyes and skin. Leukotriene modifiers are medicines that can help reduce nasal and sinus inflammation. They may be used if you have nasal polyps and aspirin sensitivity. These may be used in addition to nasal sprays and antihistamines. Examples of leukotriene modifiers are:
- Singulair ® (montelukast)
- Zyflo CR® and Zyflo® (zileuton)
Liver enzymes may become elevated with the use of Zyflo CR® and Zyflo®. Your health care provider will have to monitor your liver with regular bloodwork.
A medication to relieve pain and lessen fever may help in sinusitis, especially for acute episodes. Your healthcare provider may recommend a medication such as Tylenol® (acetaminophen), aspirin or ibuprofen, or prescribe a stronger medicine. Because some people with asthma are sensitive to aspirin or ibuprofen, check with your clinician before taking this medicine.
Systemic steroids are sometimes required to treat severe nasal and sinus inflammation, such as nasal polyps. These medicines can be in pill or syrup form, as well as injected in a muscle or into a vein. Systemic steroids are very powerful medicines that can help nasal and sinus conditions. However, many potential side effects are possible, and include: cataract formation, high blood pressure, high blood sugar, mood changes, stomach irritation, bone loss (osteoporosis), vision change, and menstrual irregularities. These side-effects are always possible when using systemic steroids but become more of concern with long-term use. Most commonly systemic steroids will prescribed as a pill in a "tapering" fashion. This means that your dose of steroid will be slowly decreased before completely stopping the medication. This approach also helps avoid some related complications.
This information has been approved by Todd Kingdom, MD (February 2013).