Treatment

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Often, acute sinusitis clears up after several weeks without treatment. You might be able to "wait it out" and find relief from your symptoms using over-the-counter (OTC) medications. There are a variety from which to choose, depending on your symptoms.

OTC medications available for sinusitis symptoms are designed to unblock nasal passages and reduce congestion, as well as relieve sinus pain and pressure. These medications include:

• nonmedicated nasal sprays, such as saline solution

• medicated nasal sprays that contain a decongestant

• decongestant oral medications

• decongestant-combination products, which contain a pain reliever and a decongestant

• antihistamine medications

Prescription-only medications include:

Nasal corticosteroids are prescription medications that include fluticasone propionate (Flonase), beclomethasone (Beconase AQ), triamcinolone acetonide (Nasacort AQ), budesonide (Rhinocort), mometasone (Nasonex) and flunisolide (Nasalide). These medications reduce secretions and swelling in the nose and may have a beneficial effect on preventing and treating sinusitis.

OTC saline nasal sprays are often the first-line treatment and prevention used to decrease congestion and wash away bacteria. They are not habit-forming. You can buy them in drugstores or make your own using ½ teaspoon salt and 8 ounces of warm tap water. Use twice a day, using an ear bulb syringe to irrigate each nostril with half the solution.

OTC nasal decongestant sprays relieve swollen nasal membranes almost immediately after they are used. They are effective in helping to keep nasal passages clear in the early stages of a cold. However, they shouldn't be used for more than five days because they could cause chronic irritation or dependency.

Oral decongestants, such as pseudoephedrine (Sudafed), relieve nasal swelling pressure and congestion, but they don't treat the cause of the inflammation. Some oral decongestants are packaged in combination with other pain relievers. Side effects of decongestants include high blood pressure, nervousness, sleeplessness and dizziness. Check the label for potential side effects and discuss any special conditions you may have, such as thyroid disorder or diabetes, with your health care professional before taking a decongestant.

Antihistamines dry you up and relieve the itchiness and drainage common to sinusitis, but not the sinus congestion. OTC antihistamines may cause drowsiness or grogginess. Antihistamine-decongestant combinations relieve multiple symptoms of congestion and drainage and reduce the side effects of both.

Nonmedical approaches may prove helpful in alleviating sinusitis symptoms in the short term. These include the use of steam inhalants, such as taking a steam shower, increasing the amount of fluids you drink, using humidifiers during winter and using saline nasal sprays.

OTC medications will often relieve your symptoms and may cure a sinus infection, if you've developed one. If symptoms persist for more than seven days despite OTC decongestant medications, you may have developed a bacterial sinus infection. In this case, antibiotics are often prescribed to reduce the severity of symptoms, decrease the duration of symptoms and prevent serious complications. Antibiotics prescribed by a health care professional are not necessary to cure a sinus infection, but do provide some benefit over decongestant therapy alone.

Sinus infections are typically treated with the following antibiotics:

• amoxicillin (Doryx, Monodox)

• trimethoprim-sulfamethoxazole

• doxycycline (Doryx, Monodox)

• erythromycin (ERY-C, Ery-Tab)

• fluoroquinolones (Levaquin, Tequin)

• cephalosporins (a variety of brand names)

A 10-day course of treatment is typically recommended for cases of acute sinusitis. Often, antibiotic treatment for chronic sinusitis or an infection that is resistant to treatment will last three weeks or longer.

If your chronic sinusitis is severe or recurrent, your health care professional might prescribe oral steroids, such as prednisone, along with an antibiotic to help reduce inflammation. Steroids do have significant side effects, however, so they are only used when other medications have proven ineffective.

About 20 percent of patients with chronic sinusitis develop nasal polyps, which are growths that block the sinus passages. Surgery may be recommended to remove polyps. Short-term use of an oral steroid may reduce the size of polyps and prevent the need for sinus surgery. These steroid treatment "bursts" can also be used after sinus surgery to reduce the need for a repeat surgical procedure. Nasal steroid sprays are the most effective treatment for chronic suppression of polyps' size and regrowth. Nasal polyps often regrow even after surgery. Discuss your options with a health care professional if you are diagnosed with this condition.

Surgery

If all other therapies fail, surgery may be recommended. Failure of previous treatments suggests a difficult case of sinusitis, and surgery, too, may fail. The most common sinus procedure is called functional endoscopic sinus surgery (FESS), in which the natural openings from the sinuses are enlarged to allow more drainage. During the surgery, which takes anywhere from one to three hours, a surgeon uses an endoscope to look directly into your nose, remove diseased tissue and polyps and open the sinus outflow track. This outpatient procedure can be done using local or general anesthesia and is less invasive than older sinus surgery. Serious complications, like meningitis, cerebrospinal fluid leak and eye injury are rare, yet possible.

A full recovery may take several weeks. You probably will have some dry blood, mucus and crust in your nose, and maybe even symptoms like those of a cold or sinus infection. Your health care professional will tell you how to take care of these minor side effects. About 80 percent of patients experience reduction of symptoms after FESS, although sinusitis can return.