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Treatments and drugs
By Mayo Clinic staff
The goal of treating chronic sinusitis is to:
- Reduce sinus inflammation
- Keep your nasal passages draining
- Eliminate the underlying cause
- Reduce the number of sinusitis flare-ups you have
Treatments to relieve symptoms
Your doctor may recommend treatments to help relieve sinusitis symptoms. These include:
- Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
- Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ), mometasone (Nasonex) and beclomethasone (Beconase).
- Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Examples include prednisone and methylprednisolone. Oral corticosteroids can cause serious side effects when used long term, so they're only used to treat severe asthma symptoms.
- Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Examples of OTC oral decongestants include Sudafed and Actifed. Nasal sprays include phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). These medications are generally only taken for a few days at most; otherwise they can cause the return of more severe congestion (rebound congestion).
- Over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Because of the risk of Reye's syndrome — a potentially life-threatening illness — never give aspirin to children.
- Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis. However, this treatment can have serious complications such as intestinal bleeding or severe asthma attacks.
Antibiotics
Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. However, chronic sinusitis is usually caused by something other than bacteria and antibiotics won't help.
Antibiotics used to treat chronic sinusitis caused by a bacterial infection include amoxicillin (Amoxil, Trimox, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra, others). If the infection doesn't subside or if the sinusitis comes back, your doctor may try a different antibiotic.
If your doctor does prescribe antibiotics, it's critical to take the entire course of medication. Generally, this means you'll need to take them for 10 to 14 days or even longer — even after your symptoms get better. If you stop taking them early, your symptoms may come back.
Immunotherapy
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat the condition.
Surgery
In cases that continue to resist treatment or medication, endoscopic sinus surgery may be an option. For this procedure, the doctor uses an endoscope, a thin, flexible tube with an attached light, to explore your sinus passages. Then, depending on the source of obstruction, the doctor may use various tools to remove tissue or shave away a polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.
- Joint Task Force on Practice Parameters for Allergy and Immunology. The diagnosis and management of sinusitis: A practice parameter update. Journal of Allergy and Clinical Immunology. 2005; 116(6)(suppl):13-47.
- Hamilos D, et al. Clinical manifestations, pathophysiology, and diagnosis of chronic rhinosinusitis. http://www.uptodate.com/home/index.html. Accessed Sept. 24, 2008.
- Leung R, et al. The diagnosis and management of acute and chronic sinusitis. Primary Care Clinics. 2008;35:11-24.
- Hamilos D, et al. Management of chronic rhinosinusitis. http://www.uptodate.com/home/index.html. Accessed Sept. 24, 2008.
