How are patients treated for sinusitis?
Patients are treated with medications first, in an attempt to clear the infection and reduce the inflammation. This treatment may include antibiotics (often guided by bacterial cultures), oral/topical steroids, mucus thinners, and saline nasal irrigations. If allergies are present, anti-histamines and/or allergy shots may be added. Nearly all cases of acute sinusitis and the vast majority of patients with chronic sinusitis can be successfully treated with appropriate medical therapy alone. The typical duration of treatment for acute sinusitis is 7-14 days (with some recent research suggesting as few as 3-5 days may be possible). Chronic sinusitis usually requires longer courses of therapy for 4-8 weeks or longer, depending upon the patient and other underlying conditions. What medications are used to treat sinusitis?
Antibiotics are used in most cases of sinusitis. The particular antibiotic that is chosen and the length of therapy are based upon many factors. These include any culture information, the most likely bacteria causing the infection, potential drug resistance of the bacteria, patient drug allergies, other medical conditions, current medications and previous treatments. Oral steroids (prednisone, medrol) are very useful, especially in patients with significant inflammatory environmental triggers, such as allergies or asthma. These are typically prescribed in a tapering fashion over a course of 2-8 weeks, depending upon the individual patient. This class of drugs can have significant side effects (such as bone loss, weight gain, irritability, diabetes, etc.) if taken on a daily basis for an extended period of time. Topical nasal steroids are very useful in most cases of chronic sinusitis. They reduce the inflammation in the lining of the nose and sinuses with very few side effects. Some patients may experience minor nose bleeds from time to time, but these medications are generally very well-tolerated. Nasal saline irrigations are useful in most patients. They help to flush the nose/sinuses and remove viral particles, pollen, irritants, bacterial and fungal debris. There are few significant side effects from saline washes. Some physicians prescribe sterile saline from the pharmacy, while others permit patients to make their own saline at home. Regardless of the source, any devices used to irrigate the nose (such as bulb syringes or Water Pik type devices) must be cleaned or replaced regularly to avoid the risk of contamination with mold or fungus. Mucus thinners, such as guaifenesin, can provide symptom relief in patients who experience thick post-nasal drainage or phlegm in the back of the throat. These medications are very safe and can be used long-term. Oral and topical decongestants are generally prescribed on an as-needed basis. Short term (3-5 days) use may alleviate some of the symptoms of congestion and nasal obstruction seen in sinusitis. There is the potential for side effects, such as high blood pressure, hyperactivity, insomnia, and recurrent nasal congestion, with long-term use. Antihistamines can be very useful in patients with documented environmental allergies (see Allergy section). They may cause thickening of secretions in the nose and mouth, drowsiness, urinary retention and constipation, thus non-allergic patients should probably refrain from using them. Allergy shots (immunotherapy) are also useful in patients with proven allergies (See Allergy section). Patients require weekly shots for the first year and a tapering schedule after that, but allergy shots may provide patients with significant long-term relief without the need for chronic medications. Other newer treatments for chronic sinusitis include systemic and topical anti-fungal medications, leukotriene inhibitors and aspirin desensitization. These treatments are for selected patients and may not have proven efficacy. You should discuss these with your sinus specialist if you have further questions. Other Online Resources:
 Sinusitis (National Institute of Allergy and Infectious Diseases)
Sinusitis (American Academy of Family Physicians)
Sinusitis (American Academy of Family Physicians)- Español
Tips to Remember: Sinusitis (American Academy of Allergy, Asthma, and Immunology)
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