What are the treatment options for chronic sinusitis?

From the Guidelines

Chronic sinusitis treatment should prioritize saline nasal irrigation and topical intranasal corticosteroids for symptom relief, as recommended by the most recent and highest quality studies 1.

Treatment Overview

Chronic sinusitis treatment typically involves a combination of medications and self-care strategies.

• Daily saline nasal irrigation using a neti pot or squeeze bottle with sterile saline solution to flush out mucus and irritants
• Intranasal corticosteroids like fluticasone (Flonase) or mometasone (Nasonex) at 1-2 sprays per nostril daily to reduce inflammation

Additional Considerations

For bacterial infections, antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 10-14 days) or doxycycline (100 mg twice daily for 10-14 days) may be prescribed, as suggested by older studies 1.

• Oral decongestants like pseudoephedrine can provide temporary relief but shouldn't be used long-term
• For allergic components, antihistamines such as loratadine or cetirizine may help
• In severe cases unresponsive to medication, endoscopic sinus surgery might be necessary to remove blockages and improve drainage

Lifestyle Modifications

Lifestyle modifications are also important:

• Avoid known allergens
• Quit smoking
• Use a humidifier in dry environments
• Manage allergies and asthma effectively These treatments work by reducing inflammation, fighting infection, improving mucus drainage, and addressing underlying causes of chronic sinus inflammation, which is defined as symptoms lasting more than 12 weeks despite treatment attempts.

From the FDA Drug Label

What if I’m having severe sinus pain If you feel severe pain in your face, have thick nasal discharge, or think you may have a sinus infection, stop using Fluticasone Propionate Nasal Spray, USP and see your doctor. Your doctor may want to consider if other medicines are needed. The treatment for chronic sinusitis may involve stopping the use of Fluticasone Propionate Nasal Spray, USP and consulting a doctor, as they may consider other medicines to be necessary 2.

• If symptoms such as severe pain in the face, thick nasal discharge, or suspected sinus infection occur, discontinue use of Fluticasone Propionate Nasal Spray, USP and consult a doctor.
• The doctor may prescribe alternative treatments or additional medications to manage the condition.

From the Research

Treatment Options for Chronic Sinusitis

• Medical treatment is the first line of therapy for chronic sinusitis, with topical intranasal and oral corticosteroids being the main treatment options 3
• Long-term treatment with corticosteroid nasal spray can reduce inflammation and nasal polyp size, and improve nasal symptoms such as nasal blockage, rhinorrea, and the loss of smell 3
• Short courses of oral steroids are recommended in severe chronic rhinosinusitis with nasal polyps or when a rapid symptomatic improvement is needed 3

Pharmacologic Treatment

• Pharmacologic treatment with local or systemic corticosteroids, such as mometasone furoate, fluticasone propionate, beclometasone dipropionate, or oral prednisolone, coupled with nasal lavage with isotonic saline solutions, are the cornerstones of disease management 4
• Systemic antibiotics, including amoxicillin/clavulanic acid, ciprofloxacin, clarithromycin, and trimethoprim/sulfamethoxazole, are often administered to patients with chronic sinusitis and underlying bacterial infection 4
• Antihistamines may be considered in patients with underlying allergy 4

Surgical Treatment

• Endoscopic sinus surgery is only recommended when medical treatment fails 3
• Surgery should be functional and involve widening the natural drainage openings of the sinuses and preserving the ciliated epithelium as much as possible 4
• In the case of nasal polyposis, surgery is more aggressive, involving removal of the diseased polypous mucosa 4

Postoperative Treatment

• Intranasal corticosteroids should be continued postoperatively 3
• Medical treatment should be continued post-sinus surgery 4
• The use of clarithromycin combined with fluticasone propionate in patients after functional endoscopic sinus surgery for chronic rhinosinusitis is effective in relieving clinical symptoms, improving nasal function, enhancing mucociliary transport function, and reducing inflammatory response 5

Alternative Treatment Options

• Daily high-volume saline irrigation with topical corticosteroid therapy is supported as a first-line therapy for chronic sinusitis 6
• A short course of systemic corticosteroids, a short course of doxycycline, or a leukotriene antagonist may be considered in patients with nasal polyps 6
• A prolonged course of macrolide antibiotic may be considered for patients without polyps 6
• Treatment with fluticasone propionate nasal drops can reduce the need for surgery in patients with nasal polyposis and chronic rhinosinusitis 7