From the Guidelines
Treatment for chronic sinusitis should start with saline nasal irrigation and topical intranasal corticosteroids, as recommended by the most recent guidelines 1.
Initial Treatment Approach
The initial treatment approach for chronic sinusitis involves a combination of saline nasal irrigation and topical intranasal corticosteroids. This approach is based on the recommendation by the clinical practice guideline update for adult sinusitis 1. The use of nasal corticosteroid sprays like fluticasone (Flonase) or mometasone (Nasonex) once or twice daily, combined with saline nasal irrigation using a neti pot or squeeze bottle twice daily, can help alleviate symptoms.
Lifestyle Modifications
In addition to medical treatment, lifestyle modifications can significantly improve outcomes. These include:
- Avoiding known allergens
- Quitting smoking
- Managing allergies with antihistamines
- Using a humidifier in dry environments
Further Treatment Options
If symptoms persist after 2-4 weeks, further treatment options may be considered, including:
- Oral antibiotics such as amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 10-14 days
- A short course of oral corticosteroids like prednisone (starting at 30 mg daily and tapering over 5-7 days) for severe cases or those not responding to initial treatment
Surgical Intervention
In cases where medical management fails, endoscopic sinus surgery may be considered to improve sinus drainage, as suggested by previous guidelines 1. This approach targets the underlying causes of chronic sinusitis, including inflammation, infection, and impaired mucus drainage, with the goal of reducing inflammation, clearing infections, and promoting better sinus function.
From the Research
Treatment Options for Chronic Sinusitis
- Medical therapies for chronic sinusitis aim to optimize patient quality of life and daily functioning, and minimize the risk of acute inflammatory exacerbations 2
- Daily high-volume saline irrigation with topical corticosteroid therapy is supported as a first-line therapy for chronic sinusitis 2
- A short course of systemic corticosteroids (1-3 weeks), short course of doxycycline (3 weeks), or a leukotriene antagonist may be considered in patients with nasal polyps 2
- A prolonged course (3 months) of macrolide antibiotic may be considered for patients without polyps 2
- Nasal corticosteroids may be beneficial in treating chronic sinusitis, with evidence showing improvement in overall symptom scores and polyp scores 3, 2
- Saline irrigation has been shown to improve symptom scores compared to no treatment, with a standardized mean difference of 1.42 2
Antibiotic Therapy
- Amoxicillin-clavulanate is recommended for the treatment of acute bacterial sinusitis, with a course of 10 to 14 days 3, 4
- Macrolides are considered therapy options for chronic rhinosinusitis, mainly due to their anti-inflammatory activity 5
- The use of antibiotics should be avoided in most cases of acute rhinosinusitis, as most cases have a viral origin 5
- In patients with persistent or worsening symptoms, empirical therapy with amoxicillin (with or without clavulanate) may be considered 5
Other Treatment Options
- Decongestants may be recommended, but topical decongestants should not be used for more than three days to avoid rebound congestion 3
- Topical ipratropium and sedating antihistamines may have anticholinergic effects that are beneficial, but there is limited evidence to support their use 3
- Nasal irrigation with hypertonic and normal saline has been shown to be beneficial in chronic sinusitis, with no serious adverse effects 3