From the Guidelines
For sinus infections, a corticosteroid nasal spray such as fluticasone (Flonase) or mometasone (Nasonex) is often the most effective over-the-counter option. Use 1-2 sprays in each nostril once daily, preferably in the morning. Continue use for at least 2-3 weeks for maximum benefit, even if symptoms improve sooner. Before each use, gently blow your nose and shake the bottle well. Tilt your head forward slightly, insert the nozzle into one nostril, and spray while breathing in gently through your nose. Repeat for the other nostril. Avoid sniffing hard or tilting your head back, as this can cause the medication to flow down your throat.
These sprays work by reducing inflammation in the nasal passages, which helps to relieve congestion, pressure, and other sinus infection symptoms, as recommended by the clinical practice guideline update for adult sinusitis 1. They also help to shrink swollen tissues, allowing better drainage. While they don't directly fight the infection, they can significantly improve comfort and potentially speed recovery by improving sinus drainage. It's essential to note that it may take a few days of consistent use before you notice significant improvement. If symptoms persist beyond 7-10 days or worsen, consult a healthcare provider, as you may need antibiotics or other treatments.
Some studies suggest that topical decongestants like xylometazoline nasal spray can reduce congestion of sinus and nasal mucosa on imaging studies 1. However, these should not be used more than 3 to 5 consecutive days without a prolonged intervening drug-free period due to their propensity to cause rebound congestion and rhinitis medicamentosa. In contrast, corticosteroid nasal sprays have been shown to provide symptom relief for chronic rhinosinusitis (CRS) with a preponderance of benefit over harm 1.
Key points to consider:
- Use a corticosteroid nasal spray for at least 2-3 weeks for maximum benefit
- Consult a healthcare provider if symptoms persist or worsen
- Topical decongestants should be used with caution and not for extended periods
- Corticosteroid nasal sprays are a recommended treatment option for CRS, as supported by the clinical practice guideline update for adult sinusitis 1 and the study on chronic upper airway cough syndrome secondary to rhinosinus diseases 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Nasal Sprays for Sinusitis Treatment
- Nasal saline irrigation is a commonly used treatment for sinusitis, with various devices employed, such as nasal douches, neti pots, or sprays 2.
- The use of saline nasal irrigation has been observed to be beneficial in the treatment of chronic rhinosinusitis, with evidence suggesting it can improve symptom scores and quality of life 3, 4.
- Hypertonic saline nasal irrigation has been shown to be effective in reducing symptoms and medication use in patients with frequent sinusitis 3.
- Nasal saline irrigation is also recommended for the treatment of acute rhinosinusitis, although the evidence is less conclusive 2, 5.
Types of Nasal Sprays
- Isotonic and hypertonic saline solutions are commonly used for nasal irrigation, with hypertonic solutions showing some evidence of improving objective measures, although the impact on symptoms is less clear 4.
- The concentration of saline solutions can vary, with a recommended concentration of 2-3.5% to prevent infections 2.
Safety and Efficacy
- Nasal saline irrigation is generally considered safe, with minor adverse effects, such as epistaxis, pain, and dryness of the nose, being recognized by healthcare professionals 6.
- The beneficial effect of saline appears to outweigh the minor side effects for the majority of patients, making it a useful addition to the treatment of chronic rhinosinusitis 4.