From the Guidelines
Chronic sinusitis should be treated with a combination of saline nasal irrigation and topical intranasal corticosteroids, as these have been shown to provide symptom relief and are based on a preponderance of benefit over harm 1. The treatment of chronic sinusitis typically involves a combination of medications and self-care strategies to reduce inflammation and clear infection. Initial treatment includes:
- Saline nasal irrigation (using a neti pot or squeeze bottle) 1-2 times daily with distilled water and salt packets to flush mucus and irritants from sinuses
- Intranasal corticosteroid sprays like fluticasone (Flonase) or mometasone (Nasonex), used as 1-2 sprays per nostril daily, reduce inflammation and are the cornerstone of treatment 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. However, the role of antibiotics in chronic sinusitis is controversial, and their use should be carefully considered 1. Additional strategies that may help include:
- Maintaining hydration
- Using a humidifier
- Avoiding irritants like smoke
- Elevating the head during sleep If symptoms persist beyond 12 weeks despite medical therapy, or if complications develop, surgical options like functional endoscopic sinus surgery might be considered. Chronic sinusitis often results from persistent inflammation rather than infection alone, which explains why anti-inflammatory treatments are crucial for long-term management.
From the Research
Treatment Options for Chronic Sinusitis
The treatment for chronic sinusitis typically involves a combination of medical therapies to manage symptoms and reduce inflammation. Some of the treatment options include:
- Saline irrigation: High-volume saline irrigation has been shown to improve symptom scores compared to no treatment 2
- Topical corticosteroid therapy: Topical corticosteroids have been found to improve overall symptom scores, polyp scores, and reduce polyp recurrence after surgery 2
- Systemic corticosteroids: Short courses of systemic corticosteroids may be considered in patients with nasal polyps 2
- Leukotriene antagonists: Leukotriene antagonists have been shown to improve nasal symptoms in patients with nasal polyps 2
- Macrolide antibiotics: A prolonged course of macrolide antibiotics may be considered for patients without polyps 2
Antibiotic Therapy
The use of antibiotic therapy in chronic sinusitis is still debated, and there is limited evidence to support its use. One study found that amoxicillin-clavulanate did not change the clinical course of acute exacerbation of chronic rhinosinusitis compared to placebo 3. Another study compared the efficacy of short-course gatifloxacin with standard 10-day regimens of amoxicillin/clavulanate in patients with acute bacterial sinusitis, and found that the short-course gatifloxacin was associated with comparable clinical cure rates and tolerability to those of standard 10-day therapy 4.
Corticosteroid Treatment
Corticosteroid treatment is a common approach for managing chronic rhinosinusitis, including nasal polyps. Long-term treatment with corticosteroid nasal spray can reduce inflammation and nasal polyp size, and improve nasal symptoms 5. Short courses of oral steroids may be recommended in severe chronic rhinosinusitis with nasal polyps or when a rapid symptomatic improvement is needed 5.
Other Treatments
Other treatments that may be considered for chronic sinusitis include:
- Decongestants: Decongestants may be recommended, but their use should be limited to avoid rebound congestion 6
- Nasal irrigation with hypertonic and normal saline: Nasal irrigation has been found to be beneficial in chronic sinusitis and has no serious adverse effects 6
- Nasal corticosteroids: Nasal corticosteroids may be beneficial in treating chronic sinusitis 6