What is the treatment for chronic sinus drainage?

Treatment for Chronic Sinus Drainage

The cornerstone treatment for chronic sinus drainage includes intranasal corticosteroids and saline irrigation, which provide symptomatic relief and improved quality of life by reducing inflammation and facilitating mucus clearance. 1

First-Line Treatments

• Intranasal corticosteroids are the most effective first-line treatment for chronic sinus drainage, providing superior symptom relief by reducing inflammation and nasal congestion 2, 3
• Saline irrigation (not spray) is highly effective as either a sole treatment or adjunctive therapy with minimal side effects, improving mucous clearance, enhancing ciliary activity, and removing antigens and inflammatory mediators 1
• For optimal results, use both treatments together as they target different aspects of the condition - inflammation reduction and mechanical clearance 4

Proper Administration Techniques

Intranasal Corticosteroids

• Shake the bottle well before use 1
• Look down by bending your neck toward the floor 1
• Use right hand for left nostril and left hand for right nostril 1
• Aim toward the outer wall (not the nasal septum) to prevent irritation and bleeding 1
• Do not sniff hard after application 1
• Regular scheduled use provides better symptom control than as-needed use 5

Saline Irrigation

• Use irrigation rather than spray as it's more effective in expelling secretions 1
• Options include squeeze bottles, Neti pots, pulsatile irrigation, or low-pressure irrigation devices 1, 6
• Either isotonic or hypertonic saline solutions can be used, though some evidence suggests hypertonic may be more effective 4, 6
• Homemade solutions can be cost-effective compared to commercial preparations 1

Antibiotic Therapy

• Antibiotics should NOT be prescribed unless significant or persistent purulent nasal discharge is present on examination 1
• Chronic sinusitis is primarily an inflammatory condition rather than an infectious problem 1
• When bacterial infection is suspected (with purulent discharge), appropriate antibiotics may be considered 2, 4
• Overuse of antibiotics should be avoided due to limited efficacy and potential for side effects 1, 4

Adjunctive Therapies

• First-generation antihistamine/decongestant combinations may help specifically with cough associated with postnasal drip 2
• Oral decongestants can reduce nasal congestion but have potential systemic side effects, particularly in patients with hypertension, cardiovascular disease, urinary retention, or glaucoma 3
• Topical decongestants should not be used for more than 3-5 consecutive days due to risk of rebound congestion (rhinitis medicamentosa) 3

When to Consider Specialist Referral

• Sinusitis refractory to standard treatment 2
• Recurrent episodes (more than 3-4 per year) 2
• Presence of complications or suspected anatomical abnormalities 2
• Evaluation for underlying conditions such as allergies, immunodeficiency, or structural abnormalities 1

Common Pitfalls to Avoid

• Using saline spray instead of irrigation (irrigation is more effective) 1
• Discontinuing intranasal corticosteroids too early when symptoms improve 3
• Using topical decongestants for more than 3-5 days 3
• Prescribing antibiotics without evidence of bacterial infection 1, 4
• Failing to address underlying conditions such as allergic rhinitis 4

Special Considerations

• For patients with allergic components to their chronic sinusitis, evaluation for IgE sensitization to inhalant allergens may be beneficial 1
• Environmental management, such as avoidance of triggers and improved ventilation, can be effective for irritant-induced congestion 3
• Surgical intervention may be considered for patients with documented chronic sinus infection refractory to medical therapy or when anatomic obstruction is present 3