From the Guidelines
Chronic sinusitis treatment should prioritize saline nasal irrigation and topical intranasal corticosteroids for symptom relief, as recommended by the most recent clinical practice guideline update 1.
Treatment Overview
Chronic sinusitis treatment typically involves a combination of medications and self-care strategies to reduce inflammation and clear infection.
- Initial treatment includes saline nasal irrigation 1-2 times daily using a neti pot or squeeze bottle with distilled water, which helps flush out mucus and irritants.
- Intranasal corticosteroids like fluticasone (Flonase) or mometasone (Nasonex), used as 1-2 sprays per nostril daily, reduce inflammation and are often the most effective medication.
Medical Management
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 earlier guidelines 1.
- Oral decongestants like pseudoephedrine can provide temporary relief but shouldn't be used longer than 3-5 days to avoid rebound congestion.
- For patients with allergic components, antihistamines may help.
Surgical Intervention
If symptoms persist beyond 12 weeks despite medical therapy, an ENT evaluation may be needed to consider procedures like balloon sinuplasty or endoscopic sinus surgery, with a focus on functional endoscopic sinus surgery as the contemporary surgical standard of care 1.
- Lifestyle modifications including avoiding irritants, managing allergies, and using a humidifier can support treatment.
- Chronic sinusitis treatment works by reducing inflammation, promoting drainage, and eliminating infection in the sinus cavities, allowing the natural mucociliary clearance system to function properly.
Diagnostic Evaluation
Evaluation should include coronal sinus CT with extra cuts through the ostiomeatal complex to clarify the extent of disease and specific location or locations, as well as consideration for nasal-sinus biopsy in suspected cases of neoplasia, fungal disease, granulomatous disease, or tracheal biopsy for evaluating ciliary structures, function, or both 1.
From the Research
Treatment Options for Chronic Sinusitis
- Medical therapies for chronic sinusitis aim to optimize patient quality of life and daily functioning, while minimizing the risk of acute inflammatory exacerbations 2
- Evidence supports daily high-volume saline irrigation with topical corticosteroid therapy as a first-line therapy for chronic sinusitis 2
- A short course of systemic corticosteroids, short course of doxycycline, or a leukotriene antagonist may be considered in patients with nasal polyps 2
- A prolonged course of macrolide antibiotic may be considered for patients without polyps 2
Antibiotic Therapies
- Ciprofloxacin has been shown to be at least as effective as amoxycillin/clavulanic acid in the treatment of chronic sinusitis, with a superior safety profile 3
- Amoxicillin/clavulanate has been found to have good tissue and serum distribution in patients with chronic sinusitis, making it a potentially effective treatment option 4
- The use of postoperative antibiotics, such as amoxicillin/clavulanate, has been shown to improve outcomes in patients undergoing endoscopic sinus surgery, particularly in the early blood crust healing phase 5
Other Therapies
- Acetylcysteine, a mucolytic and antioxidant agent, has been investigated as a potential treatment for subacute sinusitis, but has been found to have no benefit when added to amoxicillin-clavulanic acid, pseudoephedrine, and intranasal normal saline 6