What are the best ways to relieve nasal sinus pressure?

Relief of Nasal Sinus Pressure

For immediate symptomatic relief of nasal sinus pressure, use intranasal corticosteroids as first-line therapy combined with nasal saline irrigation, and add analgesics (acetaminophen or ibuprofen) for pain relief. 1, 2

First-Line Treatment Approach

Intranasal Corticosteroids (Most Important)

• Intranasal corticosteroids are the most strongly recommended first-line treatment for relieving sinus pressure, congestion, and inflammation 2
• Mometasone or fluticasone nasal sprays (200μg daily) provide effective anti-inflammatory control with excellent safety profiles 2
• These agents relieve facial pain and nasal congestion even in viral rhinosinusitis 2
• Important caveat: Full benefit may not be evident for 2 weeks, so patients must be counseled to continue use despite delayed onset 1
• Side effects are minimal but include headache, nasal itching, and nosebleeds (approximately 1 in 14 patients benefit) 1

Nasal Saline Irrigation (Essential Adjunct)

• Nasal saline irrigation should be recommended for all patients with sinus pressure as it improves mucociliary clearance and mechanically removes inflammatory debris 1, 2
• Use isotonic or hypertonic saline (3% may provide superior symptom relief) 2
• Large-volume irrigation is effective, though insufficient data exists to prove superiority over nasal spray 1
• Benefits include thinning mucus, clearing inflammatory proteins, and flushing irritants from sinus cavities 1

Analgesics for Pain Relief

• Acetaminophen or ibuprofen (NSAIDs) are recommended as first-line analgesics for relieving facial pain/pressure and fever 1, 2, 3
• NSAIDs do not increase bleeding risk and may reduce pain more effectively 2

Short-Term Adjunctive Options

Topical Nasal Decongestants (Use With Caution)

• Topical decongestants (oxymetazoline, xylometazoline) provide rapid, effective relief of nasal congestion 3, 4
• Critical limitation: Use for maximum 3-5 days only to avoid rhinitis medicamentosa (rebound congestion) 1, 3, 4
• These agents work within minutes by causing vasoconstriction 1
• Recent evidence suggests no rebound congestion occurs with oxymetazoline up to 7 days or xylometazoline up to 10 days at recommended doses 5

Oral Decongestants (Alternative Option)

• Pseudoephedrine temporarily relieves sinus congestion and pressure 6
• Oral decongestants have modest effects on nasal airway resistance and symptom scores 1
• Use with caution in patients with hypertension, anxiety, glaucoma, or urinary retention 1, 2
• Oral agents do not cause rebound congestion unlike topical formulations 1

What NOT to Use

Antihistamines (Not Recommended)

• Antihistamines should not be used routinely for sinus pressure relief as they have side effects and do not effectively relieve symptoms 1, 3
• Exception: May have a role only if underlying allergic rhinitis is present 1
• When administered alone, antihistamines provide no value in reducing nasal stuffiness 7

Oral Corticosteroids (Not Recommended)

• Oral steroid medicines should not be used routinely due to side effects without proven benefit 1

Enhanced Treatment Options for Refractory Cases

Budesonide Saline Irrigation

• For persistent symptoms, consider nasal saline irrigation with budesonide (Pulmicort) to improve drug distribution in sinus cavities 2
• Mometasone irrigation (2000μg in 240ml saline) shows superior outcomes compared to spray formulation alone 2

Xylitol-Enhanced Irrigation

• Xylitol-containing irrigations (12g in 240ml) demonstrate significantly better symptom improvement compared to plain saline at 30 days 2

Common Pitfalls to Avoid

• Do not continue topical decongestants beyond 3-5 days as this leads to medication-induced rhinitis requiring immediate cessation 1, 4
• Do not expect immediate relief from intranasal corticosteroids—counsel patients that 2 weeks of consistent use is needed for full benefit 1
• Do not use antihistamines for simple sinus pressure unless allergic rhinitis is documented 1
• Do not obtain imaging (CT/X-ray) for uncomplicated sinus pressure unless complications or alternative diagnosis suspected 1