How can we help unclog her sinuses?

How to Help Unclog Her Sinuses

The most effective approach combines saline nasal irrigation with intranasal corticosteroid spray, as this dual therapy targets both mechanical clearance of mucus and reduction of inflammation. 1

First-Line Treatment Strategy

Saline Nasal Irrigation

• Use high-volume irrigation (nasal douche or squeeze bottle) rather than saline spray, as larger volumes achieve better penetration into the sinuses and more effective symptom relief 2, 1
• Isotonic (normal) saline is generally as effective as hypertonic saline and may be better tolerated 2
• Benefits include improved mucociliary clearance, reduced nasal edema, and mechanical removal of infectious debris and allergens 2, 1

Proper irrigation technique: 2

1. Gently blow nose before use
2. Lie supine with head tilted back off the edge of the bed (Mygind's position), with chin as the highest point
3. Instill irrigation solution while breathing normally
4. Hold position for 2 minutes after instillation
5. Clean the irrigation device after each use to prevent spreading infection 2

Intranasal Corticosteroids

• Intranasal corticosteroids are the most effective first-line treatment for reducing inflammation and nasal congestion 1
• Fluticasone propionate 200 mcg once daily provides relief starting within the first day, with full effectiveness building over several days 3
• Unlike decongestant sprays, corticosteroids do not cause rebound congestion and can be used safely for up to 6 months in adults 3

Proper spray technique: 2, 1

1. Gently blow nose first
2. Shake bottle vigorously
3. Keep head upright (not tilted back)
4. Use right hand for left nostril and left hand for right nostril to aim spray away from the nasal septum toward the outer nasal wall
5. Breathe in slowly while activating spray (shallow breath, like smelling a flower)
6. Do not sniff hard after application
7. Breathe out through mouth after spraying

Combined Therapy

• Using both saline irrigation and intranasal corticosteroids together provides optimal results, as they address different mechanisms—mechanical clearance and inflammation reduction 1
• Many rhinologists recommend this combination because nasal sprays alone have minimal sinus penetration, even after sinus surgery 2

Adjunctive Symptomatic Relief

For Acute Symptoms

• Analgesics (acetaminophen or ibuprofen) for pain and discomfort 2, 4
• Warm facial packs and steamy showers to help loosen secretions 5, 4
• Sleeping with head elevated to reduce congestion 5
• Adequate hydration to thin secretions 5, 4

Decongestants (Use With Caution)

• Oral decongestants may reduce congestion but have systemic side effects, particularly problematic in patients with hypertension, cardiovascular disease, urinary retention, or glaucoma 1
• Topical decongestants (oxymetazoline) should NEVER be used for more than 3-5 consecutive days due to risk of rebound congestion (rhinitis medicamentosa) 2, 1

For Post-Nasal Drip and Cough

• First-generation antihistamine-decongestant combinations are effective for cough related to post-nasal drip through their anticholinergic properties 2, 1, 5
• Newer non-sedating antihistamines are NOT effective for this purpose 5

Critical Pitfalls to Avoid

• Do NOT use saline spray instead of irrigation—irrigation is significantly more effective 1
• Do NOT discontinue intranasal corticosteroids when symptoms improve—continue regular use to maintain control 2, 1
• Do NOT prescribe antibiotics unless there is purulent nasal discharge on examination—most sinus congestion is inflammatory, not infectious 1
• Do NOT use topical decongestants beyond 3-5 days—this causes worsening rebound congestion 1
• Do NOT share nasal delivery devices between people to prevent spreading infections 2

When to Seek Further Evaluation

Consider specialist referral or further workup if: 1

• Symptoms persist despite 1-2 weeks of appropriate treatment
• Severe facial pain or high fever develops (may indicate bacterial sinusitis requiring antibiotics) 2, 5, 4
• Recurrent episodes occur (4+ per year)
• Thick purulent discharge is present on examination
• Complications are suspected
• Underlying allergies or anatomical abnormalities need evaluation

Special Considerations

• For children ages 4-11: Use only 1 spray per nostril once daily; limit use to 2 months per year due to potential growth effects 3
• For adults: Can use 1-2 sprays per nostril once daily for up to 6 months 3
• If allergic component suspected: Consider evaluation for IgE sensitization to inhalant allergens 1
• Environmental triggers: Identify and avoid irritants; improve ventilation 1