SinusDynamics - Breathe Easier, Fast Sinus Relief

Treatment Options

Bacterial sinusitis: Therapy for bacterial sinusitis should include an appropriate antibiotic. If you have three or more symptoms of sinusitis (See Symptom Chart), be sure to see your doctor for diagnosis. In addition to an antibiotic, an oral spray, nasal spray or drop decongestant may be recommended to relieve congestion. It is advised, however, to avoid prolonged use of nonprescription nasal sprays or drops.  Inhaling steam and using saline irrigations can also help relieve sinus discomfort.

How is sinusitis treated?

Because acute sinusitis involves a bacterial infection within the sinus cavities, the treatment includes an antibiotic given in sufficient dosage for an adequate period of time. Our rule of thumb is to treat the patient until he or she is well, plus an additional seven days. For acute sinusitis, that usually means 10 to 14 days of antibiotic therapy, such as amoxicillin. For chronic sinusitis, it may mean four to six weeks of antibiotics, such as amoxicillin/clavulanate or cefuroxime.

In addition, a decongestant, either applied topically or orally is recommended. Topical decongestants such as oxymetazoline act to open the sinus outflow track and facilitate sinus drainage. Over-the-counter antihistamines are generally not used in this circumstance because of their drying action. The exception to this rule is sinusitis in an allergic subject during the allergy season. In this circumstance, a non-sedating antihistamine such as fexofenadine or loratidine is selected because these agents do not cause mucus to dry.

In order to help clear secretions, patients are advised to drink six to eight full glasses of liquid per day and to wash their nasal cavities with saline (see below). Most patients think that washing their nose and sinus is one of the most important components of the treatment plan. Our experience is that nasal washing helps treat acute sinusitis and prevents recurrent disease.

In order to open the sinus ostia and reduce swelling in the nasal passage, topical nasal corticosteroid preparations such as triamcinalone, fluticasone, mometasone, and budesonide, are used in the treatment of both acute and chronic sinusitis.

Thus, the treatment for acute and chronic sinusitis may include oral hydration, an antibiotic, a topical (or less often, systemic) decongestant, nasal washings and a topical corticosteroid.

What is nasal washing?

To remove secretions from the nose and sinuses, we recommend irrigating the nose in the morning and at night. This can also be done after one to two sprays of long-acting nasal decongestant. Topical decongestants may be used up to three days in a row, or as often as every other day.

Nasal Washing in Two Easy Steps:

Step 1. Prepare the saline using one-half teaspoon of table salt in eight ounces of warm tap water with a pinch of baking soda. You may alternatively use non-iodinated salt to avoid stinging; kosher salt, sal-de-mer, pickling salt.

Step 2.Using an ear bulb syringe, wash each side of the nose with saline. Lean over the sink and expel the full syringe into first one nostril and then the other, repeatedly aspirating and washing the nose until all secretions are washed out.

Some alternatives are: Using a cold steam respiratory vaporizer to create a "steam tent" for 15 minutes, a facial sauna, or long hot showers. For recurrent disease, especially after surgical enlargement of the sinus outflow track, the purchase of a Water Pik with a Grossan nasal adapter may be warranted (Bradley Pharmaceuticals, Fairfield, N.J.).