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Treating acute sinusitis

Last Update: February 25, 2015; Next update: 2019.

Sinusitis treatments include nasal steroid sprays, decongestant nasal sprays and sometimes antibiotics.

The fall is the most common time for it to start: More and more of your coworkers call in sick, in bed with a stuffy nose and fever. For some people, a common cold can turn into sinusitis. Acute sinusitis may be over in a few days, but it can also last a few weeks. If you have acute sinusitis you will likely feel weak and ill and, in addition to the cold symptoms you may have very bad aches and pains in the forehead that sometimes spread to the jaw.

There are a number of ways to treat sinusitis.

Steroids

Nasal steroid sprays aim to reduce inflammation and swelling in the sinus mucous membranes. Studies confirm that these nasal sprays can relieve the discomfort caused by sinusitis, but they often need several days to take effect. They also do not work for everybody. After two to three weeks, the studies found the following:

  • Without nasal spray: 66 out of 100 people who used a placebo showed significant improvement.
  • With nasal spray: 73 out of 100 people who used a steroid spray showed significant improvement.

That means the steroid spray was able to relieve symptoms in 7 out of 100 people. These types of nasal sprays can sometimes have side effects like nosebleeds or headaches.

Steroids in tablet form probably have no effect when used on their own, but they might help when combined with antibiotics. That kind of treatment is only done when the symptoms are very severe and caused by a bacterial infection, which is very rare.

Painkillers and decongestant nasal sprays

There are several medications that can relieve symptoms but have no effect on recovery time. These include aspirin, acetaminophen (also called paracetamol) and nasal sprays and drops to reduce swelling (decongestants). Unlike steroid sprays, decongestants start to work right away. They aim to reduce swelling in the mucous membranes and make it easier to breathe through your nose right away. They do not have an anti-inflammatory effect, however. Overall, their use in the treatment of sinusitis has not been well studied.

Decongestants may also have an opposite effect: After a few hours the membranes in the nose can swell back up again. This is known as a rebound effect. The longer the drugs are taken, the stronger this effect is, so it is not recommended to take these drugs for more than a few days at a time. There are many different decongestant medications with different active ingredients that can also cause unpleasant side effects like headaches or dizziness.

Saline solutions and inhalations

In addition to medication, you can use saline solutions to reduce swelling in the mucous membranes and to help drain your sinuses. Saline solutions are available as pre-packaged nasal sprays. You can also rinse your nose with salt water, or heat up water and inhale the vapor. Some people add chamomile or peppermint to the water. These kinds of home remedies are often believed to be helpful, but there is no scientific research on their advantages and disadvantages. There are no good studies on the use of infrared radiation either.

Antibiotics

Antibiotics are only effective against bacteria. Sinusitis is usually caused by viruses, so antibiotics will not work most of the time. But even if your sinusitis is found to have been caused by bacteria, targeted antibiotic treatment is rarely effective. That is because sinusitis usually clears up just as quickly without drug treatment, as studies confirm:

Without antibiotics, symptoms improve on their own within two weeks in 86 out of 100 people with maxillary sinusitis.

In people who take antibiotics, this number increases to 91 out of 100, meaning that about an extra 5 out of 100 people get better sooner.

So if you would like to avoid taking antibiotics, you can wait one or two weeks to see if your symptoms get better on their own. If symptoms do not go away, you can still talk to your doctor about whether antibiotics might help.

Antibiotics can have side effects, including stomach and bowel problems and fungal infections. Overusing antibiotics can lead to an increase in bacteria that are resistant to antibiotics. Antibiotics should therefore generally not be used to treat less serious illnesses.

But it is essential that antibiotics are used quickly in severe cases to prevent serious complications such as meningitis. Signs of more severe sinusitis include high fever, swelling around the eyes, red and inflamed skin, severe facial pain, sensitivity to light and a stiff neck.

Sources

  • Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, Liira H et al. Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev 2014; (2). CD000243. [PubMed: 24515610]
  • Ah-See K. Acute Sinusitis. BMJ Clinical Evidence 2011; 12: 511.
  • Shaikh N, Wald Ellen R, Pi M. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database of Syst Rev 2012; (9). CD007909. [PubMed: 21154389]
  • Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ et al. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev 2014; (3). CD008115.
  • Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database of Syst Rev 2013; (12). CD005149.
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)

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