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Treating acute sinusitis

Created: ; Last Update: October 18, 2018; Next update: 2021.

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

Once the summer months are over, it usually doesn’t take long before colleagues start calling in sick, having to stay in bed with a blocked 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. It makes you feel weak and ill and – in addition to the cold symptoms – you may have severe pain in your forehead that sometimes spreads to your jaw.

There are a number of ways to treat sinusitis.

Steroids

Steroid nasal sprays aim to reduce inflammation and swelling in the mucous membranes lining the sinuses. Studies confirm that these nasal sprays can relieve the symptoms of sinusitis, but they often need several days to take effect. They also don’t work for everybody. They help the most if you have an allergy or regularly recurring sinusitis. After two to three weeks, the studies found that:

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

In other words, the steroid spray relieved symptoms in 7 out of 100 people. These types of nasal sprays sometimes have side effects like nosebleeds or headaches.

Oral steroids (tablets) on their own probably have no effect. They might help if combined with antibiotics. But that is only done if 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 don’t speed up recovery. These include acetylsalicylic acid (the drug in medicines like 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, make it easier to breathe through your nose in the short term, and help you sleep better at night. They don’t reduce the inflammation, though. Overall, their use in the treatment of sinusitis hasn’t been well studied.

Decongestants may also have the opposite effect: After a few hours, the membranes in the nose usually swell up again. This is known as the rebound effect. The longer the drugs are used, the stronger this effect is, so they shouldn’t be used for more than a few days at a time. There are many different decongestant medications with different active ingredients that can also cause side effects like headaches or dizziness.

Saline solutions and inhalations

In addition to medication, people sometimes use saline (salt water) solutions to reduce swelling in the mucous membranes and to help loosen the mucus. Saline solutions are available as ready-to-use nasal sprays. You can also rinse your nose with salt water (nasal irrigation) using special devices. Another option is to heat up water and inhale the vapor. Some people add things like 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 only fight bacteria. Sinusitis is usually caused by viruses, though, so antibiotics normally don’t help. But even if your sinusitis is found to have been caused by bacteria, targeted antibiotic treatment is rarely effective. That’s because sinusitis usually clears up on its own within two weeks.

So it’s generally possible to wait one or two weeks to see if your symptoms get better on their own. If they last longer, you can still talk to your doctor about whether antibiotics might help.

Antibiotics can have side effects, including fungal infections and gastrointestinal (stomach and bowel) problems. Overusing antibiotics can lead to the development of more bacteria that are resistant to antibiotics. So if you have a mild infection of your airways, it’s best to avoid using them to start off with.

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

Sources

  • Ah-See K. Sinusitis (acute). BMJ Clin Evid 2011: pii: 0511.
  • Shaikh N, Wald ER. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database Syst Rev 2014; (10): CD007909. [PubMed: 25347280]
  • Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R et al. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev 2014; (3): CD008115. [PubMed: 24664368]
  • Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev 2013; (12): CD005149. [PubMed: 24293353]
  • 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)
Bookshelf ID: NBK279483

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