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Treating chronic sinusitis

Last Update: February 25, 2015; Next update: 2018.

Chronic sinusitis can be a very bad illness that affects your quality of life. But some remedies have been proven to be effective at relieving the symptoms. Nasal steroid sprays are the most helpful, and surgery is sometimes an option too.

Having a stuffy nose for a short time is quite normal and is usually unproblematic. But things become more unpleasant if it is hard to breathe through your nose over a longer period of time and you feel pain or pressure in your face. These kinds of symptoms are often caused by chronic inflammation of the sinuses (chronic sinusitis).

There are two main types of bilateral chronic sinusitis (where both sides of the face are affected).

This information deals with these two main forms. Rarer forms of chronic sinusitis can occur as a result of a weak immune system or due to fungal infections. They may require special treatment.

What kinds of drug treatment are available?

Steroids

Nasal steroid sprays reduce mucous membrane swelling and help ease discomfort. Treatment with steroid sprays can cause any polyps that might be there to shrink. It usually takes a few days for the full effects of steroid sprays to be felt. Relieving symptoms for good usually means that medication needs to be taken for several months or even over a year.

The nasal mucous membranes may become irritated or dry out. People sometimes have temporary headaches too. Nosebleeds can occur, particularly when taking higher doses. But the side effects are usually mild.

Nasal steroid sprays have far fewer side effects than steroids taken in tablet form or as an infusion (drip). That is because steroids in tablets are carried throughout the entire body, whereas topical agents like nasal sprays or skin creams mainly affect only the area they are applied to. It is best to talk with your doctor about the advantages and disadvantages of the treatment.

Antibiotics

There is not enough good-quality research to tell how effective antibiotics are. It is known that sinusitis is not usually caused by bacteria. But antibiotics can only fight bacteria. Plus, inflammation caused by chronic sinusitis is often influenced by other factors as well, such as allergies.

Severe bacterial sinusitis can lead to complications in rare cases though. In that event, antibiotics need to be taken quickly to prevent serious complications such as meningitis.

Decongestant nose drops

Decongestant nose drops or nasal sprays aim to soothe the mucous membranes and reduce swelling. This improves nasal breathing in the short term – which can make it easier to sleep. But decongestant drugs can quickly have an opposite effect as well. After just a few hours, the nasal mucous membranes will start to swell again. The more often the medication is used, the stronger this effect is. So it is not a good idea to use this medication continuously for more than a few days.

Nasal irrigation and inhalation

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. To relieve symptoms, you can also try rinsing your nose with saltwater. Heating water and inhaling the steam is another option. Some people like to add chamomile or peppermint. But there is not enough scientific research on saline solutions or steam inhalation to say for sure how effective they are.

Painkillers

Some medications may not be able to make you healthy faster, but they can relieve the pain. These include pain-relieving and anti-inflammatory drugs like ibuprofen, acetaminophen (paracetamol) or acetylsalicylic acid (the drug used in "Aspirin"). But some people have an intolerance to aspirin. It might make their chronic sinusitis worse, or even trigger asthma attacks. Painkillers like acetaminophen are more suitable in that case.

Other treatments

Apart from drug-based therapies, a variety of other treatments are available. They include herbal products, acupuncture, infrared light therapy and zinc products. There is no scientific evidence that these treatments help to treat chronic sinusitis.

Can surgery help?

Some people decide to have surgery, especially if the symptoms are very severe and medication alone does not provide enough or long-lasting relief. One common type of surgery is a procedure that expands narrowed passageways in the paranasal sinuses. Mucous membrane growths (polyps) and inflamed parts of the mucous membrane are also removed. This operation is called "functional endoscopic sinus surgery (FESS)." It aims to improve nasal ventilation and the sense of smell, and make it easier to drain nasal secretion. During the procedure the narrowed sinus passageways are expanded using small instruments inserted via a tube (endoscope).

Unfortunately, only few good-quality studies have looked into what long-term effect FESS has on symptoms. There is also no conclusive information about whether surgery can be an alternative to treatment with steroids or antibiotics. Surgery is an option if steroid sprays and other treatments have not provided enough relief. The procedure also aims to help medications or saline solutions work better because they can reach the nasal cavities better once they have been expanded. But even after surgery, you will probably need to continue to use a steroid spray or other medication to relieve the symptoms.

Severe complications following FESS are very rare. More common complications include short-term bleeding, inflammation, bruising and an impaired sense of smell. According to various estimates, between 5 and 15 out of 100 people can expect these kinds of temporary side effects following surgery. Your nose is often stuffed up for several days after the procedure and scabs may form, but this gets better quickly. It may take several weeks until the wounds in the sinuses have completely healed, though. That is why it is important to have regular check-ups for several weeks, and to rinse your nose with a saline solution. Your doctor will also remove wound secretions from your nose at several different appointments.

One newer surgical procedure is balloon sinus dilation. A catheter is placed inside the nose to slowly inflate a balloon resting at the sinus opening. This procedure aims to expand the narrowed passageways at the sinus openings, but it is not suitable for all forms of chronic sinusitis. There is not yet enough conclusive research available on the benefits and possible side effects of balloon dilation.

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