SINUSITIS: INFORMATION AND TREATMENT
17 May 2016
GENERAL TREATMENT APPROACHES
The primary objectives for treatment of sinusitis are reduction of swelling, eradication of infection, draining of the sinuses, and ensuring that the sinuses remain open. Fewer than half of patients reporting symptoms of sinusitis need aggressive treatment. Home remedies can be very useful.
Treatment of Acute Sinusitis.
- Support treatment with only saline nasal irrigation, decongestants, antihistamines, and expectorants are appropriate for a minimum of 7 - 10 days for patients with mild-to-moderate symptoms, and may be used for longer.
- Antibiotics are not helpful for patients with mild-to-moderate symptoms, so they should not be prescribed for at least the first 7 days.
Treatment of Chronic Sinusitis.
- A broad-spectrum antibiotic (one that can eliminate a wide range of bacteria) may be helpful. Some patients benefit from prolonged therapy.
- A corticosteroid nasal spray. Some doctors also recommend oral corticosteroids (such as prednisone) for patients who do not respond to nasal corticosteroids or for those patients who have nasal polyps. Prednisone is also used for patients who have allergic fungal sinusitis.
- Saline nasal irrigation is often needed on an ongoing basis.
- If the condition dramatically improves after 1 - 2 months, antibiotics are stopped. The patient should continue with both the steroid and saline nasal solutions. If there is no improvement after this time, surgery may be considered. For some people with chronic sinusitis, however, the condition is not curable, and the goal of treatment is to improve the quality of life.
- A thorough diagnostic work-up should be performed to rule out any underlying conditions, including but not limited to allergies, asthma, any immune problems, gastroesophageal reflux disorder, and structural problems in the nasal passages. If a primary trigger for chronic sinusitis can be identified, it should be treated or controlled if possible.
Home remedies that open and hydrate sinuses may, indeed, be the only treatment necessary for mild sinusitis that is not accompanied by signs of acute infection.
- Drinking plenty of fluids and getting lots of rest when needed is still the best bit of advice to ease the discomforts of the common cold. Water is the best fluid and helps lubricate the mucus membranes. (There is NO evidence that drinking milk will increase or worsen mucus, although milk is a food and should not serve as fluid replacement.)
- Chicken soup does, indeed, help congestion and aches. The hot steam from the soup may be its chief advantage, although laboratory studies have actually reported that ingredients in the soup may have anti-inflammatory effects. In fact, any hot beverage may have similar soothing effects from steam. Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.
- Spicy foods that contain hot peppers or horseradish may help clear sinuses.
- Inhaling steam 2 - 4 times a day is extremely helpful, costs nothing, and requires no expensive equipment. The patient should sit comfortably and lean over a bowl of boiling hot water (no one should ever inhale steam from water as it boils) while covering the head and the bowl with a towel so the steam remains under the cloth. The steam should be inhaled continuously for 10 minutes. A mentholated or other aromatic preparation may be added to the water. Long, steamy showers, vaporizers, and facial saunas are alternatives.
A nasal wash can be helpful for removing mucus from the nose. A saline solution can be purchased in a spray bottle at a drug store or made at home. (Mix 1 teaspoon of table, Kosher, or sea salt with 2 cups of warm water. Some people add a pinch of baking soda.) Perform the nasal wash several times a day. Researchers have reported that daily irrigation of the nasal passages with a hypertonic saline solution relieves sinusitis symptoms and also reduces antibiotic use and the occurrence of acute exacerbations.
A simple method for administering a nasal wash is:
- Lean over the sink head down.
- Pour some solution into the palm of the hand and inhale it through the nose, one nostril at a time.
- Spit out the remaining solution.
- Gently blow the nose.
Neti pots have also become popular in recent years for prevention and treatment of sinusitis. Nasal irrigation with a saline solution through a neti pot involves:
- Lean over the sink with your head tilted to one side.
- Insert the spout of the neti pot in the upper nostril.
- Slowly pour the salt water into your nose while continuing to breathe through your mouth.
- The water will flow through the upper nostril and out through the lower nostril.
- When the water finishes dripping out, blow your nose.
- Reverse the tilt of your head and repeat the process with the other nostril.