acute sinusitis

What is acute sinusitis

Acute sinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.

With acute sinusitis, it might be difficult to breathe through your nose. The area around your eyes and face might feel swollen, and you might have throbbing facial pain or a headache.

The American Academy of Otolaryngology–Head and Neck Surgery 1) classifies rhinosinusitis into subtypes based on symptom duration 2), 3):

  • Acute sinusitis, symptoms come on suddenly, which lasts up to 4 weeks
  • Subacute sinusitis, symptoms which lasts 4 to 12 weeks
  • Chronic sinusitis, symptoms last more than 12 weeks and can continue for months or even years
  • Recurrent sinusitis, with several attacks within a year

Acute rhinosinusitis is further categorized as bacterial or viral.

Acute sinusitis is mostly caused by the common cold (viral infection). Unless a bacterial infection develops, most cases resolve within a week to 10 days.

In most cases, home remedies are all that’s needed to treat acute sinusitis. However, persistent sinusitis can lead to serious infections and other complications. Sinusitis that lasts more than 12 weeks despite medical treatment is called chronic sinusitis.

Each year in the United States, rhinosinusitis affects one in seven adults, resulting in more than 30 million annual diagnoses 4). Rhinosinusitis is the fifth most common diagnosis for which antibiotics are prescribed in the United States.1–3 The management of acute and chronic sinusitis has a direct cost of more than $11 billion per year, not including the economic impact of lost productivity due to illness 5).

When to see your doctor

See your doctor if:

  • your symptoms are severe or getting worse
  • your symptoms haven’t started to improve after around 7-10 days
  • you have frequent episodes of sinusitis.

Your doctor may prescribe medicines including regular pain relief, a saline nasal spray or a nasal decongestant. In some cases, your doctor may decide to give you inhaled steroids or an antibiotic. If you often get sinusitis, it could be due to an allergy so they may refer you to an ear, nose and throat (ENT) specialist.

Tell your doctor if you develop bleeding from the nose, a stiff neck, swelling, or problems with your vision.

If symptoms worsen or if they recur with clearing between episodes, physicians should reevaluate the patient to confirm the diagnosis of acute bacterial rhinosinusitis, exclude other causes of illness, and detect complications 6). People who are immunocompromised, seriously ill, or continue to deteriorate despite an extended course of antibiotics should be referred to a subspecialist 7). Complications of acute bacterial rhinosinusitis are estimated at approximately one in 1,000 episodes 8). Although rare in the United States, sinonasal cancer should also be included in the differential diagnosis 9). The box below summarizes indications for subspecialist referral in patients with acute bacterial rhinosinusitis 10).

Indications for Subspecialist Referral for Acute Bacterial Sinusitis
  • Anatomic defects causing obstruction
  • Complications, such as orbital cellulitis, subperiosteal abscess, intraorbital abscess, altered mental status, meningitis, cavernous sinus thrombosis, intracranial abscess, Pott puffy tumor (osteomyelitis of frontal bone)
  • Evaluation of immunotherapy for allergic rhinitis
  • Frequent recurrences (three to four episodes per year)
  • Fungal sinusitis, granulomatous disease, or possible neoplasm
  • Immunocompromised host
  • Nosocomial infection
  • Severe infection with persistent fever greater than 102°F (39°C)
  • Treatment failure after extended antibiotic courses
  • Unusual or resistant bacteria

The sinuses

The paranasal sinuses are spaces in the bones of the skull which are mainly full of air. The paranasal sinuses include:

  • the sphenoid sinus – in the centre of the head;
  • the maxillary sinuses – situated in the cheekbones;
  • the frontal sinuses – above the eyes; and
  • the ethmoidal sinuses – on either side of the nose.

The lining of the sinuses produces clear fluid – mucus – which cleans them. This fluid passes through narrow drainage passages into the back of the nose and throat, from where it is swallowed. This happens continually, although we are usually unaware of it.

Because the drainage holes from the sinuses are narrow, they block up easily. So any excess mucus production can cause a blockage, and pressure builds up in the sinuses.

The 2 main causes of excess mucus production are:

  • Infection; and
  • Allergy.

Figure 1. Paranasal sinuses

Paranasal sinusesParanasal sinuses - medial aspect

Complications of acute sinusitis

Acute sinusitis complications are uncommon. If they occur, they might include:

  • Chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. Chronic sinusitis lasts longer than 12 weeks.
  • Meningitis. This infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord.
  • Other infections. Uncommonly, infection can spread to the bones (osteomyelitis) or skin (cellulitis).
  • Partial or complete loss of sense of smell. Nasal obstruction and inflammation of the nerve for smell (olfactory nerve) can cause temporary or permanent loss of smell.
  • Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness that can be permanent.

Acute sinusitis causes

Sinusitis is caused by too much mucus, or a swelling of the lining of the sinuses and nose, which can block the narrow channels. This can occur during a cold, or may be due to allergy (for example, hayfever) or irritation of the linings of the sinuses (for example, from chlorine in a swimming pool). Bacteria (germs) then grow inside the sinuses, causing pain, headache and sometimes fever. Mucus from infected sinuses can be yellow or green. Some people get sinusitis with most colds, while others get it rarely.

In the first three to four days of illness, viral rhinosinusitis cannot be differentiated from early acute bacterial rhinosinusitis 11). Figure 2 summarizes the natural course of signs and symptoms associated with rhinovirus infections 12). A pattern of initial improvement followed by a worsening of symptoms—called double sickening—between days 5 and 10 of the illness is consistent with acute bacterial rhinosinusitis 13).

Physicians should not rely solely on colored nasal drainage as an indication for antibiotic therapy because it does not predict the likelihood of sinus infection (positive likelihood ratio = 1.5; negative likelihood ratio = 0.5) 14). Local sinus pain with unilateral predominance in addition to purulent rhinorrhea had an overall reliability of 85% for diagnosing sinusitis according to one study 15). Another study showed that four signs and symptoms with a high likelihood ratio for acute bacterial sinusitis are double sickening, purulent rhinorrhea, an erythrocyte sedimentation rate greater than 10 mm per hour, and purulent secretion in the nasal cavity. A combination of at least three of these four signs and symptoms has a specificity of 81% and sensitivity of 66% for acute bacterial rhinosinusitis 16). Diagnosis of acute bacterial rhinosinusits is indicated when signs or symptoms of acute rhinosinusitis persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms 17). After 10 days of upper respiratory symptoms, the probability of bacterial rhinosinusitis is 60% 18).

Figure 2. Natural course of symptom prevalence for rhinovirus infections

Natural course of symptom prevalence for rhinovirus infections
[Source 19)]

Causes of infective sinusitis include:

Acute sinusitis is most often caused by the common cold, which is a viral infection. In some cases, a bacterial infection develops.

  • Viral infections such as the common cold;
  • Bacterial infections (usually a complication of viral sinusitis);
  • Fungal infections (usually seen in people with an underlying problem with their sinuses or immune system).

Acute bacterial sinusitis

Acute bacterial rhinosinusitis is caused by various factors (Table 1). However, it is most often the result of a viral cause associated with upper respiratory infection 20). Sinus mucosa edema, sinus ostia obstruction, and decreased mucociliary activity are three key factors in the pathophysiology of rhinosinusitis. As a result, secretions stagnate, providing a favorable environment for bacterial growth 21). In adult patients with suspected acute maxillary sinusitis following a viral upper respiratory infection, about one-half were found to have pus or mucopus in the sinus aspirate, and one-third had bacterial pathogens growing in culture 22), 23). The most common bacterial organisms in community-acquired bacterial rhinosinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella (Branhamella) catarrhalis. The most common viruses in acute viral rhinosinusitis are rhinovirus, adenovirus, influenza virus, and parainfluenza virus 24), 25).

Table 1. Predisposing Factors for Acute Bacterial Sinusitis

Dental infections and procedures

Iatrogenic causes: sinus surgery, nasogastric tubes, nasal packing, mechanical ventilation

Immunodeficiency: human immunodeficiency virus infection, immunoglobulin deficiencies

Impaired ciliary motility: smoking, cystic fibrosis, Kartagener syndrome, immotile cilia syndrome

Mechanical obstruction: deviated nasal septum, nasal polyps, hypertrophic middle turbinates, tumor, trauma, foreign body, Wegener granulomatosis

Mucosal edema: preceding viral upper respiratory infection, allergic rhinitis, vasomotor rhinitis

[Sources 26), 27)]

Risk factors for sinusitis

Factors that can increase your risk of developing sinusitis include:

  • obstruction in the nose or sinuses (due to problems such as nasal polyps – small benign growths in the nose, or a deviated septum after a fractured nose);
  • allergy (hay fever, or allergic rhinitis);
  • a medical condition such as cystic fibrosis;
  • problems with your immune system such as HIV/AIDS.

Prevention of acute sinusitis

Take these steps to help reduce your risk of getting acute sinusitis:

  • Avoid upper respiratory infections. Minimize contact with people who have colds. Wash your hands frequently with soap and water, especially before your meals.
  • Manage your allergies. Work with your doctor to keep symptoms under control.
  • Avoid cigarette smoke and polluted air. Tobacco smoke and other pollutants can irritate and inflame your lungs and nasal passages.
  • Use a humidifier. If the air in your home is dry, such as it is if you have forced-air heat, adding moisture to the air may help prevent sinusitis. Be sure the humidifier stays clean and free of mold with regular, thorough cleaning.

Acute sinusitis symptoms

Acute sinusitis symptoms often include:

  • Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat (postnasal drainage)
  • Nasal obstruction or congestion, causing difficulty breathing through your nose
  • Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead that worsens when bending over

Other signs and symptoms can include:

  • Ear pressure
  • Headache
  • Aching in your upper jaw and teeth
  • Reduced sense of smell and taste
  • Cough, which might be worse at night
  • Bad breath (halitosis)
  • Fatigue
  • Fever
  • 38° C (100.4° F) or more
  • Tiredness;
  • Pain in the upper jaw and/or teeth; A sinus infection (sinusitis) or inflammation can cause a toothache — specifically in the upper rear teeth, which are close to the sinuses.
  • Nausea;
  • Generally feeling unwell.

A sensation of partial deafness or blockage in the ear may also occur. This is because the Eustachian tube, which connects the middle ear to the back of the nose, blocks up in just the same way as the nearby sinus openings.

Acute sinusitis diagnosis

Your doctor will feel for tenderness in your nose and face and look inside your nose.

During the past decade, expert panels have created evidence-based guidelines for the diagnosis (Table 2) and management of acute rhinosinusitis in adults 28).

Table 2. Summary of Guidelines for the Diagnosis of Acute Rhinosinusitis in Adults

GuidelineSigns and symptomsDiagnostic criteria

Clinical Practice Guideline (update): Adult Sinusitis 29)

Purulent nasal discharge with nasal obstruction, facial pain, or facial pressure

Presumed acute viral rhinosinusitis:

Symptoms last less than seven days and do not worsen

Presumed acute bacterial rhinosinusitis:

Severe symptoms in first three to four days of illness; symptoms persist seven days or longer after initial presentation; symptoms worsen within seven days of initial presentation

European Position Paper on Rhinosinusitis and Nasal Polyps 2012 30)

Inflammation of the nasal cavity and paranasal sinus, characterized by either nasal congestion or obstruction or nasal discharge with or without facial pain or pressure with or without decreased sense of smell

Presumed acute viral rhinosinusitis:

Symptoms last less than 10 days and do not worsen

Presumed acute bacterial rhinosinusitis:

Symptoms persist more than 10 days after start of URI; symptoms worsen after five days

IDSA Clinical Practice Guideline 2011 31)

Two major symptoms or one major and more than two minor symptoms

Presumed acute viral rhinosinusitis:

Major symptoms: Purulent nasal discharge, nasal congestion or obstruction, facial congestion or fullness, facial pain or pressure, decreased sense of smell, fever

For mild symptoms, watchful waiting for first three days of illness

Minor symptoms: Headache; ear pain, pressure, fullness; halitosis; dental pain; cough; fever; fatigue

Presumed acute bacterial rhinosinusitis:

Severe symptoms in first three to four days of illness; symptoms persist more than 10 days after start of URI; symptoms worsen after three to four days

Joint Task Force on Practice Parameters 2005 32)

Nasal congestion, purulent rhinorrhea, facial-dental pain, postnasal drainage, headache, cough, tenderness over sinuses, dark circles under eyes

Presumed acute viral rhinosinusitis:

Symptoms last less than 10 days and do not worsen

Presumed acute bacterial rhinosinusitis:

Symptoms persist more than 10 to 14 days

Severe symptoms: fever with purulent nasal discharge, facial pain or tenderness, periorbital swelling

Rhinosinusitis Initiative 2004 33)

Two or more major symptoms or one major and two or more minor symptoms (see IDSA symptom lists above)

Presumed acute bacterial rhinosinusitis:

Severe symptoms in first three to four days of illness; symptoms persist more than 10 days after start of URI; symptoms worsen within 10 days of initial improvement


IDSA = Infectious Diseases Society of America; URI = upper respiratory infection.

[Source 34)]

Other methods that might be used to diagnose acute sinusitis and rule out other conditions include:

  • Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to visually inspect the inside of your sinuses.
  • Imaging studies. A CT scan or MRI can show details of your sinuses and nasal area. While not recommended for uncomplicated acute sinusitis, imaging studies might help identify abnormalities or suspected complications.
  • Nasal and sinus cultures. Laboratory tests are generally unnecessary for diagnosing acute sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue cultures might help determine the cause, such as a bacterial infection.
  • Allergy testing. If your doctor suspects that allergies have triggered your acute sinusitis, he or she will recommend an allergy skin test. A skin test is safe and quick, and can help pinpoint the allergen that’s responsible for your nasal flare-ups.

LABORATORY TESTS

Erythrocyte sedimentation rate and C-reactive protein (CRP) are somewhat useful tests for diagnosing acute bacterial maxillary sinusitis. In a study of 173 patients using antral puncture as the reference standard, 30 of 38 (79%) of those with a CRP level greater than 49 mg per L (466.7 nmol per L) had acute maxillary sinusitis compared with 37 of 61 (61%) of those with a CRP level of 11 to 49 mg per L (104.8 to 466.7 nmol per L) and only 25 of 74 (34%) of those with a CRP level less than 11 mg/L 35).

IMAGING

Radiography is not recommended in the evaluation of acute uncomplicated rhinosinusitis 36). It is somewhat helpful in ruling out the presence of fluid when the results are negative. Positive results are not helpful because they cannot differentiate between viral and bacterial sinusitis.

For patients with recurrent acute or chronic rhinosinusitis, computed tomography (CT) of the sinuses without contrast media is the imaging method of choice 37). CT of the sinuses should be performed only after completing maximal medical therapy. CT is primarily used to define the anatomy of the sinuses before surgery, as well as to assess the extent, pattern, and a probable mechanical cause of the recurrent or chronic rhinosinusitis. A thickened mucosa of 5 mm or greater on CT is a significant sign of sinus infection 38). Antral puncture data from patients with CT evidence of fluid in the maxillary sinus were associated with demonstrated pus or mucopus by sinus lavage in 90% of patients reviewed 39).

Acute sinusitis treatment

Most cases of acute sinusitis, those caused by a viral infection, resolve on their own. Self-care techniques are usually all you need to ease symptoms.

Treatments to relieve symptoms

Your doctor may recommend treatments to help relieve sinusitis symptoms, including:

  • Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
  • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase, Veramyst), budesonide (Rhinocort), mometasone (Nasonex) and beclomethasone (Beconase AQ, Qnasl, others).
  • Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. Nasal decongestants should not be used for longer than 3 days or in young children. Otherwise they may cause the return of more severe congestion (rebound congestion).
  • Hay fever treatment, including antihistamine nasal spray or tablets, is recommended when allergic rhinitis is contributing to sinusitis. Immunotherapy for ongoing hay fever is another treatment option.
  • Pain relievers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).

Over-the-counter (OTC) pain relievers, such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.

Watchful waiting

Watchful waiting is appropriate in place of antibiotics for seven to 10 days after upper respiratory symptoms appear when there is assurance of follow-up 40). Antibiotic therapy should be considered if the patient’s condition does not improve by seven to 10 days after initial presentation or if symptoms worsen at any time 41). Symptomatic therapies should be offered to patients who are under observation. Physicians may also provide these patients with a safety net antibiotic prescription (also called a delayed prescription), with instructions describing when to fill the prescription 42). Watchful waiting is supported by four meta-analyses that were published after the 2007 American Academy of Otolaryngology–Head and Neck Surgery clinical practice guideline was released 43), 44), 45), 46). These studies did not provide evidence confirming or disproving the American Academy of Otolaryngology–Head and Neck Surgery position that patients with more severe acute bacterial rhinosinusitis should initially be treated with antibiotics.

A Cochrane review showed that the symptoms of bacterial rhinosinusitis had resolved in 47% of all patients after seven days with or without antibiotic therapy (Lemiengre MB, van Driel ML, Merenstein D, Young J, De Sutter AI. Antibiotics for clinically diagnosed acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2012;(10):CD006089.()). In addition, approximately 70% of patients improved within two weeks without antibiotics 47). Antibiotic therapy did increase cure rates for patients between seven and 15 days compared with placebo; however, the clinical benefit was small, with only 5% of patients having a faster cure 48). Moreover, analysis of individual patient data found that it was not possible to identify which patients with rhinosinusitis would benefit from antibiotics based on the presence of common clinical signs and symptoms 49). The number needed to treat was estimated to be 11 to 15.1,22,24 Adverse effects occurred more often with antibiotics than with placebo (number needed to harm = 8) 50). The risk of harm outweighs the potential benefit of antibiotic therapy. As a result of this research, the 2015 American Academy of Otolaryngology–Head and Neck Surgery guideline recommends offering watchful waiting to patients regardless of illness severity 51).

Acute sinusitis antibiotics

Antibiotics are sometimes needed to treat sinusitis when a bacterial infection is suspected. Acute bacterial sinusitis is suspected when:

  • symptoms are getting worse after initial improvement;
  • you have a high fever, symptoms are severe and have lasted for more than 3 days; or
  • symptoms of rhinosinusitis have lasted for longer than 7 days.

Antibiotics for the treatment of acute bacterial rhinosinusitis are outlined in Table 3. Most guidelines recommend amoxicillin with or without clavulanate as a first-line antibiotic for adults because of its safety, effectiveness, low cost, and narrow microbiologic spectrum 52). Amoxicillin/clavulanate (Augmentin) should be used in patients who are at high risk of bacterial resistance or who have comorbid conditions, as well as in those with moderate to severe infection 53). No significant differences in acute bacterial rhinosinusitis cure rates are noted between different antibiotic classes 54).

Table 3. Oral Antibiotics for the Treatment of Acute Bacterial Sinusitis

AntibioticClinical effectiveness (%)Dosage
First line for most patients
Amoxicillin (regular dose)83 to 88500 mg every eight hours for five to 10 days
or
875 mg every 12 hours for five to 10 days
First line for coverage of beta lactamase–producing Haemophilus influenzae and Moraxella (Branhamella) catarrhalis
Amoxicillin/clavulanate (Augmentin; regular dose)90 to 92500 mg/125 mg every eight hours for five to 10 days
or
875 mg/125 mg every 12 hours for five to10 days
For possible Streptococcus pneumoniae resistance (e.g., child in household who attends day care)
Amoxicillin (high dose)83 to 881 g every eight hours for five to 10 days
or
1 g four times per day for five to 10 days
For moderate to severe disease, high risk of resistance, recent antibiotic use, or treatment failure
Amoxicillin/clavulanate, extended release (Augmentin XR)90 to 922,000 mg/125 mg twice per day for 10 days
For patients with penicillin allergy or as second-line antibiotic
Doxycycline77 to 81100 mg twice per day or 200 mg once per day for five to 10 days
Levofloxacin (Levaquin)‡90 to 92500 mg per day for 10 to 14 days
or
750 mg every day for five days
Moxifloxacin (Avelox)‡90 to 92400 mg per day for 10 days
Non–type I penicillin allergy or second-line antibiotic
Clindamycin77 to 81300 mg three times per day for five to10 days
plus
Cefixime (Suprax)83 to 88400 mg per day for 10 days
or
Cefpodoxime83 to 88200 mg twice per day for 10 days

†—May be available at discounted prices at one or more national retail chains.

‡—Fluoroquinolones should be reserved for those who do not have alternative treatment options.

[Sources 55), 56)]

Respiratory fluoroquinolones are not recommended as first-line antibiotics because they conferred no benefit over beta-lactam antibiotics and are associated with a variety of adverse effects 57). According to a recent U.S. Food and Drug Administration safety alert, fluoroquinolones should be reserved for patients who do not have other treatment options 58). Macrolides, including azithromycin (Zithromax), trimethoprim/sulfamethoxazole, and second- or third-generation cephalosporins, are no longer recommended as initial therapy for acute bacterial rhinosinusitis because of high rates of resistance in S. pneumoniae and H. influenzae 59).

The recommended duration of therapy for uncomplicated acute bacterial rhinosinusitis is five to 10 days for most adults 60). This recommendation is based primarily on findings from a meta-analysis of 12 randomized controlled trials 61). A shorter treatment course (median of five days) may be just as effective as a longer course of treatment (median of 10 days) and is associated with fewer adverse effects 62). Regardless, clinicians should assess disease and symptom response before stopping antibiotic therapy prematurely, especially in older adults and in patients with underlying disease.

Treatment failure occurs when a patient’s symptoms do not improve by seven days after diagnosis or when they worsen at any time, with or without antibiotic therapy 63). If treatment failure occurs following initial antibiotic therapy, an alternative antibiotic with a broader spectrum is required. High-dose amoxicillin/clavulanate, a respiratory fluoroquinolone, or the combination of clindamycin plus a third-generation oral cephalosporin may be considered 64).

Adjunctive symptomatic treatment

Current guidelines consider analgesics, intranasal corticosteroids, and saline nasal irrigation to be options for the management of rhinosinusitis symptoms 65). They are recommended for use within the first 10 days but may be continued if antibiotics are initiated. Selection of interventions should be based on shared decision making. Decongestants, antihistamines, and guaifenesin are not recommended for patients with acute bacterial rhinosinusitis because of their unproven effectiveness, potential adverse effects, and cost 66). Table 2 summarizes adjunctive therapies for acute rhinosinusitis 67), 68), 69).

Table 4. Adjunctive Therapies for Acute Rhinosinusitis

TreatmentEvidence summaryComment

Intranasal corticosteroids

Two systematic reviews of randomized controlled trials showed minimal benefit and symptom relief occurred late (at 15 to 21 days) 70)

Some agents available over the counter

Saline nasal irrigation

One small randomized controlled trial found hypertonic saline decreased nasal symptoms 71)

Available in a low-pressure method using a spray or squeeze bottle or a gravity-flow method using a vessel with a nasal spout

Another study found no significant difference between groups receiving no treatment vs. those treated with saline nasal solutions, topical decongestants, and intranasal corticosteroids 72)

Oral decongestants

No clinical trial evidence for patients with acute sinusitis

Significant adverse effects; phenylephrine is similar in effectiveness to placebo for nasal congestion due to seasonal allergic rhinitis 73)

Topical decongestants

One comparative trial found no significant difference in improvement among groups receiving no treatment vs. those treated with saline nasal solutions, topical decongestants, and intranasal corticosteroids 74)

May cause rebound congestion when used for prolonged periods

Intranasal Corticosteroids

Intranasal corticosteroids may be helpful in reducing mucosal swelling of inflamed tissue and facilitating sinus drainage because of an anti-inflammatory effect 75). However, data on intranasal corticosteroids as monotherapy for symptomatic relief in patients with acute sinusitis are limited 76). Several studies suggest that they provide additional benefit in symptom improvement when used with antibiotics in patients with acute sinusitis 77). A meta-analysis of six trials 78) concluded that intranasal corticosteroids offered a modest therapeutic benefit in patients with acute sinusitis (number needed to treat = 13).

Similarly, a 2013 Cochrane review found that patients receiving intranasal corticosteroids were more likely to experience symptom improvement after 15 to 21 days compared with those receiving placebo (73% vs. 66.4%; number needed to treat = 15) 79). Higher doses of intranasal corticosteroids had a greater effect on symptom relief than lower doses. Even though their benefits are only marginal,3 intranasal corticosteroids are often used as an adjunct to antibiotic therapy in the symptomatic treatment of acute bacterial sinusitis. They are likely most beneficial in patients with concurrent allergic rhinitis 80).

Saline Nasal Irrigation

Intranasal irrigations with either physiologic or hypertonic saline have been shown to improve mucociliary clearance and may be beneficial for the treatment of acute rhinosinusitis 81). One randomized controlled trial of 76 patients with frequent sinusitis found that daily hypertonic saline nasal irrigation decreases nasal symptoms and medication use 82). A Cochrane review concluded that saline nasal irrigation may relieve symptoms of upper respiratory infection 83). Despite limited evidence regarding effectiveness, saline nasal irrigation can be a safe and inexpensive adjunctive therapy for symptom relief in acute rhinosinusitis. It is important to inform patients to prepare irrigations using distilled, boiled, or filtered water because there have been reports of amebic encephalitis due to contaminated tap water rinses 84).

Decongestants

Oral decongestants have been shown to be modestly effective for short-term relief of symptoms in adults with the common cold by reducing nasal airway resistance 85). However, the effect of decongestants in the nasal cavity does not extend to the paranasal sinuses 86). There are currently no randomized controlled trials evaluating the effectiveness of decongestants in patients with sinusitis. Oral decongestants should be used with caution in patients with hypertension or cardiovascular disease. Topical decongestants should not be used for longer than 72 hours, owing to the potential for rebound congestion (rhinitis medicamentosa).

Antihistamines

Antihistamines are often used to relieve symptoms of excessive secretions and sneezing. However, there are no studies to support the effectiveness of antihistamine in acute rhinosinusitis 87). Antihistamines may also worsen congestion by overdrying the nasal mucosa. Current guidelines do not recommend antihistamines as an adjunctive therapy for acute bacterial rhinosinusitis, except in patients with a history of allergy 88).

How to treat acute sinusitis at home yourself

If you are looking after yourself, the tips below may help relieve the symptoms:

  • Decongestant medicines – available as tablets, nasal sprays or drops – may be helpful, but do not take them for longer than instructed.
  • Always follow the manufacturer’s instructions when taking or giving someone else any medicines.
  • It is important to stay well hydrated so drink plenty of water. If you have an existing medical condition check with your doctor about how much water is right for you.
  • Gently blow your nose one nostril at a time.
  • Place a warm or cool cloth, whichever helps, over the aching area.
  • Use a saline nasal spray. Saline washes or sprays can remove thick secretions and allow the sinuses to drain.
  • Rinse your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear your sinuses. If you make your own rinse, use water that’s contaminant-free — distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller — to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with contaminant-free water and leave open to air-dry.
  • Moisten your sinus cavities. Drape a towel over your head as you breathe in the vapor from a bowl of hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain.
  • Sleep with your head elevated. This will help your sinuses drain, reducing congestion.
  • Rest and avoid heavy activity until symptoms go away.
  • Keep the room at a comfortable temperature.
  • Smoking or breathing in other people’s smoke can make symptoms worse. Try to avoid being around people who are smoking. If you are a smoker, try to cut down or quit. For advice on quitting smoking, visit our quit smoking article.
  • Find advice on suitable medicines for pain.
  • Find out more about self-care tips if you have a high temperature (fever).

Most people with acute sinusitis get better without antibiotics. However, if your symptoms are severe or last longer than a few days, talk to your doctor.

Making your own saline nasal irrigation solution

There are many over-the-counter saline (salt water) solutions available, but you can make your own saline solution at home:

  • 1 quart (4 cups) boiled or distilled water
  • 1 teaspoon baking soda
  • 1 teaspoon non-iodized salt

If you make your own rinse, use water that’s contaminant-free — distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller — to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with contaminant-free water, and let air-dry.

 

Over-the-counter medicines for pain

An over-the-counter analgesic, such as acetaminophen or a nonsteroidal anti-inflammatory drug, is often sufficient to relieve pain or fever in acute rhinosinusitis. Narcotics are not recommended because of potential adverse effects 89).

There are a range of pain relief medicines that can be bought without prescription as over-the-counter pain relievers, including paracetamol (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and aspirin. Always use over-the-counter products as directed.

Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.

Just because they are available over-the-counter does not mean that they are completely free of side effects and you should always check with your pharmacist or doctor if you are unsure whether these drugs are safe for you or not.

If you have allergies, chronic illness or are on any other medicines always check first before taking these medicines. The pharmacist can help in giving medication advice in these cases. Always if your pain persists or you are concerned see your doctor.

Paracetamol (acetaminophen)

Paracetamol (acetaminophen) is effective for mild to moderate pain, if used correctly. When you take paracetamol, check that none of your other medicines contain the same active ingredient, as it can cause serious liver damage if taken in larger doses than recommended. Arthritis medicines and over-the-counter cold and flu medicines can contain paracetamol.

Paracetamol (acetaminophen) can be given to children from the age of one month for pain and symptoms of fever. Paracetamol for children can only be bought at pharmacies. Make sure you’ve got the right strength for your child’s age and weight as overdosing can be dangerous. Read and follow the directions on the label carefully. If you are not sure, check with your doctor or pharmacist.

Ibuprofen

Non-steroidal anti-inflammatory (NSAIDs) drugs, such as ibuprofen, are effective against mild to moderate pain. Use these at the lowest dose that improves your symptoms and only use them for a short time. These medicines may not be suitable for people with stomach troubles, heart problems, kidney impairment, high blood pressure or asthma. See your doctor if you need to take these drugs for more than one week. The use of oral NSAIDs in older people is not recommended.

Ibuprofen can be given for pain and symptoms of fever in children aged three months and over who weigh more than 5kg. Ibuprofen for children can only be bought at pharmacies. Make sure you’ve got the right strength for your child’s age and weight as overdosing can be dangerous. Read and follow the directions on the label carefully. If you are not sure, check with your doctor or pharmacist. Avoid ibuprofen if your child has asthma, unless advised by your doctor.

If you have a high temperature there are a number of things you can do to help manage the condition:

  • it’s important to stay well hydrated so drink plenty of clear non-alcoholic fluids
  • ice blocks or iced drinks may be soothing
  • wear lightweight clothing and avoid using blankets or quilts in bed as this may make you too hot and increase your temperature
  • keep the room at a comfortable temperature
  • Rinse your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others) or neti pot. This home remedy, called nasal lavage, can help clear your sinuses. If you make your own rinse, use water that’s contaminant-free — distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller — to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with contaminant-free water and leave open to air-dry.
  • Moisten your sinus cavities. Drape a towel over your head as you breathe in the vapor from a bowl of hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air. This will help ease pain and help mucus drain.
  • Apply warm compresses to your face. Place warm, damp towels around your nose, cheeks and eyes to ease facial pain.
  • rest and avoid heavy activity until your symptoms go away
  • sleep with your head elevated. This will help your sinuses drain, reducing congestion.
  • avoid cool baths or sponging – this can actually make you or your child feel more uncomfortable
  • see your doctor if your fever persists or you are concerned.

Medicines you can take if you have a high temperature

There is no need to take medicines for fever unless you are experiencing discomfort.

If you are experiencing discomfort consider:

  • paracetamol (acetaminophen)
  • ibuprofen.

Before taking any medicine, you should check that it’s safe to take them:

  • with any medical conditions that you may have
  • with any other medicines that you are taking
  • if you are pregnant or breastfeeding.

You can do this by reading the information leaflet inside the packet or asking a pharmacist.

References   [ + ]