How Sinus Infection Is Treated

The treatment for a sinus infection depends on the type of sinusitis and the source of the inflammation or infection. For example, you might need antibiotics to clear up a sinus infection or a short course of steroids like prednisone for sinus infection symptoms.

Acute viral sinusitis can usually resolve on its own, acute bacterial sinusitis can usually be cured with antibiotics, and anti-fungal medications might be needed for treating fungal sinusitis. You might feel better with treatment for your symptoms as your sinus infection resolves.

Getting treatment for allergies that might be contributing to an acute or chronic sinus infection can help, and endoscopic surgery may be needed in some cases of chronic sinusitis.

Home Remedies and Lifestyle

At-home remedies can greatly reduce sinus infection symptoms, although they do not treat the infection.

Saltwater nasal irrigation is one of the treatments of choice for the symptoms of chronic sinusitis in adults, though studies show no benefit for children. Nasal irrigation is easy to do at home using a neti pot or other sinus rinse methods.

Using a steam vaporizer or a warm or cool mist humidifier may help keep your mucus thin. Inhalation of steam mixed with eucalyptus, chamomile, or peppermint may also help. While there's no scientific research that these additives improve symptoms, you may find them soothing.

Other helpful tips:

• A hot shower may relieve pain, promote drainage, and open up the sinus cavities.
• Reduce facial pain and swelling by applying a warm compress to your face.
• Drink lots of fluids and get plenty of rest. 

Over-the-Counter Therapies

Over-the-counter therapies (OTC) can be used to reduce sinus pain, congestion, and for allergy relief. You should always check with your healthcare provider or pharmacist before taking a new medication or combining medications, even if they are OTC.

Sinus Pain Relief

Sinusitis can cause headaches, toothache, and pain, and pressure in the face.

Over-the-counter pain relievers can be helpful in managing the discomfort and include:

• Tylenol (acetaminophen)
• Advil, Motrin (ibuprofen)
• Aleve (naproxen)
• Aspirin

Some of these medications can be combined; for example, most healthy adults can take acetaminophen and ibuprofen simultaneously, as long as they follow the dosing instructions included in the package. But ibuprofen and naproxen should not be combined because their chemical actions are very similar.

Aspirin is a potent blood thinner and you shouldn't take it if you have a bleeding risk or are already taking blood thinners. Aspirin should not be given to children due to the risk of Reye's syndrome.

If your symptoms become worse after taking aspirin or a non-steroidal anti-inflammatory (NSAID), you may have an aspirin intolerance that aggravates the symptoms of sinusitis. Signs include tightness in the chest, wheezing, cough, and sudden nasal congestion within a few hours of taking aspirin, ibuprofen, or naproxen. If you have this condition, avoid taking these medications. Aspirin intolerance can also be associated with nasal polyps and asthma (Sampter's Triad).

If over-the-counter pain relievers don't control your pain, consult your healthcare provider.

Nasal Congestion Relief

Nasal congestion, runny nose, and postnasal drip can all be symptoms of sinusitis. Saline nasal spray and Mucinex (guaifenesin) work to thin your mucus and help it drain easier, which may help relieve congestion.

A variety of over-the-counter decongestant medications may help control symptoms of chronic sinusitis. Decongestants are not recommended for adults or children with acute sinusitis, as studies have shown no benefit.

Examples of decongestants include:

• Afrin (oxymetazoline) nasal spray
• Sudafed (pseudoephedrine)
• Sudafed PE (phenylephrine)

Always consult with your physician before taking Sudafed or Sudafed SE.

OTC steroid nasal sprays may help treat congestion, especially with chronic sinusitis. These need to be taken over a longer period in order to get the full benefit. They are usually safe to use daily for an extended time, but you should check with your doctor.

They include:

• Flonase (fluticasone)
• Nasacort (triamcinolone acetonide)

Antihistamines

Antihistamine medications may work to dry up mucus, and they're most effective for people who develop sinusitis as a result of allergies. These drugs do not pose a risk of rebound congestion. They are not recommended for adults or children with acute bacterial sinusitis.

Some antihistamines cause drowsiness, which may also be beneficial if your symptoms are preventing you from sleeping at night.

If you are looking for an antihistamine that can also help you rest, the following are known for causing drowsiness:

• Benadryl (diphenhydramine)
• Unisom (doxylamine)

The following antihistamines are considered non-drowsy:

• Allegra (fexofenadine hydrochloride)
• Claritin (loratadine)
• Zyrtec (cetirizine hydrochloride)

Antihistamine nasal spray is also available. 

Prescriptions

Your healthcare provider may prescribe medications that can help relieve your symptoms and treat the underlying cause of your sinusitis.

Prescription Steroid Medications

Steroid nasal sprays open up the nasal passageways by relieving inflammation. They are different than steroid medications taken in pill form in that they don't cause as many side effects throughout the body.

Prescription steroid sprays include

• Nasonex (mometasone)
• Rhinocort (budesonide)

Steroid nasal sprays, drops, or oral corticosteroids may also be used if you have nasal polyps that are contributing to your sinusitis. There is no risk of rebound congestion with their use.

Leukotriene Modifiers

Another group of oral medications called leukotriene modifiers may be beneficial for some people with chronic sinusitis and those who have sinusitis associated with an aspirin allergy.

These prescription medications include:

• Singulair (montelukast)
• Accolate (zafirlukast)

Antibiotics

Antibiotics are not given unless there is an indication that the infection is bacterial rather than viral.

Acute bacterial sinusitis is often presumed in children and adults when the symptoms are not improving after 10 days, they are severe for more than three days, or the symptoms got better, then get worse again. Your healthcare provider may use a period of observation before prescribing antibiotics to see if you improve without them to avoid prescribing the drugs unnecessarily.

Children and adults who are not at risk of having an infection caused by resistant bacteria may be treated with a regular dose of amoxicillin. Antibiotic treatment in adults is usually continued for five to seven days. For children, it is usually given for 10 to 14 days.

Risk factors for antibiotic resistance include:

• Under the age 2 or over age 65
• Having taken antibiotics in the past month
• Having been hospitalized in the past five days
• Being immunocompromised or having other associated health conditions

Those at increased risk of resistant bacterial infection and those who do not improve with amoxicillin after three to five days may be given high-dose amoxicillin or high-dose Augmentin ES (amoxicillin-clavulanate).

Alternatives can include Omnicef (cefdinir), Ceftin (cefuroxime), Vantin (cefpodoxime), or, if someone is experiencing vomiting, a shot of Rocephin (ceftriaxone). For children and adults with a serious allergy to penicillin, Biaxin (clarithromycin), Zithromax (azithromycin), or Cleocin (clindamycin) may be used. Because many bacteria are resistant to older antibiotics, Bactrim (trimethoprim-sulfamethoxazole) and Pediazole (erythromycin-sulfisoxazole) are less likely to be used.

People who don't improve with two antibiotics may be treated with intravenous cefotaxime or ceftriaxone, or referred to an ear, nose, and throat (ENT) specialist. Cultures or imaging studies may be done.

In the case of chronic sinusitis, antibiotics may be used if you have a bacterial infection or if your healthcare provider can't rule out an infection. The course of the antibiotics might be extended to four to six weeks.

Antifungal Agents

Antifungal medications are usually not given for allergic fungal sinusitis or non-invasive fungal sinusitis (fungus ball or mycetoma). Antifungal medications may be prescribed for invasive fungal sinusitis, and a surgical procedure may be needed.

Immunotherapy for Allergies

If your sinusitis is caused or worsened by allergies (including fungal allergy), an allergist can give you allergy shots or oral medications to desensitize you to those triggers. These are customized for each person and steadily increase the amount of allergen to reduce your sensitivity.

Desensitization treatment may also be done if aspirin allergy is the cause of their sinusitis.

Specialist-Driven Procedures

Enlarged tissues, abnormal growths, scar tissue, and structural abnormalities can block the sinuses and contribute to recurrent and chronic sinus infections. These often require surgery, which may be done by an ENT specialist.

Sinus surgery is done with general anesthesia, and is usually minimally invasive and done with an endoscope. A tiny fiber-optic tube is passed through the nostrils into the sinus cavities, and no incision is needed.

While you are usually able to go home the same day, you need to be in the care of another adult for 24 hours and you should not drive.

Some types of sinus surgery that can treat certain causes of chronic sinusitis include:

• Enlarged adenoids in the back of the throat can be removed by an adenoidectomy, which is often performed through the mouth and done as same-day surgery.
• Turbinates are structures in the nasal passages that warm and humidify the air you breathe. They can become enlarged and may develop an air pocket in the middle turbinate called a concha bullosa. Turbinate reduction can be done with endoscopic surgery.
• A deviated septum is when the piece of cartilage that divides your nostrils is not centered. A septoplasty surgery repairs this problem.
• Facial birth defects (such as cleft palate) or injuries can require surgical correction if they are contributing to sinusitis.
• Nasal polyps are benign masses of tissue that can develop due to inflammation, and contribute to blocking the sinuses and sinusitis. They can be removed with endoscopic surgery.
• Malignant or benign tumors are less common causes of sinus blockage and can be removed surgically.
• Fungal sinus infections may require sinus surgery. A fungal ball or invasive fungal infection may not be cleared by antifungal medications alone. Endoscopic surgery can clean out the infectious material and any damaged tissues.

Complementary Medicine (CAM)

Nasal irrigation is one CAM treatment that has become mainstream and is recommended by conventional healthcare providers for adults with sinusitis. Other CAM therapies/approaches may also be suggested, but there's not enough supporting research to recommend them. 

Many alternative healthcare providers believe that food sensitivities can cause sinus congestion and sinusitis, although this is not generally supported by conventional medicine. Sensitivities to dairy, wheat, oranges, or sugar are purported to promote the formation of mucus, and some people may consider removing these foods from their diet to see if it helps.

As with any alternative therapy, it's important to discuss the use of such options with your healthcarecare provider before trying them. 

Also, supplements may not be safe for pregnant women, nursing mothers, children, and those taking medications that may interact with them.