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 at its root. Acute viral sinusitis can resolve on its own and treatment is only for symptom relief, while acute bacterial sinusitis can usually be cured with a round of antibiotics. Treating allergies that might be contributing to an acute or chronic sinus infection can also help.

 Chronic sinusitis may be a bit more complicated, as diseased or abnormal tissue may be blocking the sinus cavities and require surgery. If a fungus, rather than a bacterium, has grown inside of the sinuses, anti-fungal medications and endoscopic surgery may be needed to clear it out.

Home Remedies and Lifestyle

There are quite a few at-home remedies that can greatly reduce sinus infection symptoms. 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.

(Note: Hot vaporizers are a burn hazard and should not be used around children.) 

Other helpful tips:

  • A hot shower will 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

    With the exception of antibiotics and anti-fungal medications, which are prescriptions, any medications recommended for sinusitis are for symptom management and not to cure the infection. The main symptoms most seek to treat are related to sinus paincongestion, and allergy relief. Even though many of the medications listed below are available over-the-counter, you should always check with your doctor or pharmacist before taking a new medication or combining medications.

    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)
    • Aleven (naproxen)
    • Aspirin

    Some of these medications can be combined; for example, most healthy adults can take both acetaminophen and ibuprofen simultaneously, as long as they follow the dosing instructions included in the package. It's typically recommended that ibuprofen and naproxen not be combined, as the action of these two drugs is very similar. Aspirin is a potent blood thinner and should not be taken by anyone who is already taking blood thinners, or by people with certain high-risk conditions.

    Aspirin should not be given to children due to the risk of Reye's syndrome.

    If your symptoms become worse after taking aspirin, you may be one of the unlucky few that have aspirin intolerance that actually aggravates the symptoms of sinusitis. Indications include feelings of tightness in the chest, wheezing, cough, and sudden nasal congestion within a few hours of taking aspirin, ibuprofen, or naproxen. If you suspect you might have this condition, avoid taking these medications and use acetaminophen instead.

    If over-the-counter pain relievers are not effective in controlling pain, consult your doctor.

    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 to relieve congestion. Like other methods of nasal irrigation, a saline nasal spray is recommended for adults with acute bacterial sinusitis and chronic sinusitis.

    There are a variety of over-the-counter decongestant medications available to control symptoms in those with chronic sinusitis. Use should be limited to three to five days to avoid rebound congestion, which happens when the body reacts to the decongestant wearing off by producing increased swelling. Decongestants are not recommended for adults or children with acute sinusitis, as studies have shown no benefit. Examples of decongestants include:

    There are also over-the-counter steroid nasal sprays that can 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 safe to use daily for an extended time. They include:

    • Flonase (fluticasone)
    • Nasacort (triamcinolone acetonide)

    Antihistamines

    Antihistamine medications may work to "dry up" mucus, but they're most effective in people who develop sinusitis as a result of allergies. As with decongestants, they are not recommended for adults or children with acute bacterial sinusitis. Some antihistamines cause drowsiness, which may also be beneficial if you're unable to sleep at night because of bothersome symptoms. 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:

    Antihistamine nasal spray is also available. These drugs do not pose a risk of rebound congestion.

    While medications can be helpful in treating sinusitis, you may also need to try other suggestions, like nasal irrigation or lifestyle changes, to decrease symptoms of sinusitis. 

    Prescriptions

    Your doctor may prescribe medications that can help relieve symptoms as well as treat the underlying cause of the sinusitis.

    Prescription Steroid Medications

    If the over-the-counter steroid nasal sprays do not work for you, you may respond better to prescription steroid medications, including:

    These are steroid nasal sprays that work to open up the nasal passageways by relieving inflammation. They are superior to steroid medications taken in pill form because they don't have as many side effects throughout the body. That said, if nasal sprays are not effective in treating your congestion, your physician may prescribe an oral steroid (prednisone). Oral steroids are preferred for allergic fungal sinusitis.

    Steroid nasal sprays, drops, or oral corticosteroids may also be used if you have nasal polyps that are contributing to the 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 until there is an indication that the infection is bacterial rather than viral. Bacterial acute sinusitis is presumed in children and adults when the symptoms are not improving after 10 days, they are severe for more than three days, or there is a double-sickening seen after three to four days (the symptoms got better, then got worse again). A doctor may use a three-day period of observation before prescribing antibiotics to see if there is an improvement without them to avoid prescribing the drugs unnecessarily.

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

    Those risk factors for antibiotic resistance include being under the age of 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 on 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 fail to respond to two antibiotics may be treated with intravenous cefotaxime or ceftriaxone, or referred to an ENT specialist to take sinus cultures or perform imaging studies to look for noninfectious causes.

    In the case of chronic sinusitis, antibiotics may be used if you have a bacterial infection or if the doctor 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, along with surgical procedures.

    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 can also be done for those whose 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 to treat and may be done by an ENT specialist.

    Sinus surgery can often be done with an endoscope and is minimally invasive. A tiny fiber-optic tube is passed through the nostrils into the sinus cavities and no incision is needed. It is usually performed on an outpatient basis, but you may receive general anesthesia. 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.

    Enlarged adenoids in the back of the throat can be removed by an adenoidectomy, which is often done as a day surgery and is performed through the mouth.

    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. These problems can be corrected with endoscopic surgery.

    You may have a deviated septum, the piece of cartilage that divides your nostrils, due to a birth defect or an injury. A septoplasty surgery repairs this problem. Other 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 then further 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 that can be removed by surgery.

    Fungal sinus infections may require sinus surgery to resolve as a fungal ball or invasive fungal infection may not be cleared by antifungal medications alone. Endoscopic surgery can clean out the infectious material as well as any damaged tissues.

    Complementary Medicine (CAM)

    Nasal irrigation is one CAM treatment that has become mainstream and recommended by conventional medical practitioners for adults with sinusitis. Other CAM therapies/approaches may also be suggested, such as the below, but there's simply not enough supporting research to recommend them at this point. 

    Bromelain is a substance normally found in pineapples that have been used in oral supplements. It breaks down proteins and is believed to thin mucus in nasal secretions and have anti-inflammatory effects. The German Commission E (the country's equivalent of the FDA) approves its use for treating sinus and nasal swelling. People have used it for acute sinusitis as well as chronic sinusitis, and there have been small studies that appear to show some effects.​

    Many alternative medicine practitioners 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 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 these or other such options with your primary care provider first. Self-treating a condition and avoiding or delaying standard care may have significant consequences. Also, supplements may not be safe for pregnant women, nursing mothers, children, and those taking medications that may interact with them.

    Sources:

    Büttner Lm Achilles N, Böhm M, Shah-Hosseini K, Mösges R. Efficacy and Tolerability of Bromelain in Patients With Chronic Rhinosinusitis—a Pilot Study. B-ENT. 2013:9(3):217-25.

    Chow AW, Benninger MS, Brook I, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis. 2012;54(8):e72–e112.

    Shaikh N, Wald ER. Decongestants, Antihistamines and Nasal Irrigation for Acute Sinusitis in Children. Cochrane Database of Systematic Reviews. 2014. doi:10.1002/14651858.cd007909.pub4.

    Treating Chronic Sinusitis. Informed Health Online: Institute for Quality and Efficiency in Health Care. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072668/.

    Wald ER, Applegate KE, Bordley C, et al. Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Pediatrics. 2013;132(1):e262-80.