Treating acute sinusitis

Steroid nasal sprays reduce the inflammation in the lining of the sinuses, causing the swelling to go down. Research has shown that these nasal sprays can relieve the symptoms of sinusitis. But it often takes several days for them to start working, and they don’t work for everybody. They help the most if you have allergic rhinitis (an allergy-related stuffy nose) or regularly recurring sinusitis. The studies found the following after two to three weeks:

• Without nasal spray: 66 out of 100 people who used a placebo (fake treatment) showed a significant improvement.
• With nasal spray: 73 out of 100 people who used a steroid spray showed a significant improvement.

These types of nasal sprays sometimes have side effects like nosebleeds or headaches.

Steroid tablets probably aren't effective when used alone. They might help when combined with antibiotics. That is only done if the symptoms are very severe and caused by a bacterial infection, which is rare.

The pain can be treated with acetylsalicylic acid (the drug in medicines like Aspirin), acetaminophen (paracetamol) or ibuprofen. Because they can lead to side effects like stomach problems, even over-the-counter painkillers should only be used for a few days at a time.

Decongestant (anti-swelling) nasal sprays or drops work straight away. They temporarily make it easier to breathe through your nose, helping you to sleep better at night. They don’t reduce the inflammation, though. There is a lack of research on their use in the treatment of sinusitis.

Decongestant nasal sprays should only be used for a few days because they can start having the opposite effect otherwise: Just a few hours after using the spray, the membranes lining the nose can then become very swollen again. The more often it is used, the stronger this effect is.

There are also herbal nasal sprays that contain extracts of the Cyclamen Europaeum plant. It is not clear whether these sprays help in acute sinusitis. Studies on herbal nasal sprays found that they often led to side effects such as irritated mucous membranes.

Saline solutions can help to remove the secretions (fluid) in the sinuses. You can buy them as ready-to-use nasal sprays in bottles. You can also rinse your sinuses using special nasal irrigation devices. Nasal sprays and rinses are available from pharmacies, for instance. To make the saline solution, you simply mix tap water with normal table salt or special packets of salts that are also available from pharmacies.

Hypertonic saline solutions (20 grams of salt per liter, about 5 teaspoons) are somewhat more effective than isotonic saline solutions (9 grams of salt per liter, about 2 teaspoons). But they can also have more side effects: Because they have more salt in them, they’re more likely to cause the soft tissue lining the nose to become dry and irritated.

Heating water and inhaling the steam is another option. Some people like to add things like chamomile or peppermint. But there's a lack of good research on the effectiveness of inhaling steam in this way.

Because antibiotics only fight bacteria, and sinusitis is typically caused by viruses, there's usually no need to take antibiotics. What's more, sinusitis usually clears up on its own within two weeks – even if bacteria are involved.

So it’s generally possible to wait one or two weeks to see if your symptoms get better on their own. If they last longer, you can still talk to your doctor about whether antibiotics might be a good idea.

Antibiotics can have side effects such as fungal infections and gastrointestinal (stomach and bowel) problems. Overusing antibiotics can lead to the development of bacteria that can't be treated effectively with (are resistant to) antibiotics. So if you have a mild respiratory infection, it's best not to use antibiotics at first.

In severe cases, though, it’s important to use antibiotics quickly. This can prevent serious complications such as meningitis. Signs of more severe sinusitis include a high fever, swelling around the eyes, red and inflamed skin, severe facial pain, sensitivity to light and a stiff neck. But acute sinusitis rarely has severe consequences.