Treating acute sinusitis

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Sinusitis typically gets better after one to two weeks, even without treatment. The treatment options include steroid nasal sprays, painkillers and saline (salt water) solutions. It usually doesn't make sense to use .

Acute sinusitis may go away after a few days, but it can also last a few weeks. As well as causing typical cold symptoms, it can lead to severe pain in your forehead or even as far down as your jaw. There are various treatment options for sinusitis.

When are steroids considered?

Steroid nasal sprays reduce the 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 . That is only done if the symptoms are very severe and caused by a bacterial , which is rare.

What about painkillers and decongestant nasal sprays?

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 , 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.

Do saline (salt water) solutions and inhalations help?

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.

When are antibiotics used?

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

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

In severe cases, though, it’s important to use 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.

Chitsuthipakorn W, Kanjanawasee D, Hoang MP et al. Benefits of nasal saline treatment in acute rhinosinusitis: Systematic review and meta-analysis. Int Forum Allergy Rhinol 2022; 12(8): 1006-1017.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC), Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Rhinosinusitis (S2k-Leitlinie, in Überarbeitung). AWMF-Registernr.: 053-012. 2017.

Kanjanawasee D, Seresirikachorn K, Chitsuthipakorn W, Snidvongs K. Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-analysis. Am J Rhinol Allergy 2018; 32(4): 269-279.

Lemiengre MB, van Driel ML, Merenstein D et al. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev 2018; (9): CD006089.

Shaikh N, Wald ER. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database Syst Rev 2014; (10): CD007909.

Venekamp RP, Thompson MJ, Hayward G et al. Systemic corticosteroids for acute sinusitis. Cochrane Database Syst Rev 2014; (3): CD008115.

Zalmanovici Trestioreanu A, Barua A, Pertzov B. Cyclamen europaeum extract for acute sinusitis. Cochrane Database Syst Rev 2018; (5): CD011341.

Zalmanovici Trestioreanu A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev 2013; (12): CD005149.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on April 17, 2024

Next planned update: 2027


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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