Treating chronic sinusitis

Steroid nasal sprays reduce swelling in the sinuses and ease the symptoms. Treatment with steroid sprays can cause any polyps that might be there to shrink. It usually takes a few days for the full effects of steroid sprays to be felt. In order to relieve the symptoms permanently, you often need to take medication for several months or even over a year. There are various steroid sprays, all of which have a similar effect according to the research.

Some people are reluctant to take any medication containing steroids. Steroids can have side effects when taken in high doses and over a longer period of time. In particular, they may irritate or dry out the membranes lining the nose. People sometimes have temporary headaches too. Nosebleeds can occur, particularly when taking higher doses. But the side effects are usually mild.

Steroid nasal sprays have far fewer side effects than steroids taken in tablet form or as an infusion (drip). Steroids in tablets or infusions are carried throughout the entire body, whereas topical medications like nasal sprays or skin creams mainly affect only the area they are applied to.

Although steroid tablets are effective too, they are generally only used in exceptional cases due to their side effects. They should not be used for more than three weeks.

Only few studies have looked into the benefits of antibiotics in chronic sinusitis. But they were not able to find out how effective they really are. Antibiotics only fight bacteria – but sinusitis is typically caused by viruses, not bacteria. Plus, the inflammation in chronic sinusitis is often influenced by other factors as well, such as allergies.

Severe bacterial sinusitis can lead to complications. Although this rarely happens, antibiotics need to be taken quickly in order to prevent serious complications such as meningitis.

Decongestant nose drops or nasal sprays aim to soothe the mucous membranes and reduce swelling. This makes it easier to breathe through the nose in the short term – which can make it easier to sleep. But decongestant drugs can quickly have the opposite effect as well. After just a few hours, the membranes lining the nose may start to swell again. The more often the medication is used, the stronger this effect is. So it's not a good idea to use this medication continuously for more than a few days.

In addition to medication, you can use saline (salt water) solutions to reduce swelling in the mucous membranes and to help loosen the mucus. Saline solutions are available as ready-to-use nasal sprays. To relieve symptoms, you can also try rinsing your nose with salt water. Heating water and inhaling the steam is another option. Some people like to add chamomile or peppermint. But there is not enough scientific research on saline solutions or steam inhalation to say for sure how effective they are.

Some medications may not be able to make sinusitis to go away faster, but they can relieve the pain. These include pain-relieving and anti-inflammatory drugs like ibuprofen, acetaminophen (paracetamol) or acetylsalicylic acid (the drug used in medicines like Aspirin). But some people don't tolerate acetylsalicylic acid well. It might make their chronic sinusitis worse, or even trigger asthma attacks. Painkillers like acetaminophen (paracetamol) are more suitable in that case.

The medication dupilumab (trade name: Dupixent) has been approved in Germany since October 2019 for the treatment of severe chronic sinusitis and nasal polyps in adults. It is used in addition to a steroid nasal spray, and injected under the skin every two weeks. Studies have shown that dupilumab relieves the symptoms of chronic sinusitis better than a steroid nasal spray alone.

A wide variety of other treatments are available. In addition to other medications, they include herbal products, acupuncture, infrared light therapy and zinc products. There is no scientific evidence that these treatments help in the treatment of chronic sinusitis, though.

Especially if the symptoms are very severe and they don't improve enough – or for long enough – just by taking medication, some people decide to have surgery. One common type is a procedure that expands narrow passageways in the sinuses. Non-cancerous growths ( polyps) and inflamed parts of the mucous membrane are also removed. This operation is called "functional endoscopic sinus surgery (FESS)." It aims to improve airflow through the nose and the sense of smell, and make it easier for mucus to flow out. During the procedure, the narrowed sinus passageways are expanded using small instruments inserted through a tube ( endoscope).

Unfortunately, only few conclusive studies have looked into whether FESS can improve the symptoms over the long term or how effective the operation is compared with medications like steroids. But surgery is an option if steroid sprays and other treatments haven't provided enough relief. The procedure also aims to help medications or saline solutions work better because they can reach the nasal cavities better after they have been expanded. Even after surgery, you will probably need to continue to use a steroid spray or other medication to relieve the symptoms.

Severe complications following FESS are very rare. More common complications include short-term bleeding, inflammation, bruising and an impaired sense of smell. According to various estimates, between 5 and 15 out of 100 people can expect these kinds of temporary side effects following surgery. People often have a stuffy nose for several days after the procedure, and scabs may form, but this gets better quickly. It may take several weeks until the wounds in the sinuses have completely healed, though. For this reason, it's important to have regular doctor's appointments for several weeks. He or she will rinse your nose with a saline solution. The ear, nose and throat (ENT) doctor will also remove wound secretions from your nose at several different appointments.

Another surgical procedure is known as balloon sinus dilation. This involves inserting a catheter through the nose and slowly inflating a balloon at the sinus opening. The aim is to expand the narrowed passageways at the sinus openings, but it is not suitable for all forms of chronic sinusitis.