Chronic sinusitis is thought to affect around 10% of the US population, which is a relatively high number for this condition. If you’ve been diagnosed with chronic sinusitis or you think you may have it, the good news is that there are a number of medications available to help you manage it.
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What is chronic sinusitis?
Chronic sinusitis is defined as a long-lasting swelling or infection in your sinuses, caused by a number of factors. Some of the most common causes of chronic sinusitis include bacteria or fungus, which can present with or without nasal polyps.
What are the different types of chronic sinusitis medication?
Depending on the type and severity of your chronic sinusitis, and what your medical professional suggests, there may be a few different treatment options and medications available to you. These include steroid treatments, antibiotics, and nasal irrigation, among others, each with their own mechanisms of action and specific benefits depending on the severity and underlying cause of the condition.
Steroids
Doctors may prescribe steroid treatments as the initial treatment option for chronic sinusitis to bring down the swelling in the sinus membranes. These are most often in the form of inhaled steroids, however serious cases of chronic sinusitis may also benefit from oral steroids. Although steroid tablets can be effective, they are often only used in rare cases due to their side effects.
When used for a prolonged period, steroids can have side effects such as sore throat, upset stomach, heartburn, weight gain, thinning of the bones, glaucoma, steroid-induced diabetes, mood swings, memory problems, confusion, or delirium. It’s important to monitor any side effects of steroids and keep in contact with your doctor as you take them.
How do steroids work?
Steroids, or corticosteroids, are powerful antiinflammatories which means they can significantly reduce the amount of swelling in the nasal passages and sinuses, improving the ease and ability to breathe. If someone has nasal polyps alongside chronic sinusitis, a prescription nasal spray with steroids can help to shrink them, while also reducing mucus production and nasal inflammation.
When are steroids used for chronic sinusitis?
Steroids are drugs commonly used to relieve inflammation in various parts of the body, and they are a good medication for chronic sinusitis too. Medics will typically prescribe steroid treatments for chronic sinusitis when there is severe inflammation or other severe symptoms. They may also be used in a postoperative period if someone has undergone surgery for chronic sinusitis.
Patients could be prescribed inhaled or oral steroids for their condition, and doctors will often prescribe a combination of a nasal wash and nasal steroid spray to effectively treat chronic sinusitis.
Antibiotics
In some cases, antibiotics may be prescribed for chronic sinusitis. However, there have only been a handful of studies that look into how well they work as a medication for the condition which means it’s still unclear how efficient they really are. Typically, antibiotics are used to treat a sinus infection, but they are not commonly handed out for chronic sinusitis due to the side effects.
Inappropriate or unnecessary use of antibiotics can lead to bacterial resistance and other side effects, which is why medical professionals prescribe them sparingly. Antibiotics only work for bacterial infections, so they will not help chronic sinusitis caused by a virus or other factors.
How do antibiotics work?
Antibiotics are designed to treat bacterial infections, and they do this by killing bacteria or stopping them from working. This then helps the body's natural immune system to fight the infection. In cases of chronic sinusitis, antibiotics can reduce swelling in the sinuses and nasal passages, lessening any facial pain or pressure while enabling the patient to breathe more easily.
When are antibiotics used for chronic sinusitis?
If your doctor or healthcare professional believes a bacterial infection has caused your chronic sinusitis, they may prescribe a course of antibiotics. While acute sinusitis can often be treated with a 10-14 day course, chronic cases may take much longer. In rare cases, severe bacterial sinusitis can lead to complications, so it’s important to thoroughly discuss whether antibiotics are the best course of action for you.
Decongestant nose drops
Over-the-counter medication, such as decongestant nose drops, can also be a suitable treatment for some cases of chronic sinusitis. Available as drops or sprays, this medication aims to soothe the mucus membranes in the nose and reduce any swelling. While they can offer temporary relief, some patients may experience swelling in the lining of the nose again after a few hours.
Depending on the severity of your chronic sinusitis, it’s a good idea to discuss this medication with your doctor before you start using it. In some chronic sinusitis cases, it may not be recommended to use decongestants as they are only intended to be used for a few days at a time, and chronic sinusitis is typically much longer lasting.
How do decongestants work?
Decongestants are designed to reduce the amount of mucus you have in your sinuses and shrink the swollen nasal tissue. The more they are used, the more relief will be experienced. It’s important to read the label to ensure you do not take it for longer than suggested as occasionally, too much use could result in further congestion.
When are decongestants used for chronic sinusitis?
Decongestants are commonly used for acute sinusitis to provide temporary relief from symptoms. While they are not often recommended for chronic sinusitis, patients suffering may find they offer some relief on occasion. As most decongestants do not require a prescription, they can be a good option if you’re looking to relieve symptoms for a little while.
Painkillers
Another over-the-counter medicine that chronic sinusitis sufferers commonly use is painkillers, such as ibuprofen, paracetamol, or acetylsalicylic acid (the drug in aspirin). They are used to ease discomfort and reduce swelling in some cases. It’s important to follow the instructions on the label and avoid taking them for more than 10 days. While painkillers can temporarily relieve some pain caused by chronic sinusitis, they will not make it go away any quicker.
How do painkillers work?
Painkillers work by preventing injured cells from releasing prostaglandin, a hormone-like substance. When painkillers sense a release of prostaglandin, the body’s nerve endings transmit a message through the nervous system to the brain, telling it where and how much an area of the body is in pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, relieve pain by reducing swelling in the nasal passage and providing relief. Acetaminophen, or aspirin, works to relieve sinus pressure and pain in the same way.
When are painkillers used for chronic sinusitis?
As they are available over-the-counter, and commonly found in most people’s homes, painkillers can be used any time the person with chronic sinusitis is experiencing pain or discomfort. They are recommended when pain is severe or fever is present, and a pharmacist can usually advise you on the best option for your needs.
Nasal irrigation
Alongside nasal sprays and drops, people with chronic sinusitis can also use nasal irrigation to help with symptoms. These are commonly available in pharmacies, but can also be made at home. Nasal irrigation can be done with a saline solution to clear out the nasal passage and provide some relief.
To make a nasal irrigation solution at home, people can simply mix water with ordinary table salt or packets of specialist salts from a pharmacy. After doing a nasal irrigation, you should wait until the draining stops and then continue using other medications as prescribed by your doctor, such as a nasal spray.
How does nasal irrigation work?
Nasal irrigation removes mucus, bacteria, and other irritants from the nose and sinuses. It works by thinning mucus, clearing debris, and moistening the nasal passage to provide pressure, pain, and inflammation relief.
When is nasal irrigation used for chronic sinusitis?
Nasal irrigation can be used as a stand-alone treatment or in combination with other therapies as recommended or prescribed by a healthcare professional. It can be used to treat chronic rhinosinusitis, allergic rhinitis, and other sinus or nasal conditions. It is commonly recommended where polyps are also present as it can help to prevent them from worsening or getting infected.
Antihistamines
In many cases, chronic sinusitis occurs due to uncontrolled allergies, and this is when antihistamines can be an effective medication. If you’ve not yet been diagnosed with allergies, it could be worth speaking to your healthcare professional about undertaking allergy testing to see if this could be the cause of your chronic sinusitis.
Once you have an allergy diagnosis, antihistamines and avoiding triggers can help to soothe your symptoms. Antihistamines are commonly available over-the-counter in nasal spray or oral form. You may also be able to get allergy shots which can make you gradually less sensitive to the triggers that set off your symptoms.
How do antihistamines work?
Antihistamines work by blocking histamine, the main chemical produced by our bodies that causes an allergic reaction. They effectively prevent histamine from causing an allergic reaction, which in chronic sinusitis, can relieve symptoms such as sneezing, itching, and a runny nose or nasal drip.
When are antihistamines used for chronic sinusitis?
Antihistamines are typically recommended by healthcare professionals only when an allergy is present in combination with chronic sinusitis.
Leukotriene modifiers
Leukotriene modifiers, also known as leukotriene receptor antagonists, are a class of medications used to treat allergic rhinitis, allergies, and asthma. They can also be used as a medication for chronic sinusitis. Leukotrienes cause inflammation in the nose, sinuses, eyes, and skin, and leukotriene modifiers help reduce nasal and sinus inflammation.
If your healthcare professional has recommended you use leukotriene modifiers, they will need to regularly monitor your liver with bloodwork to ensure damage is not caused to the liver.
How do leukotriene modifiers work?
Leukotriene modifiers work by blocking the action of leukotrienes. For those with allergies and asthma, leukotriene modifiers can help ensure the bronchial tubes do not constrict. They effectively block the action of leukotrienes or prevent the body from producing them.
When are leukotriene modifiers used for chronic sinusitis?
Like antihistamines, leukotriene inhibitors or modifiers are commonly used to treat chronic sinusitis caused by allergies. This is because they target leukotrienes produced by the body in a similar way to how antihistamines target histamine.
Leukotriene modifiers can also be used in addition to other treatments, such as nasal sprays and antihistamines, and are particularly useful for cases where nasal polyps are present or the patient has aspirin sensitivity.
Are there any new medications available for chronic sinusitis?
While many medications already exist for chronic sinusitis, researchers are still considering whether new medications could be used as effective treatment options. As such, there have recently been several medications approved for chronic sinusitis in the USA, expanding the treatment options for patients.
Recently approved medications for chronic sinusitis
The first medication recently approved was Dupixent (dupilumab). This was initially approved for treating various allergic conditions but has now been approved for adults and adolescents aged 12 years and older with chronic rhinosinusitis with nasal polyps (CRSwNP) who do not respond to intranasal steroids. Even though it is an approved treatment, there are still many active clinical trials exploring dupilumab.
Dupixent helps reduce the size of nasal polyps, improves nasal congestion, and can reduce the need for surgery or oral steroids. It works by blocking certain inflammatory pathways involved in allergic conditions and is administered by injection by a healthcare professional.
This medication has a strong track record in reducing symptoms like nasal congestion and loss of smell but there can be some side effects, including injection site reactions, eye and eyelid inflammation, gastritis, joint pain, trouble sleeping, and toothache.
Fluticasone Propionate was also FDA approved in March 2024, for the treatment of chronic rhinosinusitis without nasal polyps, marking it as the first drug with such an indication. It delivers fluticasone, a corticosteroid, directly into the nasal cavity using a unique exhalation delivery system which enables more effective targeting of inflamed areas within the sinuses. It was previously approved for patients with nasal polyps, but this recent approval extends its use to a broader group of chronic rhinosinusitis patients.
Medications in clinical trials for chronic sinusitis
Several other promising medications are currently in clinical trials for chronic sinusitis. These trials aim to offer new therapeutic options for patients who have not responded to conventional treatments.
Developed by Lyra Therapeutics, LYR-210 is a bioresorbable nasal implant designed to deliver a six-month dose of mometasone furoate (an anti-inflammatory steroid) directly to the sinonasal tissues. It is currently being evaluated in Phase 3 trials for patients with CRS who have failed prior medical treatments and have not undergone sinus surgery. The results of this trial are expected in 2025.
Another medication, XHANCE, which delivers fluticasone propionate (a corticosteroid) via an exhalation delivery system, is being studied for its potential to reduce the need for sinus surgery in patients with nasal polyps.
Should you participate in a clinical trial for chronic sinusitis medications?
If you are suffering from chronic sinusitis, enrolling in a clinical trial can be a great choice. Whether you’ve tried lots of other medications and treatments to no avail, or you’re keen to support the scientific community, chronic sinusitis clinical trials can be hugely beneficial.
Taking part in a clinical trial for chronic sinusitis can offer a multitude of benefits, both personally and for the wider medical research space. Firstly, clinical trials test the most innovative treatments that are not yet publicly available. This means participants can gain early access to the latest treatments or medications for chronic sinusitis.
Want to better understand the pros and cons of clinical trials? Discover what to expect when participating in a clinical trial in our in-depth guide. Make an informed decision about your healthcare options today!
Participants in a clinical trial for chronic sinusitis are also subject to close monitoring and more personalized care, which they may not have access to outside a clinical trial. They will be continually monitored by experienced medical professionals with an interest in the condition, therefore delivering more specific care and guidance.
Clinical trials are beneficial for science too, largely contributing to the advancement of medical knowledge while supporting the improvement of treatment options for future patients. Participating in a clinical trial can also deliver a sense of empowerment, with patients playing an active role in their treatment journey while paving the way for others.
Conclusion
Chronic sinusitis can be a difficult condition to manage and treat, especially given how long it typically lasts without treatment. Many medications currently available can help manage symptoms and improve the lives of people suffering from chronic sinusitis. But if medications aren’t working, there is hope that the clinical trials underway will provide even more medication options for patients in the future.