Chronic sinusitis can be a difficult condition to manage for those living with it, and while there are treatment options available, it’s not always easy to understand which options are most suitable. This condition affects around 10% of people in the USA, but symptoms and severity can vary which means treatments that work for one person may not work for another.
If you’re suffering from chronic sinusitis, it’s important to understand the various treatment options available to you, how they work, and when your doctor might recommend them. As with any condition, consulting with medical professionals is essential for finding the best treatment for you.
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What is chronic sinusitis?
Chronic sinusitis refers to prolonged inflammation, swelling, or infection of the nasal sinuses. While sinusitis is quite common, when symptoms persist for more than three months or recur frequently within short intervals, it’s diagnosed as chronic. This condition can be particularly challenging for those affected, as it often leads to ongoing discomfort and may significantly impact daily life.
Symptoms of chronic sinusitis
People living with chronic sinusitis may experience a number of different symptoms, with the main symptoms being tenderness or pressure around the nose, eyes, and forehead. Other chronic sinusitis symptoms include thick yellow or green mucus from your nose, postnasal drip, a stuffy nose, toothache, cough, headache, tiredness, ear pain, loss of taste and/or smell, and bad breath.
How is chronic sinusitis diagnosed?
To diagnose chronic sinusitis, medical professionals will consider several factors including your symptoms and how long you have experienced them for. They may also examine the inside of your nose with an endoscope which allows them to see inside your nose and the sinuses. If you’ve experienced sinusitis symptoms for 12 weeks or more, they will likely diagnose you with chronic sinusitis.
In some cases, a CT scan or MRI can be used to look for nasal polyps or a deviated septum which could also be causing similar symptoms. If your doctor has reason to suspect your symptoms are caused by something other than chronic sinusitis, they may decide to take a biopsy but this is rare when diagnosing chronic sinusitis.
Treatments for chronic sinusitis
Most treatments and medications for chronic sinusitis focus on easing and controlling inflammation. The treatments recommended or prescribed by your medical professional will depend on your individual circumstances, symptom severity, and root cause of the condition.
Antibiotics
Antibiotics are sometimes needed to treat chronic sinusitis caused by bacteria. However, they will not work for viral chronic sinusitis. In most cases, antibiotics can be given for an extended period of three weeks, but there is no consensus on their routine use for chronic sinusitis as only a few studies have researched how well antibiotics work for this condition.
Do I need antibiotics for every sinus infection?
Antibiotics are not a routine treatment for chronic sinusitis, and so they are not prescribed for every sinus infection. Medical professionals will often wait to see how long symptoms last before prescribing them to avoid unnecessarily giving them and ensuring they are only used for bacterial infections. Most cases of chronic sinusitis are caused by viruses like common colds, and therefore not suitable for antibiotic treatment.
Immunotherapy
Immunotherapy treatments can help people with chronic sinusitis caused by environmental allergies. These preventative treatments usually involve gradually introducing the body to small amounts of an allergen to retrain the immune system to tolerate it. Immunotherapy for chronic sinusitis can eliminate future allergic reactions to substances like dust mites, grass pollens, and bee venom. It can also improve sinus surgery outcomes and reduce sinus infections.
Immunotherapy is usually given as a series of injections over three to five years. The dose of the allergen is gradually increased to induce tolerance without reactions and most patients experience relief from symptoms within the first few months of treatment.
Steroids
Steroids can be an effective chronic sinusitis treatment if nasal polyps are present. A nasal steroid spray can be used to shrink nasal polyps and reduce any swelling or inflammation. However, caution is advised due to the side effects that could be caused, such as mood changes, difficulty sleeping, indigestion, increased appetite, and an increased risk of infections.
In most cases, doctors will prescribe nasal steroid sprays, but if these are ineffective, oral steroids can be considered. Nasal steroid sprays can be used alongside other treatments such as nasal saline irrigation. Caution is often advised with nasal steroid sprays as while they can ease severe chronic sinusitis, they are not intended for long-term use.
Decongestant nose drops
To soothe mucus membranes and reduce swelling, decongestant nose drops may be recommended. These can also be used in the form of nasal sprays. Decongestants can be used for symptomatic relief without a prescription, but there is a lack of evidence to support their use for chronic sinusitis specifically. They may also have the opposite of the desired effect, with the nasal membranes swelling again after only a few hours.
Nasal irrigation
In addition to other treatments and medications, nasal irrigation can help to reduce swelling and loosen mucus which could be causing discomfort. Nasal rinses are available from most pharmacies, providing an easy-access option when symptoms become difficult. Most nasal rinses are made using a saline solution, which can also be made at home using water and table salt or special salt packets from a pharmacy. While nasal saline solutions can be helpful, they are not thought to be as effective as steroid sprays for example.
Painkillers
Painkillers, such as ibuprofen and paracetamol can be helpful for pain relief but will not actively treat chronic sinusitis or make it go away any quicker. Painkillers are often used simply to ease some of the pressure and painful inflammation associated with chronic sinusitis, in addition to other treatments or medications.
Biological drugs (biologics)
Several biological drugs, antibiotics, and medications can be prescribed for chronic sinusitis, offering a welcome relief from symptoms. The most commonly used drugs prescribed for chronic sinusitis include augmentin, amoxicillin, doxycycline, levofloxacin, omalizumab, cefixime, cefpodoxime, and clindamycin.
Some medications can reduce the size of nasal polyps, reduce inflammation, or lessen stuffiness felt in the nose and sinuses. Aspirin desensitization treatment can also be used in people who react to aspirin in a way that causes sinusitis and nasal polyps.
Many other medications are currently in chronic sinusitis clinical trials, including dupilumab and mepolizumab, which are both already approved for use in adults with chronic sinusitis and polyps in Germany. Dupilumab is thought to relieve symptoms better than steroid nasal sprays alone, but USA-based clinical research is yet to publish findings on this.
Other treatments
A variety of other treatments for chronic sinusitis are available too, including:
- Leukotriene antagonists which reduce nasal and sinus inflammation
- Allergy testing to help identify environmental triggers for patients to avoid
- Antihistamines if allergic components are suspected
- Over-the-counter (OTC) cold and allergy medications
- Drinking plenty of fluids and maintaining a healthy lifestyle
Interested in exploring other treatment options? Clinical trials offer an excellent opportunity to access innovative therapies. Discover everything you need to know about clinical trials and how to participate in our comprehensive guide.
Can surgery help chronic sinusitis?
If chronic sinusitis symptoms are severe and don’t improve with treatment for a long enough period, some people may be offered surgery. This option is usually only considered if other treatments such as steroid sprays or medications don’t relieve symptoms well enough, or inflammation has spread and could increase the risk of complications. Depending on the circumstances, severity, and root cause of the chronic sinusitis, doctors may offer one of several surgery options.
Endoscopic surgery
Endoscopic sinus surgery is the most commonly recommended surgical procedure for people with chronic sinusitis. It is often considered for patients who fail medical management or in combination with medication in complicated or severe cases. This surgery works to remove obstructions, restore drainage, and clear mucus to ventilate the sinuses and reduce symptoms.
Research is limited for this surgery, with only a few good-quality studies having looked into whether it can improve the symptoms over the long term or how effective it is compared with using steroids alone. Surgeons use a nasal endoscope in this surgery and it is performed under general anesthesia, with no visible incisions required. During surgery, high-quality images of the nasal passages and sinuses are transmitted from the endoscope to a monitor in the operating room so surgeons can clearly see what needs to be removed.
Balloon dilation (sinuplasty)
Where inflamed sinuses are causing issues with chronic sinusitis, a balloon sinuplasty may be a viable treatment option. In this surgery, the blocked sinus is dilated to create an open space in which the sinus can drain normally. Surgeons will locate the blockage before a thin catheter with a small balloon attached is guided to the blockage and positioned at the opening. They will then inflate the balloon to stretch the opening of the sinuses and widen any narrowed areas.
How can clinical trials help with chronic sinusitis?
Clinical trials are essential for testing new treatments and innovations for a wide range of health conditions, including chronic sinusitis. While many treatment options exist, they don't always work for everyone, especially for those who have dealt with chronic sinusitis for years without success. Clinical research provides hope by exploring new therapeutic avenues that may be more effective.
A number of chronic sinusitis clinical trials are currently underway to explore novel treatments for this condition. Some focus on innovative medications, while others target specific patient groups, such as people with chronic sinusitis and nasal polyps or those living with cystic fibrosis.
One promising trial is a Phase II study evaluating the safety and effectiveness of a bioresorbable nasal implant that delivers the corticosteroid mometasone furoate over six months. This implant is designed to reduce inflammation and improve symptoms in patients who have not responded to standard treatments.
Another active trial is investigating Dupilumab (Dupixent), a biologic therapy, in patients with chronic sinusitis without nasal polyps. Dupixent is already approved for use in patients with nasal polyps, and this study aims to expand its application to a broader group of sinusitis sufferers.
Should you participate in a clinical trial for chronic sinusitis?
Clinical trials play a crucial role in advancing the treatment of chronic sinusitis by offering new and innovative therapies that aren't yet widely available. For patients who have not found relief with standard treatments, clinical trials provide access to experimental drugs and therapies that could be more effective.
These trials often focus on novel approaches, such as biologics that target specific immune responses involved in chronic sinusitis. By participating, patients could potentially experience significant improvements in symptoms, including reduced inflammation, easier breathing, and fewer infections.
Additionally, clinical trials offer participants close medical supervision from experts who specialize in chronic sinusitis. This ensures participants receive personalized care, with ongoing monitoring and adjustments to treatment as needed. Beyond personal benefits of participating in a clinical trial, they also contribute to the greater scientific understanding of chronic sinusitis, leading to the development of improved treatment options for future patients. By taking part, individuals help advance medical knowledge and shape the future of care for others facing the same condition.
Conclusion
With several different treatment options currently available for chronic sinusitis, your medical professional will be able to help you decide which one might be best suited to your needs. The good news is that if it doesn’t work, you can always try something else. And with several clinical trials underway, there is a chance that new and better treatments will be available soon.
FAQs
Are complementary and alternative therapies useful for treating sinusitis?
Some complementary and alternative therapies can help relieve sinusitis symptoms, but they are unlikely to be as effective for chronic cases. If you are considering trying a new treatment for your condition, it’s important to consult a healthcare professional first. Some alternative therapies people use for sinusitis include acupuncture, herbal remedies, dehumidification, warm compresses, nasal rinses, and increasing hydration, although there is limited research on how effective these treatments are.
Can chronic sinusitis be prevented?
In some cases, chronic sinusitis can be prevented if you manage to get a handle on your condition before it gets to a chronic stage. To prevent chronic sinusitis, you should protect your health, manage your allergies, avoid cigarette smoke and polluted air, and consider lifestyle changes if appropriate. For example, you could consider using a humidifier if your home has dry air.
How do I know if I have sinusitis, COVID, a cold, or an allergy?
Sinusitis, colds, allergies, and COVID-19 can all display similar symptoms, which can make it difficult to diagnose what you have. However, COVID-19 can also cause additional symptoms like fever and shortness of breath which makes this one slightly easier to distinguish from the others. Each of these conditions can cause sinus infections though, so you may start with a cold that develops into sinusitis as your symptoms worsen. If you’re not sure, you should consult your healthcare professional.
What happens if sinusitis is left untreated?
Regular sinusitis often goes away on its own without treatment, but if symptoms persist, it could develop into chronic sinusitis which brings along additional symptoms and more discomfort. If you have chronic sinusitis, it’s important to seek advice from a medical professional and start a treatment to resolve it. If you don’t treat chronic sinusitis, it’s unlikely to go away and could worsen. In extremely rare cases, untreated sinusitis could lead to meningitis, a brain abscess, or bone infection.