Sinusitis medical therapy

Overview
Try the following measures to help reduce congestion in your sinuses:
 * Apply a warm, moist washcloth to your face several times a day.
 * Drink plenty of fluids to thin the mucus.
 * Inhale steam 2 - 4 times per day (for example, sitting in the bathroom with the shower running).
 * Spray with nasal saline several times per day.
 * Use a humidifier.

Be careful with over-the-counter spray nasal decongestants. They may help at first, but using them beyond 3 - 5 days can actually worsen nasal congestion.

Also, for sinus pain or pressure:
 * Avoid flying when you are congested.
 * Avoid temperature extremes, sudden changes in temperature, and bending forward with your head down.
 * Try acetaminophen or ibuprofen.

Antibiotics are usually not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time you or your child is sick. Antibiotics may be prescribed sooner for:
 * Children with nasal discharge, possibly with a cough, that is not getting better after 2 - 3 weeks
 * Fever higher than 102.2° Fahrenheit (39° Celsius)
 * Severe swelling around the eyes
 * Headache or pain in the face

At some point, your doctor will consider prescription medications, antibiotics, further testing, or referral to an ear, nose, and throat (ENT) or allergy specialist.

Other treatments for sinusitis include:
 * Allergy shots (immunotherapy) to help prevent the disease from returning
 * Avoiding allergy triggers
 * Nasal corticosteroid sprays and antihistamines to decrease swelling, especially if there are swollen structures (such as nasal polyps) or allergies

Acute sinusitis should be treated for 10 - 14 days. Chronic sinusitis should be treated for 3 - 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

Acute sinusitis: Medical therapy
There are over the counter medicines that can relieve some of the symptoms associated with sinusitis. i.e. headaches, pressure, fatigue and pain. Usually these are a combination of some kind of antihistamine along with decongestant or pain reliever. Seeing a doctor will usually result in a prescription for antibiotics and a recommended rest. Furthermore, there have been studies that have concluded allergy testing results in detection of inhaled allergens that lead to inflammation which can trigger sinusitis.

Therapeutic measures range from the medicinal to the traditional and may include nasal irrigation or jala neti using a warm saline solution, hot drinks including tea and chicken soup, inhaling steam, over-the-counter decongestants and nasal sprays, and getting plenty of rest. Analgesics (such as aspirin, paracetamol (acetaminophen) or ibuprofen) can be used, but caution must be employed to make sure the patient does not suffer from aspirin-exacerbated respiratory disease (AERD) as this could lead to anaphylaxis.

If sinusitis doesn't improve within 48 hours, or is causing significant pain, a doctor may prescribe antibiotics (Amoxicillin usually being the most common) with amoxicillin/clavulanate (Augmentin/Co-Amoxiclav) being indicated for patients who fail amoxicillin alone. Fluoroquinolones may be used in patients who are allergic to penicillins.

Simple measures
Nasal irrigation and flush promotes sinus cavity health, and patients with chronic sinusitis including symptoms of facial pain, headache, halitosis, cough, anterior rhinorrhea (watery discharge) and nasal congestion found nasal irrigation to be "just as effective at treating these symptoms as the drug therapies." Recently the introduction of pulsatile irrigators specifically for sinus irrigation have been reported best for nasal irrigation In other studies, "daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis," and is "recommended as an effective adjunctive treatment of chronic sinonasal symptoms." and irrigation is recommended as an "effective adjunctive treatment of chronic sinonasal symptoms."

Medical approaches
For chronic or recurring sinusitis, referral to an otolaryngologist may be indicated for more specialist assessment and treatment, which may include nasal surgery.

A relatively recent advance in the treatment of sinusitis is a type of surgery called FESS - functional endoscopic sinus surgery, whereby normal clearance from the sinuses is restored by removing the anatomical and pathological obstructive variations that predispose to sinusitis. This replaces prior open techniques requiring facial or oral incisions and refocuses the technique to the natural openings of the sinuses instead of promoting drainage by gravity, the idea upon which the Caldwell-Luc surgery was based.

Another recently developed treatment is Balloon Sinuplasty™. This method, similar to balloon angioplasty used to "unclog" arteries of the heart, utilizes balloons in an attempt to expand the openings of the sinuses in a less invasive manner. Its final role in the treatment of sinus disease is still under debate but appears promising.

Based on the recent theories on the role that fungus may play in the development of chronic sinusitis, newer medical therapies include topical nasal applications of antifungal agents. Much of the original research indicating fungus took place at the Mayo Clinic and they have since patented this treatment option. Although there are some licensing battles taking place over these drugs as a result of the patent, they are currently available for other uses and therefore can be compounded by pharmacies or even by the patient.

Other approaches
Phage therapy: Since the discovery of spontaneous bacterial lysis (from bacteriophages) by Frederick Twort and by Felix d'Herelle, phage therapy (treatment with bacterial viruses) has been used extensively with miscellaneous bacterial infections in the areas of otolaryngology, stomatology, ophthalmology, dermatology, pediatrics, gynecology, surgery (especially against wound infections), urology, and pulmonology.

Treatment with phages was developed in the Soviet Union in parallel to the western development of antibiotics. Currently phage therapy for chronic Sinusitis is available at the Phage Therapy Center, Tbilisi, Republic of Georgia, or in Poland.