The primary treatment for acute sinusitis is antibiotics for eradicating infection. A prolonged course is often needed because the blood supply to bony areas such as the sinuses is limited. This course may vary but a typical treatment takes three weeks.



Establishing Drainage

In sinus disease it is crucial to establish good drainage, which is often achieved with decongestants such as pseudoephedrine. Antihistamines can also help, particularly in allergic patients, but may not be a good idea for many asthmatics owing to the risk of drying up the bronchial secretions. To avoid excessive dryness, decongestants are often combined with an expectorant such as guaifenesin. A saline nasal spray may help rinse out dried secretions and add moisture to dry membranes.

Treating Chronic Sinusitis

Even after a sinus infection has been eradicated, many patients will continue to experience congestion, pain, and recurring bouts of sinus infection. In patients with chronic disease, particularly allergic ones, adding intranasal corticosteroid sprays may be extremely helpful in reducing inflammation. Beclomethasone, budesonide, fluticasone, flunisolide, and triamcinolone are available in the United States. Intranasal cromolyn sodium may also help these patients. An intranasal preparation of nedocromil sodium should be available soon.

Should You Consider Surgery?

In patients who suffer from persistent sinus infections despite courses of appropriate antibiotics, a surgical drainage procedure may be needed. A sinus CAT scan documenting the presence of infection and maximal medical therapy should have been given before surgery. When possible, this surgery is increasingly performed through the endoscope. The technique is less traumatic than older sinus drainage procedures and is often performed in an outpatient setting.

Physicians must individualize treatment of sinus disease for each patient. Aggressive treatment of sinus disease, however, may also improve the control of bronchial asthma.