Sinusitis is another term for sinus infections, though sinusitis refers to inflammation of the sinuses, with or without an infection. Sinus infections are usually classified as acute or chronic depending on how long they last, with acute infections resolving within 4 weeks and chronic infections lasting 12 weeks or longer. (1) Sinus infections most often arise after a viral infection, such as the common cold, and are most often caused by viruses, such as rhinoviruses, influenza viruses, and parainfluenza viruses. Less frequently, sinus infections may be due to bacteria, such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Fungi can also cause a sinus infection in rare cases. Aspergillus fumigatus is usually responsible for fungal sinus infections, but many other species can also cause the illness. (2) Treatment options for sinus infections depend on the cause of the infection and whether it’s acute or chronic.
Acute Sinus Infection Home Remedies
Acute sinus infections caused by viruses usually last only 7 to 10 days. These cases are usually treated by addressing the symptoms rather than the underlying cause (antibiotics are for bacterial infections, not viral infections, and the overuse of antibiotics can create drug-resistant bacteria). Common symptoms of acute sinus infections include nasal congestion and blockage, yellow-to-green nasal discharge, decreased sense of smell, postnasal drip, and a feeling of pain, pressure, or fullness in the face. (3) To help relieve symptoms, particularly sinus pain and stuffiness, without medications, try the following recommendations:
Use a saline nasal spray, neti pot, or saline squeeze bottle to help flush out the sinuses several times a day.Apply a warm, moist washcloth or compress over your nose and forehead to relieve sinus pressure.Use a humidifier.Inhale steam from a bowl of hot water or while in the shower.Drink plenty of fluids (this helps thin the mucus) (1,4,5,6)
Acute Sinus Infection Medications
If the remedies listed above don’t do the trick, you can also take various over-the-counter medications to help relieve your sinus infection symptoms. These include:
Nasal steroids, such as fluticasone (Flonase), budesonide (Rhinocort), and mometasone (Nasonex), to reduce swelling in the noseOral decongestants such as pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) if you have ear pain or fullnessNasal decongestants such as oxymetazoline (Afrin) or phenylephrine. Note that these drugs may help at first, but prolonged use can worsen nasal stuffinessMucus-thinning medications such as guaifenesin-phenylephrine (Nariz)Pain relievers or fever reducers, such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve) (1,4,5,6)
Oral antihistamines such as diphenhydramine (Benadryl) are not recommended for sinus infections because they may not improve symptoms and can cause side effects. (6)
When to See a Doctor About Sinus Infection Symptoms
Most people with acute sinusitis get better without seeing a doctor. But if your symptoms last more than 10 days or if your symptoms initially improve but then worsen again within the first 7 days, you may have developed a secondary bacterial sinus infection, which can be more severe than a viral infection. Fever and purulent nasal discharge can be helpful in differentiating bacterial sinusitis from viral sinusitis. See a doctor immediately if you experience:
A persistent fever greater than 102 degrees F (normal sinus infection fevers are at least 100.4 degrees F)Changes in vision, including double visionSymptoms that are resistant to over-the-counter pain relievers, fever reducers, or nasal decongestantsMultiple infections within the past yearSudden, severe pain in the face or headDifficulty thinking clearlySwelling or redness around the eyesStiff neck (5,6)
Antibiotics for Bacterial Sinus Infections
Many people with a bacterial sinus infection improve by using the same treatments as those used for viral sinus infections. But if your symptoms continue to not improve or even worsen, your doctor may prescribe you antibiotics. (6) The antibiotic your doctor prescribes depends on if you have an allergy to penicillin and if it’s likely that you have a drug-resistant bacterial infection. The standard antibiotic therapy for bacterial sinus infection in people who are not allergic to penicillin is amoxicillin (Amoxil) or amoxicillin-clavulanate. High dose amoxicillin-clavulanate is recommended if bacterial resistance is likely, (7) such as in:
People who have recently received antibioticsHospitalization in the last five daysHealthcare providersPeople who live in areas where there is a high rate of community resistancePeople whose infection is severe or lasts longer than usualThe elderlyPeople with a severe coexisting condition, including diabetes, renal disease, liver disease, chronic cardiac issues, and health issues that cause a weakened immune system
People who are allergic to penicillin may be treated with:
doxycycline (Vibramycin)clindamycin (Cleocin Hcl)levofloxacin (Levaquin)moxifloxacin (Vigamox) (8)
Most healthy patients with bacterial sinusitis often get better even without the use of antibiotics. This is especially important in cases where the risks of antibiotic use outweigh the benefits. (5)
Chronic Sinusitis Treatment
While acute sinusitis is often due to viruses or bacteria, chronic sinusitis usually has a more mysterious cause. A clinical diagnosis of chronic sinusitis can be confirmed via anterior rhinoscopy, nasal endoscopy, or computed tomography (CT) scan to document sinonasal inflammation. For some people, the inflammation of the mucous membranes may be caused by:
Airborne allergens, such as dust mites, animal dander, molds, and cockroachesAllergies to fungi living in the sinusesReactions to airborne irritants, such as tobacco smoke and environmental toxins like formaldehydeInfections, including viral infections like the common coldNasal polyps, or abnormal growths in the nose or sinuses
Deviated septum (a bending of the wall between the two nostrils) and immune system disorders may increase a person’s risk of chronic sinusitis or make symptoms worse. People with chronic sinusitis usually require lifelong treatment to keep their symptoms in check. These treatments can include:
Lifestyle changes, such as quitting smoking, changing jobs to avoid environmental toxins, or altering the home to reduce dust mites, pet dander, or cockroachesWashing the sinuses daily with salineFrequent use of steroid nasal sprays, washes, or drops to reduce nasal and sinus inflammationOral steroid pills, such as prednisone (Deltasone)AntibioticsLeukotriene modifiers (which reduce inflammation in a different way than steroids), such as montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo)Surgery to reopen the sinuses and remove trapped mucus or polyps (9)
Fungal Sinusitis Treatment
Sinus infections from fungi come in several different forms, each of which requires its own type of treatment. The most common type of fungal sinus infection is the aptly named fungus ball — a ball of fungal debris that has a peanut butter–like appearance. Treatment is straightforward and involves removing the ball with surgery (endoscopic sinus surgery). In some cases, people develop an allergic reaction to fungi in the sinuses, resulting in allergic fungal sinusitis. The allergic response results in nasal polyps and secretions that are golden-yellow with a cement-like consistency. Treatment of allergic fungal sinusitis begins with surgery to remove the polyps and cleanse the sinuses, followed by long-term oral and topical corticosteroids; in some cases, antifungals and antibiotics (for additional bacterial infections) may be necessary. Some people also receive immunotherapy and antihistamines to reduce their allergic reactions to the fungi. Acute invasive fungal sinusitis develops in people who have weakened immune systems, such as from chemotherapy or diabetes. The infection is aggressive and can quickly spread to the eye and brain. Treatment involves aggressive surgical and medical therapy, including systemic antifungal medications, and possibly efforts to improve the immune system. Comparatively, chronic invasive fungal sinusitis affects the body much slower. Treatment is less aggressive but also involves surgery and medications such as antifungal drugs. (10)
Sinus Infection Treatment in Children
Sinus infections affect children similarly. If your child has a sinus infection, the aforementioned home remedies may help, but make sure to follow your pediatrician’s recommendations to treat your child’s illness. Note that various over-the-counter medications may not be suitable for your child:
Babies 6 months old or younger should only receive acetaminophen for pain reliefChildren older than 6 months can receive acetaminophen or ibuprofen (check with your doctor for the correct dosage)Children should never receive aspirin and teenagers recovering from chicken pox or flu-like symptoms should not take aspirin because of the risk of a rare and severe illness called Reye’s syndrome (12)
Children younger than 4 years should not receive cough or cold products unless directed by a pediatrician (a stuffy nose can be relieved with a rubber suction bulb, saline drops, a humidifier, or a cool-mist vaporizer). (4)
