Here we discuss the management of sinusitis from conservative (lifestyle modifications), medical (medical therapies) and surgery.
Lifestyle Modifications
In addition to medical treatment, for some patients, certain lifestyle modifications can help manage sinusitis and reduce the risk of recurrence:
Avoidance of triggers: Identify and avoid triggers that may exacerbate sinusitis symptoms, such as allergens, environmental pollutants, tobacco smoke, or strong odors.
Nasal hygiene: Practice good nasal hygiene by using nasal saline washes and/or sprays regularly.
Humidification: Some patients find some symptomatic improvement with the use of a humidifier. This adds moisture to the air in your home, especially during dry winter months or in environments with low humidity.
Medical Management
Symptomatic relief: Over-the-counter pain relief such as paracetamol or ibuprofen can help alleviate facial pain, headache, and fever associated with acute sinusitis. Nasal saline washes (irrigation) or decongestants may also provide temporary relief from nasal congestion (we would suggest not using nasal decongestants for longer than 7 days).
Nasal corticosteroids: Nasal steroid drops and sprays are highly effective at reducing inflammation, improving sinus drainage, and relieving symptoms of chronic sinusitis. We will guide you on different types of steroids and duration of treatment.
Antibiotics: Antibiotic therapy may be indicated for bacterial sinusitis or acute exacerbations of chronic sinusitis. Often we consider a long-term course as there is evidence to suggest that this improves outcomes.
For patients with sinusitis accompanied by nasal polyps, further treatments include:
Oral steroids: Short-term oral corticosteroids to reduce inflammation and relieve symptoms during acute exacerbations of chronic sinusitis with nasal polyps. (We generally do not recommend long-term oral steroids for this condition due to the risk side effects.)
Biologic therapies: These offer more novel treatment options. Biologic medications (such as dupilumab) have shown promise in the treatment of chronic sinusitis with nasal polyps associated with conditions such as asthma according to recent research. These medications target specific inflammatory pathways involved in the development of nasal polyps and can help reduce symptoms and prevent recurrence. Although the results of research studies are promising, they are not freely available for nasal polyps in the UK.
Surgery
Surgery: In cases of severe sinusitis, with no relief from medications, surgery may be necessary to improve the sinus drainage pathways and remove diseased tissue or causes of obstruction. Endoscopic sinus surgery (ESS) is a minimally invasive procedure that we perform (usually under general anesthesia), in which we use cameras (endoscopes) to visualize and access the sinuses, allowing for precise removal of polyps, diseased tissue, or bony obstructions. We will be discussing this in more detail in the following section.
Conclusion
Effective management of sinusitis, with or without nasal polyps, involves a comprehensive approach that addresses underlying inflammation, infection, and structural abnormalities. Often patients benefit from a combination of medical and surgical management resulting in a significant improvement in their quality of life.
