Medical Edge Newspaper Column

Can Nasal Steroid Sprays Be Used Long Term?

February 3, 2008
Dear Mayo Clinic:
Last year, I was diagnosed with severe sinusitis. I was treated with two rounds of antibiotics and oral steroids. I was then given steroid nasal spray, which finally seemed to alleviate most of my symptoms. I have been using the spray on an almost-daily basis since then. If I stop for a few days, my sinuses swell up again. My doctor told me to keep using the spray, but I'm worried about long-term use. Has this been studied? What are the risks? Does sinusitis ever completely go away?

Answer:
Steroid nasal sprays are commonly used to treat the symptoms of chronic sinusitis. Long-term use of the spray does not pose a significant risk, but as you've learned, it doesn't necessarily resolve the situation, either.

Sinusitis is a condition in which the mucous membranes in the passages in and around your nose (your sinuses) become swollen and inflamed. This inflammation causes your sinuses to plug up, which prevents normal mucus drainage and causes fluid to build up. Sinusitis can cause headaches, tenderness and aching in your face, and it can make breathing through your nose difficult. Sinusitis often results from an infection caused by viruses, bacteria, or fungi. It also may be caused by allergies, nasal polyps or other sinus obstructions, or environmental triggers such as air pollution, smoke or changes in altitude.
The goal of treatment for sinusitis is to clear your sinuses and get rid of the underlying cause of the inflammation. If your doctor suspects a bacterial infection, antibiotics are used to combat sinusitis. If allergies are the source of the problem, a variety of anti-allergy treatments are available, and immunotherapy may be used to stimulate antibodies that block your body's reaction to the substance (allergen) that's inducing the allergy. Decongestants and antihistamines also can provide some short-term relief.

In some severe cases of sinusitis, surgery may be a treatment option. In endoscopic sinus surgery, your doctor uses an endoscope — a thin tube with a light — to explore your sinus passages. Then, depending on the source of obstruction in your sinuses, your doctor may remove tissue or shave away a bone or polyp that's causing nasal blockage. Enlarging a narrow sinus opening may improve drainage and prevent infection.

With treatment, most cases of sinusitis go away within a couple of weeks to 12 weeks. When the condition resolves within 12 weeks, it is known as acute rhinosinusitis (or acute sinusitis). When symptoms last more than 12 weeks, as in your case, it's considered a chronic condition, and it is designated chronic rhinosinusitis.

Nasal steroid sprays also are often used as therapy for acute and chronic sinusitis. They can help control symptoms of nasal obstruction and sinusitis and can successfully prevent and reduce sinus inflammation. But, they aren't a cure. As you've found, when you stop using the steroid spray, symptoms usually return. It's not uncommon for people with chronic sinusitis to use a nasal steroid spray long term, sometimes for years. Research has found no significant health risks linked to this type of ongoing use.

Although there are no long-term health risks associated with nasal steroid use, you may experience some side effects, such as burning, dryness, irritation and itching inside your nose and throat, sneezing, headaches, nosebleeds, runny nose or an upset stomach, among others. If side effects don't go away or if they become severe, talk to your doctor.

If you'd like additional evaluation to find out if a specific cause for your chronic sinusitis can be identified and treated, I'd recommend you consult an ear, nose and throat specialist (otorhinolaryngologist) who has experience treating chronic sinusitis.

— Oren Friedman, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.