Your doctor may ask about your symptoms. He or she may feel for tenderness in your nose and face and look inside your nose in a physical exam.
Methods for diagnosing chronic sinusitis include:
- Imaging tests. Images taken using CT or MRI can show details of your sinuses and nasal area. These might pinpoint a deep inflammation or physical blockage, such as polyps, tumors or fungi, that's difficult to detect using an endoscope.
- Looking into your sinuses. A thin, flexible tube with a fiber-optic light inserted through your nose allows your doctor to see the inside of your sinuses. This can help your doctor see a deviated nasal septum, polyps or tumors.
- An allergy test. If your doctor suspects that allergies might be triggering your chronic sinusitis, he or she might recommend an allergy skin test. A skin test is safe and quick and can help detect what allergen is responsible for your nasal flare-ups.
- Samples from your nasal and sinus discharge (cultures). Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment or is worsening, your doctor may swab inside your nose to collect samples that might help determine the cause, such as bacteria or fungi.
Treatments for chronic sinusitis include:
- Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone, triamcinolone, budesonide, mometasone and beclomethasone. If the sprays aren't effective enough, your doctor might recommend rinsing with a solution of saline mixed with drops of budesonide or using a nasal mist of the solution.
- Saline nasal irrigation, with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
- Oral or injected corticosteroids. These medications are used to relieve inflammation from severe sinusitis, especially if you also have nasal polyps. Oral corticosteroids can cause serious side effects when used long-term, so they're used only to treat severe symptoms.
- Allergy medications. If allergies are causing sinusitis, your doctor may recommend allergy medications.
- Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis and nasal polyps. Under medical supervision, you're gradually given larger doses of aspirin to increase your tolerance.
- Antifungal treatment. If your infection is due to fungi, you may have antifungal treatment.
- Medication to treat nasal polyps and chronic sinusitis. If you have nasal polyps and chronic sinusitis, your doctor may give you an injection of dupilumab or omalizumab to treat your condition. These medications may reduce the size of the nasal polyps and lessen congestion.
Antibiotics are sometimes necessary for sinusitis if your infection is caused by bacteria. If your doctor can't rule out an underlying infection, he or she might recommend an antibiotic, sometimes with other medications.
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens might improve the condition.
Endoscopic sinus surgery
The upper left illustration shows the frontal (A) and maxillary (B) sinuses, as well as the ostiomeatal complex (C). In endoscopic sinus surgery (right illustration), your doctor uses a thin tube (endoscope) and tiny cutting tools to open the blocked passage and restore natural drainage (D).
In cases resistant to treatment or medication, endoscopic sinus surgery might be an option. For this procedure, the doctor uses a thin, flexible tube with an attached light (endoscope) to explore your sinus passages.
Depending on the source of the blockage, the doctor might use various instruments to remove tissue or shave away a polyp that's causing nasal blockage. Enlarging a narrow sinus opening also may be an option to promote drainage.
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Lifestyle and home remedies
A neti pot is a container designed to rinse the nasal cavity.
These self-help steps can help relieve sinusitis symptoms:
- Rest. This can help your body fight inflammation and speed recovery.
- Moisturize your sinuses. Drape a towel over your head as you breathe in the vapor from a bowl of medium-hot water. Keep the vapor directed toward your face. Or take a hot shower, breathing in the warm, moist air to help ease pain and help mucus drain.
- Warm compress. A warm compress on your nose and forehead may help relieve the pressure in your sinuses.
- Rinse out your nasal passages. Use a specially designed squeeze bottle, saline canister or neti pot to rinse your nasal passages. This home remedy, called nasal lavage, can help clear your sinuses.
Preparing for your appointment
You'll likely see your primary care doctor first for symptoms of sinusitis. If you've had several episodes of acute sinusitis or appear to have chronic sinusitis, your doctor may refer you to an allergist or an ear, nose and throat specialist for evaluation and treatment.
When you see your doctor, expect a thorough examination of your sinuses. Here's information to help you get ready for your appointment.
What you can do
Make a list of:
- Your symptoms, including any that seem unrelated to the reason for your appointment
- Key personal information, including whether you have allergies or asthma, and family medical history
- All medications, vitamins or other supplements you've recently been taking, including the doses
- Questions to ask your doctor
For chronic sinusitis, questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What treatments are available and which do you recommend for me?
- I have these other health conditions. How can I best manage these conditions together?
- Should I see a specialist?
- Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you questions, such as:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Does anything seem to improve your symptoms?
- What, if anything, appears to worsen your symptoms?