Diagnosis

Your doctor will feel for tenderness in your nose and face and look inside your nose.

Other methods for diagnosing chronic sinusitis include:

  • Nasal endoscopy. A thin, flexible tube (endoscope) with a fiber-optic light inserted through your nose allows your doctor to see the inside of your sinuses. This also is known as rhinoscopy.
  • Imaging studies. Images taken using a CT scan or MRI can show details of your sinuses and nasal area. These might pinpoint a deep inflammation or physical obstruction that's difficult to detect using an endoscope.
  • Nasal and sinus cultures. Cultures are generally unnecessary for diagnosing chronic sinusitis. However, when the condition fails to respond to treatment or is worsening, tissue cultures might help determine the cause, such as bacteria or fungi.
  • An allergy test. If your doctor suspects that the condition might be triggered by allergies, he or she might recommend an allergy skin test. A skin test is safe and quick and can help pinpoint the allergen that's responsible for your nasal flare-ups.

Treatment

The goal of treating chronic sinusitis is to:

  • Reduce sinus inflammation
  • Keep your nasal passages draining
  • Eliminate the underlying cause
  • Reduce the number of sinusitis flare-ups

Treatments to relieve symptoms

These treatments include:

  • Saline nasal irrigation, with nasal sprays or solutions, reduces drainage and rinses away irritants and allergies.
  • Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase, Veramyst), triamcinolone (Nasacort 24), budesonide (Rhinocort), mometasone (Nasonex) and beclomethasone (Beconase AQ, Qnasl, others).

    If the sprays aren't effective enough, your doctor might recommend rinsing with a solution of saline mixed with drops of budesonide (Pulmicort Respules) or using a nasal mist of the solution.

  • 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.
  • Aspirin desensitization treatment, if you have reactions to aspirin that cause sinusitis. Under medical supervision, you're gradually given larger doses of aspirin to increase your tolerance.

Antibiotics

Antibiotics are sometimes necessary for sinusitis if you have a bacterial infection. If your doctor can't rule out an underlying infection, he or she might recommend an antibiotic, sometimes with other medications.

Immunotherapy

If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens might improve the condition.

Surgery

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 obstruction, 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.

Lifestyle and home remedies

These self-help steps can help relieve sinusitis symptoms:

  • Rest. This will help your body fight inflammation and speed recovery.
  • Drink fluids, such as water or juice. This will help dilute mucous secretions and promote drainage. Avoid beverages that contain caffeine or alcohol, which can be dehydrating. Drinking alcohol also can worsen the swelling of the lining of the sinuses and nose.
  • Moisturize your sinus cavities. 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.
  • Apply warm compresses to your face. Place warm, damp towels around your nose, cheeks and eyes to ease facial pain.
  • Rinse out your nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others), saline canister or neti pot to rinse your nasal passages. This home remedy, called nasal lavage, can help clear your sinuses.

    If you make your own rinse, use water that's contaminant-free — distilled, sterile, previously boiled and cooled, or filtered using a filter with an absolute pore size of 1 micron or smaller — to make up the irrigation solution. Also be sure to rinse the irrigation device after each use with contaminant-free water, and let air-dry.

  • Sleep with your head elevated. This will help your sinuses drain, reducing congestion.

Preparing for your appointment

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 take, including the doses
  • Questions to ask your doctor

Take a family member or friend along, if possible, to help you remember the information you're given.

For chronic sinusitis, questions to ask your doctor include:

  • What's likely causing my symptoms?
  • What are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • 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?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?