If you’re one of the millions of Americans who suffer from chronic sinusitis, with that nasal discharge, painful pressure and congestion that builds up in your head and just won’t go away, you may have tried just about anything to get relief—antibiotics, decongestants, pain relievers, saline sprays, steroid sprays, steroid pills…you name it. You may have even considered surgery.

You can stop now. We know what really works.


Sinus passages are small, hollow air-filled spaces in your face that drain into your nose. After a cold, you might feel nasal congestion for a few days or a week, and then it goes away. But for some people the condition turns into a constant stuffy nose, pain and pressure in the face, postnasal drip, and a reduced sense of smell. You have trouble sleeping, which makes you tired during the day. You’re just miserable. When this lasts three months or more, it’s chronic sinusitis. It affects 3% to 7% of the population.

When you just can’t take it anymore, you might run to your doctor for an antibiotic. It’s a common treatment that many doctors still rely on. But most of the time, antibiotics just don’t work. Here’s why: While chronic sinusitis was until recently believed to be basically an infection, it’s now recognized as primarily an inflammatory disease…similar to asthma.

To find out what works best, researchers at University of Calgary in Canada and the Medical University of South Carolina performed a systematic review of more than 40 clinical studies. They found out that antihistamines, antibiotics and other common treatments didn’t work very well.

Here’s what probably will: A combination of saline nasal irrigation and prescription corticosteroid sprays.


Saline irrigation doesn’t mean those low-volume saline nasal sprays or mists you can buy in the pharmacy—which only help a little—but a product such as a neti pot. These vessels look like tiny tea pots or squeeze bottles, and they make it easy to pour salt water into one side of your nose and let it drain out the other side. They’ve been used for centuries but have only recently become a part of mainstream Western medicine. Saline irrigation helps clean the sinuses by removing mucus and irritants that contribute to inflammation. According to the new analysis, saline irrigation improves sinusitis symptoms—and quality of life.

Cortocosteroid nasal sprays are prescription-only topical medicines that reduce inflammation and reduce symptoms such as nasal congestion and nasal discharge. Steroid sprays by themselves have been shown to be more effective than nasal irrigation by itself.

While there haven’t been studies of the two approaches together, these were the only two treatments that scored the highest rating (A-1) based on the American Heart Association Grade of Evidence and Recommendation Grading Scale. They also work in a true complementary fashion—nasal irrigation clears out the sinus passages while corticosteroids fight the inflammatory process.

Based on the strength of the evidence, the researchers recommend a combination of the two treatments as the best first therapy for most people with chronic sinusitis.


If you’re concerned about using a steroid medication, it’s important to realize that a topical spray is much safer than a steroid pill. Corticosteroid sprays are considered safe for all adults, although pregnant women should discuss this treatment option with their physicians before using it. It typically takes two to three weeks before symptoms start to improve, and that depends on how severe your sinusitis is. Some patients use the sprays for a few months during seasons when their symptoms are the worst, while others need to be on them indefinitely.

As for using a neti pot, you can do that once or twice a day. However, some research has found that using a neti pot every day can lead to more infections—after all, there’s a reason your body produces mucus, which has antimicrobial properties. So removing your mucus all the time isn’t ideal. “It comes down to balancing the benefit with potential risks,” says Luke Rudmik, MD, clinical associate professor at University of Calgary in Canada and the lead author of the study. “If you don’t have symptoms, you may not want to use a neti pot preventively. You can use it when you do get symptoms, such as when you have a cold. But if you have daily symptoms of chronic sinusitis, then the benefit of using daily saline irrigations often outweighs the small risks.”

Since several other conditions can mimic sinusitis, including sinus migraines, if your symptoms don’t improve after about two to three months, check back in with your doctor to rule out other conditions. If you’re seeing your primary care doctor, he or she may send you for a CT scan of your sinuses or to an otolaryngologist for more detailed evaluation.

Finally, no one study can replace individualized medical care. For example, many people with chronic sinusitis have nasal polyps—noncancerous, teardrop-shaped growths that form in the nose or sinuses. For them, according to Dr. Rudmik, the best treatment is often to take an oral corticosteroid pill (such as prednisone) for one to three weeks, to take a course of the antibiotic doxycycline for three weeks or to use a leukotriene receptor antagonist (such as montelukast/Singulair), a drug that blocks inflammation.

If you don’t want to use any medications at all, there’s no harm in trying a neti pot for a few weeks and seeing if that works for you. Make it part of your preventive strategy. Since sinus infections typically follow a cold or other upper respiratory infection, use your neti pot at the first sign of an infection coming on. Avoid cigarette smoke, which can irritate nasal membranes, and consider getting a humidifier at home to increase the moisture in the air.

But if preventing colds plus saline irrigation isn’t enough help for a chronic sinus condition, talk to your doctor about adding a corticosteroid spray to the mix.