Sinusitis

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

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.

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

Endoscopic sinus 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 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.