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 Adjuncts to the Treatment of Sinusitis/Phlegm

Appropriate therapy of sinusitis includes measures designed to prevent the recurrence of acute disease or development of chronic sinusitis or both. Three basic principles define our approach to treating infection in the sinus cavity:

  1. Treat the infection, if present (usually an antibiotic will be required)
  2. Facilitate drainage of the obstructed sinus
  3. Promote post-treatment drainage to prevent recurrent infection or disease

In addition to conventional therapy, adjunctive measures have been identified to promote the drainage and clearing of impacted sinus secretions. Once the infection is controlled, the therapeutic goal is to prevent or alleviate blockage of the sinuses, rather than to retreat the expectant recurrent infection.

Many non-pharmacologic measures are advocated for the symptomatic relief of acute sinusitis. However, many of the benefits of these measures are short lived and must be repeated as the symptoms recure. The patient must understand that scientific data to support the efficacy of these suggestions are lacking and that research-oriented physicians may dismiss their usefulness as “home remedies.” In general, these non-pharmacologic adjuncts are safe and have stood the test of time. They may offer additional symptomatic and therapeutic support of scientifically backed therapy.

Steam
The traditional method of steam inhalation is to:

  1. Pour boiling water into a pan
  2. Sit at a table with a towel draped over head to make a tent over the pan of water
  3. Hold the face a few inches above the water and breathe through the nose for approximately 10 minutes

This procedure liquefies and softens crusts while moisturizing the dry, inflamed nasal mucosa. Many patients find that two such treatments a day provide symptomatic relief. Addition of pine oil or Vicks Vaporub added to the hot water has offered improved benefit to some patients. If it seems unreasonable to perform this simple procedure, using a vaporizer or a facial sauna or taking long hot showers may substitute for the hot water and tent method. This treatment should not be uncomfortable or cause pain. Remember, don’t breathe steam directly from a boiling kettle.

Saline
Nasal saline (salt water) spray between steam treatments may continue the benefits of clearing the nose of crusts or secretions and moisturizing the nasal mucous membranes. The salt water sprays are inexpensive and available at the pharmacy. It seems that the generic brands are as useful as the name brands. They seem to be most effective when kept warm at body temperature. Therefore, it seems acceptable to keep the sprays in your pocket and use them throughout the day. The use of saline nasal sprays after the application of topical medical or steroid sprays may cancel the therapeutic benefit. You are safe to use the steam and salt water sprays before the application of prescription nasal sprays.

Gargle
A gargle may freshen the throat and minimize any discomfort related to nasal discharge. Patients report benefit from many different solutions including: tap water, salt water (1/4 teaspoon of salt to a quart of water), mouthwash, and a mixture of 1/3 tap water with 1/3 mouthwash and 1/3 hydrogen peroxide. The gargle may be used frequently, but maximal relief seems to be when used in the early morning and at bedtime. This may help get rid of the thick posterior discharge that is often very bothersome.

Room humidifier
A room humidifier may aid in providing the nasal moisture that is often lacking. A cool mist humidifier can be placed at bedside but needs to be cleaned once or twice a week. Also the water should be changed daily to prevent the buildup of bacteria.

Medications
Topical Decongestant Nasal Spray. Nasal decongestant sprays provide highly effective, short-term symptomatic relief of congestion in acute sinusitis. However, use of decongestant nasal sprays (not saline or topical steroids) for longer than 3 or 4 days may lead to increasing congestion and nosebleeds. These sprays are available from the local drug store and shorten the course of acute sinusitis by increasing the drainage of retained secretions. It does not seem to make any difference which of the topical sprays is selected for decongestant.

Topical Steroid Nasal Spray. Topical steroids may be prescribed to reduce nasal mucous membrane inflammation and promote drainage. Their use is mostly focused on chronic sinusitis and not the acute illness. If nasal obstruction prohibits the sprays from entering the nose then 1 to 2 days of nasal decongestant spray may help.

The patient should remember that nasal saline sprays should not follow the application of steroid topical sprays as they may rinse away the medication. The topical steroids have very limited absorption and are safe to use if applied as directed, even in children.

Expectorants. While scientific data is lacking, patient impressions suggest that use of expectorants may be beneficial either alone or in combination with oral decongestants. The expectorants may help increase the nasal mucous flow.

Pain medication. The use of prescription pain medication should be on a controlled and limited basis. Avoid aspirin because the risk of Reye’s syndrome in children and gastrointestinal bleeding in adults. We currently recommend an over-the-counter sinus preparation that contains a decongestant.

Antihistamine therapy. Antihistamines are medications that block the effects of allergies. While allergies play a significant role in sinusitis there is a limited role for these medications in the treatment of sinusitis. The benefit of antihistamines may be of value in sinusitis therapy when the patient has symptoms of allergy in conjunction with sinusitis during the allergy season. Some of these symptoms are thin, watery nasal discharge, with sneezing and itchy nose.

There remains strong association of allergy and sinusitis. Therefore, it seems prudent that anti-allergy therapy be included with the treatment of sinusitis when symptoms overlap.

Conclusion
Appropriate therapy of acute sinusitis today includes measures designed to prevent recurrence of acute disease or development of chronic sinusitis or both. Although scientific data is lacking it seems reasonable that the use of “home remedies” can be of significant benefit in the treatment of sinusitis, either alone or in conjunction with medical therapy. Indeed, these measures may provide sufficient relief for the patient who is only moderately symptomatic.

Overview

“Home remedies”

  1. Steam inhalation with/without astringent (pine oil, Vicks)
  2. Saline nasal spray
    1. Use in combination with steam inhalation
    2. You may use before, but not after applying nasal steroid spray
    3. If not using steroid spray, you may apply many times during the day without worry about bad side effects.
    4. A good habit is to keep the spray in your pocket so that it is at body temperature and available for frequent use.
    5. You may wish to increase your use during very dry season, or when the furnace is on during the winter.
  3. Gargle
  4. Room humidifier

“Medical therapy”

  1. The medical therapy can be used in conjunction with the above suggestions for improved results.
  2. Decongestant nasal sprays – use for only 4 days or less. May help during the acute phase of sinusitis.
  3. Oral decongestants – may use for longer periods of time. Avoid these if you have hypertension, glaucoma, or ulcer disease.
  4. Topical steroid spray – use after saline spray.

We hope the above information is of benefit in your health care. Remember, the information provided is an aid to your understanding of your health and medical care and is not intended to replace the directions provided by your doctor.