Make an Appointment
To make an appointment or refer a patient, contact the Division of Sino-Nasal Disorders and Allergy.
The UPMC Sino-Nasal Disorders and Allergy Center uses many types of medicine for sinus infections (sinusitis) and nasal disorders.
If sinus infection medicine doesn't bring sinus relief, we also offer nasal and sinus surgery options.
Medications for Sinus Disorders
Antibiotics
Antibiotics help fight bacterial infections. They're useful for treating bacterial sinus infections but will not help a cold caused by a virus. Many bacteria that were once treatable by common antibiotics have become resistant, so doctors in the UPMC Sino-Nasal and Allergy Center are careful when prescribing antibiotics for sinus problems. A culture of the bacteria found in the sinuses will provide guidelines to the best sinus antibiotic to use.
While taking an antibiotic, it may help to restore the good bacteria in your system by taking probiotics or acidophilus tablets. You can also eat foods that contain large amounts of benign bacteria, such as yogurt or kefir.
Antihistamines
The body releases histamine during an allergy attack. Histamine causes sneezing, itching, and welting. Antihistamines block the histamine receptors that cause allergic reactions.
Newer antihistamines — like Zyrtec (ceterizine), Clarinex (desloratadine), Allegra (fexafenadine), and Claritin (loratadine) — have a very low rate of causing side effects, compared to older antihistamines. They do not cause drowsiness, except for Zyrtec. Zyrtec may impair performance or cause sedation, but much less often than the older antihistamines.
Decongestants
Decongestants bring sinus relief to nasal congestion by narrowing the blood vessels in the nasal membranes.
Decongestant nasal sprays give instant relief, but you can only use them for three or four days before they start to cause rebound swelling.
Sudafed (pseudoephedrine) is now a behind-the-counter decongestant. Phenylephrine is less effective than pseudoephedrine. All oral decongestants can cause side effects such as urinary retention, insomnia, and jitteriness.
Leukotriene modulators
Leukotrienes are potent agents of broncho constriction.
Drugs such as Singulair (montelukast) can treat both asthma and hay fever (allergic rhinitis). However, not all people have symptom or sinus relief. Often, your UPMC sino-nasal and allergy doctor will start a trial of four days to see whether your asthma or hay fever will respond to drugs like Singulair.
Doctors sometimes use zileuton — an asthma drug — along with Singulair to improve your symptoms. If we prescribe zileuton, we will check your liver functions monthly for at least three months.
Mucus thinners
Thick postnasal discharge is a common allergy symptom. A mucus thinner allows the mucus to drain better, making you less aware of the discharge.
Nasal rinses
Irrigation of the nose and sinus cavity with any commercial nasal saline rinse can be very helpful in removing mucus and crusts.
You can also make your own nasal rinses or home remedies for your sinuses by mixing 1½ teaspoons of salt and 1 teaspoon of baking soda in 1 quart of sterile water. People with cystic fibrosis may benefit from increasing the salt content of the saline wash so that it is hypertonic. This means mixing 3 teaspoons of salt to 1 quart of water.
There are a many irrigation devices you can buy, including Neti pots, baby bulb syringes, and water picks. Be sure to clean the device every few days to prevent the growth of mold or bacteria.
Doctors suggest that you try nasal rinses for sinus relief before turning to prescription nasal sprays.
Nasal sprays
All nasal sprays work best if directed into the nose and slightly tilted toward the outside of the nose. Do not direct the nasal spray toward the center of the nose or septum, as this increases the chance of irritation and nosebleeds.
The two most common prescription nasal sprays are antihistamine and steroid sprays. Steroid nasal sprays may take a few days to take full effect. Antihistamine nasal sprays work much faster.
Antihistamine nasal sprays
Unlike oral antihistamines — which only treat sneezing and itch — antihistamine nasal sprays (like Azelastine) also help with nasal congestion and sinus infection. Side effects of Azelastine include an occasional bitter taste and rare cases of drowsiness. You can reduce the bitter taste by leaning forward, directing the spray toward the outside of your nose, and not sniffing for a few minutes.
Over-the-counter antihistamine sprays include Neo-Synephrine (phenylephrine) and Afrin (oxymetazoline). You should not use these sprays for more than three or four days in a row because they may cause rebound congestion. This “addiction” does occur with prescription decongestant nasal sprays. You can reduce this risk by using the decongestant spray along with a steroid nasal spray.
Over-the-counter saline nasal sprays are good for moisturizing the nose and reducing the chance of nosebleeds that occur because of dryness.
Steroid nasal sprays
There are many steroid nasal sprays on the market. For most people, all work equally well, although some may do better with a certain brand.
Most steroid nasal sprays do not cause any detectable change in the body. The newest steroid sprays — such as mometasone fuorate, fluticasone fuorate, or propionate — have the lowest detectable systemic levels. Doctors may prescribe these if your child needs a steroid nasal spray.
Topical antibiotic and antifungal rinses
Depending on the bacteria found on the culture from your sinus infection diagnostic test and the sensitivities of the bacteria tosinus antibiotics, your doctor may prescribe a custom antibacterial wash such as:
- Mupirocin (Bactroban) — 5g in 45cc of saline — as a spray or wash for treating staph aureus infections.
- Gentamicin — 80mg per 500cc of saline — for pseudomonas infections.
- Amphotericin B. irrigations to treat fungus.
Sinus Infection and Disorder Surgical Treatments
Coblation of the inferior turbinates
Coblation is an in-office procedure that reduces the size of the turbinate — the structures that swell up from either side of the nose — that can block the airway and impair breathing.
Numbing the nose takes about 15 minutes, and the procedure itself takes 10 minutes. After coblation, you will need to wait for 10 to 15 minutes to ensure that no bleeding occurs. Most people return to work or routine activities right away.
Endoscopic sinus surgery
An outpatient sinus operation, endoscopic sinus surgery (ESS) corrects structural defects of the nose and sinuses. Your surgeon in the UPMC Sino-Nasal and Allergy Center uses an endoscope, a slender device with a video camera attached, to guide the surgical tools during the sinus operation.
ESS can relieve chronic sinusitis Isinus infection) if sinus remedies have been unsuccessful.
Doctors can also remove nasal polyps in the office using ESS. After applying an anesthetic to the nasal membranes, your doctor will remove the polyps with a microdebrider, a hollow rotating suction that cuts and removes the tissue. Most people can return to normal activities right away. Other outpatient ESS procedures require a longer recovery time.
Rhinoplasty
Rhinoplasty changes the outward structure of the nose.
Some people need this operation to allow the inside of the nose to work properly. For example, a person with a badly fractured nose may need rhinoplasty to unblock the airway.
Other people may choose to have this sinus surgery for cosmetic reasons.
Surgeons can perform this outpatient procedure while you are completely asleep (anesthetized) or under mild sedation ("twilight" anesthesia).
Septoplasty
Septoplasty corrects a deviated septum with little or no change to the outward appearance of the nose.
Surgeons perform septoplasty when a person has constricted nasal breathing because of a septal obstruction.
To make an appointment or to refer a patient, contact one of our Sino-Nasal Disorders and Allergy locations.
Learn More About Sinus Treatments
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