Duration Health — Field Guide: Nose and Sinus

Nose and Sinus

Introduction

Congestion of the nose is very common and is usually caused by the viruses that cause “the common cold” or seasonal allergies. This congestion often spreads to the sinuses, leading to a feeling of mild pressure in the nose and face, and a mild headache.

Sometimes the congestion can continue for too long and can lead to bacterial growth in the sinuses, which can lead to an infection called bacterial sinusitis. This presents with severe congestion with pus coming from the nose, facial pain or pressure that is worst on the sides of the nose or the forehead, fevers, and headaches. This infection requires antibiotic treatment because if left untreated, it can spread deeper into the face, into the facial bones and even spread to the brain, which is a life-threatening medical emergency that necessitates immediate care.

Treatment

For nasal congestion and sinus pressure, you can try oxymetazoline (generic for Afrin®) nasal spray or fluticasone propionate (generic for Flonase®) nasal spray to relieve the congestion, ibuprofen to relieve pain and inflammation, or nasal saline to help clear the mucus. Bacterial sinusitis may be treated with an antibiotic called amoxicillin-clavulanate.

Most "sinus infections" do NOT need antibiotics. Millions of people suffer side effects every year, including uncontrollable diarrhea, after taking antibiotics for sinus symptoms when one is not necessary. It is highly recommended to try ibuprofen first and wait to see if your symptoms resolve, before considering antibiotics.

When To Worry

Seek immediate medical care if you have any of the following:

  • persistent fever that does not improve with medication
  • vision changes
  • hearing changes
  • eye bulging or swelling around the eyes
  • severe headache
  • paralysis of the facial muscles

Pediatrics

Quick Guide

If you have

  • nasal congestion < 10 days
  • mild cough
  • mild sore throat
  • mild facial pressure
  • no fever

You may have

viral upper respiratory infection or allergic rhinitis (seasonal allergies or "hay fever")

Consider using

oxymetazoline nasal spray (generic for Afrin®) 2 sprays in each nostril every 12 hours for not more than 3 days

OR

fluticasone propionate nasal spray (generic for Flonase®) 1 spray in each nostril once daily

OR

ibuprofen 600 mg every 6 hours as needed for pain

OR

acetaminophen 1000 mg every 6-8 hours as needed for pain (do not exceed 3000 mg per day)

If you have

  • fever 100.4°F or higher
  • facial pain
  • persistent nasal congestion (>10 days)
  • nasal drainage with pus

You may have

bacterial sinusitis

Consider using

amoxicillin-clavulanate 875 mg-125 mg twice daily for 7 days

OR

doxycycline 100 mg by mouth twice daily for 7 days

and seek emergency medical care

Most "sinus infections" do NOT require antibiotics. See the Infection section.

If amoxicillin-clavulanate is unavailable or if an allergy to penicillins is present, either doxycycline OR azithromycin may be considered as an alternative, although they may be less effective.

If you have

  • persistent fever that does not improve with medication
  • vision changes
  • hearing changes
  • eye bulging or swelling around the eyes
  • severe headache
  • paralysis of the facial muscles

You may have

an abscess or meningitis

You should

seek emergency medical care

Reference

amoxicillin-clavulanate

Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

Prescription only

InfectionMedication

amoxicillin-clavulanate pediatric

Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

Prescription only

InfectionMedication

amoxicillin-clavulanate suspension

Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

Prescription only

InfectionMedication

amoxicillin capsule

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

InfectionMedication

fluticasone propionate

Fluticasone propionate is a steroid nasal spray. It is used to treat nasal congestion and reduce inflammation in the nasal passages. Fluticasone propionate may take a few days to start working but can be used for a longer period, as compared with oxymetazoline (generic for Afrin) which may start working within a few hours but can be used for 3 days at most.

GeneralMedication

amoxicillin pediatric

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

PediatricsMedication

amoxicillin

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

PediatricsMedication

oxymetazoline

Oxymetazoline (generic for Afrin) is a nasal decongestant spray. It is used to treat nasal congestion and sinus pressure as occurs with the common cold and upper respiratory allergies. Interestingly, oxymetazoline works by constricting blood vessels in the nose. Oxymetazoline tends to work within a few hours but can be used only for 3 days at most, as compared with fluticasone propionate (generic for Flonase) which takes longer to work but can be used for a longer period.

GeneralMedication

ibuprofen

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

GeneralMedication

acetaminophen

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

GeneralMedication

ibuprofen blisterpack

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

GeneralMedication

acetaminophen blisterpack

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

GeneralMedication

acetaminophen pack

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

GeneralMedication

ibuprofen pack

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

GeneralMedication

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