Brad Bichey MD

You can help yourself by trying chronic sinusitis treatment with Flonase or other nasal steroid sprays. I use these in my practice to help control symptoms and prevent recurrence of chronic sinusitis. If you have tried these medications and they have failed, there is chronic sinusitis treatment available. If you are like me you have struggled with chronic sinusitis your whole life. Maybe you are looking for solutions and this journey is what eventually drew me to specialize in treating patients with sinus and allergy symptoms.  I only see the worst patients now in my office and if you are wondering what you can try at home so you don’t have to come see me or another sinus specialist, you have reached the right place!

In this 3rd installment of a four part series I am going to outline the various over-the-counter Nasal Steroids available to help improve and in some cases eliminate chronic sinusitis symptoms.  Let’s get to it!

Nasal Steroids

• The second category of over-the-counter treatment you should try after you are already using nasal saline spray and/or nasal saline irrigation are nasal steroids. Chronic sinusitis treatment with Flonase or other nasal steroids can be very effective for some patients. (i.e. Nasacort, Flonase, Sensimist, Rhinocort)
• The unique thing about nasal and sinus inflammation as opposed to inflammation you may have in your knee joint is that you can more easily use direct application of medication at the source to try to reverse disease in your nose.  Many other parts of your body require an injection.  Reducing inflammation with a topical application or spray is how nasal steroids work.  You may have used a steroid cream on a rash to get rid of itching and swelling.  Nasal steroids do the same thing but inside your nose.  By using them daily they slowly reduce the inflammation and swelling you are having and by reducing the inflammation our hope is that your symptoms also improve.
• There are many over the counter brands available in the allergy aisle of your local pharmacy and all of the one’s available are about equally effective in published studies. I recommend starting with the lowest cost nasal steroid available and then find one that is effective and has little to no side effects.  Some have tastes or smells you might not like so a little experimentation will go a long way.
• Finally a couple things about nasal steroids are important to understand.  They work best after you have used them daily for one to two weeks so they are much less effective when used as needed.  If you are using saline spray or irrigation like I have recommended then use the saline first and then blow your nose.  The nasal steroid spray is much more effective when you do this as the mucosal surface has been prepped to receive the spray for better penetration of the medication. 
• Also, many of my patients have fears about steroid side effects like weight gain and moodiness.  There have been many studies published verifying that nasal steroids are safe and effective for use long-term with a very small incidence of side-effects.  They are a typically a great main-line treatment for chronic sinusitis in most individuals and I recommend you try them if you are having persistent symptoms or are thinking of searching for a sinus specialist near you.

Best Strategies

So your best things to try when it comes to reverse nasal and sinus inflammation to stop chronic sinusitis is to follow this effective strategy:

• Identify and avoid your triggers in your home, work and where you play.
• Identify and avoid any foods that may be triggering inflammation.
• Start nasal saline spray several times a day and especially after you do a triggering activity.  This may help wash out the things in your nose that are making you sick.
• For you over-achievers out there try using nasal saline irrigation once or twice a day until your symptoms improve.  If you have a dirty job or dirty hobbies this one can be a very effective approach to feeling better and it does not involve extra medication use.  Many patients like that.
• Move on to medication trials when saline does not work.  If you are having nasal congestion, headache, facial pain and pressure or thick mucus/post-nasal drainage your best option is to do a trial of chronic sinusitis treatment with Flonase or other nasal steroid sprays.  As mentioned, these have been shown to be effective at reversing nasal sinus inflammation and may give you good relief.  Nasal steroids are also a good option to control allergy when you can’t find an oral antihistamine that works without side effects.
• If you are having itching or watering of the eyes, nose or throat or having excessive clear nasal drainage you should try using an oral antihistamine to control symptoms.  The better you control your allergies the better you will control that root cause of your sinus symptoms… Inflammation!

What to do if all these things don’t help?

When medications fail that’s when you want to consider searching for a sinus specialist near me on google.  We are out there and we are here to help.  

Click HERE if you want to start an immediate discussion with me about your nasal sinus symptoms and options for care.

I sincerely hope you found this article helpful.  Have a great day!

Dr. B

Frequently Asked Questions About Flonase for Sinusitis

How long does it take for Flonase to work for a sinus infection? Flonase and other nasal steroid sprays need one to two weeks of daily use before you’ll feel the full effect on a sinus infection. They aren’t designed for as-needed relief the way a decongestant is. Consistent daily use is what allows the medication to gradually reduce the inflammation and swelling inside your nasal passages, so most sinus specialists recommend committing to a full two-week trial before deciding whether Flonase is working.

Can I use Flonase twice a day for a sinus infection? Yes — the standard adult dose of Flonase is two sprays in each nostril once a day, but doubling that to twice a day (two sprays per nostril, twice daily) is generally considered safe for a sinus infection flare-up and is sometimes recommended by sinus specialists during the first one to two weeks of treatment. Drop back to once daily for maintenance after symptoms improve.

Does Flonase help with sinus pressure? Flonase can help relieve sinus pressure when the pressure is caused by inflammation in the nasal passages — which is the case for most sinus infections, allergies, and chronic sinusitis. By reducing swelling in the mucosal lining, Flonase opens up sinus drainage pathways and lets trapped mucus move out. Note that it won’t help pressure caused by a structural blockage like a deviated septum.

Should I use saline spray before or after Flonase? Use saline first. Rinsing with a saline spray or irrigation system clears out mucus and debris, which preps the mucosal lining so the nasal steroid can penetrate more effectively. Blow your nose after the saline rinse, then apply Flonase. This two-step approach — saline followed by steroid — is what sinus specialists consistently recommend for getting the most out of either medication.

Can Flonase cure chronic sinusitis? Flonase can significantly reduce — and in some cases eliminate — chronic sinusitis symptoms by controlling the underlying nasal inflammation — the same mechanism behind chronic rhinitis and other inflammatory nasal conditions. However, it doesn’t address structural issues like a deviated septum or nasal polyps that physically block your sinus drainage. If your symptoms persist after several weeks of consistent nasal steroid use plus saline irrigation, it may be time to see a sinus specialist to evaluate whether a procedure like balloon sinuplasty could help.

When should I see a doctor instead of using Flonase? If you’ve followed a full at-home treatment plan — trigger avoidance, daily saline rinses, and a consistent two-week trial of Flonase — and your symptoms haven’t improved, that’s the signal to see a sinus specialist for professional care. Persistent facial pressure, thick discolored mucus lasting more than 10 days, or recurring infections more than 3–4 times a year are all indicators that an in-office evaluation is warranted.

You can help yourself by trying chronic sinusitis treatment with nasal saline to improve your chronic sinus symptoms. I use nasal saline in my practice to help control symptoms and prevent recurrence of chronic sinusitis. If you have tried these treatments and they have failed, there is chronic sinusitis treatment available. If you are like me you have struggled with chronic sinusitis your whole life. Maybe you are looking for solutions and this journey is what eventually drew me to specialize in treating patients with sinus and allergy symptoms.  I only see the worst patients now in my office and if you are wondering what you can try at home so you don’t have to come see me or another sinus specialist, you have reached the right place!

In this 2nd installment of a four part series is am going to outline the benefits of nasal saline use to help improve and in some cases eliminate chronic sinusitis symptoms.  Let’s get to it!

Nasal Saline

• This treatment comes in several forms and is not a medication at all. It’s safe and effective with anyone down to a young age and is typically used by all of my patients regardless if they use other medications or not.
• You want to think of chronic sinusitis treatment with nasal saline in two categories – mists or sprays, and irrigations.  They can be used in different situations.
• Mists and sprays are used to moisturize the nasal mucosa.  They are particularly important to use if you experience nasal dryness and crusting or dried mucus.  Any mucus that becomes trapped in the nose can be a set up for inflammation and possible infection so it is important to use nasal saline spray frequently if you are experiencing chronic sinusitis symptoms.  They come in two varieties over-the-counter.  Those with preservatives use a squeeze bottle (i.e. Ocean Spray) and the ones that do not come in a pressurized canister (ie. Simply Saline).  I personally have sensitivity to the preservatives used in most nasal sprays and opt to spend a little more on the unpreserved saline sprays.
• Nasal saline irrigations (i.e NeilMed Sinus Rinse) are another type of treatment that can be very effective at controlling and reversing symptoms.  They come in kits and are typically sold right next to the nasal saline sprays in most markets.  Nasal saline irrigation uses a much higher volume than saline sprays and physically washes the nasal mucosa free of bacteria, yeasts, mold, pollens and other debri that may be sitting on the surface of the mucosa causing chronic sinus inflammation.  These can work much better than nasal saline sprays but do require a little more time to mix the solution and use.  They are also less convenient to use and more messy so most people use these only in the morning or evening and not while they are out in public.  The major thing to remember with these treatments is that you need to read all instructions on the sinus irrigation kit and always use sterile bottled water – never tap water as this can cause serious infections!

Best Strategies

So your best things to try when it comes to reverse nasal and sinus inflammation to stop chronic sinusitis is to follow this effective strategy:

• Identify and avoid your triggers in your home, work and where you play.
• Identify and avoid any foods that may be triggering inflammation.
• Start nasal saline spray several times a day and especially after you do a triggering activity.  This may help wash out the things in your nose that are making you sick.
• For you over-achievers out there try using nasal saline irrigation once or twice a day until your symptoms improve.  If you have a dirty job or dirty hobbies this one can be a very effective approach to feeling better and it does not involve extra medication use.  Many patients like that.
• Move on to medication trials when saline does not work.  If you are having nasal congestion, headache, facial pain and pressure or thick mucus/post-nasal drainage your best option is to do a trial of nasal steroid sprays.  As mentioned, these have been shown to be effective at reversing nasal sinus inflammation and may give you good relief.  Nasal steroids are also a good option to control allergy when you can’t find an oral antihistamine that works without side effects.
• If you are having itching or watering of the eyes, nose or throat or having excessive clear nasal drainage you should try using an oral antihistamine to control symptoms.  The better you control your allergies the better you will control that root cause of your sinus symptoms… Inflammation!

What to do if all these things don’t help?

When medications fail that’s when you want to consider searching for a sinus specialist near me on google.  We are out there and we are here to help.  

Click HERE if you want to start an immediate discussion with me about your nasal sinus symptoms and options for care.

I sincerely hope you found this article helpful.  Have a great day!

Dr. B

You can help understand chronic sinusitis treatment if you understand what causes your chronic sinusitis symptoms. Indiana can be a tuff place to live if you struggle with symptoms of nasal congestion, sinus infections, thick nasal drainage, sinus headache, sinus pain or pressure or pain in the upper teeth and gums. If you are like me you have struggled with chronic sinusitis your whole life. Maybe you are looking for solutions.  That journey is what eventually drew me to specialize in treating patients with sinus and allergy symptoms.  I only see the worst patients now in my office and if you are wondering what you can try at home so you don’t have to come see me or another sinus specialist, you have reached the right place!

This is the first post of a four part series. In the coming weeks I will be outlining the various over-the-counter treatments available to help improve and in some cases eliminate chronic sinusitis symptoms.  But first let’s outline and answer some common symptoms complaints and questions I hear from my sinus patients every-day.

Are my chronic sinus symptoms normal?

Here are the most common symptoms I see from patients who present to my office.  You’re not the only one!  Millions of Americans have sinus symptoms making them sick every day.  The good news is there are simple solutions out there if you are suffering from one or many of these symptoms.

What are the causes chronic sinusitis symptoms?

Let’s look at the root cause of chronic sinusitis. Simply put, it’s INFLAMMATION. Inflammation causes swelling of the lining of your nose called the nasal mucosa.  Unfortunately the sinus and nasal airway passages are narrow to begin with and a few millimeters of swelling can dramatically decrease, narrow or even close off either the path of air for breathing or the path of mucous drainage of the sinuses.  When this happens you will frequently experience one or many of the symptoms listed above.

What causes chronic nasal and sinus inflammation?

This follow-up question I get all the time.  My patients always want to know what are the causes of chronic sinusitis, what is causing all this inflammation, and how to get rid of it.  That is where things can get complicated.  Depending on where you live in the United States, nasal and sinus inflammation can be caused from a variety of triggers including pollen, allergies, farm dust, farm chemicals, air-pollution, ozone, mold, and various other environmental exposures. 

Your job or where you live and play can even be the problem depending on your exposures.  More recently there is new research indicating diet and food related allergies as well as leaky gut can contribute to worsening chronic nasal and sinus inflammation.  Inflammatory triggers causing continued symptoms lasting more than 2-3 months leads to a condition called chronic sinusitis.

What are the best ways to reduce my symptoms without seeing a doctor?

I see a lot of patients who reach out to me with this question.  That’s understandable because if you don’t control your symptoms now and don’t start reversing the inflammation causing your chronic sinusitis symptoms, at some point you will get so bad that over-the-counter remedies won’t work.  That’s when you will be forced to see a sinus specialist like me.  The patients I see in my office typically need imaging, like a sinus CT, and procedures to reverse things.  It becomes a more involved approach to care.

Some of these procedures are in-office treatments like Balloon Sinuplasty, Vivaer, or Rhinaer. These can be very effective at improving nasal obstruction, nasal congestion, and chronic sinusitis but other treatments may require invasive trips to the operating room.  So before you get to that point or even if you are bad enough where you are thinking you need to have something done, it’s worth it to try one of these simple strategies.

Over-counter-medications and treatment

The over-the-counter treatments I am going to outline over the coming weeks are available to anyone.  They are inexpensive and either involve no medication or medications that are now available without prescription that have been proven safe and can be very effective for many individuals.  All of them target that thing that is causing all the problems.  Inflammation.  Stay tuned for more!

Click HERE if you want to start an immediate discussion with me about your nasal sinus symptoms and options for care.

I sincerely hope you found this article helpful.  Have a great day!

Dr. B