Editing Sinusitis (section)

==Treatment==
{| style="float:right; width:40em; border:solid 1px #999999; margin:0 0 1em 1em;"
|+ style="background-color: #CCEEEE;" | Treatments for sinusitis<ref name="American Academy of Family Physicians-2012">{{cite web |author1 = Consumer Reports |author2 = American Academy of Family Physicians |author1-link = Consumer Reports |author2-link = American Academy of Family Physicians |date = April 2012 |title = Treating sinusitis: Don't rush to antibiotics |publisher = [[Consumer Reports]] |work = Choosing wisely: an initiative of the [[ABIM Foundation]] |url = http://consumerhealthchoices.org/wp-content/uploads/2012/04/ChoosingWiselySinusitisAAFP.pdf |access-date = August 17, 2012 |url-status = live |archive-url = https://web.archive.org/web/20120611205432/http://consumerhealthchoices.org/wp-content/uploads/2012/04/ChoosingWiselySinusitisAAFP.pdf |archive-date = June 11, 2012 }}</ref><ref>{{cite web |author = ((American Academy of Allergy, Asthma, and Immunology)) |author-link = American Academy of Allergy, Asthma, and Immunology |title = Five things physicians and patients should question |publisher = [[American Academy of Allergy, Asthma, and Immunology]] |work = Choosing Wisely: an initiative of the [[ABIM Foundation]] |url = http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AAAAI.pdf |access-date = August 14, 2012 |url-status = live |archive-url = https://web.archive.org/web/20121103151124/http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_AAAAI.pdf |archive-date = November 3, 2012 }}</ref>
|-
!scope="col"| Treatment
!scope="col"| Indication
!scope="col"| Rationale
|-
|-
!scope="row" style="text-align:left; font-weight:normal;"| Time
| Viral and some bacterial sinusitis
| Sinusitis is usually caused by a virus which is not affected by antibiotics.<ref name="American Academy of Family Physicians-2012"/>
|-
!scope="row" style="text-align:left; font-weight:normal;"| Antibiotics
| Bacterial sinusitis
| Cases accompanied by extreme pain, skin infection, or which last a long time may be caused by bacteria.<ref name="American Academy of Family Physicians-2012"/>
|-
!scope="row" style="text-align:left; font-weight:normal;"| [[Nasal irrigation]]
| [[Nasal congestion]]
| Can provide relief by helping decongest.<ref name="American Academy of Family Physicians-2012"/>
|-
!scope="row" style="text-align:left; font-weight:normal;"| Drink liquids
| Thick [[phlegm]]
| Remaining hydrated loosens mucus.<ref name="American Academy of Family Physicians-2012"/>
|-
!scope="row" style="text-align:left; font-weight:normal;"| [[Antihistamines]]
| Concern with [[allergies]]
| Antihistamines do not relieve typical sinusitis or cold symptoms much; this treatment is not needed in most cases.<ref name="American Academy of Family Physicians-2012"/>
|-
!scope="row" style="text-align:left; font-weight:normal;"| [[Nasal spray]]
| Desire for temporary relief
| Tentative evidence that it helps symptoms.<ref name="pmid25892369">{{cite journal |vauthors=King D, Mitchell B, Williams CP, Spurling GK |date=April 2015 |title=Saline nasal irrigation for acute upper respiratory tract infections |url=http://espace.library.uq.edu.au/view/UQ:201653/UQ201653_OA.pdf |url-status=live |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=4 |pages=CD006821 |doi=10.1002/14651858.CD006821.pub3 |pmc=9475221 |pmid=25892369 |archive-url=https://web.archive.org/web/20210829061619/https://espace.library.uq.edu.au/data/UQ_201653/UQ201653_OA.pdf?Expires=1630217866&Key-Pair-Id=APKAJKNBJ4MJBJNC6NLQ&Signature=fvzZFSRIkQZTLEhLp~QFYol~hVWVs5Yo2o0Vw3BhGOL7U3pmZx7K1xwMdix20C-ZBOBTDrFZyWfczpiMKk7xmMWYUsYU8tEF9SRghcv~x04vWlZkkUuL3E7OHRYrkCFawyesJkkEEQO5sQxtD0LLWuoQWlT7yRRWk4ZqrLeW7OCsFY5NhBYavteJhqCqtWifH5hIamsdfCYNZnVKx4mp66bQ5L5iozTDtmriPethrPxdoRvyPvYoPscI~ayOcvCjCjdYxsooSxLtw1KPpsbBbtEACOPp35YxrEPcON9XJO04wJeqpcy9FsRhJHM1Gg1-b8p5xUSx3LRrF42Dirskaw__ |archive-date=2021-08-29 |access-date=2018-04-20}}</ref> Does not treat cause. Not recommended for more than three days' use.<ref name="American Academy of Family Physicians-2012"/>
|-
|}

Recommended treatments for most cases of sinusitis include rest and drinking enough water to thin the mucus.<ref name="American Academy of Allergy, Asthma, and Immunology-2012">{{Citation |author1 = Consumer Reports |author2-link = American Academy of Allergy, Asthma, and Immunology |author2 = ((American Academy of Allergy, Asthma, and Immunology)) |date = July 2012 |title = Treating sinusitis: Don't rush to antibiotics |publisher = [[Consumer Reports]] |work = Choosing Wisely: an initiative of the [[ABIM Foundation]] |url = http://consumerhealthchoices.org/wp-content/uploads/2012/04/ChoosingWiselySinusitusAAAAI.pdf |access-date = August 14, 2012 |url-status = live |archive-url = https://web.archive.org/web/20130124031216/http://consumerhealthchoices.org/wp-content/uploads/2012/04/ChoosingWiselySinusitusAAAAI.pdf |archive-date = January 24, 2013 |author1-link = Consumer Reports }}</ref> Antibiotics are not recommended for most cases.<ref name="American Academy of Allergy, Asthma, and Immunology-2012"/><ref>{{cite journal | vauthors = Lemiengre MB, van Driel ML, Merenstein D, Liira H, Mäkelä M, De Sutter AI | title = Antibiotics for acute rhinosinusitis in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD006089 | date = September 2018 | issue = 9 | pmid = 30198548 | pmc = 6513448 | doi = 10.1002/14651858.CD006089.pub5 }}</ref>

Breathing high-temperature steam such as from a hot shower or [[gargling]] can relieve symptoms.<ref name="American Academy of Allergy, Asthma, and Immunology-2012"/><ref>{{cite journal | vauthors = Harvey R, Hannan SA, Badia L, Scadding G | title = Nasal saline irrigations for the symptoms of chronic rhinosinusitis | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD006394 | date = July 2007 | pmid = 17636843 | doi = 10.1002/14651858.CD006394.pub2 | veditors = Harvey R }}</ref> There is tentative evidence for [[nasal irrigation]] in acute sinusitis, for example during [[upper respiratory infection]]s.<ref name="pmid25892369"/> [[Decongestant]] [[nasal spray]]s containing [[oxymetazoline]] may provide relief, but these medications should not be used for more than the recommended period. Longer use may cause [[rhinitis medicamentosa|rebound sinusitis]].<ref>{{EMedicine|article|995056|Rhinitis medicamentosa}}</ref> It is unclear if nasal irrigation, [[antihistamine]]s, or decongestants work in children with acute sinusitis.<ref>{{cite journal | vauthors = Shaikh N, Wald ER | title = Decongestants, antihistamines and nasal irrigation for acute sinusitis in children | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 10 | pages = CD007909 | date = October 2014 | pmid = 25347280 | doi = 10.1002/14651858.CD007909.pub4 | pmc = 7182143 }}</ref> There is no clear evidence that plant extracts such as ''[[Cyclamen purpurascens|Cyclamen europaeum]]'' are effective as an intranasal wash to treat acute sinusitis.<ref>{{cite journal | vauthors = Zalmanovici Trestioreanu A, Barua A, Pertzov B | title = Cyclamen europaeum extract for acute sinusitis | journal = The Cochrane Database of Systematic Reviews | volume = 5 | pages = CD011341 | date = May 2018 | issue = 8 | pmid = 29750825 | pmc = 6494494 | doi = 10.1002/14651858.CD011341.pub2 }}</ref> Evidence is inconclusive on whether anti-fungal treatments improve symptoms or quality of life.<ref>{{cite journal | vauthors = Head K, Sharp S, Chong LY, Hopkins C, Philpott C | title = Topical and systemic antifungal therapy for chronic rhinosinusitis | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD012453 | date = September 2018 | issue = 9 | pmid = 30199594 | pmc = 6513454 | doi = 10.1002/14651858.cd012453.pub2 }}</ref>

===Antibiotics===
Most sinusitis cases are caused by viruses and resolve without antibiotics.<ref name="pmid18206715"/> However, if symptoms do not resolve within 10 days, either [[amoxicillin]] or [[amoxicillin/clavulanate]] are reasonable antibiotics for [[Therapy#Lines of therapy|first treatment]] with [[amoxicillin/clavulanate]] being slightly superior to [[amoxicillin]] alone but with more side effects.<ref name="pmid33236525">{{cite journal |last1=Orlandi |first1=Richard R. |last2=Kingdom |first2=Todd T. |last3=Smith |first3=Timothy L. |last4=Bleier |first4=Benjamin |last5=DeConde |first5=Adam |last6=Luong |first6=Amber U. |last7=Poetker |first7=David M. |last8=Soler |first8=Zachary |last9=Welch |first9=Kevin C. |last10=Wise |first10=Sarah K. |last11=Adappa |first11=Nithin |last12=Alt |first12=Jeremiah A. |last13=Anselmo-Lima |first13=Wilma Terezinha |last14=Bachert |first14=Claus |last15=Baroody |first15=Fuad M. |year=2021 |title=International consensus statement on allergy and rhinology: rhinosinusitis 2021 |url=https://ueaeprints.uea.ac.uk/id/eprint/77501/1/Accepted_Manuscript.pdf |url-status=live |journal=International Forum of Allergy & Rhinology |publisher=Wiley |volume=11 |issue=3 |pages=213–739 |doi=10.1002/alr.22741 |issn=2042-6976 |pmid=33236525 |s2cid=227165628 |archive-url=https://web.archive.org/web/20230307191717/https://ueaeprints.uea.ac.uk/id/eprint/77501/1/Accepted_Manuscript.pdf |archive-date=2023-03-07 |access-date=2023-01-21 |last16=Batra |first16=Pete S. |last17=Bernal-Sprekelsen |first17=Manuel |last18=Beswick |first18=Daniel |last19=Bhattacharyya |first19=Neil |last20=Chandra |first20=Rakesh K. |last21=Chang |first21=Eugene H. |last22=Chiu |first22=Alexander |last23=Chowdhury |first23=Naweed |last24=Citardi |first24=Martin J. |last25=Cohen |first25=Noam A. |last26=Conley |first26=David B. |last27=DelGaudio |first27=John |last28=Desrosiers |first28=Martin |last29=Douglas |first29=Richard |last30=Eloy |first30=Jean Anderson |last31=Fokkens |first31=Wytske J. |last32=Gray |first32=Stacey T. |last33=Gudis |first33=David A. |last34=Hamilos |first34=Daniel L. |last35=Han |first35=Joseph K. |last36=Harvey |first36=Richard |last37=Hellings |first37=Peter |last38=Holbrook |first38=Eric H. |last39=Hopkins |first39=Claire |last40=Hwang |first40=Peter |last41=Javer |first41=Amin R. |last42=Jiang |first42=Rong-San |last43=Kennedy |first43=David |last44=Kern |first44=Robert |last45=Laidlaw |first45=Tanya |last46=Lal |first46=Devyani |last47=Lane |first47=Andrew |last48=Lee |first48=Heung-Man |last49=Lee |first49=Jivianne T. |last50=Levy |first50=Joshua M. |last51=Lin |first51=Sandra Y. |last52=Lund |first52=Valerie |last53=McMains |first53=Kevin C. |last54=Metson |first54=Ralph |last55=Mullol |first55=Joaquim |last56=Naclerio |first56=Robert |last57=Oakley |first57=Gretchen |last58=Otori |first58=Nobuyoshi |last59=Palmer |first59=James N. |last60=Parikh |first60=Sanjay R. |last61=Passali |first61=Desiderio |last62=Patel |first62=Zara |last63=Peters |first63=Anju |last64=Philpott |first64=Carl |last65=Psaltis |first65=Alkis J. |last66=Ramakrishnan |first66=Vijay R. |last67=Ramanathan |first67=Murugappan |last68=Roh |first68=Hwan-Jung |last69=Rudmik |first69=Luke |last70=Sacks |first70=Raymond |last71=Schlosser |first71=Rodney J. |last72=Sedaghat |first72=Ahmad R. |last73=Senior |first73=Brent A. |last74=Sindwani |first74=Raj |last75=Smith |first75=Kristine |last76=Snidvongs |first76=Kornkiat |last77=Stewart |first77=Michael |last78=Suh |first78=Jeffrey D. |last79=Tan |first79=Bruce K. |last80=Turner |first80=Justin H. |last81=Drunen |first81=Cornelis M. |last82=Voegels |first82=Richard |last83=Wang |first83=De Yun |last84=Woodworth |first84=Bradford A. |last85=Wormald |first85=Peter-John |last86=Wright |first86=Erin D. |last87=Yan |first87=Carol |last88=Zhang |first88=Luo |last89=Zhou |first89=Bing}}</ref><ref name="pmid18206715"/> A 2018 Cochrane review, however, found no evidence that people with symptoms lasting seven days or more before consulting their physician are more likely to have bacterial sinusitis as one study found that about 80% of patients have symptoms lasting more than 7 days and another about 70%.<ref name="pmid30198548"/> Antibiotics are specifically not recommended in those with mild / moderate disease during the first week of infection due to risk of adverse effects, [[antibiotic resistance]], and cost.<ref>{{cite journal | vauthors = Smith SR, Montgomery LG, Williams JW | title = Treatment of mild to moderate sinusitis | journal = Archives of Internal Medicine | volume = 172 | issue = 6 | pages = 510–3 | date = March 2012 | pmid = 22450938 | doi = 10.1001/archinternmed.2012.253 }}</ref>

[[Fluoroquinolones]], and a newer [[macrolide]] antibiotic such as [[clarithromycin]] or a [[tetracycline]] like [[doxycycline]], are used in those who have severe allergies to [[penicillin]]s.<ref>{{cite journal | vauthors = Karageorgopoulos DE, Giannopoulou KP, Grammatikos AP, Dimopoulos G, Falagas ME | title = Fluoroquinolones compared with beta-lactam antibiotics for the treatment of acute bacterial sinusitis: a meta-analysis of randomized controlled trials | journal = CMAJ | volume = 178 | issue = 7 | pages = 845–54 | date = March 2008 | pmid = 18362380 | pmc = 2267830 | doi = 10.1503/cmaj.071157 }}</ref> Because of increasing resistance to amoxicillin the 2012 guideline of the [[Infectious Diseases Society of America]] recommends amoxicillin-clavulanate as the initial treatment of choice for bacterial sinusitis.<ref name="pmid22438350">{{cite journal | vauthors = Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM | title = IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults | journal = Clinical Infectious Diseases | volume = 54 | issue = 8 | pages = e72–e112 | date = April 2012 | pmid = 22438350 | doi = 10.1093/cid/cir1043 | doi-access = free }}</ref> The guidelines also recommend against other commonly used antibiotics, including [[azithromycin]], [[clarithromycin]], and [[trimethoprim/sulfamethoxazole]], because of growing antibiotic resistance. The [[FDA]] recommends against the use of [[fluoroquinolone]]s when other options are available due to higher risks of serious [[side effect]]s.<ref>{{cite web|title=Fluoroquinolone Antibacterial Drugs: Drug Safety Communication – FDA Advises Restricting Use for Certain Uncomplicated Infections|url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm500665.htm|website=FDA|access-date=16 May 2016|date=12 May 2016|url-status=live|archive-url=https://web.archive.org/web/20160516004228/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm500665.htm|archive-date=16 May 2016}}</ref>

A short-course (3–7 days) of antibiotics seems to be just as effective as the typical longer-course (10–14 days) of antibiotics for those with clinically diagnosed acute bacterial sinusitis without any other severe disease or complicating factors.<ref>{{cite journal | vauthors = Falagas ME, Karageorgopoulos DE, Grammatikos AP, Matthaiou DK | title = Effectiveness and safety of short vs. long duration of antibiotic therapy for acute bacterial sinusitis: a meta-analysis of randomized trials | journal = British Journal of Clinical Pharmacology | volume = 67 | issue = 2 | pages = 161–71 | date = February 2009 | pmid = 19154447 | pmc = 2670373 | doi = 10.1111/j.1365-2125.2008.03306.x }}</ref> The [[Infectious Diseases Society of America|IDSA]] guideline suggest five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The guidelines still recommend children receive antibiotic treatment for ten days to two weeks.<ref name="pmid22438350"/>

===Corticosteroids===
For unconfirmed acute sinusitis, [[Nasal spray#Corticosteroid|nasal sprays]] using [[corticosteroid]]s have not been found to be better than a [[placebo]] either alone or in combination with antibiotics.<ref>{{cite journal | vauthors = Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, Little P | title = Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial | journal = JAMA | volume = 298 | issue = 21 | pages = 2487–96 | date = December 2007 | pmid = 18056902 | doi = 10.1001/jama.298.21.2487 | doi-access =  }}</ref> For cases confirmed by radiology or nasal endoscopy, treatment with intranasal corticosteroids alone or in combination with antibiotics is supported.<ref>{{cite journal | vauthors = Zalmanovici Trestioreanu A, Yaphe J | title = Intranasal steroids for acute sinusitis | journal = The Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD005149 | date = December 2013 | pmid = 24293353 | pmc = 6698484 | doi = 10.1002/14651858.CD005149.pub4 }}</ref> The benefit, however, is small.<ref>{{cite journal | vauthors = Hayward G, Heneghan C, Perera R, Thompson M | title = Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis | journal = Annals of Family Medicine | volume = 10 | issue = 3 | pages = 241–9 | year = 2012 | pmid = 22585889 | pmc = 3354974 | doi = 10.1370/afm.1338 }}</ref>

For confirmed chronic rhinosinusitis, there is limited evidence that intranasal steroids improve symptoms and insufficient evidence that one type of steroid is more effective.<ref>{{cite journal | vauthors = Chong LY, Head K, Hopkins C, Philpott C, Schilder AG, Burton MJ | title = Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD011996 | date = April 2016 | issue = 4 | pmid = 27115217 | doi = 10.1002/14651858.cd011996.pub2 | pmc = 9393647 | s2cid = 205210710 | url = https://kclpure.kcl.ac.uk/portal/en/publications/intranasal-steroids-versus-placebo-or-no-intervention-for-chronic-rhinosinusitis(281bb1c8-9c9a-4d27-adde-37f93e7bf7fc).html | access-date = 2019-11-15 | archive-date = 2019-11-15 | archive-url = https://web.archive.org/web/20191115193627/https://kclpure.kcl.ac.uk/portal/en/publications/intranasal-steroids-versus-placebo-or-no-intervention-for-chronic-rhinosinusitis(281bb1c8-9c9a-4d27-adde-37f93e7bf7fc).html | url-status = live }}</ref><ref>{{cite journal | vauthors = Chong LY, Head K, Hopkins C, Philpott C, Burton MJ, Schilder AG | title = Different types of intranasal steroids for chronic rhinosinusitis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD011993 | date = April 2016 | issue = 4 | pmid = 27115215 | doi = 10.1002/14651858.cd011993.pub2 | pmc = 8939045 | s2cid = 205210689 }}</ref>

There is only limited evidence to support short treatment with corticosteroids by mouth for chronic rhinosinusitis with nasal polyps.<ref>{{cite journal | vauthors = Head K, Chong LY, Hopkins C, Philpott C, Burton MJ, Schilder AG | title = Short-course oral steroids alone for chronic rhinosinusitis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD011991 | date = April 2016 | issue = 4 | pmid = 27113367 | doi = 10.1002/14651858.cd011991.pub2 | pmc = 8504433 }}</ref><ref name="pmid17844873">{{cite journal | vauthors = Fokkens W, Lund V, Mullol J | title = European position paper on rhinosinusitis and nasal polyps 2007 | journal = Rhinology. Supplement | volume = 20 | issue = 1 | pages = 1–136 | year = 2007 | pmid = 17844873 | doi = 10.1017/S0959774306000060 | s2cid = 35987497 }}</ref><ref>{{cite journal | vauthors = Thomas M, Yawn BP, Price D, Lund V, Mullol J, Fokkens W | title = EPOS Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps 2007 - a summary | journal = Primary Care Respiratory Journal | volume = 17 | issue = 2 | pages = 79–89 | date = June 2008 | pmid = 18438594 | pmc = 6619880 | doi = 10.3132/pcrj.2008.00029 }}</ref> There is limited evidence to support corticosteroids by mouth in combination with antibiotics for acute sinusitis; it has only short-term effect improving the symptoms.<ref>{{cite journal | vauthors = Venekamp RP, Thompson MJ, Hayward G, Heneghan CJ, Del Mar CB, Perera R, Glasziou PP, Rovers MM | title = Systemic corticosteroids for acute sinusitis | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD008115 | date = March 2014 | pmid = 24664368 | doi = 10.1002/14651858.CD008115.pub3 | pmc = 11179165 | url = https://pure.bond.edu.au/ws/files/32844104/Systemic_corticosteroids_for_acute_sinusitis.pdf | access-date = 2019-11-15 | archive-date = 2019-11-15 | archive-url = https://web.archive.org/web/20191115193635/https://pure.bond.edu.au/ws/files/32844104/Systemic_corticosteroids_for_acute_sinusitis.pdf | url-status = live }}</ref><ref>{{cite journal | vauthors = Head K, Chong LY, Hopkins C, Philpott C, Schilder AG, Burton MJ | title = Short-course oral steroids as an adjunct therapy for chronic rhinosinusitis | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD011992 | date = April 2016 | issue = 4 | pmid = 27115214 | doi = 10.1002/14651858.cd011992.pub2 | pmc = 8763342 | s2cid = 205210682 }}</ref>

===Surgery===
For sinusitis of dental origin, treatment focuses on removing the infection and preventing reinfection, by removal of the [[microorganism]]s, their byproducts, and pulpal debris from the infected [[root canal]].<ref name="American Association of Endodontists-2018"/> Systemic [[antibiotic]]s are ineffective as a definitive solution, but may afford temporary relief of symptoms by improving sinus clearing, and may be appropriate for rapidly spreading infections, but [[debridement]] and disinfection of the root canal system at the same time is necessary. Treatment options include non-surgical [[root canal treatment]], [[periradicular surgery]], [[tooth replantation]], or extraction of the infected tooth.<ref name="American Association of Endodontists-2018">{{cite web |title=Maxillary Sinusitis of Endodontic Origin |url=https://www.aae.org/specialty/wp-content/uploads/sites/2/2018/04/AAE_PositionStatement_MaxillarySinusitis.pdf |website=American Association of Endodontists |access-date=26 March 2019 |date=2018 |archive-date=26 March 2019 |archive-url=https://web.archive.org/web/20190326020125/https://www.aae.org/specialty/wp-content/uploads/sites/2/2018/04/AAE_PositionStatement_MaxillarySinusitis.pdf |url-status=live }}</ref>

For chronic or recurring sinusitis, referral to an [[Otolaryngology|otolaryngologist]] may be indicated, and treatment options may include nasal surgery. Surgery should only be considered for those people who do not benefit with medication or have non-invasive fungal sinusitis<ref>{{cite web |last=Meghanadh |first=Dr Koralla Raja |date=2022-12-16 |title=Fungal sinusitis - causes, symptoms, and treatment |url=https://www.medyblog.com/post/fungal-sinusitis-causes-symptoms-treatment-noninvasive |access-date=2023-05-05 |website=Medy Blog |language=en |archive-date=2023-05-05 |archive-url=https://web.archive.org/web/20230505104623/https://www.medyblog.com/post/fungal-sinusitis-causes-symptoms-treatment-noninvasive |url-status=live }}{{Unreliable medical source|date=February 2024}}</ref>{{Unreliable medical source|date=February 2024}}.<ref name="pmid17844873"/><ref>{{cite web |url=http://www.sinuses.com/faq.htm#surgery |title=FAQ — Sinusitis |access-date=2007-10-28 | vauthors = Tichenor WS |date=2007-04-22 |url-status=live |archive-url=https://web.archive.org/web/20071101052144/http://www.sinuses.com/faq.htm#surgery |archive-date=2007-11-01 }}</ref> It is unclear how benefits of surgery compare to medical treatments in those with nasal polyps as this has been poorly studied.<ref>{{cite journal | vauthors = Rimmer J, Fokkens W, Chong LY, Hopkins C | title = Surgical versus medical interventions for chronic rhinosinusitis with nasal polyps | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 12 | pages = CD006991 | date = 1 December 2014 | pmid = 25437000 | doi = 10.1002/14651858.CD006991.pub2 | pmc = 11193160 }}</ref><ref>{{cite journal | vauthors = Sharma R, Lakhani R, Rimmer J, Hopkins C | title = Surgical interventions for chronic rhinosinusitis with nasal polyps | journal = The Cochrane Database of Systematic Reviews | issue = 11 | pages = CD006990 | date = November 2014 | volume = 2014 | pmid = 25410644 | doi = 10.1002/14651858.cd006990.pub2 | pmc = 11166467 }}</ref>

A number of surgical approaches can be used to access the sinuses and these have generally shifted from external/extranasal approaches to intranasal [[endoscopic]] ones.  The benefit of [[functional endoscopic sinus surgery]] (FESS) is its ability to allow for a more targeted approach to the affected sinuses, reducing tissue disruption, and minimizing post-operative complications.<ref>{{cite journal | vauthors = Stammberger H | title = Endoscopic endonasal surgery--concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations | journal = Otolaryngology–Head and Neck Surgery | volume = 94 | issue = 2 | pages = 143–7 | date = February 1986 | pmid = 3083326 | doi = 10.1177/019459988609400202 | s2cid = 34575985 }}</ref> However, if a traditional FESS with Messerklinger technique is followed the success rate will be as low as 30%, 70% of the patients tend to have recurrence within 3 years.<ref name="Medyblog-Meghanadh-2023">{{cite web |last=Meghanadh |first=Dr Koralla Raja |date=2023-02-07 |title=Sinusitis Surgery: An Overview of the Different Technologies |url=https://www.medyblog.com/post/sinusitis-surgery-types-fess-endoscopic-tfse-debriders-navigation-guided-balloon-sinuplasty |access-date=2023-05-05 |website=Medy Blog |language=en |archive-date=2023-05-05 |archive-url=https://web.archive.org/web/20230505101613/https://www.medyblog.com/post/sinusitis-surgery-types-fess-endoscopic-tfse-debriders-navigation-guided-balloon-sinuplasty |url-status=live }}{{Unreliable medical source|date=February 2024}}</ref>{{Unreliable medical source|date=February 2024}} On the other hand with use of TFSE technique along with navigation system, debriders and balloon sinuplasty or EBS can give a success rate of over 99.9%.<ref name="Medyblog-Meghanadh-2023" />{{Unreliable medical source|date=February 2024}} The use of [[Bioresorbable stents|drug eluting stents]] such as [[propel mometasone furoate implant]] may help in recovery after surgery.<ref>{{cite journal | vauthors = Liang J, Lane AP | title = Topical Drug Delivery for Chronic Rhinosinusitis | journal = Current Otorhinolaryngology Reports | volume = 1 | issue = 1 | pages = 51–60 | date = March 2013 | pmid = 23525506 | pmc = 3603706 | doi = 10.1007/s40136-012-0003-4 }}</ref>

Another recently developed treatment is [[balloon sinuplasty]]. This method, similar to [[balloon angioplasty]] used to "unclog" arteries of the heart, utilizes balloons in an attempt to expand the openings of the sinuses in a less invasive manner.<ref name="pmid21735433" /> The effectiveness of the functional endoscopic balloon dilation approach compared to conventional FESS is not known.<ref name="pmid21735433" />

[[Histopathology]] of sinonasal contents removed from surgery can be diagnostically valuable:
<gallery mode="packed" heights="150">
File:Histopathology of sinonasal inflammatory polyp with mixed inflammation, annotated.jpg|'''Benign chronic mixed inflammation''' of an inflammatory sinonasal polyp
File:Histopathology of acute sinusitis.png|'''Acute inflammation''' characterized by [[neutrophil]]s
File:Histopathology of extranodal NK-T cell lymphoma, nasal type.png|'''[[Extranodal NK/T cell lymphoma, nasal type]]'''.<ref>{{cite journal| author=Takahara M, Kumai T, Kishibe K, Nagato T, Harabuchi Y| title=Extranodal NK/T-Cell Lymphoma, Nasal Type: Genetic, Biologic, and Clinical Aspects with a Central Focus on Epstein-Barr Virus Relation. | journal=Microorganisms | year= 2021 | volume= 9 | issue= 7 | page=1381 | pmid=34202088 | doi=10.3390/microorganisms9071381 | doi-access=free | pmc=8304202 }}<br>- "This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/ {{Webarchive|url=https://web.archive.org/web/20171016050101/https://creativecommons.org/licenses/by/4.0/ |date=2017-10-16 }})."</ref> It may be incidentally discovered in people undergoing surgery for sinusitis.<ref name="pmid28652944">{{cite journal| author=Althoff A, Bibliowicz M| title=Extranodal Natural Killer/T-Cell Lymphoma: An Incidental Finding. | journal=Cureus | year= 2017 | volume= 9 | issue= 5 | pages= e1260 | pmid=28652944 | doi=10.7759/cureus.1260 | doi-access=free | pmc=5476476 }}</ref> 
</gallery>

===Treatments directed to rhinovirus infection===
A study has shown that patients given spray formulation of 0.73&nbsp;mg of Tremacamra (a soluble intercellular adhesion molecule 1 [ICAM-1] receptor) reduced the severity of illness.<ref>{{Cite journal |last=Turner |first=Ronald B. |last2=Wecker |first2=Margaret T. |last3=Pohl |first3=Gerhardt |last4=Witek |first4=Theodore J. |last5=McNally |first5=Eugene |last6=St. George |first6=Roger |last7=Winther |first7=Birgit |last8=Hayden |first8=Frederick G. |date=1999-05-19 |title=Efficacy of Tremacamra, a Soluble Intercellular Adhesion Molecule 1, for Experimental Rhinovirus InfectionA Randomized Clinical Trial |url=https://jamanetwork.com/journals/jama/fullarticle/189972 |journal=JAMA |volume=281 |issue=19 |pages=1797–1804 |doi=10.1001/jama.281.19.1797 |issn=0098-7484}}</ref><ref name="pmid31430424"/>