Over-the-counter treatment

Studies show that many short-term bacterial sinus infections will get better on their own without antibiotics. If your symptoms are mild, the following can help.

Decongestant nose sprays (Afrin and others). If you feel a sinus infection coming on, this is the first thing to reach for. Two sprays in each nostril every 12 hours for 3 days. You can also take Sudafed if you tolerate it well. Allergy pills (antihistamines) are not usually recommended at this stage — especially the older "drying" kind. Rinsing the nose with saltwater is also a good idea, and most pharmacies now sell good saltwater rinse kits.

If the symptoms of a bacterial sinus infection don't get better, or get worse, see a doctor.

What can a doctor do for a bacterial sinus infection?

Your doctor can examine you, talk about your specific symptoms, and give you a plan that fits your situation.

Antibiotics are the main treatment when a bacterial sinus infection is the diagnosis. Picking the right one depends on several things. The simplest choice is often the best. For people with mild symptoms, infections that don't happen often, and no history of long-lasting infections, a first-line antibiotic for about 10 days is the usual plan.

For people who have had a lot of antibiotics, those who recently had a long-lasting infection, or those who have already failed one or more rounds of antibiotics, I use stronger and broader antibiotics, at higher doses, for longer — often 3 or 4 weeks — and then follow up with some kind of imaging if any symptoms remain.

Depending on your situation and any allergies, my preferred antibiotics are second-generation cephalosporins, Augmentin, or fluoroquinolones. Each has its place, and now and then other types are right.

If allergies are also flaring up at the same time as the sinus infection, it helps to treat them too. Steroid sprays and steroid pills bring down allergy swelling and can help the sinuses drain.

What can a specialist do for me?

At some point it may be necessary to see a specialist. An ENT doctor (ear, nose, and throat specialist), especially one who focuses on sinus and nasal problems, is the right doctor for hard-to-treat sinus problems.

Where a specialist can help

Choosing antibiotics based on experience with tough sinus cases
Knowing when to get an X-ray or a CT scan
Special exam techniques like an in-office camera exam (nasal endoscopy)
Taking a sample for lab testing under direct view with a small camera — this is the modern standard when a culture is needed
Setting up IV antibiotics for some patients
Using advanced sprays or rinses with antibiotics or anti-fungal medicine when needed
Treating complications of a sudden sinus infection, such as a sinus-related abscess

It may be time to see an ENT specialist. Appointments are often easy to schedule, you don't always need a referral from your regular doctor, and a specialist visit can cost less than a visit to your family doctor.