What are the recommended non-pharmacological treatments for acute sinusitis in adults?

Recommended non-pharmacological treatments for acute sinusitis in adults include:

• Advising patients on the usual cause and course of acute sinusitis, emphasizing that it is usually viral and self-limiting, resolving within 12 weeks without antibiotics.
• Encouraging self-management strategies such as taking paracetamol or ibuprofen for pain or fever relief.
• Considering a trial of nasal saline irrigation to relieve nasal congestion and discharge, with instructions available on the NHS website for cleaning the nose with a saltwater solution.
• Advising avoidance of allergic triggers and smoking cessation to reduce risk factors that may predispose to sinusitis.
• Recommending good dental hygiene to reduce the risk of dental infections associated with bacterial sinusitis.
• Advising avoidance of underwater diving if prominent symptoms are present due to risk of barotrauma.
• Considering a short course (up to 14 days) of high-dose intranasal corticosteroids (e.g., mometasone) especially if allergic causes are suspected, although this is pharmacological, it is often part of initial management.
• Considering temporary use of nasal decongestants only if the nose is very blocked, but generally not recommended for routine use.
• Providing written advice and clear instructions on when to seek further medical advice, such as if symptoms worsen rapidly, do not improve after 3 weeks, or systemic illness develops.

There is no evidence supporting the use of oral decongestants, antihistamines, mucolytics, steam inhalation, or warm face packs for acute sinusitis.

Antibiotics are generally not recommended routinely due to limited benefit and potential adverse effects.

Referral to specialists is advised if symptoms persist beyond 6–12 weeks or if complications or comorbidities are suspected.

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