Manage sinusitis with saline nasal irrigation (1–2 times daily) and/or intranasal corticosteroids, such as mometasone (2 sprays per nostril once daily). For short-term relief, intranasal decongestants like oxymetazoline may be used but should be limited to 3–5 days to prevent rebound congestion. Avoid antihistamines unless sinusitis is clearly allergic and systemic steroids due to limited efficacy and side effects.
January 14, 2025

Sinusitis: Doctor’s First Choice Treatments

Evidence-Based Over-The-Counter Guide

See all guides. Have more questions?

This guide is based on the 2015 American Academy of Otolaryngology updated clinical practice guidelines.

Inflammation of the sinuses, often following a viral upper respiratory infection. Symptoms include nasal congestion, facial pain, and purulent nasal discharge. Symptoms typically improve within 10 days and resolve within 14 days.

Over-the-counter treatments can be used by patients with acute or chronic sinusitis. Evidence supports nasal sprays over oral medication.

First-line recommendations:

  • Saline nasal irrigation: Helps clear mucus and reduce nasal congestion. Use 1–2 times daily. Neti Pot nasal cleanser.

  • Intranasal corticosteroids: Used to reduce inflammation in the sinuses. Mometasone is currently the only intranasal steroid with an FDA indication for sinusitis and is only approved for adults. Dose: 2 sprays in each nostril once daily. Nasonex 24Hr Allergy Nasal Spray (FDA NDA 215712).

Second-line recommendations:

Not recommended:

  • Antihistamines should not be used unless sinusitis is clearly allergic, or else they can actually worsen sinusitis symptoms by drying out and thickening mucous 

  • Systemic steroids should not be used due to reduced efficacy and greater side effect profile compared to intranasal steroids

  • Guaifenesin shows little to no evidence of symptomatic relief in sinusitis

Prescription medications:

  • Antibiotics (e.g., amoxicillin-clavulanate): Prescribed for bacterial sinusitis persisting >7 days or with severe symptoms (e.g., fever >102°F).

Citation

Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al. Clinical practice guideline (update): Adult sinusitis. Otolaryngol Head Neck Surg. 2015; 152(2S): p.S1-S39. doi: 10.1177/0194599815572097

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

Where do I view other OTC guides?

Browse topic list here:

You can view all of our published OTC guides here.