Decongestants, available in both oral and topical formulas, reduce nasal passage swelling, congestion, runny nose, and sinus pressure. Decongestants are not effective for long-term relief, and may even worsen symptoms if used more than a few days. This is especially true for topical (nasal) decongestants such as Afrin, which should not be used in CF. Side effects include jitteriness or difficulty sleeping.
Inhaled nasal steroids, which help reduce sinus inflammation, can be used for long periods of time to treat chronic sinusitis. Relief is not as immediate as with decongestants.
When intranasal steroids fail to relieve sinus symptoms, antibiotics may help. The bacteria that infect the sinuses, including Staphylococcus aureus and Pseudomonas aeruginosa, are similar to those that infect the lungs of individuals with CF. Sinus infections are common in people with CF, and fungal sinusitis may occur, too. Antibiotic treatment usually requires several weeks to be effective. In some cases prolonged courses of intravenous antibiotics may be necessary.
Daily irrigation with saline can help remove excess mucus from the sinuses. Irrigation with an antibiotic solution every few weeks may suppress sinus bacteria. Because the sinuses are difficult to penetrate, oral or intravenous antibiotics rarely eradicate all of the bacteria.
When medication does not resolve sinusitis, surgery may be necessary to drain the sinuses and remove infected material. Sinus surgery is often needed to remove polyps which can interfere with breathing, cause pain, or contribute to infection. Unfortunately, nasal polyps frequently recur after removal. Surgery is not a permanent solution for CF sinus disease, so it is reserved for patients who have serious symptoms despite aggressive medical management.