man suffering from sinus infections

The start of school, football games, and cooler weather means, unfortunately, the arrival of autumn allergies. Chronic allergies can lead to sinus infections.

So, we thought it's the perfect time to update our guide to all things related to sinuses. From sinus infections and allergies, to sinus cancer, sinus surgery, and more.

Here's everything you need to know.

Update on the Current Allergy Season

As of publication, roughly 36 percent of the country is experiencing “medium” status for allergens, the substances that cause allergic reactions.

Common allergens include pollen and ragweed. For Raleigh, Durham, and Chapel Hill, the status is also designated as “medium,” according to an allergy forecasting site, This means that many Triangle residents will likely be seeking allergy treatment and/or sinus infection treatment before the year's over. is an informational site provided by IQVA, a public company that performs detailed research in the health care field and prepares syndicated health care studies. 

Worst Cities for Allergies in 2019 also ranked the worst cities for 2019 fall allergies—and thankfully, no North Carolina cities made it into the top five.

As of publication, they were:

  • Hartford, CT
  • Buffalo, NY
  • Traverse City, MI
  • Alpena, MI
  • Syracuse, NY

Update on Sinus Treatment for Acute Sinusitis

Acute sinusitis is one of the most common issues people go the doctor for, and 95% of acute sinusitis infections are caused by viruses (common cold).

Antibiotics do not work for viruses.

However, a recent study showed that about 70% of people that go to the doctor for acute sinusitis are treated with an antibiotic. Unnecessary antibiotic use has been definitively shown to lead to the formation of antibiotic-resistant bacteria.

It is currently thought that over the next 10-20 years, infections caused by antibiotic-resistant bacteria will cause over 10 million deaths worldwide, according to the World Health Organization.

Unnecessary antibiotic use can also cause long-lasting damage to an individual’s microbiome, which can lead to other diseases, such as other types of infections (C. Diff colitis, yeast infection), allergies/asthma, gastrointestinal diseases, and autoimmune disease.

Another study showed that a nasal steroid spray (like Flonase) worked better to treat acute sinusitis compared to amoxicillin and that a placebo (sugar pill) worked just as well as amoxicillin.

The current recommendation for treatment of acute sinusitis is a nasal steroid spray (like Flonase) and simply treating the symptoms with OTC medicines.

For example, acetaminophen or ibuprofen for pain/sore throat, decongestants for congestion/pressure, and nasal saline for nasal congestion/drainage. 

Rest and hydration help, too. Treatment with antibiotics should be considered in the small number of cases of acute sinusitis where there is high fever, severe pain on one side of the face, and a lot of discolored or bad-smelling nasal drainage.

We all need to work together to be good antibiotic stewards!

Sinus Surgery Updates for 2019

Recent studies reveal ways to manage post-operative pain after sinus - ENT - surgery.

It is well-known that there is a crippling problem with opioid use and addiction that is currently rampant in America.

As a result, many types of surgeons are studying how to manage post-operative pain better and with fewer opioids, including ENT surgeons.

Many recent studies have looked at pain after nasal or sinus surgery in order to try to understand this better.

On a scale of 1-10, with 1 being no pain and 10 being the most severe pain, most patients had a moderate pain level (4-7) for two to three days after nasal/sinus surgery. By the eighth day after surgery, this pain level had decreased to mild (1-3).

Regardless of the type of surgery performed, this pain pattern was basically the same. The average time back to work after nasal or sinus surgery was seven days.

These studies have helped us to understand that the pain after nasal/sinus surgery is not as severe as previously thought. This allows us to counsel patients better and manage pain after nasal/sinus surgery more effectively and safely.

Recent studies have also showed that the use of acetaminophen (Tylenol) and ibuprofen for pain after nasal/sinus surgery decreased the need for the use of opioids.

In addition, the acetaminophen (Tylenol) worked better if it was scheduled to be taken every four hours for the first three days after nasal/sinus surgery, rather than taken as needed.

At Raleigh-Capitol ENT, we are well aware of the dangers of opioids and of our duty to help our society by minimizing exposure to opioids whenever possible.

If you need nasal/sinus surgery, do not worry! The pain after this type of surgery is not bad, and we will help you to manage the pain as effectively and safely as possible with the care and compassion you deserve.

The Most Frequently Asked Questions About Sinuses

A stuffy nose, sore throat and headache do not always equal a sinus infection. In fact, there are several disorders that have these same symptoms, and as a result, many are lumped together as “sinus infections” when they are actually other diseases.

To provide some clarity, we’ve provided some answers to some of the most frequently asked questions about your sinuses, and when you may need sinus infection treatment.

What are Sinuses for?

With all the trouble they can cause, you may wonder what the sinuses actually do, or what their purpose is.

Your sinuses play an important role in warming and filtering the air you breathe. They are also responsible for helping shape the sound of our voices.

In addition, if your skull had no sinus cavities, it would weigh much more than it does.

Are my sinuses to blame for Snoring?

Perhaps, although there are a lot of other reasons for snoring as well. Sleep apnea may be the most likely cause. It’s important to get treatment for sleep apnea because it can increase your risk for several diseases such as heart attacks or strokes.

Fortunately, as ENTs in the Triangle area, we’re experts in helping diagnose and treat sleeping disorders.

How do You Know if You Have A sinus infection?

There are several diseases that have similar symptoms, so it’s easy to get them confused. Not every stuffy nose or headache is the beginning of sinusitis; likewise, not every sniffle and sneeze means an infection. 

Overuse of antibiotics when not needed can contribute to resistant strains of bacteria. Antibiotics will not be effective against a virus, which usually has to “run its course.”

So how can you tell if your sinusitis is caused by a virus or bacteria?

Only your ear, nose and throat doctor can make an accurate diagnosis and determine the best course of sinus treatment. However, if you have had symptoms of a sinus infection longer than 10 days - like a sinus headache, sinus pressure, cough, and thick, colored mucus. Or, if you have gotten better, only to get worse again, you may have a bacterial infection.

We recommend making an appointment with an ENT doctor near you to get a proper diagnosis and treatment, if needed.

How Can I Treat a Sinus Infection at Home?

There are some things you can do that will help you feel better, regardless of whether the cause is bacterial or viral.

These include:

  1. Sinus irrigations
  2. Over-the-counter pain relievers
  3. Allergy nasal sprays, such as OTC Flonase or Nasacort, have been shown to be helpful in improving symptoms and shortening the course of the illness.
  4. Decongestants can be very helpful for symptom relief, as long as there are no medical conditions preventing their safe usage.
  5. Plenty of rest and hydration can also help.
  6. Probiotics may be helpful in preventing upper respiratory tract infections.

Are Sinus Infections contagious?

Yes and no. Sinusitis itself is not contagious, however, the cold virus or infection that may have preceded sinusitis certainly is.

That means the stray cough germs from your coworkers didn’t give you sinusitis, but they did open the door and set the stage for it.

The best defense is a good offense: Wash your hands frequently, especially before eating and after caring for or being around others who are sick.

While it goes without saying that you should always cover your mouth when you sneeze, be sure to wash your hands if you come into contact with someone who may not be quite as considerate. Immediately dispose of used tissues.

Do I need sinus surgery?

There are a few instances in sinus treatment when surgery may be needed. This can be when over-the-counter medicine or other treatment is ineffective or if there is a problem with the shape or structure of the sinuses.

How Can I Prevent sinus infections?

Sinus infection treatment is very common in the fall and winter months when allergies seem to reach their peak. However, there are a few things that can help you avoid sinus infections:

  • Allergies and colds can lead to sinusitis. Therefore, treat any symptoms promptly. 
  • Avoid second-hand smoke, which can irritate your sinuses. (If you smoke, this would be a great time to quit!)
  • Use a humidifier.
  • Avoid those who have colds and upper respiratory infections. If you have a cold or infection, think of your coworkers and opt to take a sick day if possible.
  • In some cases, chronic sinusitis may be due to structural problems within the sinuses themselves, and may require surgery. Speak our ear, nose and throat physicians who can determine whether or not you are a candidate for surgery.

Common Treatments for Chronic Sinus Problems

Sinus problems aren’t just annoying; they can significantly reduce the quality of your life.

Studies reveal that those with chronic sinus problems actually feel worse than patients with COPD and heart disease. The research also discovered that they feel as bad as someone on kidney dialysis.

Those who deal with chronic sinus problems often have difficulty concentrating at work or enjoying favorite activities. Almost 13 percent of American adults—roughly 30 million people—are diagnosed with sinusitis every year, according to the Centers for Disease Control. 

Chronic sinus problems are one of the most common issues our patients face, which is why we’ve established a comprehensive sinus center to provide a multifaceted approach to customized treatment. 

Remember that sinus infections may be caused by bacteria or a virus. Antibiotics will not help if you have a viral infection. Virial infections have to “run their course” and typically will clear up within 10 days.

However, if you get better and then get worse, it’s very possible you have a bacterial infection. In this case, you should contact us. Only our experienced ear, nose and throat doctors can make an accurate diagnosis and prescribe antibiotics if they are appropriate.

Immunotherapy for Allergies and Sinus Problems 

If you don’t want to be on allergy medicine all year, immunotherapy may be a good option. Through immunotherapy, your body is gradually exposed to a small amount of the allergen. As the dosage increases over time, your immune system develops a tolerance. 

If the idea of “allergy shots” doesn’t appeal to you, sublingual immunotherapy may be a good option. Through this process, drops of the diluted allergens are held under the tongue.

We can conduct allergy tests and provide you with a comprehensive list of treatment options and discuss the ones that will be most effective for you.

Sinus Surgery as Treatment for Sinus Problems

Sometimes the root of sinus problems is within the structure of the sinuses themselves, such as a deviated or torn septum. Often, the sinus passages swell, preventing fluid from draining properly. In cases like these, surgery may be appropriate.

These surgeries include:

Functional Endoscopic Sinus Surgery (FESS)

This procedure treats chronic rhinosinusitis or chronic sinusitis. It widens the opening of the sinuses to relieve swelling and inflammation by allowing them to drain.

Typically, FESS is a good option for those who have naturally narrow sinus passageways, those with chronic obstruction or sinus blockage. These conditions cause fluid to build up in the sinus, causing chronic infections.

How is FESS performed?

During this procedure, we use an endoscope, a flexible tube fitted to a small camera and light. This allows our surgeon to clearly see inside your nose and sinuses. Because FESS is minimally invasive, there is no need for incisions in your face or mouth, and it’s often an outpatient procedure.


This is a surgery to repair problems with the septum, the part of your nose that divides it into the right and left nostrils. 

The septum is the part of your nose that separates it into the left and right nostrils. It’s made from cartilage and bone. Sometimes, there is a hole or tear in it, called a septal perforation.

Another common problem is a deviated septum—one that veers to the right or left— which causes difficulties and contributes to chronic sinus problems. In extreme cases, a deviated septum can complete obstruct the nasal passage. A procedure to correct these conditions is called a septoplasty, according to information from the Mayo Clinic.

How is a septoplasty performed?

During the procedure, your surgeon lifts the mucosa lining off the cartilage and bone to reshape it. If necessary, some portions are removed before the lining is returned into place. This may be done as an inpatient or outpatient procedure, depending upon each individual case.

Balloon Sinuplasty

This is a minimally invasive procedure that involves inserting a tiny balloon into the sinus cavity. The balloon is then inflated to open the sinus passage before being deflated and removed. As a result, the sinuses are allowed to drain.

Advantages include:

  • Patients are able to return to work or regular activities much sooner than with traditional sinus surgery
  • There is less bleeding
  • It can be performed either in an operating room with general anesthesia or in our office with local anesthesia
  • There is less pain
  • No nasal packing is involved

How is balloon sinuplasty performed?

A tiny, narrow balloon is threaded through the sinus passages and is then gently inflated, deflated, and removed. This effectively opens sinus passages that had been blocked.

Effective Sinus Infection Treatment in Raleigh, Cary, and the Triangle

Our board-certified physicians evaluate each individual case to determine the right treatment for you. In addition to sinus surgery, we also offer a wide range of procedures including plastic surgery, ear tube placement and tumor removal.

Raleigh Capitol Ear, Nose, and Throat is the area's premier physician-owned ENT practice with six convenient locations throughout Wake County. Our board-certified physicians have extensive experience in treating both common and complex cases to help adults and children alike. For more information or to schedule an appointment, contact us.


This article was reviewed by  Dr. Jeevan Ramakrishnan.