Treatment of Sinusitis with Frequent Cough

Diagnosis and Classification

• The American College of Chest Physicians defines sinusitis with cough as often part of Upper Airway Cough Syndrome (UACS), previously known as postnasal drip syndrome 1
• Acute sinusitis is generally defined as symptoms lasting less than 3 weeks, while chronic sinusitis persists beyond 12 weeks 1

First-Line Treatment Approach

• The American Academy of Otolaryngology recommends intranasal corticosteroids as the cornerstone of treatment due to their anti-inflammatory effects 2, 4
• Intranasal corticosteroids have been shown to significantly improve symptoms compared to placebo 4
• Saline irrigation is recommended to prevent crusting of secretions and facilitate mechanical removal of mucus 2

Antibiotic Therapy

• Antibiotics should be reserved for symptoms lasting more than 7-10 days or severe symptoms with high fever and purulent nasal discharge, as recommended by the Infectious Diseases Society of America 1, 5
• First-line antibiotic options include amoxicillin-clavulanate and second/third-generation cephalosporins (cefuroxime-axetil, cefpodoxime-proxetil) 5

Special Considerations for Cough

• Cough associated with sinusitis is typically due to postnasal drip, and first-generation antihistamine/decongestant combinations may be helpful for cough specifically 1

When to Refer to a Specialist

• Sinusitis refractory to standard treatment should be referred to a specialist, as recommended by the American Academy of Otolaryngology 2
• Recurrent episodes (more than 3-4 per year) or presence of complications or suspected anatomical abnormalities also require specialist referral 3