Treatment of Dizziness Associated with Sinusitis

First-Line Treatment

The American Academy of Otolaryngology recommends treating the underlying sinusitis with appropriate antibiotics and adjunctive therapies, as dizziness typically resolves when the sinus infection is adequately managed 1.
For acute bacterial sinusitis causing dizziness, the American Academy of Family Physicians recommends initiating amoxicillin 500 mg twice daily for mild disease or 875 mg twice daily for moderate disease, continuing for 10-14 days or until symptom-free for 7 days 1.
High-dose amoxicillin (80-90 mg/kg/day in children) should be used in areas with high prevalence of resistant Streptococcus pneumoniae or in patients with recent antibiotic exposure, as recommended by the American Academy of Pediatrics 1.

The American College of Allergy, Asthma, and Immunology strongly recommends intranasal corticosteroids (mometasone, fluticasone, or budesonide twice daily) as adjunctive therapy to reduce mucosal inflammation and improve symptom resolution, including dizziness 2, 1.
Oral decongestants (pseudoephedrine) or topical decongestants may alleviate pressure-related dizziness, but should be used with caution, as recommended by the American Academy of Otolaryngology 3, 4, 5.

If no improvement occurs within 3-5 days of initial antibiotic therapy, the American Academy of Family Physicians recommends switching to a different antibiotic, such as high-dose amoxicillin-clavulanate or respiratory fluoroquinolones 2, 1.
Consider referral to otolaryngology or allergy-immunology if symptoms persist after two courses of appropriate antibiotics, or if there are suspected complications, as recommended by the American Academy of Otolaryngology 2, 1.

The American College of Physicians recommends avoiding the use of antibiotics for viral rhinosinusitis lasting <10 days, as 98-99.5% of acute rhinosinusitis is viral and resolves spontaneously 1.
The American Academy of Family Physicians recommends confirming bacterial sinusitis by identifying persistent symptoms ≥10 days without improvement, severe symptoms, or "double sickening" 1.