Usually harmless

In this case, doctors speak of rhinosinusitis, which is characterised by obstructed nasal breathing or the discharge of nasal secretions via the nose or throat. This is often accompanied by pain in the forehead, cheek or upper jaw as well as a feeling of pressure in the face, which increases when bending over. In adults, smelling is also often impaired and in children, rhinosinusitis is often accompanied by a cough. On average, adults suffer from acute rhinosinusitis two to five times a year. In children, up to ten cases are considered normal. In the majority of cases, acute rhinosinusitis is triggered by viruses and usually heals within ten days with or without medication. If this does not happen or if the symptoms worsen during the course of the disease, this indicates post-viral acute rhinosinusitis. Bacteria are rarely at work. If so, this usually manifests itself in severe pain in the sinus and frontal sinus area, a strong feeling of illness and a fever above 38 °C, in adults also slightly below this. Greenish nasal discharge is not clear evidence of a bacterial infection.

If there are at least four episodes of illness per year with no symptoms in between, doctors speak of recurrent rhinosinusitis. If the symptoms persist for more than twelve weeks, this is referred to as chronic inflammation of the sinuses. It can become more complicated over time and increases the risk of pneumonia, bronchial asthma or COPD. If chronic or recurrent rhinosinusitis is suspected, PTA and pharmacists should refer those affected to an ENT specialist. The same applies if the symptoms have not subsided after two weeks or if those affected show a severe course of the disease with severe pain and fever. Otherwise, topical and supportive measures, which can be used as part of self-care, are the most important therapeutic components in the treatment of acute rhinosinusitis.

This includes the use of isotonic or hypertonic nasal sprays and rinses such as Emser® Sinusitis Spray, Bepanthen® Seawater Nasal Spray, Rhinomer® plus). They have been proven to alleviate the unpleasant symptoms of rhinitis and rhinorrhoea in acute viral rhinosinusitis. Acute bacterial rhinosinusitis is characterised by more severe symptoms such as facial pain and fever, which are not affected by their use. A meta-analysis of eleven individual studies showed that the symptoms improved with the application of larger volumes. The authors therefore recommend nasal rinsing at least twice a day with 100 to 250 ml of saline solution. The application should be continued until the symptoms disappear, but for no longer than two weeks.

In a study of chronic and recurrent rhinosinusitis, daily rinsing with 150 ml of 2 per cent saline solution also improved the symptoms. However, nasal rinsing also harbours risks: If the mucous membrane is very swollen, the water from the facial cavities may no longer be able to drain away completely. This »water congestion« can make the situation worse. Rinsing should also be avoided in the case of severely inflamed and festered sinuses. There is no recommendation for inhaling with hot water vapour. Although it is an extremely popular household remedy for colds, no positive effect has been proven in studies to date. However, there are also no known negative effects.

If the nose is blocked and nasal breathing is difficult or even impossible, decongestant nasal sprays or drops are the treatment of choice. They contain a beta-sympathomimetic such as xylometazoline or oxymetazoline as the active ingredient. The effect lasts for five to eight hours. The newly updated EPOS (European Position Paper on Rhinosinusitis and Nasal Polyps) no longer recommends the use of nasal sprays containing glucocorticoids. A small positive effect could only be shown for post-viral rhinosinusitis. 

There is a clear recommendation in the EPOS position paper for the use of herbal medicines. This can also be found in the AWMF guideline »Rhinosinusitis«, which is currently being revised. Combination preparations of cowslip, gentian, dock, elder and verbena (as in Sinupret®) have a secretolytic effect and allow nasal symptoms such as a runny nose and postnasal drip as well as headaches and facial pain to subside more quickly. Cineol and Andrographis paniculata alleviate the intensity of the symptoms. According to EPOS, zinc supplements can also reduce the duration of the illness if they are taken within 24 hours of the onset of the first symptoms at a dose of at least 75 mg per day.