Hmm i dont think i have ever started a thread before. I get this question a lot from friends and family so i figured id make a quick post that may help some people.
There are many causes of sinus congestion some are anatomic ( i.e bad deviated septum, abnormal drainage), some are inflammatory like allergies and some are infectious. Then there are some other less common causes like cancer.
Im going to discuss the inflammatory and infectious ones and what you can do. Now normally id suggest imaging but knowing that not everyone can just go and get a CT scan tomorrow ill leave that out.
1. Inflammatory. This is actually pretty important for bodybuilders and ill explain why in a min. The short of it is something is causing histamine release. Often its environmental and unless you get a full allergy workup it could be million different things. So what can you do.
Daily nasal lavage: I dont like the passive neti pot type stuff. I prefer a 20cc syringe. I put a table spoon of salt and two squirts of baby shampoo in a cup and mix with warm water. I GENTLY irrigate my sinuses while tilting head to the side. you are not powerwashing them..go easy. if you cant go easy then get a neti pot but i like the syringe. The salt will help kill some bacteria but will also draw some fluid out of ur turbinates due to the hyertonic solution so they will shrink for a bit and help you breath. The baby shampoo is very important. It acts as a surfactant and helps clear our both debris and bacteria that has formed a biofilm ( a reason why some antibiotics taken for sinusitis may not work well). The warm water will clear out mucus and debris and allergans which is important to do before using nasal spray meds.
Flonase or other steroid: Keep inflammation under control. Two sprays each nostril twice daily. Use it even when you think you may not need it. If you are really breathing well then consider just 1 spray. It can take a while to work and once inflammation develops its challenging to get it under control.
Azelastine HCL: My favorite. I think its a 2nd gen antihistamine and it works GREAT. It also stabilizes mast cells. It works in about 15-30 min. Its an absolute must for people who have tried flonase and hasnt completely helped them. 2 sprays twice a day. Once under control you can reduce it. If sinuses are doing great then u can use PRN.
Dexamethasone in nasal spray: LAST RESORT. This is NOT an approved use. I am speaking from personal experience that this works but use with caution. If inflammation is very bad and you dont want to take oral steroids then you can mix injectable dexamethasone in a saline spray..add like 3mg in a few mL. A few sprays each nostril twice daily for no longer then 2-3 days. This will knock it out. Its a nonparticulate so i imagine its absorbed better then if you tried putting kenalog into a saline spray. Im sure its goes systemic too but at least for me the nasal spray works better then taking oral prednisone.
Oral prednisone: Systemic effects...dont take too often.
INFECTIOUS:
Nasal lavage: Helps clear bacteria, dead cells/debris. Baby shampoo and salt should help prevent bacteria from growing. I would not suggest adding antibiotics to it.. Ive done it... but dont suggest it.
Oral antibiotics: Good choices would be augmentin and cipro/leva. You often need to take these for longer duration and at least 14 days sometimes 21.
Other tools:
Bronkaid: Is there anything that bronkaid doesnt cure? JK..but its an ongoing joke among me and my friends. Helps constrict some blood vessels in your nasal passages and opens them up. 25-50mg 2x a day should be enough.
Oral benadryl or other antihistimine: I like zyrtec in the morning. If you need benefits of sleeping aid then 50mg benadryl at night will help.
Afrin: BECAREFUL. Great for congestion from colds. Do not use for more then 3 days. I suggest diluting it. If you need it for your allergies id use it before doing nasal lavage. Open things up so the water flow better. use sparingly. If you respond to afrin then theres a good chance your issues are from your turbinates.
Bodybuilding note:
Have you have noticed that your sinus congestion gets worse on cycle and seems to improve when you are off? I know dozens of guys who say this is the case and it doesnt matter the time of the year. There are some studies showing that elevated estrogen levels ( and other hormones) can cause mast cells to be more sensitive to allergans and overall increase in histamine levels. I also believe that the overall polycythemia induced by AAS use increases our overall amount of basophils( arise from hemotopoesis) and also contributes. So keep estrogen levels in check and keep dosages reasonable level and that may help
Im not going to discuss surgical options.
There are many causes of sinus congestion some are anatomic ( i.e bad deviated septum, abnormal drainage), some are inflammatory like allergies and some are infectious. Then there are some other less common causes like cancer.
Im going to discuss the inflammatory and infectious ones and what you can do. Now normally id suggest imaging but knowing that not everyone can just go and get a CT scan tomorrow ill leave that out.
1. Inflammatory. This is actually pretty important for bodybuilders and ill explain why in a min. The short of it is something is causing histamine release. Often its environmental and unless you get a full allergy workup it could be million different things. So what can you do.
Daily nasal lavage: I dont like the passive neti pot type stuff. I prefer a 20cc syringe. I put a table spoon of salt and two squirts of baby shampoo in a cup and mix with warm water. I GENTLY irrigate my sinuses while tilting head to the side. you are not powerwashing them..go easy. if you cant go easy then get a neti pot but i like the syringe. The salt will help kill some bacteria but will also draw some fluid out of ur turbinates due to the hyertonic solution so they will shrink for a bit and help you breath. The baby shampoo is very important. It acts as a surfactant and helps clear our both debris and bacteria that has formed a biofilm ( a reason why some antibiotics taken for sinusitis may not work well). The warm water will clear out mucus and debris and allergans which is important to do before using nasal spray meds.
Flonase or other steroid: Keep inflammation under control. Two sprays each nostril twice daily. Use it even when you think you may not need it. If you are really breathing well then consider just 1 spray. It can take a while to work and once inflammation develops its challenging to get it under control.
Azelastine HCL: My favorite. I think its a 2nd gen antihistamine and it works GREAT. It also stabilizes mast cells. It works in about 15-30 min. Its an absolute must for people who have tried flonase and hasnt completely helped them. 2 sprays twice a day. Once under control you can reduce it. If sinuses are doing great then u can use PRN.
Dexamethasone in nasal spray: LAST RESORT. This is NOT an approved use. I am speaking from personal experience that this works but use with caution. If inflammation is very bad and you dont want to take oral steroids then you can mix injectable dexamethasone in a saline spray..add like 3mg in a few mL. A few sprays each nostril twice daily for no longer then 2-3 days. This will knock it out. Its a nonparticulate so i imagine its absorbed better then if you tried putting kenalog into a saline spray. Im sure its goes systemic too but at least for me the nasal spray works better then taking oral prednisone.
Oral prednisone: Systemic effects...dont take too often.
INFECTIOUS:
Nasal lavage: Helps clear bacteria, dead cells/debris. Baby shampoo and salt should help prevent bacteria from growing. I would not suggest adding antibiotics to it.. Ive done it... but dont suggest it.
Oral antibiotics: Good choices would be augmentin and cipro/leva. You often need to take these for longer duration and at least 14 days sometimes 21.
Other tools:
Bronkaid: Is there anything that bronkaid doesnt cure? JK..but its an ongoing joke among me and my friends. Helps constrict some blood vessels in your nasal passages and opens them up. 25-50mg 2x a day should be enough.
Oral benadryl or other antihistimine: I like zyrtec in the morning. If you need benefits of sleeping aid then 50mg benadryl at night will help.
Afrin: BECAREFUL. Great for congestion from colds. Do not use for more then 3 days. I suggest diluting it. If you need it for your allergies id use it before doing nasal lavage. Open things up so the water flow better. use sparingly. If you respond to afrin then theres a good chance your issues are from your turbinates.
Bodybuilding note:
Have you have noticed that your sinus congestion gets worse on cycle and seems to improve when you are off? I know dozens of guys who say this is the case and it doesnt matter the time of the year. There are some studies showing that elevated estrogen levels ( and other hormones) can cause mast cells to be more sensitive to allergans and overall increase in histamine levels. I also believe that the overall polycythemia induced by AAS use increases our overall amount of basophils( arise from hemotopoesis) and also contributes. So keep estrogen levels in check and keep dosages reasonable level and that may help
Im not going to discuss surgical options.