Best Nasal Spray for Sinusitis: Steroid Sprays Compared
Mometasone vs beclometasone for sinusitis—plus where saline rinses and decongestants actually fit in the timeline.
Part of our Sinusitis condition guide. If sneezing and itchy eyes are your main problem, see our hay fever and allergic rhinitis guide.
Here's the thing: There are three completely different types of nasal spray, and swapping one for the other is the most common mistake we see. Saline for the first 10 days, a steroid spray for stubborn inflammation after that, and a decongestant spray only for a few days—absolutely no longer than a week. Using the wrong one at the wrong time is why so many people think nasal sprays 'don't work'.
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Access Doctor is a UK online doctor and GPhC-registered pharmacy. Our pharmacist prescribers can supply mometasone or beclometasone for sinusitis after a short consultation—no GP waiting room required.
View Sinusitis Treatments →The three types of nasal spray
Let's clear this up right away. People talk about "a nasal spray" like it's one product, but they are as different as tea and coffee. Using the wrong one at the wrong stage is the fastest way to get frustrated and think nothing works.
| Type | Examples | What it does | Best for | Duration limit |
|---|---|---|---|---|
| Saline | Sterimar, saline rinse pots | Washes out mucus and irritants | First 10 days; alongside anything else | None |
| Steroid | Mometasone, beclometasone | Reduces inflammation blocking drainage | Symptoms past 10 days; chronic sinusitis | 14 days acute; months in chronic, under review |
| Decongestant | Xylometazoline, oxymetazoline | Constricts blood vessels, unblocks fast | Short-term relief only | About 7 days maximum |
10 days
before a steroid spray is even considered
14 days
NICE-suggested course for acute sinusitis
7 days
absolute limit for decongestant sprays
When a steroid spray is the right choice
UK guidance is pretty clear on this. For acute sinusitis that's been dragging on for about 10 days with no improvement, NICE recommends considering a high-dose nasal corticosteroid for 14 days in adults and children aged 12 and over.
Important: this is off-label use. These sprays are licensed for hay fever and nasal polyps, not sinusitis. NICE recommends them for sinusitis anyway because the evidence supports it, but it's officially outside the product licence. It's routine, well-established UK practice, but any prescriber should tell you this—so we're telling you here.
The thinking is simple. By day 10, the main problem is inflammation, not bacteria. Swelling has closed off the tiny drainage channels, mucus is trapped, and pressure builds. Reducing that swelling reopens the channels, lets things drain, and breaks the cycle. That works whether the original trigger was viral or bacterial.
- Sinus symptoms past day 10 that are stuck—the main indication
- Chronic sinusitis—here it's the backbone of treatment, used for months, not a fortnight
- Allergy-driven sinus problems—where hay fever keeps the lining swollen
- Recurrent episodes—sometimes used preventively under clinical guidance
Don't reach for it on day two. Using a steroid spray during the first 10 days of a cold-related sinus episode is treating a problem that hasn't developed yet. Saline and pain relief are the right tools at that stage—see how to relieve sinus pressure.
Mometasone vs beclometasone
These are the two steroid sprays we supply for sinusitis. Both are corticosteroids, both reduce inflammation, and no decent trial shows one clearly beating the other for symptom relief.
| Mometasone | Beclometasone | |
|---|---|---|
| Full name | Mometasone furoate | Beclometasone dipropionate |
| Strength per spray | 50 micrograms | 50 micrograms |
| Systemic absorption | Very low, under 1% | Higher than mometasone |
| Typical dosing | Once or twice daily depending on indication | Usually twice daily |
| Smell and taste | Largely odourless | Some people notice a taste |
| Track record | Widely used, extensive modern data | Decades of established use |
| Onset of full effect | Several days to 2 weeks | Several days to 2 weeks |
| Effectiveness for sinusitis | Good | Good |
The honest take: For most people, the difference is modest. Mometasone's very low systemic absorption (under 1%) and once-daily dosing make it the more common first choice, especially if you're using it long-term. Beclometasone is a solid alternative with a long safety record. But here's the secret—technique and consistency will make a bigger difference to your results than which steroid you pick.
Mometasone for sinusitis
Mometasone nasal spray for sinusitis delivers 50 micrograms per puff. Its standout feature is its negligible systemic bioavailability—less than one per cent reaches your bloodstream. That's because anything you swallow is broken down by the liver before it gets a chance to circulate.
That matters most if you're using it for months. For chronic sinusitis, where you might be using a spray daily for months on end, minimising systemic exposure is a genuine advantage, not just a marketing line.
Dosing varies by indication. The high-dose regimen NICE recommends for acute sinusitis is higher than the standard hay fever dose. Always follow the dose your prescriber specifies. Our mometasone nasal spray guide covers dosing and technique in detail.
One quick warning: Mometasone also comes as a skin cream and scalp treatment for eczema (sold as Elocon). Those are completely different products for completely different problems. Only the nasal spray is used for sinusitis—never substitute one for the other.
Beclometasone for sinusitis
Beclometasone nasal spray for sinusitis also delivers 50 micrograms per spray and is typically used twice a day.
It's been around for decades, which gives it an unusually long safety record. Some people notice a slight taste or smell that mometasone doesn't have—minor, but occasionally the deciding factor if you're going to be using it daily for months.
Systemic absorption is higher than mometasone's, though still low in absolute terms. For a 14-day acute course, that's not a big deal. For prolonged use, it's one of the things a prescriber will weigh up.
How steroid nasal sprays work
Corticosteroids applied to the nasal lining calm the local inflammatory response—they reduce swelling, inflammatory mediators, and the cellular infiltration that thickens the lining.
In sinusitis, the practical result is mechanical. The sinus drainage openings are only a few millimetres wide. Even a small reduction in swelling can make a big difference to whether they're open or closed. Reopen the channel, trapped mucus drains, pressure drops, and the environment becomes much less hospitable to bacteria.
That's why they help whatever the original cause. They're not treating an infection; they're removing the blockage that's keeping the problem going.
Technique: the bit that makes or breaks it
This is the part nobody reads on the leaflet, and it's the most common reason people think a steroid spray "doesn't work." The good news is it's completely fixable.
1
Blow your nose gently first
Clear the passages so the spray reaches the lining, not just sits in a pool of mucus. A saline rinse beforehand is even better.
2
Tilt your head slightly forward
Not back. Tilting back sends the spray straight down your throat, which is where most of it ends up when people get this wrong.
3
Use the opposite hand and aim outwards
Right hand for the left nostril and vice versa. This angles the nozzle away from the septum and towards the outer wall, where the inflamed tissue is. Aim roughly towards the ear on that side.
4
Breathe in gently—do not sniff hard
A sharp sniff drags the spray straight past the lining and into your throat. A soft breath keeps it where it needs to act.
5
Use it every single day
Not only when you're blocked. The effect is cumulative and relies on continuous suppression of inflammation.
6
Give it two weeks before judging
Some benefit appears within days, but full effect takes one to two weeks. Stopping at day three because it's not an instant decongestant is the classic mistake.
Aiming at the septum causes nosebleeds. The septum is the thin partition in the middle of your nose. It's delicate and easily irritated by repeated direct spraying. If you're getting nosebleeds, technique is almost certainly the reason, not the drug itself.
Saline sprays and rinses
Saline is hugely underrated. It's the right first-line nasal treatment for sinusitis during the first 10 days, and it remains useful alongside a steroid spray afterwards.
- Rinses beat sprays for sinusitis—a larger volume through a rinse pot or squeeze bottle clears far more than a fine mist
- Use cooled boiled or distilled water—never straight from the tap
- Rinse before your steroid spray—clearing mucus first helps the steroid reach the lining
- No duration limit—unlike decongestants, saline can be used indefinitely
- Safe in pregnancy and generally suitable for children, though check the specific product
Decongestants and rebound congestion
Decongestant sprays like xylometazoline or oxymetazoline work by constricting blood vessels in the nasal lining. They unblock your nose within minutes, which feels like magic—and for a few days, they genuinely are useful.
Do not use them for more than about a week. Beyond that, the lining becomes dependent on the vasoconstriction. Each time the spray wears off, the blood vessels dilate more than before and your nose becomes more blocked than it was originally. That's rhinitis medicamentosa—rebound congestion. I've lost count of the patients I've seen who've been using Otrivine for three weeks solid and are terrified to stop. Breaking the cycle usually requires stopping the spray and enduring a few uncomfortable days, sometimes with a steroid spray to help.
Used correctly—a few days at the peak of an acute episode, particularly to help with sleep—they're a reasonable short-term tool. They do nothing for the underlying inflammation.
Side effects and safety
Common, and mostly technique-related
- Nasal dryness or irritation
- Sneezing immediately after use
- Nosebleeds—usually from spraying at the septum
- An unpleasant taste, more often with beclometasone
- Sore throat from spray running down the back
Less common
- Headache
- Nasal thrush—uncommon with nasal sprays
- Rarely, septal perforation with prolonged incorrect technique aimed at the septum
Modern steroid nasal sprays act locally with minimal systemic absorption, which is why they're considered suitable for extended use in a way oral steroids aren't. If you also use a steroid inhaler for asthma or take steroid tablets, mention this at consultation so total steroid exposure can be considered.
Stop and seek urgent help if you develop swelling of the face, lips or tongue, difficulty breathing, or a widespread rash after use. Seek prompt review for persistent or heavy nosebleeds, or any change in vision.
If your problem is really hay fever
Steroid nasal sprays are used for both sinusitis and allergic rhinitis, so it's worth being clear which problem you're treating. If hay fever is the driver, treating the allergy properly does more than treating each sinus episode.
It's allergy if symptoms are seasonal, come with sneezing bouts and itchy watery eyes, produce clear rather than thick discharge, and improve indoors or away from a trigger. It's sinusitis if the dominant features are facial pressure and a lost sense of smell following a cold.
They often overlap. Untreated allergic rhinitis is one of the leading reasons sinusitis becomes recurrent or chronic. Our hay fever and allergic rhinitis guide covers the allergy pathway, including the fluticasone-based sprays used for that indication, which are a separate group from the two compared here.
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Complete a short consultation and a GPhC-registered pharmacist prescriber will confirm which steroid nasal spray suits you and at what dose. Dispensed from our UK pharmacy with next-day delivery.
View Mometasone Nasal Spray →Frequently Asked Questions
What is the best nasal spray for sinusitis?
For sinus symptoms that have lasted beyond 10 days without improving, a steroid nasal spray is the best option, and mometasone or beclometasone are the two UK guidance supports. Mometasone has the edge for most people because less than one per cent is absorbed into the bloodstream and it is dosed once or twice daily. Beclometasone is equally effective at reducing inflammation and is a well-established alternative. For the first 10 days, a simple saline spray or rinse is the more appropriate choice.
Mometasone or beclometasone: which is better for sinusitis?
Both reduce the inflammation blocking sinus drainage and neither is dramatically better at clearing symptoms. The practical differences are that mometasone has very low systemic absorption at under one per cent, compared with a higher figure for beclometasone, and mometasone is usually dosed less frequently. Beclometasone is long established with decades of use behind it. For most adults starting treatment for sinusitis, mometasone is the more common first choice, but either is a reasonable option.
How long does a steroid nasal spray take to work for sinusitis?
Some people notice a difference within a day or two, but the full anti-inflammatory effect builds over one to two weeks of consistent daily use. This is the single most common reason people abandon these sprays: they expect the instant unblocking a decongestant gives and stop after three days. UK guidance suggests a 14-day course for acute sinusitis, and for chronic sinusitis they are used for months. Use it every day, not only when symptoms flare.
Can I use a decongestant nasal spray for sinusitis?
Only briefly. Decongestant sprays containing xylometazoline or oxymetazoline unblock the nose quickly, which is genuinely useful for a few days, but they must not be used for longer than about a week. Beyond that they cause rebound congestion, where the nose becomes more blocked than it was originally each time the spray wears off. This is a common and avoidable cause of persistent blockage that people mistake for worsening sinusitis.
Do saline nasal sprays work for sinusitis?
Yes, and they are the right first step during the first 10 days. Saline rinses and sprays clear mucus, allergens and inflammatory debris, and keep the lining moist. Larger-volume rinsing with a rinse pot is more effective than a light spray for sinusitis specifically. Always use cooled boiled water or distilled water, never water straight from the tap. Saline can safely be used alongside a steroid spray, and rinsing first helps the steroid reach the lining.
Are steroid nasal sprays safe to use long term?
Modern steroid nasal sprays are generally considered suitable for extended use because they act locally on the nasal lining with very little absorbed into the bloodstream. This is quite different from steroid tablets. The common side effects are local: nasal dryness, irritation and occasional nosebleeds, most of which are reduced by correct spray technique. For chronic sinusitis they are used for months under clinical review, and your prescriber will discuss the balance for your situation.
Why is my nasal spray not working?
Technique and consistency are the usual explanations. Aiming the spray straight up the nostril hits the septum and delivers very little to the inflamed lining, and sniffing hard afterwards sends it down the throat instead. Using it only on bad days rather than daily is the other frequent problem, since the effect depends on continuous use. Give it two weeks of correct daily use before concluding it has failed, and speak to a pharmacist who can check your technique.
Completing the treatment
A steroid nasal spray works best alongside daily saline rinsing and, where indicated, an antibiotic for genuinely bacterial episodes. Access Doctor supplies these after a short online consultation reviewed by a GPhC-registered pharmacist independent prescriber, dispensed from our UK pharmacy with no GP appointment needed. See the full range on the sinusitis treatment page.
Steroid spray · Rx
Mometasone Nasal Spray for Sinusitis
Very low systemic absorption and simple dosing. Common first choice.
View product →Steroid spray · Rx
Beclometasone Nasal Spray for Sinusitis
Long-established alternative with decades of clinical use.
View product →Antibiotic · Rx
Phenoxymethylpenicillin for Sinusitis
Where bacterial infection is likely rather than inflammation alone.
View product →Antibiotic · Rx
Doxycycline Capsules for Sinusitis
Alternative antibiotic where penicillin cannot be used.
View product →References
- National Institute for Health and Care Excellence. Sinusitis (acute): antimicrobial prescribing (NG79). nice.org.uk
- NICE Clinical Knowledge Summaries. Sinusitis. cks.nice.org.uk
- Joint Formulary Committee. British National Formulary: mometasone furoate (nasal). bnf.nice.org.uk
- Joint Formulary Committee. British National Formulary: beclometasone dipropionate (nasal). bnf.nice.org.uk
- NHS. Steroid nasal sprays. nhs.uk
- NHS. Decongestants. nhs.uk
- European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS). rhinologyjournal.com
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.