Sinusitis in older adults differs from sinusitis in younger adults in three ways: the ageing nose clears mucus less efficiently, symptoms are easier to confuse with other age-related nasal changes, and many standard remedies interact with the medicines older patients already take. Oral decongestants can raise blood pressure and worsen urinary retention in men with an enlarged prostate. First-generation antihistamines carry a high risk of confusion and falls. Some antibiotics carry specific tendon and aortic warnings for people over 60. None of this makes sinusitis more dangerous in itself, but it makes self-treatment riskier.
For background, see the sinusitis hub, the full list of sinusitis symptoms, and the shorter overview of sinusitis in the elderly.
How Does Ageing Change the Nose and Sinuses?
Ageing thins the nasal lining, slows mucociliary clearance and alters the immune response, a group of changes clinicians call presbynasalis. These changes explain why older patients often feel a dry, crusted or blocked nose even without an infection.
Thinner lining and slower clearance
Studies in older adults describe thinning of the nasal mucosa and decreased mucociliary clearance, the mechanism by which tiny hairs sweep mucus out of the sinuses. Slower clearance lets mucus stay in the sinuses longer, which is the starting condition for sinusitis.
Atrophic changes and crusting
Some older patients develop atrophic rhinitis, in which the lining loses mucus-producing goblet cells and becomes drier. The result is crusting and a sensation of blockage that can feel identical to nasal congestion from sinusitis but has a different cause and needs different care.
A different immune response
Immunosenescence, the gradual ageing of the immune system, reduces the ability to respond to new infections. A 2019 study in the Journal of Allergy and Clinical Immunology found that chronic sinusitis in patients aged 60 and older was associated with a neutrophil-driven inflammatory pattern, with higher mucus levels of IL-1β, IL-6, IL-8 and TNF-α than in younger patients. That pattern was linked to persistent inflammation and difficulty clearing bacteria.
How Do Sinusitis Symptoms Look in Older Adults?
Older adults have the same four cardinal sinusitis symptoms as younger adults — nasal blockage, nasal discharge, facial pain or pressure and reduced sense of smell — but two of them overlap with normal ageing. That overlap is the main reason sinusitis is under-recognised or misattributed in this age group.
Smell loss that is not only age
Sense of smell declines naturally with age. A reduced sense of smell in a 70-year-old can therefore reflect ageing, sinusitis, nasal polyps or a neurological condition. Smell that dropped suddenly, or alongside new blockage and discharge, points toward sinus-related smell loss rather than ageing alone and deserves assessment.
Runny nose that is not always sinusitis
Many older adults have a constantly runny nose from non-allergic causes, including a type sometimes called senile or geriatric rhinorrhoea. Clear, watery discharge without facial pain, blockage or smell change is more consistent with this than with sinusitis. Rhinitis and sinusitis often coexist, which is why a doctor’s examination helps.
Medicines that cause nasal symptoms
A review of chronic sinusitis with nasal polyps in the elderly by Merrill and Kanaan in Clinical Interventions in Aging noted that patients over 65 take at least 5 medications on average, and that many medications list rhinitis as a side effect. Some blood pressure medicines and other common prescriptions can cause nasal congestion, so a medication review is part of assessing nasal symptoms in older patients.
Which Sinus Remedies Carry Extra Risk After 65?
Oral decongestants, first-generation antihistamines and decongestant nasal sprays carry higher risks in older adults because of their effects on blood pressure, the prostate, the brain and the nasal lining. Check any over-the-counter sinus or cold product with a pharmacist before taking it, and bring the full list of your current medicines.
Oral decongestants
Pseudoephedrine can raise blood pressure and heart rate and is associated with cardiovascular complications in older patients. In men, it can worsen urinary flow: a prospective study of patients with nasal congestion found that most patients older than about 53 showed worsening voiding function after taking pseudoephedrine, and the effect increased with age. Men with an enlarged prostate and anyone with high blood pressure or heart disease should not take oral decongestants without medical advice.
First-generation antihistamines
The American Geriatrics Society Beers Criteria list first-generation antihistamines, including diphenhydramine, chlorpheniramine, brompheniramine, promethazine and hydroxyzine, as medicines to avoid in older adults. They are highly anticholinergic, their clearance falls with age, and they increase the risk of confusion, dry mouth, constipation and falls. Many combination “cold and sinus” and night-time products contain them, so read the label.
Decongestant nasal sprays
Decongestant sprays such as oxymetazoline relieve blockage quickly but must be limited to a maximum of about five days, because longer use causes rebound congestion known as rhinitis medicamentosa. Older patients with a thin, dry nasal lining are particularly poorly served by a spray that worsens dryness and dependence.
Which Antibiotics Need Caution in Older Patients?
Fluoroquinolone antibiotics carry FDA boxed warnings that are especially relevant after 60, including tendon rupture and aortic aneurysm rupture or dissection. This matters because most sinusitis is viral and needs no antibiotic, and where one is needed, alternatives usually exist.
The fluoroquinolone warnings
The FDA added a boxed warning to systemic fluoroquinolones in 2016 covering serious adverse effects including tendon rupture, and warned in December 2018 of an increased risk of ruptures or tears in the aorta. The risk of tendinitis and tendon rupture is higher in patients over 60, in those taking corticosteroids, and in transplant recipients. The FDA advises that fluoroquinolones should not be used in patients at increased risk unless no other treatment options are available.
What this means for sinusitis
Most acute sinusitis resolves without antibiotics. If an antibiotic is needed, the choice belongs to the doctor, who will consider kidney function, other medicines and allergies. Tell the prescriber if you have had an aortic aneurysm, a tendon problem, or are taking corticosteroids.
How Is Sinusitis Diagnosed in Older Adults?
Sinusitis in older adults is diagnosed on symptoms and duration, confirmed by nasal endoscopy and, where needed, a non-contrast CT scan. The diagnostic criteria are the same as for younger adults; the difference is the need to rule out other causes that become more common with age.
Criteria and duration
Rhinosinusitis is diagnosed when two or more symptoms are present, one of which must be nasal blockage or nasal discharge. Acute sinusitis lasts less than 12 weeks; symptoms lasting 12 weeks or longer meet the criteria for chronic sinusitis. The sinusitis self-assessment test applies these criteria to your own symptoms.
Why examination matters more with age
One-sided symptoms, blood-stained discharge, persistent one-sided blockage, or facial numbness or swelling need prompt examination in older adults, because sinonasal tumours, although rare, become more common with age. Endoscopy lets the specialist see the nasal cavity directly. The full pathway is described in how sinusitis is diagnosed.
What Can Older Adults Do to Relieve Sinus Symptoms Safely?
Saline irrigation, humidified air, adequate fluid intake and head elevation relieve sinus symptoms without drug interactions, and they are the right first step for most older adults. They are particularly suited to the dry, crusted nose that often accompanies ageing.
Measures with no medication burden
Four measures carry no interaction risk: saline nasal irrigation or spray using distilled, sterile or previously boiled and cooled water; humidifying bedroom air; drinking enough fluid unless a doctor has restricted it; and sleeping with the head raised to help drainage. Saline also softens crusts in atrophic changes.
Physical safety with irrigation
Rinse bottles and neti pots require balance and a steady hand at the sink. Older adults with balance problems should use a saline spray or sit while rinsing.
When to ask for a prescription review
Ask your doctor or pharmacist for a review if nasal symptoms started after a new medicine, if you are using a decongestant spray for more than five days, or if you are taking several over-the-counter cold products at once.
Can Older Adults Use Nasodren®?
Nasodren® has no upper age limit, but older adults taking anticoagulants — including aspirin — or anticholinergic medicines must tell their doctor before using it, as its information leaflet requires. Because blood-thinning medicines are common after 65, this check applies to a large share of older users.
Nasodren® is a CE 0051 Class IIA medical device, not a medicine, and it does not claim to cure sinusitis. Nasodren® is a 100% natural nasal spray made from Cyclamen europaeum extract, applied once daily into each nostril, which stimulates nerve endings in the nasal lining and increases drainage of retained mucus. The leaflet names coumarin-type anticoagulants, acetylsalicylic acid (aspirin) and anticholinergics such as atropine as reasons to consult a doctor first, and advises waiting 1.5 to 2 hours after Nasodren® before using other nasal products. It must not be used by anyone allergic to cyclamen, primula or other Primulaceae plants.
The extract is supported by more than 30 published clinical studies and a Level A recommendation in EPOS 2012. A 2018 Cochrane review of the extract for acute sinusitis, covering 2 trials and 147 adults, concluded that its effectiveness is unknown because neither trial reported the review’s main outcomes, and recorded mild adverse events such as nasal irritation in 50% of the treatment group against 24% on placebo. Older adults who want a clinician’s view can book the free e-Health consultation at nasodren.com.
When Should an Older Adult See a Doctor About Sinus Symptoms?
Seek emergency care immediately for swelling or redness around an eye, vision changes, a severe headache, confusion, or neck stiffness, and book a prompt appointment for one-sided or blood-stained symptoms. In older adults, confusion can be the first visible sign of a serious infection.
Emergency signs
Six signs need same-day emergency assessment: swelling, redness or pain around an eye; double vision, blurred vision or vision loss; a bulging eye; a severe or unfamiliar headache; new confusion, drowsiness or slurred speech; and neck stiffness. Eye complications are covered in whether sinusitis can damage eyesight.
Signs that need a prompt appointment
Book promptly for symptoms lasting more than 10 days without improvement, for symptoms that improve and then worsen, for fever, for blood-stained discharge, for persistent one-sided blockage, for facial numbness or swelling, and for any sinus symptom in someone with diabetes or a weakened immune system.
What Do People Ask About Sinusitis in Older Adults?
Why is my nose always blocked now that I am older?
Ageing thins the nasal lining and slows the clearance of mucus, and some older adults develop dryness and crusting that feels like blockage. Medicines, including some blood pressure treatments, can also cause congestion. A doctor can distinguish these causes from sinusitis.
Is it safe for older people to take a decongestant?
Oral decongestants can raise blood pressure and heart rate and can worsen urinary retention in men with an enlarged prostate. Older adults should check with a pharmacist or doctor first. Decongestant sprays are limited to about five days because of rebound congestion.
Which antihistamines should older adults avoid?
The American Geriatrics Society Beers Criteria list first-generation antihistamines such as diphenhydramine and chlorpheniramine as medicines to avoid in older adults because they increase the risk of confusion and falls. They appear in many night-time cold products.
Are some antibiotics riskier after 60?
Fluoroquinolone antibiotics carry FDA boxed warnings for tendon rupture and aortic rupture or dissection, and the tendon risk is higher over 60. Most sinusitis needs no antibiotic, and where one is needed, the doctor chooses based on your health and medicines.
Can I use Nasodren® if I take aspirin or a blood thinner?
The Nasodren® leaflet asks users taking anticoagulants, including coumarin derivatives and acetylsalicylic acid (aspirin), to consult their doctor before use. Speak to your doctor first.
Is loss of smell in older age always normal?
Smell declines gradually with age, but a sudden drop, or smell loss with new blockage and discharge, suggests sinusitis or nasal polyps and should be assessed.
Key Takeaways: What Should You Remember About Sinusitis After 65?
Sinusitis in older adults is treated much like sinusitis at any age, but the margin for error with over-the-counter remedies is smaller. Six points summarise the article.
- Ageing slows mucus clearance and thins the nasal lining, making sinusitis easier to develop and harder to distinguish from age-related nasal changes.
- Oral decongestants can raise blood pressure and worsen urinary retentionin men with an enlarged prostate.
- First-generation antihistamines are on the Beers Criteria list of medicines to avoid in older adults because of confusion and fall risk.
- Fluoroquinolone antibiotics carry FDA boxed warnings for tendon and aortic rupture, with higher tendon risk over 60.
- Saline, humidity, fluids and head elevation are the safest first-line measures.
- Nasodren® users taking anticoagulants, including aspirin, must consult their doctor first, as the leaflet requires.
This article is for informational purposes only and does not constitute medical advice. It does not recommend any medicine or dose. Older adults should review any new over-the-counter product with a pharmacist or doctor, bringing a full list of current medicines. Seek emergency care immediately for eye swelling, vision changes, severe headache, new confusion or neck stiffness. Brand information for Nasodren® is included for commercial purposes; the medical content is sourced from published guidelines and peer-reviewed literature.
Which Medical Sources Support This Article?
- Merrill T, Kanaan A. Managing Chronic Rhinosinusitis with Nasal Polyps in the Elderly: Challenges and Solutions. Clinical Interventions in Aging. 2022;17:685-698.
- Chronic rhinosinusitis in elderly patients is associated with an exaggerated neutrophilic proinflammatory response to pathogenic bacteria. Journal of Allergy and Clinical Immunology. 2019;143(6):2098-2107.
- 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults.
- Shao IH, Wu CC, Tseng HJ, Lee TJ, Lin YH, Tam YY. Voiding dysfunction in patients with nasal congestion treated with pseudoephedrine: a prospective study. Drug Design, Development and Therapy. 2016;10:2333.
- US Food and Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Drug Safety Communication, December 2018.
- Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464.
- Zalmanovici Trestioreanu A, Barua A, Pertzov B. Cyclamen europaeum extract for acute sinusitis. Cochrane Database of Systematic Reviews. 2018;5:CD011341.
