I currently use the following for my sinuses:
1. “Triple spray”compounded at Mayo’s pharmacy with Mometasone, Ipratropium and diphenhydramine. I called them last week and they will accept an order from my Penn pulmonologist. It doesn’t leave a bad taste like Azelastine and I THINK it works better.

2 . Ipratropium spray mid afternoon. The duration of action is about 6 hrs so dose in triple spray wears off. I’d been prescribed Atrovent a few times when I lived in another state and it seemed better for me than Flonase.
3. Mometazone (compounded by local pharmacy) in 8 oz saline via sinus rinse bottle twice daily. Note-this was started by Penn frontal sinus doc last May for my hoarseness from significant secretions despite 2x daily saline rinses and allergy meds. I’ve stopped this steroid a few times. I had trouble with thrush at first. I also stop this steroid when I’m sick, but continue saline rinses.
4. Cetirizine in morning. I’m not sure it helps, but pulmonologist suggested I try it again.
5 Benadryl or doxylyamine at night.

The regular ENT guy does Rhinair, a laser procedure to decrease PND, but the Penn specialist he referred me to for frontal sinus didn’t mention it. I may ask Penn their opinion if the upcoming allergy season is tough. Has it been mentioned to you?

I asked for allergy testing and ENT did it. . It was helpful to know the triggers. Have you had that? ENT or allergist?

If you have suggestions, I’d love to hear them. Until the saga of the last 3 years, I’d had just one or two acute sinus infections a year since surgery 20 years ago.