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Chronic Sinusitis

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Frequent headaches?  Tooth pain?  Pressure and pain around your eyes?  You are probably familiar with the symptoms of sinusitis. This time of year often brings an increase in upper respiratory infections, allergies, and prolonged exposure to environmental irritants, such as dust from uncleaned heating ducts.  These factors all play a key role in the development of sinusitis.

Sinusitis is the inflammation of the sinus cavities that can occur with a viral, bacterial, or rarely a fungal infection.  The sinuses are air-filled spaces in the skull (behind the forehead, nasal bones, cheeks, and eyes) that are lined with mucus membranes. Normally mucus drains from the sinus cavities easily and air is able to circulate within.  However, when sinus openings become blocked or too much mucus builds up bacteria can grow more easily leading to infection and pain.

Chronic sinusitis is defined as inflammation of the sinuses lasting more than 12 weeks.  Chronic sinusitis is the most common chronic illness in the US and according to some surveys it has been shown to decrease quality of life beyond that of other chronic conditions such as asthma, COPD, and even heart failure.

Factors that can contribute to the development of sinusitis:

Colds or allergies often cause excessive mucus production and/or swelling of the mucus membranes and this can lead to blockage of the sinus opening.  Topical nasal medications, dental infections, smoking, diabetes, and food sensitivities can also predispose us to sinusitis.  If sinus infections you develop sinus infections frequently you may want to be evaluated for a deviated nasal septum, nasal bone spur, or a nasal polyp that may be blocking the opening of the sinuses.

Signs and symptoms of sinusitis include: pressure and pain over sinus region, nasal congestion, thick mucus (often green or yellow), post-nasal drainage with frequent throat clearing, low grade fever, malaise, and headaches.

Sinus inflammation can be caused from an anatomical obstruction of the common drainage pathway for several sinuses leading to inadequate sinus drainage of mucus. Conditions that impair normal mucus production and drainage into the nasal cavity are also implicated.

Three primary causes of sinusitis:

  1. Genetic/physiological factors
  2. Environmental factors (e.g., smoking)
  3. Structural factors (e.g., severe mid-septal deviations)

The current theory is that underlying factors (any of the above causes) induce local inflammation in the sinus mucosa leading to swelling and narrowing of the drainage channels eventually causing obstruction.  Sinus secretions pool, thicken, and become overgrown by microorganisms. The exact role of microorganisms in the chronic inflammation remains controversial. Immunodeficient patients may develop this condition from persistent infections.

Conventional treatment:

A key principle of treatment is identifying and treating underlying causes and confounding variables (e.g., allergic rhinitis, structural abnormalities). No single treatment regimen exists. Treatments are based on available medications used for acute sinusitis and those used to decrease inflammation (e.g., steroids).

Initial conventional treatment begins with a prolonged course of antibiotics, typically a minimum of 3-4 weeks but the recommendation is 12 weeks.  Preferably the bacteria is first cultured so that antibiotic therapy is chosen to work specifically against that bacterial population, but often a broad-spectrum antibiotic is used to save time.   Most conventional treatment also involves the use of  concomitant intranasal steroids to paralyze the immune response to the infection and bring inflammation down.

Often it is recommended that nasal saline irrigation (use of a netipot)  be used throughout the treatment. Other therapies considered maybe short courses of oral corticosteroids, decongestants, and possibly even leukotriene receptor antagonists (particularly when the patient has asthma, polyps, or severe allergic rhinitis).  If the patient has allergic symptoms, then antihistamines are also prescribed.

Naturopathic treatment:

Again finding the underlying cause of the condition is vital to determine appropriate treatment.  Typically naturopaths will test for allergies and look for structural abnormalities that may be causing a blockage to the sinuses.  Saline rinses (netipot) through the sinuses may include probiotics or quercetin.  Hydrotherapy is often recommended over the sinuses to decrease inflammation and encourage healthy blood flow.  Inflammation is addressed by prescribing anti-inflammatory herbs and altering the diet as needed.

Additional supportive therapies and treatments include the following:

  • Drinking plenty of fluids, especially water
  • Inhaling steam (eg, taking a hot shower) to alleviate nasal congestion 10 minutes 3-6 x/day
  • Sleeping with a humidifier at night

Environmental

  • Air filters – use type that electrostatically takes dust out of the air.  These can be in line with the heating system.  Clean heating ducts frequently
  • Hepa vacuum cleaners
  • Change pillowcase daily, sheets every 2 days (to cut down on dust mites) and launder bed clothes and sheets in hot water
  • No animal dander (if allergic)
  • No cloth wall hangings or rugs
  • Keeping ambient humidity, 50% decreases growth of dust mites and mold
Diet
  • Add garlic, onion, horseradish and ginger ad libitum as seasoning.  These will strengthen your immune system, break down mucus, and they are well known to be anti-inflammatory.
  • Avoid all dairy and any other foods you may be sensitive to
  • Increase fluid intake to >60 oz per day in form of filtered water or herbal teas
  • Lots of fresh fruits and vegetables for immune support
  • Avoid simple carbohydrates and refined sugars
  • Increase protein intake
  • Avoid trans-fats and animal fat

Supplemental Support:

  • Vitamin C, Selenium, Vitamin E, N-Acetyl Cysteine, Bromelain, Fish oil,  Quercetin

Keep in mind you should notify your primary care physician if symptoms get worse, or if they show no improvement within 5 to 7 days. If you are prescribed antibiotic medications, you need to complete the entire course.

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