Also indexed as: Sinus Infection
Sinusitis is an inflammation of the sinus passages.
There are four pairs of sinuses in the human skull that help circulate moist air throughout
the nasal passages. The common cold is the most
prevalent predisposing factor to sinusitis. Hay fever,
other environmental triggers, food allergens, and
dental infections can also lead to sinusitis.
What are the symptoms of sinusitis?
Acute sinusitis typically causes symptoms of nasal congestion and a thick yellow or green
discharge. Other symptoms include tenderness and pain over
the sinuses, frontal headaches, and sometimes chills, fever, and pressure in the area of the
sinuses. Chronic sinusitis differs slightly, in that symptoms can be milder and may only
include postnasal drip, bad breath, and an irritating dry cough.
Medical treatments
Over the counter analgesics, such as aspirin
(Bayer®, Ecotrin®, Bufferin®), ibuprofen
(Motrin®, Advil®), and acetaminophen
(Tylenol®), reduce pain due to sinus pressure. Topical nasal decongestants such as
oxymetazoline (Afrin®) and phenylephrine (NeoSynephrine®) may provide relief from
nasal congestion, but they should only be used for a few days. The oral decongestant pseudoephedrine (Sudafed®) may also help relieve nasal
congestion and sinus pressure. Guaifenesin
(Robitussin®) is an expectorant used to remove mucous in the sinuses, lungs, and
ears.
Prescription drug therapy for sinus infections
usually includes antibiotics, such as
amoxicillin/clavulanate (Augmentin®), loracarbef
(Lorabid®), cefprozil (Cefzil®), and levofloxacin (Levaquin®). Corticosteroid nasal sprays, such as flunisolide
(Nasalide®), fluticasone (Flonase®), or triamcinolone (Nasacort®), may also be
used to reduce inflammation.
Surgery may be used to unblock the sinuses and drain thick secretions if drug therapy is
not effective, or if there are structural abnormalities.
Dietary changes that may be helpful
According to some studies, 25–70% of people with sinusitis have environmental allergies.1 Although food allergies may also
contribute to the problem, some researchers believe food allergies only rarely cause
sinusitis.2 3 People with sinusitis may benefit by working with a doctor
to evaluate what, if any, effect the elimination of food and other allergens might have on
reducing their symptoms.
Nutritional supplements that may be helpful
Bromelain, an enzyme
derived from pineapple, has been reported to relieve
symptoms of acute sinusitis. In a double-blind trial, 87% of patients who took bromelain
reported good to excellent results compared with 68% of those taking placebo.4
Other double-blind research has shown that bromelain reduces symptoms of
sinusitis.5 6 Research with bromelain for sinusitis generally uses the
enteric-coated form. Enteric-coating prevents the stomach juices from partially destroying the
bromelain. Most commercially available bromelain products today are not enteric-coated, and it
is not known how the potency of these different products compares.
Studies conducted in the past have used bromelain compounds with therapeutic strengths
measured in units called Rorer units (RU). Potency of contemporary bromelain compounds are
quantified in either MCUs (milk clotting units) or GDUs (gelatin dissolving units); one GDU
equals 1.5 MCU. One gram of bromelain standardized to 2,000 MCU would be approximately equal
to 1 gram with 1,200 GDU of activity, or 8 grams with 100,000 RU of activity. Physicians
sometimes recommend 3,000 MCU taken three times per day for several days, followed up by 2,000
MCU per day.7 Much of the research conducted has used smaller amounts likely to be
the equivalent (in modern units of activity) of approximately 500 MCU taken four times a
day.
Histamine is associated with increased nasal and sinus congestion. In one study, vitamin C supplementation (1,000 mg three times per day) reduced
histamine levels in people with either high histamine levels or low blood levels of vitamin
C.8 Another study found that 2,000 mg of vitamin C helped protect people exposed to
a histamine challenge test.9 Not every study reported reductions in
histamine.10 Although preliminary evidence supports the use of vitamin C when
injected into the sinuses of people suffering with acute sinusitis, the effect of oral vitamin
C on symptoms of sinusitis has yet to be formally studied.11
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
One of the most popular supportive treatments for both acute and chronic sinusitis in
Germany is an herbal combination containing gentian root,
primrose flowers, sorrel herb, elder flowers, and European
vervain.12 The combination has been found to be useful in helping to promote
mucus drainage (“mucolytic” action) from the sinuses.13 The combination
is typically used together with antibiotics for treating
acute sinusitis.
Horseradish is another herb used traditionally as a
mucus-dissolver.14 One half to one teaspoon (3–5 grams) of the freshly grated
root can be eaten three times per day. Horseradish tincture is also available. One quarter to
one half teaspoon (2 to 3 ml) can be taken three times per day.
Eucalyptus oil is often used in a steam inhalation to
help clear nasal and sinus congestion. Eucalyptus oil is said to function in a fashion similar
to menthol by acting on receptors in the nasal mucous
membranes, leading to a reduction in the symptoms of nasal stuffiness.15
Wood betony (Stachys betonica) is used in
traditional European herbal medicine as an anti-inflammatory remedy for people with sinusitis.
Modern clinical trials have not been conducted to confirm this use of wood betony.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
A warm salt-water solution poured through the nose may offer some relief from both allergic and infectious
sinusitis. A ceramic pot, known as a “neti lota” pot, makes this procedure easy.
Alternatively, a small watering pot with a tapered spout may be used. Fill the pot with warm
water and add enough salt so the solution tastes like tears. Stand over a sink, tilt your head
far to one side so your ear is parallel to the floor, and pour the solution into the upper
nostril, allowing it to drain through the lower nostril. Repeat on the other side. This
procedure may be performed two or three times a day.
Some practitioners may treat sinus problems using various manipulation techniques. A single
case study described treatment of chronic sinusitis and sinus headaches with spinal
manipulation, massage, and a technique called: “bilateral nasal specific” (BNS).
The BNS procedure involves inflating small balloons within the nasal passages, creating a
change of pressure and, theoretically, a realignment of nasal bones. Initial treatment of a
41-year-old woman with manipulation and massage for approximately one year had resulted in
only temporary, mild relief. Her headaches resolved immediately following each treatment that
included BNS, followed by increased amounts of postnasal discharge and an improved sense of
smell. At the end of two additional months of care, her headaches were reduced significantly
in intensity and frequency.16
References
1. Bullock C. Chronic infectious sinusitis linked to allergies. Med
Trib 1995;Dec 7:1.
2. Derebery MJ. Otoplaryngic allergy. Otolaryngol Clin North Am
1993;26:593–611 [review].
3. Host A. Mechanisms in adverse reactions to food. Allergy
1995;50(20 suppl):60–3 [review].
4. Ryan R. A double blind clinical evaluation of bromelains in the
treatment of acute sinusitis. Headache 1967;7:13–7.
5. Taub SJ. The use of bromelains in sinusitis: a double-blind
evaluation. EENT Monthly 1967;46(3):361–5.
6. Seltzer AP. Adjunctive use of bromelains in sinusitis: a controlled
study. EENT Monthly 1967;46(10):1281–8.
7. Gaby AR. The story of bromelain! Nutr Healing 1995;May:3, 4,
11.
8. Clemetson, CA. Histamine and ascorbic acid in human blood. J
Nutr 1980;110:662–8.
9. Bucca C, Rolla G, Oliva A, Farina JC. Effect of vitamin C on histamine
bronchial responsiveness of patients with allergic rhinitis. Ann Allergy
1990;65:311–4.
10. Bellioni P, Artuso A, Di Luzio Paparatti U, Salvinelli F. Histaminic
provocation in allergy. The role of ascorbic acid. Riv Eur Sci Med Farmacol
1987;9:419–22 [in Italian].
11. Nikolaev MP, Longunov AI, Tsyrulnikova LG, Dzhalilov DS. Clinical and
biochemical aspects in the treatment of acute maxillary sinusitis with antioxidants. Vestn
Otorinolaringol 1994;Jan/Feb:22–6.
12. Schulz V, Hänsel R, Tyler VE. Rational Phytotherapy: A
Physician’s Guide to Herbal Medicine. Berlin: Springer-Verlag, 1998,
163–4.
13. März RW, Ismail C, Popp MA. Action profile and efficacy of a
herbal combination preparation for the treatment of sinusitis. Wien Med Wschr
1999;149:202–8.
14. Mills S, Bone K. Principles and Practice of Phytotherapy.
London: Churchill Livingstone, 2000, 21.
15. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy, 3rd ed.
Berlin: Springer Verlag, 1998, 146–7.
16. Folweiler DS, Lynch OT. Nasal specific as part of a chiropractic
approach to chronic sinusitis and sinus headaches. J Manipulative Physiol Ther
1995;18:38–41.
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The information presented in Healthnotes is for informational
purposes only. It is based on scientific studies (human, animal, or in vitro),
clinical experience, or traditional usage as cited in each article. The results reported may
not necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over-the-counter medication is also available. Consult your doctor,
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before making any changes in prescribed medications. Information expires March 2005.
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