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  Sinusitis  
 
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Signs, symptoms and indicators | Contributing risk factors | Other conditions that may be present | Recommendations

 

An estimated 37 million people in the U.S. suffer from chronic sinusitis, an inflammation of the membranes of the nose and sinus cavity. Its incidence has been increasing steadily over the last decade. Common symptoms are runny nose, nasal congestion, loss of smell and headaches. Frequently, the chronic inflammation leads to polyps, small growths in the nasal passages that hinder breathing. Any factor that creates edema of the nasal tissues resulting in obstruction and the lack of proper drainage of the area will often lead to sinus infection. As the obstruction continues, oxygen is resorbed from the sinus cavity back into the blood vessels, causing a painful relative negative pressure that draws fluid from the mucous membranes. This fluid is an excellent medium for bacteria, especially streptococcus, pneumococcus, hemophilus influenza and staphylococcus, which are the bacteria most implicated in acute sinusitis. The bacterial overgrowth leads to an influx of serum and leukocytes to fight the infection, setting up a painful positive pressure.

In cases of acute sinusitis, the therapeutic goals are to reestablish drainage and clear up the infection. Various measures can be used: local application of heat, local use of volatile oils and botanicals with antibacterial properties, and immune system support.

An article published in the Mayo Clinic Proceedings in September, 1999 by the Mayo Clinic suggests that fungal sinusitis may be much more common than previously thought. The disease previously known as AFS (allergic fungal sinusitis) is now know as EFRS (eosinophilic fungal rhinosinusitis) or EMRS (eosinophilic mucinous rhinosinusitis). Fungal growth was found in washings from the sinuses in 96% of patients with chronic sinusitis. Normal controls had almost as much growth, the difference being that those patients with chronic sinusitis had eosinophils (a type of white blood cell involved in allergic and other reactions) which had become activated. As a result of the activation, the eosinophils released a product called MBP (Major Basic Protein) into the mucus which attacks and kills the fungus but is very irritating to the lining of the sinuses. MBP is believed to injure the lining of the sinuses and this in turn allows bacteria to proliferate.

It appears that a key to resolving the problem will be to reduce the immune response or activation of eosinophils to the fungus. Just as one person reacts to ragweed while another does not, reducing the overactivity of the immune system may lead to lower levels of eosinophils (or less activation thereof), less irritation, and fewer symptoms. Since chronic sinusitis is associated with allergy, long-term control can be dependent on isolation and elimination of the food or airborne allergens which may be contributing to the overall allergic load and correction of the underlying problem which allowed the allergy to develop. This may require desensitization procedures. During the acute phase, elimination of the common food allergens (milk, wheat, eggs, citrus, corn, peanuts) is indicated until a more definitive diagnosis can be made.

In 25% of chronic maxillary sinusitis (in the cheek bone area) there is an underlying dental infection which must be resolved.

Although vasoconstrictors and antihistamines cause transient relief, their chronic use (perhaps any longer than 3 days) is contraindicated, since there is usually a rebound congestion (severe congestion caused by the excessive or abusive use of topical nasal decongestants) following continual administration. Antibiotics and over-the-counter decongestants are widely used to treat chronic sinusitis. In most cases, antibiotics are not effective for chronic sinusitis because they target bacteria, not fungi. Fungal spores (the reproductive part of the organism) become airborne like pollen. Some people develop allergies to fungi.
 

 
 

Signs, symptoms & indicators of Sinusitis:
 
 
Symptoms - General  Minor/major fatigue for over 3 months or major fatigue for over 12 months

Symptoms - Metabolic

  Having a slight/having a moderate/having a high fever
 
 

Risk factors for Sinusitis:
 
 
Autoimmune  Gluten Sensitivity / Celiac Disease

Environment / Toxicity

  Gulf War Illness

Symptoms - Head - Nose

  History of sinusitis

Tumors, Benign

  Nasal Polyps
 As the polyps make the nasal cavity narrower, mucus forms behind the polyp and may not drain properly. This may become infected or block sinus openings resulting in chronic sinus conditions.
 
 

Sinusitis suggests the following may be present:
 
 
Cell Salts  Cell Salt, Kali Sulf Need

Immunity

  Immune System Imbalance (TH2 Dominance)
 
 

Recommendations for Sinusitis:
 
 
Amino Acid / Protein  Tyrosine

Animal-based

  Microdose DNA
 Microdose DNA was especially valuable in acute and chronic sinusitis. Patients with chronic sinusitis would refuse literally to come off the microdose DNA once we had put them on it because they felt so much better. [Allan Lieberman, MD - Natural Microdose DNA AAEM Presentation, October 2004, Hilton Head, South Carolina]

Botanical

  Garlic
 Garlic’s anti-fungal properties are well known. Garlic must be fresh in order for it to be beneficial because the active ingredient is destroyed within an hour of smashing the garlic. For this reason garlic pills are worthless and should not be used. When you use the garlic, compress it with a spoon prior to swallowing it or chew it quickly before swallowing if you can.

  Cayenne Pepper (Capsicum frutescens)
 Cayenne may have some supportive activity as an antimicrobial to help control infections such as sinusitis.

  Aloe Vera

Diet

  Alcohol Avoidance
 Alcohol often causes a worsening of sinusitis. This may be because alcohol functions as a diuretic, leading to drying and thickening of the mucus which can cause a blockage of the opening of the sinuses. In patients who are allergic to red wine, yeast, sulfites or other components of the alcohol may cause make sinusitis worse.

  Dairy Products Avoidance
 If you have chronic sinus problems, eliminate all dairy products from your diet. Many have reported very significant improvement. The full benefit may take 1-2 months of avoidance, so please try to be consistent in avoiding all dairy during this time period.

  Therapeutic Fasting
 Dietary improvements can be helpful in relieving sinus congestion but fasting may be needed for more resistant cases.

  Increased Water Consumption
 Drinking lots of water can help to loosen thick secretions.

Drug

  Antibiotics
 Chronic rhinosinusitis, potentially an immune disorder triggered by airborne fungus, was effectively treated with antifungal medications in a small randomized clinical trial. "We demonstrated an improvement using antifungals in an objective finding for people with chronic rhinosinusitis," lead author David A. Sherris, MD, interim chair of the department of otolaryngology at the University of Buffalo in New York, told Medscape. Dr. Sherris conducted the research while at the Mayo Clinic. The researchers hypothesized that airborne fungi initiate an immune reaction in the sinuses in certain people sensitive to chronic sinusitis.

In a randomized, placebo-controlled, double-blind study, 30 adult patients with chronic rhinosinusitis were either given 20 mL of amphotericin B, a fungicide, or a placebo squirted into the nasal cavity twice daily. Data were analyzed for 24 patients.

Researchers performed computed tomography (CT) of patients at baseline and at six months, and they conducted endoscopic examinations for inflammation at baseline, three, and six months. Based on CT findings, the researchers found that patients receiving the antifungal had an average reduction of 8.8% in the inflammatory mucosal thickening compared with an increase of 2.5% in those receiving placebo. Similarly, 70% of the patients receiving amphotericin had an improvement in endoscopy scores, while the placebo group showed no change. The treatment group also had significant reductions of intranasal mucus levels of interleukin-5 compared with the placebo group. [AAAAI 60th Annual Meeting: Abstract 1228. Presented March 23, 2004]

For 13 years, Dr. B. Manrin Rains, III, F.A.C.S., Director of the Mid-South Sinus Center and a member of the Methodist Healthcare – Memphis Hospitals medical staff, has pioneered alternative methods of treatment for non-invasive fungal sinusitis. His retrospective case review, "Treatment of Allergic Fungal Sinusitis with High Dose Itraconazole," has been accepted for publication in the American Journal of Rhinology. Both this study and a second study, "Itraconazole Use in Non-Invasive Fungal Rhinosinusitis," were funded through the Methodist Healthcare Foundation.

"Allergic fungal sinusitis (AFS) has only been recognized as a clinical entity for the past 20 years. Thus, there hasn't been much information on how to treat it," said Rains. "The common treatment was high-dose steroids, which unfortunately produce many adverse side effects including cataracts and accelerated osteoporosis. So out of necessity, we developed our own protocol."

The protocol calls for use of oral itraconazole with short burst, low-dose steroids following endoscopic sinus surgery. The 234 patients participating in the study were treated under this protocol and showed positive outcomes. Whereas AFS has a recurrence rate of over 50%, the rate of revision surgery for patients on the new protocol was only 20%. The series was the largest ever reported in the U.S., and there were no serious adverse reactions.

"This suggests that itraconazole may reduce the need for repeat surgical intervention on patients with recurrent disease, thereby avoiding surgical morbidity and reducing treatment costs," said Rains. He presently is evaluating the use of a topical itraconazole nasal spray in fungal sinusitis; recurrence rates are remaining low. "In addition, the topical version costs run a patient approximately $30 a month, whereas oral itraconazole can total $800 to $1500 for the full course of treatment. Also, topical itraconazole causes no elevation in liver enzymes."

A compounding pharmacy may be able to provide such a preparation for your use, with your doctor's approval.

  Conventional Drugs / Information
 Please see the link between Sinusitis and Antibiotics.

Environmental

  Fungal / Mold Avoidance
 The fungus Aspergillus fumigatus, which is the species most commonly found in pillows, is also the most likely to cause disease. The resulting syndrome, aspergillosis, has become the leading infectious cause of death in leukemia patients. Fungi can also worsen asthma.

Both feather and synthetic pillows were examined for a study, and thousand of spores of fungus per gram of used pillow were discovered - well over a million spores per pillow. The pillows studied were ones that had between 1.5 and 20 years of regular use. Four to sixteen different species were identified in each sample looked at, with higher numbers found in synthetic pillows. Bread and vine molds, as well as fungi usually found on damp walls and in showers were found in addition to the Aspergillus.

Aspergillosis usually infects the lungs and sinuses, although it can spread to other organs such as the brain. It is very difficult to treat. Immuno-compromised patients can easily die of Aspergillus pneumonia or sinusitis.

Since Aspergillus can also worsen asthma and cause allergic sinusitis, constant exposure to fungus in bed could be problematic even for relatively healthy people. [University of Manchester October 14, 2005]

A high quality water, mold and spore proof pillow cover can be used under your pillow case that will prevent you from breathing any contaminants that are in your pillow. Conventional washing, even with boiling water, will not kill the spores in your pillow, so purchasing a new pillow and/or using a special cover is advised.

Extract

  Fibrinolytic Enzymes
 Due to its anti-inflammatory properties, serrapeptase has been shown in clinical studies to benefit chronic sinusitis sufferers. In this condition, the mucus in patients’ nasal cavities is thickened and hypersecreted. This thickening causes mucus to be expelled less frequently.

Japanese researchers have evaluated the effects of serratiopeptidase (30 mg/day orally for four weeks) on the elasticity and viscosity of the nasal mucus in adult patients with chronic sinusitis. Serratiopeptidase reduced the viscosity of the mucus, improving the elimination of bronchopulmonary secretions. [Arch Otorhinolaryngol. 1988;244(6): pp.355-9]

Other clinical trials support serrapeptase's ability to relieve the problems associated with chronic sinusitis. In one study, 140 patients with acute or chronic ear, nose and throat pathologies were evaluated with either a placebo or the active serratia peptidase. Patients taking the serrapeptase experienced a significant reduction in severity of pain, amount of secretion, purulence of secretions, difficulty in swallowing, nasal dysphonia, nasal obstruction, anosmia, and body temperature after three to four days and at the end of treatment. Patients suffering from laryngitis, catarrhal rhinopharyngitis and sinusitis who were treated with serrapeptase experienced a significant and rapid improvement of symptoms after 3-4 days. Physicians assessed efficacy of treatment as excellent or good for 97% of patients treated with serrapeptase compared with only 22% of those treated with a placebo.

  Plant Sterols / Sterolins (Phytosterols)
 In an open-labeled study, allergic rhinitis and sinusitis patients were followed over a period of 12 weeks and the degree of allergic responses showed significant changes accompanied by clinical improvement and symptomatic relief of patients. Markers of efficacy included decrease in serum IgE levels, decrease in the TH2 cell activity, less turbinate hypertrophy and rhinonorea, etc.. [Abstract in Proc. 26th Annu Cong Physiol. Soc. S. Afr. (1998) [Abstract 178]]

Homeopathy

  Euphorbium Nasal Spray

Lab Tests/Rule-Outs

  Test for Food Allergies
 Environmental allergies are a factor in from 25 to 75% of people with sinusitis. Food allergies play a lesser role but may be contributing to the problem.

Mineral

  Colloidal Silver
 This procedure has been reported to be helpful against sinus infection and the flu. Because silver kills on contact, it must come in contact with the infection causing pathogens. A method which brings the silver colloid into contact with the infected tissues of the sinus cavities was developed by Dr. B. J. Biagioli and is called the sinus flooding procedure.

In order to put silver into the sinus cavities a small amount of salt must be added to make an isotonic solution . When just enough salt is added, the salinity of the solution matches the salinity of the body tissue. This prevents the painful sensation that one experiences when water goes up the nose in a swimming pool.

Prepare the solution:
Add a tiny pinch of table salt to about a tablespoon of silver colloid solution to make a maximum strength rinse solution. Mix the silver and salt immediately before each session and stir together until all the salt is dissolved in the solution. Discard any left over solution; do not try to save it for later use. For additional comfort warm the rinse solution to slightly above body temperature approximately 100 degrees F. This solution may also be used with a sinus irrigator to flush out the sinus cavities if a sinus irrigator is available.

The Sinus Flooding Procedure:
a. Lay on a bed face up with the head hanging over the edge of the mattress so the nostrils are pointing straight up toward the ceiling.
b. Use an eye dropper to fill each nostril with the rinse solution. Keep filling each nostril until the rinse solution starts to drip in the throat. Remain in the same position for 2 to 3 minutes.
c. Roll over on the stomach and let the head flop forward over the edge of the mattress. Remain in that position for 2 to 3 minutes then sit up and let the rinse drain out through the nose.
d. Important: Repeat this procedure 45 minutes later. The two rinses 45 minutes apart constitute a single rinse session. Perform two or more such rinse sessions per day. Relief will typically be noticeable by the second day. It is not unusual for the sinus infection to be gone within three days.
e. Repeat two sessions per day until the infection subsides. Very persistent infections may require five to seven day or more.

Nasal spray: silver can be used in a nasal spray type bottle and sprayed directly in the nose as an adjunct to the sinus flooding procedure. No salt is needed when using a nasal spray bottle. This method can be used several times throughout the day to improve the healing benefits. This is especially convenient and transportable.

Physical Medicine

  Topical Applications
 Snorting warm salt water into the nose may help with the symptoms of both allergic and infectious sinusitis. The same solution can be poured or injected into the nasal passage also. Fill a container with a spout (or large syringe) with warm water and add enough salt so the solution tastes salty. With your head over a sink, tilt it to one side until your ear is parallel to the floor, pour/inject the solution into the upper nostril, allowing it to drain through the lower nostril. This is repeated on both sides 2 - 3 times per day.

There is a medical device available which was designed to irrigate the nasal passages. It is called The Grossan Hydro Pulse Sinus System.

  Physical Therapy
 Researchers from Sweden have found that humming can help maintain healthy nasal passages and avoid sinus infections. Humming increases the amount of air exhaled from the nose versus other common exhalations, which could lower the risk of sinus infections if done routinely.

Humming increased nitrous oxide (NO) released into the nose from the sinuses (helps blood vessels dilate). Humming also facilitated the exchange of air from sinuses into nasal passages, which essentially ventilates the sinuses and protects them from infection. [Am J Respir Crit Care Med, 2002;166: pp.144-145]

  Hydrotherapy
 Nasal Lavage by Daniel H. Chong, N.D. - The nasal lavage is a wonderful treatment used in cases of chronic infections and/or irritations in the nose and sinuses. These conditions include sinusitis, hayfever, and seasonal allergies. The goal of the nasal lavage is to reduce or eliminate the recurrent irritant so that the body can be given a chance to heal itself. Often times antihistamines, antibiotics and/or surgery are used to treat these conditions but do little to affect them, especially their recurrence. Long-term use of nasal lavage in these cases, along with appropriate diet and lifestyle changes, can be extremely helpful.

It is extremely important to follow all the instructions very carefully. Continue the routine until all symptoms resolve. This may take three to six months so BE PATIENT. For acute problems, perform the nasal wash up to four times per day until resolved. For chronic problems, it is usual to do the wash one or more times daily, continuing for several months. Pain or bleeding after the lavage may mean that an infection is still present and so it is important to continue with the program. Be persistent as it takes a lot of effort to rid your body of these chronic bacteria that may be producing the low-grade infection. If your condition continues to worsen, or no improvement is noted after a week of treatment, see your doctor.

Supplies Needed:
Sea salt
Filtered or bottled water
Neti pot or bulb syringe
Towel or washcloth
Directions: The technique, outlined below, may seem unusual at first. However, once learned, you will quickly realize how beneficial it is for sinus problems.

Locate a workable container. The neti pot is specially designed with a spout that fits comfortably in one nostril. Alternatives you can use include a bulb syringe, a small flower watering pot, a turkey baster, or just a teacup (though the latter will be messier).

Fill the container with lukewarm salt water. The salt-to-water ratio is 1 teaspoon sea salt to 1 pint (2 cups) water. Filtered or bottled water is best.

Have some tissues within reach for this next part. Over a sink, tilt your head forward so that you are looking directly down toward the sink. Insert the spout into your right nostril. It is important that you breathe through your mouth. Turn your head to the right and let water move into the right nostril and exit the left nostril. Normally, you will feel the water as it passes through your sinuses. It is fine if some of the water drains into the mouth. Simply spit it out and adjust the tilt of your head.

After using a cup of water, repeat the above procedure for the other nostril.

To finish, expel any remaining water by quickly blowing air out both open nostrils 15 times over the sink. Avoid the temptation to block off one nostril, as doing so may force water into the eustachian tube.

Another effective way to introduce the saline solution into the nasal passage is with a urinary catheter (with female Luer Lock fitting) attached to a 30-60cc syringe. This can then be inserted a short ways into the nasal passage.

An alternative formula for the lavage which some report to be more effective is:
1 pint of water
1 tsp salt
1 tsp baking soda
1 Tbsp Witch Hazel
If this seems too strong, the ingredients can be cut in half or the amount of water doubled.

Alternating Hot and Cold Sinus Compress - This treatment can be used as a stand-alone treatment for painful, swollen sinuses, but can also be used in conjunction with the nasal lavage treatment. Combining the two seems to make each one work a little better.

Supplies Needed:
Two face cloths
Hot water
Cold water
Directions:

Soak one face cloth in hot water. Wring it out so it is damp but not dripping. Place the face cloth over your nose and eyes, and sinuses surrounding these areas and leave it in place for three minutes.

Have the second face cloth soaking in cold water. Wring the cloth out. Remove the hot cloth, and place the cold cloth over the same area of your face for 30 seconds.

Repeat this alternating sequence two more times for a total of three alternating sequences of three minutes hot and 30 seconds cold.

Frequency:
For severe and acute problems, perform morning and evening.
For less severe problems or maintenance, perform once a day.

The entire procedure will take about 10 minutes once you have everything organized. If you are trying to clear drainage from your sinus passages, perform the NASAL LAVAGE procedure after you have completed the alternating hot and cold heating compresses.

ALERT! Make sure to use purified water, not tap water. 2011 - Louisiana's state health department has issued a warning about the dangers of improperly using nasal-irrigation devices called neti pots, responding to two recent deaths in the state that are thought to have resulted from "brain-eating amoebas" entering people's brains through their sinuses while they were using the devices.

Both victims are believed to have filled their neti pots with tap water instead of manufacturer-recommended distilled or sterilized water. When they used these pots to force the water up their noses and flush out their sinus cavities — a treatment for colds and hay fever — a deadly amoeba living in the tap water, called Naegleria fowleri, worked its way from their sinuses into their brains. The parasitic organism infected the victims' brains with a neurological disease called primary amoebic meningoencephalitis (PAME), which rapidly destroys neural tissue and typically kills sufferers in a matter of days.

  Steam / Spray Treatments
 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 leading to a reduction in the symptoms of nasal stuffiness. Use a humidifier in the bedroom or fill a pan with hot water, place a towel over your head and lean over the pan, breathing in the moist air. Another steam method is to run a hot shower and sit in a closed bathroom.

Surgery/Invasive

  Neural Therapy
 There is a neural therapy treatment offered by some doctors which consists of many small injections of procaine at specific points on the head and face during an office visit. Proponents of this treatment claim a high percentage of cases respond quickly, but sometimes more than one treatment is required.

Vitamins

  Bioflavonoids
 Quercetin is being used widely for sinus problems.

  Vitamin Niacinamide
  Vitamin B6 (Pyridoxine)
 One older study reported that L-tyrosine (200mg), vitamin B6 (2.5mg) and niacinamide (10mg) when given in combination for the treatment of hay fever, hives, allergic headaches and poison oak dermatitis produced significant symptomatic relief when 1-3 tablets were taken four times/day in milder cases and up to 6 tablets 4-6 times/day in more severe cases. In some cases characterized by more chronic disorders, such as chronic sinusitis, a worsening of symptoms often occurred during the first few days of treatment. This study found that treatment with each the nutrients individually, or with any two in combination, was ineffective. (Widmann RR, Keye JD Epinephrine precursors an control of allergy. Northwest Med 1952:51:588-590.)
 
 


KEY
Weak or unproven link
Strong or generally accepted link
May do some good
Likely to help
Highly recommended
 
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GLOSSARY

Acute:  An illness or symptom of sudden onset, which generally has a short duration.

Allergen:  A substance that is capable of producing an allergic response in the body.

Allergy:  Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.

Bacteria:  Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Edema:  Abnormal accumulation of fluids within tissues resulting in swelling.

Eosinophil:  The eosinophils, ordinarily about 2% of the granulocyte count (60 to 75% of the white blood cells), increase in number in the presence of allergic disorders and parasitic infestations.

Immune System:  A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.

Leukocyte:  A white blood cell which appears 5,000 to 10,000 times in each cubic millimeter of normal human blood. Among the most important functions are destroying bacteria, fungi and viruses and rendering harmless poisonous substances that may result from allergic reactions and cell injury.

Over-The-Counter:  A drug or medication that can legally be bought without a doctor's prescription being required.

Polyp:  A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.

Protein:  Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Topical:  Most commonly 'topical application': Administration to the skin.

Vasoconstriction:  A narrowing of any blood vessel, especially the arterioles and the veins in the blood reservoirs of the skin and the abdominal viscera.

White Blood Cell:  (WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.