Sinusitis refers to inflammation of the nasal sinuses (hallow cavities around the cheekbones, eyes and nose), which may or may not be the result of an infection. Today, sinusitis is often referred to as "rhinosinusitis," since inflammation of the sinuses cannot occur without some inflammation of the nose (rhinitis) as well.
Sinusitis is most common during the winter season, and it may last for months or even years if not treated properly. According to the Centers for Disease Control and Prevention (CDC), more than 18 million visits to primary care physicians result in a sinusitis diagnoses each year.
There is an association between sinusitis and asthma, according to the CDC. Researchers estimate that more than 50% of patients with moderate to severe asthma also suffer from chronic sinusitis.
Allergic fungal sinusitis:
Individuals who are allergic to fungi can develop allergic fungal sinusitis. This type of sinusitis is uncommon, and it usually occurs in individuals who have compromised immune systems. However, recently, the occurrence of fungal sinusitis has increased in the general population. The most common pathogens are from Aspergillus and Mucor species. This condition is usually chronic (lasts longer than eight weeks) and recurrent.
Acute: Acute sinusitis lasts for less than six months, and it is usually caused by a bacteria infection. Most cases of sinusitis are acute. When symptoms last between four and eight weeks, the condition is considered to be subacute.
Chronic: Symptoms of chronic sinusitis last eight weeks or longer and the severity varies. Symptoms for acute and chronic sinusitis are very similar, except chronic sinusitis symptoms last longer and often cause more fatigue. According to the CDC, chronic sinusitis affects nearly 35 million people in the United States.
When an individual suffers from three or more episodes of acute sinusitis per year, the condition is referred to as recurrent sinusitis.
Bacterial infections are usually the cause of acute sinusitis. When the sinuses are blocked for a long time, a secondary bacterial infection may develop, causing sinusitis.
Individuals who suffer from allergic asthma are more likely to develop sinusitis than non-allergic individuals. Certain allergens (like cigarette smoke, air pollution, dust mites or mold spores) can trigger inflammation of the sinuses and mucous linings. The swelling prevents the sinus cavities from getting rid of bacteria, and therefore, increases the risk of secondary bacterial sinusitis.
Individuals suffering from allergic rhinitis (hay fever) or vasomotor rhinitis (non-allergic rhinitis) are also more likely to develop sinusitis.
Individuals who have compromised immune systems (like chemotherapy patients) or immune system disorders (like HIV) are also more susceptible to sinusitis.
Structural abnormalities of the nose, including narrow drainage passages, tumors, polyps, or a deviated nasal septum, may also cause sinusitis.
The cause of chronic sinusitis is less clear. Some experts think it may be the result of an infectious disease. Fungal infections of the sinuses have also been linked to many cases of chronic sinusitis, but the evidence is still controversial.
Individuals who suffer from chronic or recurrent sinusitis usually have multiple factors that make them more susceptible to infection.
Symptoms for acute and chronic sinusitis are very similar, except chronic sinusitis symptoms last longer and often cause more fatigue.
Sinusitis can affect the nose, eyes or middle ear. Symptoms often include thick nasal drainage, bad-tasting postnasal drip, plugged-up nose, cough, difficulty breathing, head congestion, headache, facial swelling, toothache, constant fatigue, tender cheeks, swollen eyelids, pain between the eyes, neck pain and occasionally fever.
Individuals suffering from chronic sinusitis may also have nasal polyps, which are abnormal tissue growths (polypoidal masses) found in the mucous membranes of the nose and paranasal sinuses. Since nasal polyps often block the nasal passages and sinuses, they may cause breathing difficulty.
If left untreated, sinusitis can develop into a chronic condition. Sinusitis can result in several complications if not treated properly.
Acute sinusitis may trigger an asthma exacerbation.
The sinus infection could spread to the lining of the brain, resulting in meningitis.
The sinus infection may spread to the eye socket and reduce vision or cause blindness.
The sinus infection may cause problems in the veins surrounding the sinuses and lead to aneurysms or blood clots.
Allergy testing may be conducted to detect specific allergens that might be causing the sinusitis.
Computerized tomography (CT) scans, which produce detailed images of the sinus cavities, may be used to identify inflamed areas.
Cultures (blood tests) may be used to detect a bacterial or fungal infection.
An endoscopic examination may be performed. During this procedure, a narrow, flexible fiber-optic scope is inserted into the nasal cavity through the nostrils. The physician is then able to see where the sinuses and middle ear drain into the nose.
Blood tests may be conducted to rule out other conditions that may be associated with sinusitis, like an immune deficiency disorder or cystic fibrosis.
Chronic sinusitis is often difficult to treat successfully. Many individuals with chronic sinusitis still experience symptoms after taking antibiotics for a long period of time.
Allergen immunotherapy (allergy shots) may help control chronic or recurrent sinusitis. During immunotherapy, the patient receives periodic injections, as determined by the allergist/immunologist, over the course of three to five years. The solutions in the injections contain dilutions of the substances the individual is allergic to. The treatment helps the immune system tolerate the allergens and lessens the need for medications.
Antibiotics: If a bacterial infection is present, an antibiotic will be prescribed. Antibiotics are usually taken for three to 12 weeks, or until the individual is symptom-free for seven days. In addition, low doses of antibiotics and expectorants may be prescribed as preventative measures at times when symptoms are likely to be the worst, such as the winter season. Antibiotics are only used as a preventative treatment in patients who have chronic recurrent sinusitis.
Antihistamines and decongestants:
Antihistamines or decongestants can be taken orally or administered in the form of a nasal spray. These medications may reduce backed-up mucus in the sinuses and provide temporary relief. Examples of these medications include Afrin©, Sudafed©, Allegra© and Claritin©. Decongestant sprays should not be used more than twice daily for three consecutive days because rhinitis medicamentosa (rebound nasal congestion) may result.
Expectorants: Expectorants (like guaifenesin) may help thin the sinus mucus to promote drainage.
Endoscopic sinus surgery: In cases that are persistent and continually resistant to treatment, endoscopic sinus surgery may be an option. During this procedure, the physician inserts an endoscope into the nasal passage. Then, depending on the source of obstruction, the physician may remove tissue or a polyp or shave down a bone that is blocking the passageway. Also, the physician may surgically enlarge a narrowed sinus opening to promote drainage.
Nasal corticosteroids: Nasal corticosteroid sprays (like Flonase©, Beconase© or Nasacort©) may be used to reduce nasal inflammation.
Oral corticosteroids: Oral corticosteroids (like prednisone) are often used to relieve tissue swelling that contributes to sinus blockage. Since oral corticosteroids can produce serious adverse affects like hypertension, diabetes, cataracts and stomach ulcers, they should only be taken when all other medications have failed.
Other: Several non-drug treatments may also relieve symptoms. These include breathing in hot, moist air, as well as washing the nasal cavities with salt water.
Good scientific evidence
: Bromelain has been studied in various clinical studies for sinusitis with mixed results. Further research is necessary. Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye flour, wheat flour, or members of the Bromeliaceae
family. Use cautiously with history of bleeding disorder, stomach ulcers, heart disease, liver or kidney disease. Use caution before dental or surgical procedures or while driving or operating machinery. Avoid if pregnant or breastfeeding.
: Good scientific evidence suggests that butterbur may be effective for allergic rhinitis prevention in susceptible individuals. Comparisons of butterbur to prescription drugs, such as fexofenadine (Allegra©) and cetirizine (Zyrtec©), have reported similar efficacy. Additional studies are warranted before a firm conclusion can be made.
Avoid if allergic or hypersensitive to Petasites hybridus or other plants from the Asteraceae/Compositae family (such as ragweed, marigolds, daisies, and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due to the risk of liver or kidney damage or cancer. Avoid if pregnant or breastfeeding.
: There is good evidence from clinical studies to recommend the use of nasal irrigation in the treatment of allergic rhinitis. One study demonstrated that reflexology massage may be equally effective; however, the advantage of irrigation (i.e. inexpensive, performed at home, minimal adverse side effects) makes the technique beneficial. Methodological and statistical reporting are lacking in some of these trials. A well-conducted, randomized controlled trial, fully reporting data would make the case for allergic rhinitis stronger.
Early research suggests that nasal irrigation may help treat chronic sinusitis, with improvements in sinus-related quality of life, decreases in symptoms, and decreases in medication use. Further study is needed before a conclusion can be made.
Nasal irrigation is generally well tolerated. Use cautiously with history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
: Use of probiotic Enterococcus faecalis bacteria in hypertrophic sinusitis (sinus inflammation) may reduce frequency of relapses and the need for antibiotic therapy. Further research is necessary before a firm conclusion can be made. Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
Unclear or conflicting scientific evidence
: There is currently insufficient available evidence on which to base recommendations for acupuncture in non-allergic rhinitis. However, studies suggest that it may offer possible benefits. Additionally, more studies are needed of stronger design to determine whether or not acupuncture offers benefit in sinusitis.
Acupuncture should be avoided in patients with heart disease, pulmonary disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders. Pregnant women, the elderly, diabetics, people with a history of seizures, and those receiving radiation therapy and/or taking drugs increasing bleeding risks should also avoid acupuncture.
: Despite widespread use in over-the-counter agents and vapors, there is not enough scientific evidence to recommend use of eucalyptus oil as a decongestant-expectorant (by mouth or inhaled form). Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
: Studies in patients with allergies found that black seed decreased subjective measures of severity of allergies. The effect of black seed for allergies is still not clear and further study is required before a conclusion can be made. Avoid with a known allergy/hypersensitivity to black seed, its constituents, black seed oil, or to members of the Ranunculaceae family. Allergic contact dermatitis has been reported after topical use of black seed or the oil from the seed.
: It has been suggested that cat's claw may help treat allergies and related respiratory diseases. However, there is currently limited scientific evidence to support this claim. More well-designed trials are needed to determine whether cat's claw is a beneficial treatment.
Avoid if allergic to cat's claw or Uncaria plants or plants in the Rubiaceae family, such as gardenia, coffee, or quinine. Avoid with history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, lupus). Use cautiously with bleeding disorders or with history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding. Cat's claw may be contaminated with other Uncaria species. Reports exist of the potentially toxic Texan-grown plant Acacia gregii being substituted for cat's claw.
: Oral tricholine citrate (TRI) effectively relieved allergic rhinitis symptoms in limited available study. Further research is needed before a firm conclusion can be made. Choline is generally regarded as safe and appears to be well tolerated. Avoid if allergic to choline, lecithin, or phosphatidylcholine.
: Preliminary study suggests that ephedrine nasal spray may help treat allergic rhinitis. Additional research is needed before a recommendation can be made.
Ephedra taken by mouth can cause serious side effects, including heart attack, seizure, and stroke. Therefore, ephedrine nasal sprays should only be used in the nose. The U.S. Food and Drug Administration (FDA) has collected thousands of reports of serious toxicity linked to ephedra (including over 100 deaths). Ephedra products are banned from dietary supplements because of serious health risks, including heart attack, heart damage, breathing difficulties, and fluid retention in the lungs. Avoid with history of high blood pressure, abnormal heart rate, heart attack, stroke, seizure, eating disorders, anxiety, prostate disease, mental illness, kidney disease, stomach ulcers, heart disease, eye disease, depression, diabetes, thyroid disease, or sleep problems. Avoid if pregnant or breastfeeding.
: There is currently insufficient available evidence to recommend either for or against eucalyptus oil as a decongestant-expectorant. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, lung disease, or the blood condition known as acute intermittent porphyria. Use caution if driving or operating machinery. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
: Currently, there is insufficient human evidence to recommend honey for the treatment of rhinoconjunctivitis. Avoid if allergic or hypersensitive to honey, pollen, celery or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
: Several studies suggest that some horseradish constituents may offer antibiotic activity and may help treat sinusitis. Additional high-quality clinical studies are needed before a conclusion can be made. Avoid if allergic or hypersensitive to horseradish (Armoracia rusticana), its constituents, or members of the Brassicaceae family. Large oral doses may provoke allergic reactions. Use cautiously with clotting disorders, hypotension (low blood pressure), thyroid disorders, kidney disorders and inflammation, gastrointestinal conditions, and ulcers. Use cautiously if taking anticoagulants or antiplatelets (blood thinning agents), antihypertensives (blood pressure-lowering agents), anti-inflammatory agents, or thyroid hormones. Use cautiously if undergoing treatment for cancer. Avoid medicinal amounts of horseradish if pregnant or breastfeeding; based on herbal textbooks and folkloric precedent, horseradish has been used to induce abortion.
: It has been suggested that hypnotherapy may be effective for allergies and may help treat hay fever. However, further research is necessary. Use cautiously with mental illnesses such as psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders
: Conclusive data on kiwi's therapeutic benefits for preventing lung conditions and other respiratory problems is currently lacking. Kiwi and other fruits high in vitamin C may benefit lung conditions in children, especially wheezing. More research is warranted before a recommendation can be made. Avoid if allergic or hypersensitive to kiwi, latex, birch pollen, banana, chestnut, fig, flour, melon, poppy seeds, rye grain, sesame seeds, and related substances. Kiwi is generally considered safe when taken in amounts naturally found in foods. Use cautiously with anti-platelet drugs like aspirin, cilostazol, or clopidogrel. Use cautiously with hormone therapies or serotonergic drugs. Avoid if pregnant or breastfeeding because clinical trials testing safety in supplemental doses are currently lacking. The amount found in foods appears to be safe in most people.
: Limited available study suggests that the Lactobacillus acidophilus (L. acidophilus) strain L-92 (L-92) may be effective for the treatment of Japanese cedar-pollen allergy. Further research is needed to confirm these results. L. acidophilus may be difficult to tolerate if allergic to dairy products containing L. acidophilus. Avoid with history of an injury or illness of the intestinal wall, immune-disease, or heart valve surgery. Avoid with prescription drugs, such as corticosteroids, because of the risk of infection. Use cautiously with heart murmurs. Antibiotics or alcohol may destroy L. acidophilus. Therefore, it is recommended that L. acidophilus be taken three hours after taking antibiotics or drinking alcohol. Some individuals may use antacids, such as famotidine (Pepcid©) and esomeprazole (Nexium©), to decrease the amount of acid in the stomach one hour before taking L. acidophilus.
: According to preliminary clinical study, MSM reduces symptoms associated with seasonal allergic rhinitis (SAR). However, larger controlled trials are needed to confirm these findings. Avoid if allergic or hypersensitive to MSM. Long-term effects of supplementation with MSM have not been examined. Avoid if pregnant or breastfeeding.
: Research shows that topical application of an alcoholic onion extract significantly reduced responses to allergies. Although intriguing, more research is needed in this area to establish the efficacy and dosing of topical onion extracts. Avoid if allergic or hypersensitive to onion (Allium cepa), its constituents, or members of the Lilaceae family. Use cautiously with hematologic (blood) disorders, diabetes, hypoglycemia (low blood sugar), and hypotension (low blood pressure). Use cautiously if taking anticoagulants or antiplatelets (blood thinners). Avoid medicinal doses if pregnant or breastfeeding.
: Preliminary evidence suggests some benefit of perilla extract for seasonal allergies. Further clinical trials are required before conclusions can be made. Avoid if allergic/hypersensitive to perilla or members of the Lamiaciae/Labiatae family. Use cautiously with cancer, low HDL-cholesterol, and immune disorders. Use cautiously if taking NSAIDS or barbiturates. Avoid if pregnant or breastfeeding.
: Only a few types and combinations of probiotics have been studied for allergies. They have been studied mostly in children, teenagers, and young adults. Further research is necessary before a firm conclusion can be made. Probiotics are generally considered safe and well tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
: Reflexology involves the application of manual pressure to specific points or areas of the feet called "reflex points" that are believed to correspond to other parts of the body. Results from early studies are not conclusive regarding the use of reflexology for chronic sinusitis.
Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle or with severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, kidney stones, or with a pacemaker. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
: Shea butter is derived from the nut of the shea tree (Vitellaria paradoxa), which grows in West Africa. In human research, shea butter was shown to produce relief from nasal congestion. More research is needed before a conclusion can be made
Avoid with known allergy/hypersensitivity to shea butter or its constituents. Use cautiously with allergies to latex. Use cautiously if taking anticoagulants. There is currently insufficient available safety evidence for use of shea butter during pregnancy or breastfeeding.
: Research suggests that an herbal combination preparation containing sorrel, Sinupret©, may have beneficial effects in improving symptoms of sinusitis when used with antibiotics. It is not clear if these same effects would be seen with sorrel alone or what dose may be safe and effective. For allergic rhinitis, there is not enough evidence to make a conclusion at this time. More research of sorrel alone is needed.
Avoid sorrel with a known allergy to sorrel or any of its constituents. Avoid large doses of sorrel because there have been reports of toxicity and death. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl©) or disulfiram (Antabuse©). Avoid if pregnant or breastfeeding.
: Anti-inflammatory properties of spirulina may help improve symptoms of allergic rhinitis. However, further high-quality studies are needed to confirm these findings. Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously with phenylketonuria (a genetic disorder of a liver enzyme that disrupts normal body functions), autoimmune diseases, bleeding disorders, diabetes, and osteoporosis. Use cautiously with products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp.; in underweight patients or in those taking antiobesity agents or appetite suppressants; of if consuming a high-protein diet. Avoid in children or if pregnant or breastfeeding.
: For many years, a freeze-dried preparation of Urtica dioica has been prescribed by physicians and sold over-the-counter for the treatment of allergic rhinitis. Clinical trials demonstrating statistical significance over placebo and/or equivalence with other available treatments are needed to support the use of nettle in the treatment of allergic rhinitis.
Avoid if allergic or hypersensitive to nettle, the Urticaceae family or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, and/or low sodium levels in the blood. Use cautiously with diuretics and anti-inflammatory drugs. The elderly should also use nettle cautiously. Avoid if pregnant or breastfeeding.
: Thymus extract may reduce symptoms of allergies due to its potential immune stimulating effects. More clinical trials are required before recommendations can be made involving thymus extract for this use. Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding; thymic extract increases human sperm motility and progression.
: Although thought to aid in reducing the nasal symptoms of allergic rhinitis, vitamin E intake may not be effective. Current evidence is limited, however, and more studies are needed before a firm conclusion can be drawn.
Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams per day. Avoid doses higher than 1,000 milligrams a day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams; for breastfeeding women of any age, the recommended dose is 19 milligrams. Use beyond this level in pregnant women is not recommended.
Fair negative scientific evidence
: Grape seed has been used to treat immune system disorders due to its antioxidant effects. However, a well-designed human study of allergic rhinitis sufferers showed no improvement in allergy symptoms with administration of grape seed extract ingredients. Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously if taking blood thinners such as warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or anti-platelet agents. Use cautiously with bleeding disorders or if taking drugs that may increase the risk of bleeding. Use cautiously with drugs processed using the liver's "cytochrome P450" enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Avoid with disorders that increase the risk of bleeding or with active bleeding disorders (stomach ulcers, bleeding into the brain, etc.). Avoid if pregnant or breastfeeding.
When the sinuses are blocked for a long time, a secondary bacterial infection may develop causing sinusitis. Therefore, allergies should be treated quickly in order to reduce the risk of developing sinusitis.
Individuals with sinus problems and allergies should avoid environmental irritants, such as tobacco smoke and strong chemical odors, which may worsen symptoms.
Consider using a humidifier, which adds moisture to the air, to help keep the nasal passages open.
Low doses of antibiotics and expectorants may be prescribed as preventative measures at times when symptoms are likely to be the worst, such as the winter season.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Allergy Asthma & Immunology. Rhinitis & Sinusitis. www.aaaai.org. Accessed April 20, 2009.
- Asthma and Allergy Foundation of America. Rhinitis and Sinusitis. www.aafa.org. Accessed April 20, 2009.
- CDC, Vita and Health Statistics, Current Estimates from the National Health Interview Survey, 1994 (U.S. Department of Health and Human Services, Public Health Service, National Center for Health Statistics): DHHS Pub. No. PHS 96-1521, December 1995.
- National Institute of Allergy and Infectious Diseases. Sinusitis. www.niaid.nih.gov. Accessed April 20, 2009.
- Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com. Copyright © 2009. Accessed April 20, 2009.
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