Sinusitis

Also indexed as: Sinus Infection

Breathing is less of a chore when air can flow freely through your nasal passages. According to research or other evidence, the following self-care steps may help relieve the pressure and congestion caused by sinusitis:

Rule out allergies
Make an appointment with an allergist, who can help determine if your sinusitis is allergy-related

Discover the benefits of bromelain
Try taking 3,000 MCU of this enzyme, derived from pineapple, three times a day for relief from acute sinusitis

Try nasal irrigation
Prepare a warm, salt-water solution in a special ceramic pot known as a “neti lota” pot and pour it through your nose to relieve your sinuses

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full sinusitis article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About sinusitis

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.

Product ratings for sinusitis

Science Ratings	Nutritional Supplements	Herbs
	Bromelain
		Cineole (a component of eucalyptus)
	Vitamin C	Eucalyptus Gentian root, primrose flowers, sorrel herb, elder flowers, and European vervain (in combination) Horseradish Wood betony
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

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 options

Over the counter analgesics, such as aspirin (Genuine Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin IB®, Advil®), naproxen (Aleve®), and paracetamol (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®, Mucinex®) 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®), azithromycin (Zmax®), cefprozil (Cefzil®), and levofloxacin (Levaquin®). Corticosteroid nasal sprays, such as flunisolide (Nasarel®), fluticasone (Flonase®), budesonide (Rhinocort Aqua®), or triamcinolone (Nasacort AQ®), 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.

Vitamins 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 standardised 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

The main ingredient of eucalyptus oil, cineole, has been studied as a treatment for sinusitis. In a double-blind study of people with acute sinusitis that did not require treatment with antibiotics, those given cineole orally in the amount of 200 mg 3 times per day recovered significantly faster than those given a placebo.¹² Eucalyptus oil is also 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.¹³

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.¹⁴ The combination has been found to be useful in helping to promote mucus drainage (“mucolytic” action) from the sinuses.¹⁵ The combination is typically used together with antibiotics for treating acute sinusitis.

Horseradish is another herb used traditionally as a mucus-dissolver.¹⁶ 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.

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.

Integrated 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.¹⁷

References
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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. Kehrl W, Sonnemann U, Dethlefsen U. Therapy for acute nonpurulent rhinosinusitis with cineole: results of a double-blind, randomized, placebo-controlled trial. Laryngoscope 2004;114:738–42.

13. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy, 3rd ed. Berlin: Springer Verlag, 1998, 146–7.

14. Schulz V, Hänsel R, Tyler VE. Rational Phytotherapy: A Physician’s Guide to Herbal Medicine. Berlin: Springer-Verlag, 1998, 163–4.

15. 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.

16. Mills S, Bone K. Principles and Practice of Phytotherapy. London: Churchill Livingstone, 2000, 21.

17. 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, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.