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Chronic Sinusitis

MagazineApril 2009 (Vol. 20 Issue 1)Chronic Sinusitis

Q) My partner has had sinusitis for many years now

Q) My partner has had sinusitis for many years now. He's had three operations to remove nasal polyps, along with steroid treatment, but they keep reforming. His sense of smell has suffered, too. We have tried a number of naturopathic methods, including a change of diet-to no avail. What do you suggest?-E.M., via e-mail

A) Sinusitis is a common condition that causes inflammation of the mucous membranes that line the sinuses. In most cases, sinusitis is caused by an infection that clears within a week or so but, for some people, nasal congestion, difficulty breathing and facial tenderness can persist for months or even years. When sinusitis lasts for three months or longer, the condition is chronic.

Since your partner has long-term sinus problems, it's no surprise that nasal polyps formed. These swellings are the result of continual inflammation of the mucous membranes of the nasal passages. They make congest-ion worse, and reduce the sense of smell by blocking the flow of air to sensory areas in the roof of the nose.

Conventional treatment of polyps-steroids or surgery-usually only works in the short term because the underlying cause is not addressed. If your partner wants to banish polyps for good, he needs to find out what's causing the sinus problem in the first place.

The most common cause is allergy, either to foods, drugs or airborne agents, so an allergy test is a good place to start. In 200 chronic sinusitis patients, 84 per cent tested positive for allergies and 52 per cent had multiple allergen sensitivities. Year-round allergens such as molds and dustmites were mostly to blame (Otolaryngol Head Neck Surg, 2000; 123: 687-91). Identification of the offending allergen(s), therefore, and subsequent treatment by avoidance may well work.

Other studies, however, suggest that chronic sinusitis may be an immune reaction. In the US, Mayo Clinic researchers found that 96 per cent of patients with chronic sinusitis had fungi in their mucus as well as eosinophils (commonly found in an allergic response) in their nasal tissues. Yet, surprisingly, most of these patients had no evidence of an allergy to fungi, suggesting that the sinusitis may be part of the body's immune defense response (Mayo Clin Proc, 1999; 74: 877-84).

Three years later, the same team treated these patients with amphotericin B, applied intranasally (at a dose of 20 mL in a 100 mcg/mL solution) twice a day. Sinusitis symptoms improved in 75 per cent of the patients, and almost half of these were completely disease-free (J Allergy Immunol, 2002; 110: 862-6).

Nevertheless, as amphotericin B comes with major adverse effects, a safer option may be a natural anti-fungal approach. This might include an antifungal diet, the use of antifungal essential oils such as eucalypus, lavender and thyme (diluted and applied directly to the nostrils with a cottonbud), and installing a high-efficiency particulate air (HEPA) filter, which can reduce indoor fungal levels as well as sinusitis risk (Altern Med Rev, 2006; 11: 196-207).

Salt-water (saline) nasal irrigation, an age-old remedy, can also help to flush out fungi, as well as other possible sinusitis triggers such as allergens, bacteria and viruses lodged in the nasal passages. Indeed, clinical trials show that patients treated with regular nasal irrigation have an improved sinus-related quality of life, a reduction in symptoms and are less reliant on medications (J Fam Pract, 2002; 51: 1049-55; Cochrane Database Syst Rev, 2007; 3: CD006394). Some studies suggest that the technique is more effective when the saline solution is 'hypertonic'-saltier than your body fluids (J Allergy Clin Immunol, 1998; 101: 602-5; Clin Otolaryngol Allied Sci, 2000; 25: 558-60). There are a number of nasal-irrigation products on the market such as Sterimar and Nasaline.

If none of the above suggestions proves helpful to your partner, there are yet other natural treatments that might bring relief (see box below). In addition, be sure to investigate other possible causes of sinusitis

What else to try

- Acupuncture. The World Health Organization lists sinusitis as one of the many conditions that acupuncture can help (The Duke Encyclopedia of New Medicine. London: Rodale Books International, 2006).

- Humming. Strong humming for one hour daily can eliminate sinusitis symptoms in just four days. It may be that humming stimulates nitric-oxide production in the nasal cavities, which can act as an antifungal, antiviral and antibacterial (Med Hypoth, 2006; 66: 851-4).

- Ozone therapy. In 130 chronic sinusitis patients, 89 per cent of those given ozone therapy (irrigation of the sinuses with an ozone-oxygen mixture) recovered faster than those using conventional treatment (Vestn Otorinolaringol, 2002; 6: 46).

- Supplements. The following can help: bromelain (500-1000 mg/day); quercetin (400-500 mg three times a day); N-acetylcysteine (NAC) (600-1500 mg/day in three divided doses); and undecylenic acid (450-750 mg/day in three divided doses) (Altern Med Rev, 2006; 11: 196-207). Vitamin A (good for the tissues lining the sinuses), vitamin C (shrinks inflamed sinuses) and zinc (decreases respiratory tract infections) are also worth a try.

- Herbs. A popular adjunctive treatment for both acute and chronic sinusitis in Germany is Sinupret, a herbal remedy comprising gentian root, primrose flowers, sorrel herb, elder flowers and European vervain.


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