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Sinusitis - Integrative Approaches

Dr. Philip Rouchotas
6 October 2014

Sinusitis - Integrative Approaches
by: Philip Rouchotas, MSc, ND

Bolton Naturopathic Clinic
64 King St W, Bolton, ON, L7E 1C7

Sinusitis - Integrative Approaches

Overview of Sinusitis

Sinusitis is the inflammation of the sinuses. The sinuses are actually a system of openings or cavities that are part of the skull. The largest one is the maxillary sinus, located near the cheekbones. It is often the one that most people complain about when they are experiencing facial pain. The other sinuses include the frontal sinuses, the ethmoid sinuses, and the sphenoid sinuses.[1] While sinuses typically become inflamed or swollen together, if the smaller ones become inflamed, people can experience stuffiness, mucus, and breathing problems. This is because the sinuses are lined with soft tissue and a thin layer of mucus, but when they become inflamed, it doesn’t take much to feel clogged up. There are a number of different sinus conditions that can lead to irritating and sometimes debilitating symptoms.

To figure out what’s going on, a doctor may use a number of different tests. A lot of information can be obtained just by asking questions about the history of the concerns. For example: “Is anyone else around you feeling the same symptoms?” If yes, this might point to a possible infectious cause (like a bacteria or virus). These tiny organisms can infect the sinus cavity and cause inflammation. Acutely, this usually leads to increased mucus production, congestion, and even headaches. If infections happen persistently, it can become a chronic issue. Sometimes the body will even continue to experience inflammation, even if the infections have been cleared. A doctor who is taking the case may also perform some physical examinations. It is especially important to look into the nose with a light to see if all the regular structures are visible and appear normal and healthy. The doctor may push over the sinuses to see if that elicits any pain or discomfort (which would increase the chances of a diagnosis of sinusitis). They may also perform a procedure called transillumination: in this procedure, the lights in the room are dimmed and a bright light is pointed directly at the sinuses. If the sinuses are clear, light should get through fairly unopposed. If the sinuses are stuffed, then light will be obstructed. Finally, imaging tests may be used (things like a CT scan, X ray, or MRI). These methods should be able to detect problems with the bones around the sinuses, or may aid in confirming a diagnosis of chronic sinusitis.

Conventional Approaches Conventional Approaches

Depending on the cause of sinusitis, if found, the conventional treatments will vary. One possible cause of sinusitis that we have not discussed yet is a deviated septum. This is when there is a physical displacement of the internal anatomy of the nose, and it affects a large proportion of the population to a different degree. In simple cases, symptoms might be treated with medications. There are usually a couple of types that are used fairly commonly: decongestants and antihistamines. Decongestants typically act by enhancing the effects of adrenaline, or by increasing adrenergic activity.[2] This leads to the constriction of blood vessels in the nose and sinuses, which then helps to bring down inflammation and mucus in these areas. Because the area of desired action is the nose and sinuses, many decongestants come in spray form. The other common drug class is antihistamines; these work by inhibiting the action of histamine, which can help alleviate a number of symptoms. Histamine normally increases the ease of fluid escaping from the capillaries, which leads to symptoms like a runny nose and congested sinuses. The antihistamine drugs block this process. Antihistamines can be of great help for allergic causes of sinusitis for the same reason.

Another cause of sinusitis is nasal polyps. These are small growths that can grow in the nasal cavity as a result of infection, allergies, or asthma. Nasal polyps may be treated by certain types of medication (like corticosteroids), which can shrink the polyps. However, if the cause of the polyps is not properly managed, they often reoccur. Decongestants and antihistamines can also be used to help alleviate symptoms. However, if things get more serious, a surgical treatment may be recommended. Surgery is usually reserved for more serious cases, or if the alternative treatments are not effectively improving symptoms. Surgery is sometimes recommended to treat a deviated septum as well, but does not always result in the successful elimination of symptoms. In other words, surgery is not always successful. For this reason, it is especially important to try to reduce inflammation in other ways and to control any other risk factors. In adults, one of the most common contributing factors is smoking. Cigarette smoke is harmful because it damages the hair-like structures (called cilia) on the sinus surfaces, which prevent the proper movement of mucus. Smoking can also cause swelling of the sinuses by acting as a direct irritant to the membranes.

Multifaceted Naturopathic Approaches Multifaceted Naturopathic Approaches

There are many excellent natural approaches to sinusitis. Some of the treatments are good for specific causes, while others are good at reducing symptoms, no matter what the underlying cause. Naturopathic treatments can include physical therapies, acupuncture, diet and lifestyle modifications, herbal medicine, and nutritional supplements. From a lifestyle perspective, it’s recommended to identify if there are any specific triggers to the sinusitis. For example, if you have a really dusty bedroom and your sinusitis is worse at night, it might be a good idea to do a thorough cleaning (or remove any carpet in the room, as that can attract a lot of dirt and dust). The most classic natural treatment for sinusitis is the neti pot. This small item allows for the irrigation of the sinuses. It is recommended to use some lukewarm water with a little bit of salt, or even with the addition of some herbal compounds like goldenseal. The neti pot basically cleans away crust in the nasal passages and, depending on the exact solution used, can provide some direct anti-inflammatory effects. The treatment requires pouring the solution into the nasal passages and letting it leak out the other end with the help of gravity.

A great supplement to consider as a potential alternative to the conventional medications is vitamin C. Vitamin C has antihistamine effects and anti-inflammatory effects, as well as immune-stimulating properties. Overall, this means it can be potentially utilized in a number of cases of sinusitis with varied causes. Vitamin C is often paired with quercetin, a bioflavonoid (basically a plant pigment) which is found in fruits and vegetables. Taken as a supplement at the appropriate dose, Quercetin acts as a natural antihistamine and anti-inflammatory. It’s excellent for sinusitis that is caused by allergies. Another important supplement to consider is bromelain, a digestive enzyme that’s found naturally in pineapple. Bromelain has anti-inflammatory properties and also acts to break down mucus, helping it to work its way out of the body. If low immunity or infection is a causative factor, then some immune boosters can be considered. Zinc, for example, is a mineral that is necessary for proper immune function and can be taken safely orally in small doses (for the short-term).

Treatment Integration Treatment Integration

Some of the other naturopathic modalities we mentioned can produce great outcomes. Acupuncture is the use of extremely thin needles inserted into specific points in the body. When treating sinusitis, there are specific points on the face that help to directly relieve pain, reduce inflammation, and help dislodge mucus. Usually, acupuncture protocols are done in repeated sessions, meaning acupuncture may be more helpful for chronic sinusitis rather than for an acute treatment. From the herbal medicine perspective, there are herbs that can be taken orally in tincture form (alcohol extracts of herbs) that can help to break down mucus. Herbs can be used as part of steam inhalation or aromatherapy, and these protocols can be extremely soothing to the respiratory tract. Herbs with strong antimicrobial actions, like oregano, can be used as nasal sprays to exert a direct action, although these are definitely more potent and can cause side effects like stinging or burning.

From a dietary perspective, there may be food triggers that aggravate the inflammation or produce mucus. It is typically a good idea to try an elimination diet, where many possible triggers are removed from the diet for an extended period of time (usually 2–3 weeks), and are then reintroduced. During the reintroduction phase, symptoms should be diligently tracked to see if any of the foods causes a large negative response. One of the most common offending food groups is dairy.[3] Milk consumption, in particular, has been associated with increased respiratory mucus production and asthma symptoms. A subgroup of the population finds many of their symptoms seem to improve on a dairy-elimination diet.

The take-home message is that if you suffer from sinusitis, it is worthwhile visiting your health-care practitioner or naturopathic doctor to get a thorough assessment. We discussed a number of different common causes of sinusitis, but not every presentation of sinusitis is the same. For some, it is due to nasal septum deviation while for others, it is due to chronic infections. The conventional treatments vary, but rely largely on decongestants and antihistamine medications as first-line treatments. If unsuccessful, this may escalate to more serious treatments like corticosteroids or even surgery. Naturopathic approaches include diet and lifestyle modification, such as dairy elimination or the use of a neti pot. We discussed a number of potentially useful supplements, like vitamin C, quercetin, bromelain, and zinc. They possess anti-inflammatory, antihistamine, and immune-stimulating properties. We recommend considering all of your options carefully and weighing the pros and cons of each before initiating anything new. The good news is that there are so many different options available that you can likely find at least one that provides effective and consistent relief of your symptoms.