Great Smokies Medical Center of Asheville

Chronic Sinusitis

By John L. Wilson, Jr., M.D.

Sinuses are hollow cavities in facial bones that are connected to nasal passages by narrow tubes that allow drainage. Sinuses help moisten, filter and warm the air we breathe. Symptoms of sinusitis (inflammation of the sinuses) may include a feeling of pressure, congestion and pain in the face particularly when bending over, headaches often just above or below the eyes, bad breath, fatigue, fever, toothache in upper jaw, post nasal drip, cough, and colored thick nasal secretion. Sinusitis becomes chronic when it lasts longer than 12 weeks. Antibiotics are prescribed in 84% of physician visits for sinusitis. In addition, decongestants, antihistamines, pain relievers, expectorants, and surgery are commonly prescribed to help patients obtain relief of their symptoms in the 46 million physician-visits annually for sinusitis.

Sinuses are lined by mucous membranes that can be sensitive to environmental exposures, including chemicals, fumes, smoke, pollens, animal danders, dust, dust mites, molds, and changes in atmospheric pressure, humidity, and temperature. Once irritated, the lining produces mucous in an effort to separate the irritant from the mucous membrane. The tissues become inflamed and swell, resulting in blocking the drainage of mucous from the sinuses and the stage is set for infection to develop. Serial Dilution Endpoint Titration, a method of allergy skin testing, can identify such allergic triggers, and sublingual (under the tongue) allergy serum is used in place of allergy shots to desensitize to those allergens. Neural therapy, a German form of acupuncture, as well as traditional Chinese acupuncture can be used to reduce the swelling and congestion of sinus membranes. Irrigating the nose and sinuses with a weak saline solution can be soothing and helpful in easing reactions to environmental triggers such as mold and dust. Allow the saline solution to flow passively-never use forceful irrigation. Adding a weak anti-microbial silver solution or antifungal drug such as nystatin to the irrigating saline solution can be helpful.

A recent study by Mayo Clinic found that 93% of sinus infections are caused by fungal infections, which makes sense as fungus or mold prefers a moist, dark, unventilated environment. Treating a fungal infection with antibiotics, which kill bacteria, can actually make a fungal infection worse. Instead, addressing the sinusitis with a decrease in dietary sugar intake, environmental control of molds, and antifungal herbs or drugs may likely be more successful.

Both indoor and outdoor air pollution can contribute to sinusitis. So much is known and apparent in the media about outdoor air pollution, that the fact that indoor air is often more polluted than outdoor air is forgotten. Wherever chemical exposures come from, one’s exposure can often be determined by identifying one’s work or home exposures. Although avoidance is the preferred treatment to the problem of poor air quality, HEPA air filtration and masks can be very helpful when avoidance is not possible. Air filtration is especially important and effective in the bedroom where most people spend roughly a third of their lives.

Imbalances in the microbes living in the intestine (overgrowth of yeast or harmful bacteria, or lack of beneficial healthy bacteria) can also contribute to sinusitis by stressing the immune system. A stool test, Comprehensive Digestive Stool Analysis, identifies such imbalances. The use of antifungal herbs and drugs can be used when combined with dietary sugar reduction and other steps to improve the quality of the diet. Boosting the immune system with nutritional supplements such as Vitamin C, transfer factor, thymus, or herbs such as Echinacea, Goldenseal, or Astragalus can also be helpful.

One of the hidden causes of chronic sinus congestion is food allergy. Many people will develop sinus symptoms as a result of an allergic reaction to foods-especially dairy products, wheat, corn (including corn starch, corn sugars, etc), or yeast. Adverse reactions to foods are often “masked” so the sinusitis sufferer is clueless to what may be keeping them sick. Click on Elimination/Challenge Diagnostic Diet for a simple at-home method for testing food allergies.

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