Understanding sinusitis
Sinusitis is one of the most common diagnoses within primary care (7) and accounts for more antibiotic prescribing than any other condition or single diagnosis in the United States (6). Sinusitis can have marked effects on quality of life and is responsible for reduced workplace and school attendance by 3-4% and performance by 30-40%. Sinusitis, therefore, has a high economic burden with the condition and its related conditions occupying approximately one-third of primary care consultations (4). This highlights the importance of how valuable herbal medicine are for symptomatic relief and the treatment of sinusitis, especially in the treatment of viral and allergic sinusitis. They can also be a vital aid for our global burdened health systems in growing pandemic of antibiotic resistance.
Sinusitis is classified according to duration. This can be:
- Acute sinusitis – sudden onset, lasting less than 4 weeks with complete resolution
- Subacute sinusitis – a continuum of acute sinusitis but less than 12 weeks
- Recurrent acute sinusitis – four or more episodes of acute, lasting at least 7 days each, in any 1 year
- Chronic sinusitis – signs and symptoms persist 12 weeks or longer (8)
Most cases of sinusitis are due to viral pathogens with a resolution of symptoms for these acute cases being very favourable. Antibiotics or imaging may not be the necessary first port of call for clinical diagnosis or treatment for acute viral sinusitis (9).
How does sinusitis work?
Irritation and inflammation of the nasal passages and sinuses from infection or inhaled pollutants cause the cells lining (mucous membranes) of the respiratory tract to secrete extra mucus as a protective mechanism. This accumulates as catarrh and can predispose to sinusitis, which can be painful and cause headaches and postnasal drip, which in turn can cause recurrent throat and chest problems (1). This mucous membrane is a soft, moist, pink layer of cells that lines several passages and cavities in the body with openings that are exposed to the external environment and can be found in the digestive, respiratory, reproductive, and urinary tracts. As the sinus mucous is continuous with the nasopharynx (uppermost part of the throat), the microbiology of sinusitis overlaps with inflammation of the nose, throat, and inner ear.
The inflammation or swelling affects the tissue lining of the sinuses of which there are four paired cavities (spaces) located in the head. These paranasal sinuses are named after the bones that provide their structure.
With sinusitis, drainage of the sinuses is partially blocked, usually by congestion and mucosal swelling. This results in a stasis that allows a bacterial infection to take hold. Pain is caused by either negative pressure (due to absorption of the gases by the vasculature) or the positive pressure of mucosal congestion (3).
Understanding the root
Acute sinusitis is generally triggered by a viral upper respiratory tract infection, with 2% of cases being complicated by bacterial sinusitis (7) and approximately 90% of patients with colds having an element of viral sinusitis (8). It can be caused by allergens, irritants, viruses, fungi, and bacteria, with allergenic irritants such as animal dander, pollution, smoke, and dust (8).
Factors involved in the etiology of chronic sinusitis and catarrh include pollution, occupational dust exposure, tobacco smoke, adenoids, allergy (especially in children), rhinitis, cold and damp weather, dental problems, trauma, and flying. A deviated septum or other structural causes may be present (3). Chronic catarrh and sinusitis have also been linked to poor diet, food allergies, gut flora disturbances, and toxicity (1).
There is also a link to chronic sinusitis and the pathogenic fungus Candida albicans. A study in 1999 looked at a group of 210 chronic sinusitis suffers and collected mucous from the nasal cavities of each patient, and found that 96% of these patients had fungi present in their mucous. The researchers concluded that in patients with sensitivity to fungi, the presence of these fungal cells in the nasal cavity triggers an immune response that resulted in typical sinus infection symptoms (10).
Signs and symptoms
- Rhinorrhea (anterior or posterior) – commonly known as a runny nose
- Itching
- Sneezing
- Nasal obstruction – difficulty breathing normally through the nose
- Headache
- Cough
- Facial pain
- Poor olfaction – a loss or change in smell
- Disturbed sleep
- Pharyngitis – also known as sore throat
- Poor concentration and brain fog
- Postnasal drip
- Exacerbation of lower respiratory tract problems (4)
Herbal solutions
Herbs, which hold anti-infective and anti-microbial properties, are key in acute infection. Immune-stimulating herbs are an essential component in acute infection, but also important in recurrent and chronic conditions where a lowered immune system is often seen. Symptomatic relief for sinusitis usually includes anti-catarrhal, mucolytic and anti-inflammatory herbs. Demulcent herbs (that relieve inflammation and irritation), such as Marshmallow, Plantain, and Mullein, are useful to ensure that the herbal treatment isn’t too drying to the mucous membranes causing further irritation to the upper respiratory system. Herbs such as Calendula, Nettle leaf, Cleavers, Echinacea, and Solidago, help cleanse the lymphatic system of toxins and infection which otherwise can lead to excess toxins building up in the blood causing further congestion, inflammation, and a lowered immune system.
- Andrographis paniculata, is a bitter herb that has been used widely throughout Asia to enhance immunity and to treat a variety of chronic and acute infectious diseases. It has the additional benefit of supporting the liver and helping to protect it from damage from infections and toxins through its bitter action (1).
- Echinacea – Many herbalists use a combination of E.purpurea and E.angustifolia within their practice, but there is evidence that the less common Echinacea pallida, is specifically referred to for reducing the symptoms and lessening the duration of upper respiratory tract infections for both bacterial and fungal infections (12).
- Thymus vulgaris contains volatile oils that are highly antiseptic as well as a powerful anti-microbial (11), an anti-bacterial, and anti-fungal herb that is commonly used with infection particularly when the infection is in the respiratory system especially where this is characterized by excess levels of mucus, phlegm or catarrh.
- Baptisia tinctoria is a potent antimicrobial and is often used in preventing and treating infections of the ears, nose, throat, and chest through its anti-viral and antibacterial properties. It’s considered that antimicrobial herbs such as Turmeric, Garlic, Echinacea, and Wild Indigo are best combined with decongestant and astringent herbs as hot teas (1, 15)
- Horseradish – A.rusticana/C.armoracia are both indicated in cold, damp, and mucous-based conditions of the respiratory system such as excess mucous production characterized by coughing, sinusitis, chronic bronchitis, and chronic asthma. It will remove excess phlegm and stagnation by encouraging expectoration and acting as a decongestant (15).
- Ground Ivy – G. hederacea is a wonderful herb for both nasal and bronchial catarrh, specifically for sinusitis. It is a mucous membrane restorative, expectorant, and astringent for the upper respiratory system (2)
- Gallium aperine – A lymphatic tonic. G.aperine enhances lymphatic circulation, helping the body to cleanse, purify the blood and promote immune function. It is often used in conditions where there is lymphatic congestion (1).
Holistic solutions
- Nasal irrigation – Rinsing the nasal passages with a saltwater solution can help remove any excess mucous and irritants inside the nose, reducing inflammation and relieving sinusitis symptoms (14). Also known as a Jala Neti, it has a long tradition within Ayurvedic practices, where it is still a common practice performed using a teapot shape device called a neti pot.
- Essential oils used externally such as thyme, peppermint, rosemary, lavender or chamomile are good as inhalants, baths, or massages around the nose and sinuses (1,11). Steam inhalation containing anti-inflammatory and antimicrobial herbs such as tea tree, pine, or chamomile may be useful (3,15).
- Traditional Chinese Acupressure – In a 2002 study, The American Journal of Chinese Medicine found that subjects receiving acupressure treatment for sinusitis had significant improvement of both nasal and non-nasal symptoms (13). There are some excellent resources online that outline the non-invasive and effective techniques of using finger pressure at specific points.
- Lymphatic drainage and facial massage techniques can help relieve sinus pain by breaking up the mucous that collects in the sinus cavities, clearing the passageways, alleviating congestion and pressure to the neck and the face can help to decongest the painful swelling in the sinus mucous membranes and nasal cavity. Both these techniques are not recommended in the acute stages of infection without guidance from a professional.
- Supplements such as vitamin C and D, and probiotics (to support gut health) can also be beneficial in the treatment and prevention of sinusitis. Vitamin C is a powerful antioxidant, which helps to reduce damage to the cells of the body and supports immune cell function. Low vitamin D levels have been linked with conditions where there are high levels of inflammation such as sinusitis. Vitamin D is essential for a strong immune system, but it is advised to have your vitamin D levels checked before starting supplementation.
- Focus on a whole food anti-inflammatory diet. Gluten, dairy, and sugar increase mucosal production and excess phlegm leading to increased congestion and discomfort. Poor gut health and diet can exacerbate the condition and lead to overgrowth of Candida in both the digestive and sinus mucosal membranes. If you are concerned about gut health or candida overgrowth, please do see a herbalist who will be able to recommend an individual herbal approach and nutritional plan.
References
- McIntyre A. The Complete Herbal Tutor. 2nd ed. London: Aeon; 2019.
- Stableford A. Handbook Of Constitutional And Energetic Herbal Medicine. 1st ed. London: Aeon; 2020.
- Bone K, Mills S. Principles And Practice Of Phytotherapy. 2nd ed. Edinburgh: Churchill Livingstone; 2013:246.
- Scadding G. Rhinitis and Sinusitis. Clinical Respiratory Medicine. 2008:409-423. doi:10.1016/b978-032304825-5.10032-7
- Allied EMT. Sinusitis Image.; 2022. https://aentsc.com/wp-content/uploads/2020/08/sinuses_1155957880-1024×649.jpg. Accessed February 4, 2022.
- Smith S, Evans C, Tan B, Chandra R, Smith S, Kern R. National burden of antibiotic use for adult rhinosinusitis. Journal of Allergy and Clinical Immunology. 2013;132(5):1230-1232. doi:10.1016/j.jaci.2013.07.009
- DeBoer D, Kwon E. Acute Sinusitis. Ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK547701/. Published 2022. Accessed February 4, 2022.
- Battisti A, Modi P, Pangia J. Sinusitis. Ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK470383/. Published 2022. Accessed February 4, 2022.
- De Sutter A, Lemiengre M, Merenstein D, Young J, van Driel M. Antibiotics for clinically diagnosed acute rhinosinusitis in adults. Cochrane Database of Systematic Reviews. 2006. doi:10.1002/14651858.cd006089
- Ponikau J, Sherris D, Kern E et al. The Diagnosis and Incidence of Allergic Fungal Sinusitis. Mayo Clin Proc. 1999;74(9):877-884. doi:10.4065/74.9.877
- Sebeşan M, Cărăban A. Analysis of the Essential Oils from Thyme (Thymus vulgaris L) and from Peppermint (Mentha piperita L). Citeseerx.ist.psu.edu. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.551.1150&rep=rep1&type=pdf. Published 2008. Accessed February 4, 2022.
- Community Herbal Monograph on Echinacea pallida (Nutt.). Ema.europa.eu. https://www.ema.europa.eu/en/documents/herbal-monograph/superseded-community-herbal-monograph-echinacea-pallida-nutt-nutt-radix_en.pdf. Published 2009. Accessed February 4, 2022.
- Xue C, Zhang T, Zhang C, Da Costa C, Story D, Thien F. Effect of acupuncture in the treatment of seasonal allergic rhinitis: results from a randomised controlled trial. Integr Med Res. 2015;4(1):4. doi:10.1016/j.imr.2015.04.293
- Mari Egan J. Saline irrigation spells relief for sinusitis sufferers. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183918/. Published 2009. Accessed February 4, 2022.
- Yarnell E. The Botanical Approach to Chronic Sinusitis. Alternative and Complementary Therapies. 1998;4(2):109-111. doi:10.1089/act.1998.4.109
