Sinusitis
Sinusitis is an inflammation of lining of the sinuses. Sinuses are hollow spaces in the bones around the nose that connect to the nose through small, narrow channels. Sinuses implicated in sinusitis are located over the cheekbones, on the sides of the nose, and above the eyebrows. When the channels connecting the sinuses to the nose are open, air from the nose enters into the sinuses and mucus made in the sinuses drains out through the nose. When these channels are blocked due to increased mucous production or inflammation of the tissues, symptoms such as pain, headache, nasal discharge and facial pressure can result. Fever, weakness, cough, sore throat, nasal discharge and chest congestion may occur if the sinuses become infected. Sinusitis in general can be caused by viral or bacterial infection, allergens, air pollution, or structural issues such as narrow sinus passages or nasal polyps. People with asthma, immune disorders, allergies, and cystic fibrosis may be more likely to develop sinusitis.
Types of Sinusitis
Acute sinusitis lasts less than three weeks while symptoms of chronic sinusitis lasts three weeks or greater. Both acute and chronic sinusitis can become recurrent. Acute sinusitis is usually triggered by an infection such as the common cold, by transfer of bacteria from a dental infection, or allergic response. Chronic sinusitis may be triggered by viral infection, but often is the result of structural abnormalities which decrease flow of air and mucous, and/or repeat exposure to allergens such as mold or dust. These irritants cause continued inflammation within the sinus tissues and the release of chemicals such as histamine which further inflame and swell the lining of the sinuses. This in turn causes blockage of mucous and increases the likelihood of infection. Sinusitis is sometimes caused by fungal infections. Non-allergic rhinitis/sinusitis may cause similar symptoms, but may be triggered by diet, hormones, different drugs and chemicals, as well as viruses or bacteria. This type of rhinosinusitis, also called vasomotor sinusitis, results in swelling of the blood vessels in the nose and sinuses which may then produce stuffy nose for some, runny nose for some, pain, and increase mucous production and obstruction.
Sinusitis is diagnosed by a physician through physical examination to evaluate congestion and drainage in the sinuses, nose, throat, and chest, as well as assessment of other symptoms of sinusitis such as headache, fever, etc. If viral or bacterial infection is suspected, blood work may be done to examine the immune response. If symptoms are severe, do not resolve, or recur frequently, a consult to an Otolaryngologist may be made. This doctor may order scans such as a CT scan to look at the tissue of the nose and sinuses, and may look into the nose and sinus area through a procedure called a rhinoscopy (the insertion though the nose of a small, flexible tube with a camera attached). Other tests or procedures may be ordered to rule out diseases which increase the likelihood of sinusitis, such as allergies, immune disorders, or cystic fibrosis.
If You Have Been Diagnosed with Sinusitis
Acute sinusitis may be treated with medications to shrink the swelling of the sinus lining, to decrease mucous production, and control the pain associated with sinusitis. Antibiotics are sometimes indicated, but should be used with caution to prevent antibiotic resistant bacterial growth. Chronic sinusitis is sometimes treated with long-term antibiotic use. Other treatments to relieve symptoms may be recommended, such as nasal lavage, getting adequate rest, staying hydrated, and applying warm packs over painful areas of the head and face. If allergies or sensitivities trigger symptoms, avoidance of these substances may be required.
Chronic Sinusitis may present with similar symptoms as acute sinusitis. If viral or bacterial infection is triggering chronic sinusitis, the above treatment protocol may be utilized to decrease the immediate symptoms. Other medical treatment protocols may also be utilized to treat chronically inflamed sinus lining. If persistent or recurring symptoms are due to structural abnormalities, surgery may be recommended.
Fungal Sinusitis may be treated with a combination of surgical procedures and/or antifungal medications. Treatment of non-allergic sinusitis involves avoiding triggers, nasal lavage, certain medications and/or surgical procedures.
A Whole Health Perspective
Looking at Sinusitis through a Whole Health model, we explore the individual’s unique presentation from the 5 Aspects of Whole Health™ perspective.
1. Physically – The major function of the sinuses in the face/head is to produce a layer of mucous which protects the nose from allergens, irritants, viruses, and bacteria and to heat and humidify inhaled air. Inflammation of the lining of the sinuses and blocked mucous can produce symptoms of sinusitis. Inflammation can be caused by multiple factors, but some of the most common are viruses, bacteria, allergens and other irritants such as air pollutants. The nose and sinuses are part of the initial immunological response to inhaled invaders such as viruses and bacteria, and play a part in mounting an immune response to eradicate these foreign substances. Keeping the lining of the sinuses healthy and responsive can assist in proper function of the sinuses/nose and in appropriate immune response. Some techniques for keeping sinuses healthy include nasal lavage, adequately hydrating, using a humidifier to combat dry air, breathing in steam, washing hands frequently, and avoiding allergens and pollutants (such as cigarette smoke). Those with sinusitis affected by allergens may be referred to an allergist to determine how to diagnose and treat the allergy. For those with non-allergic rhinitis/sinusitis, identifying and avoiding common triggers may alleviate symptoms. These may include hormonal changes, especially for women, foods, strong scents, certain medications, changes in temperature or barometric pressure, emotional or physical stress, and environmental pollutants.
Because the nose and sinuses are part of the immunological response system, supporting the immune system is important, especially in cases of chronic sinusitis. Stress, such as a job change, relationship difficulties, or chronic illness, may cause dysfunction of the immune system. Modulating the stress response, therefore, may positively affect the immune system and sinus health. Adequate amounts of sleep, both to support the immune system and to recover from illness, are important for the healing process.
Some research exists suggesting that acupuncture may assist in the modulation of the immune response associated with upper airway dysfunction, as well as reduce symptoms such as pain. Traditional Chinese herbal medicine may also be useful. Certain homeopathic treatments suggest a possible link between natural substances and symptom reduction in rhinosinusitis.
2. Chemically/Nutritionally – Foods and chemicals ingested can impact health and wellness. Certain food, especially those one may be allergic to such as milk, can increase the risk of sinusitis. Determining and avoiding food allergens may reduce symptoms. Good health in general is supported with a nutrition plan that minimizes processed foods and foods high in sugar, triglycerides, and chemical additives. Proper nutrition supports the immune system, which is implicated in the presentation of sinusitis. During times of illness, to appropriately support the body’s healing process and reaction to the stress of illness, attention to particular vitamins and mineral is important. These include cholesterol, protein, vitamins A, C, E, and B complex, essential fatty acids, and essential minerals. Some research suggests a beneficial link between Vitamin D and sinus health. The gastrointestinal tract houses a large portion of the body’s immune system, and keeping the biome of the gut intact and healthy may play a part in the body’s ability to fight off foreign substances which could elicit sinusitis. Proper nutrition as well as supplementation with pre and probiotics can assist in healthy gut microbiome as well as the microbiome of the upper respiratory tract.
3. Emotional – Emotional responses communicate to the immune system, via chemicals called neuropeptides and neurotransmitters and through the adrenal glands (glands which respond to stressors and then biochemically communicate with other organs and tissues). Research indicates that engaging in positive emotional response affect the inflammatory response and immune system (part of the pathogenesis of sinusitis). Psychological and physical stress, and the associated emotions, may negatively affect symptoms of sinusitis. During a flare of acute or chronic sinusitis, certain relaxation practices, such as diaphragmatic breathing, mindfulness, meditation, or gentle yoga can be utilized to reduce the stress response. Other breathing techniques, such as alternate nostril breathing, can positively affect the stress response and immune system, and can be practiced when the respiratory tract is not congested. Discussing difficult emotions, such as anxiety, frustration, anger, or grief, with a mental health practitioner may be helpful, as will finding supportive relationships.
4. Environmental – Environmental triggers of sinusitis (acute and chronic) may include air pollutants such as cigarette smoke, mold, dust mites, common airborne allergens such as pet dander, and exposure to viruses or bacteria. Those with vasomotor rhinosinusitis may also notice increased symptoms upon exposure to the above substances, as well as changes in temperature or barometric pressure. Exercise can regulate the immune system, but should be practiced moderately to decrease further physical stress. Moderate exercise may also relieve some nasal and sinus stuffiness through constriction of the blood vessels. Other environmental factors, such as a stressful job, may increase symptoms through their effects on the adrenal gland stress response and immune system. Alleviating exposure to environmental triggers and stress could possibly result in symptom reduction.
5. Beliefs, Values and Worldview – also identified as Spirituality – Spiritual expression, whether through prayer, meditation, yoga, traditional worship, etc. has an influence on health and wellbeing, often by encouraging an understanding and connection between mind, body, and spirit. Possible feelings of isolation, living in discordance with one’s values, or inability to connect with support and the natural surroundings due to illness or other factors could increase stress and exacerbate symptoms.