Sinusitis refers to inflammation of the sinuses, which is generally caused by
an infection (viral, bacterial, or fungal). The sinuses are air-filled spaces
around the forehead, cheeks, and eyes that are lined with mucous membranes.
Healthy sinuses are sterile (meaning that they contain no bacteria or other
organisms) and open, allowing mucus to drain and air to circulate in the nasal
passages. When inflamed, the sinuses become blocked with mucus and can become
infected. Each year, over 30 million people (adults and children alike) get
sinusitis in the United States at some point. Sinusitis can be acute (lasting
anywhere from 2 to 8 weeks) or chronic, with symptoms lingering even longer than
Signs and Symptoms
The classic symptoms of acute sinusitis are listed below. These symptoms
usually follow a cold that does not improve, or one that worsens after 5 to 7
days of symptoms.
Nasal congestion (rhinitis)
Nasal discharge (yellow or green)
Postnasal drip (a sensation of fluid dripping down the back of your
throat, particularly at night or when lying down)
Headache, often described as a pressure-like pain
Pain behind the eyes
Cough, often worse at night
Sore throat (pharyngitis)
Fever (may be present)
Loss of smell
General sense of not feeling well (malaise)
Symptoms of chronic sinusitis are the same as acute cases of sinusitis, but
are milder and last longer than 8 weeks. Chronic sinusitis is most common in
people who have allergies.
Sinusitis typically follows an upper respiratory infection (for example, the
common cold) or an allergic reaction (like hay fever, also called allergic
rhinitis). These can cause inflammation and swelling that prevents the sinuses
from draining properly. This makes the sinuses a great place for organisms like
bacteria, viruses, and fungus to live and grow rapidly.
Other common causes for sinusitis include the following:
Changes in atmospheric pressure (for example, from swimming or
climbing high altitudes)
Infections from dental problems
Disease or an abnormal structure in the sinus area (such as nasal
polyps, deviated septum, or nasal bone spur)
Physical injury to the sinuses
Bacteria, viruses, and fungi
Poorly treated recurrent cases of sinusitis can cause chronic
Young age or old age—the very young and very
old are most at risk for serious upper respiratory tract infections and for
complications from them
History of asthma
Overuse of nasal decongestants
Frequent swimming and/or diving
Climbing or flying to high altitudes
Nasal polyps (swellings in the nasal passage) or nasal bone spurs
(projections of bone in the nose); nasal or facial tumors; or other structural
abnormalities such as a deviated septum or cleft palate
Conditions that compromise your immune system such as human
immunodeficiency virus (HIV), being on immunosuppressive medications (for
example, following an organ transplant), or cancer, especially if you are
People with one of a number of diseases that prevent the cilia (hairs
that line the sinuses and help remove mucus) from working properly are also at
risk. These diseases include: Kartagener's syndrome, cystic fibrosis, and
immotile cilia syndrome
Exposure to air pollution and cigarette smoke
Gastroesophageal reflux disease (GERD), a disorder in which the acid
from the stomach backs up into the esophagus
Hospitalization, especially if the reason you are in the hospital is
related to a head injury or you needed a tube inserted into the nose (for
example, a nasogastric tube from your nose to your
Your health care provider can generally make the diagnosis of sinusitis from
your history (that is, asking you a series of specific, appropriate questions)
and by examining you, with a focus on the sinuses and upper respiratory system.
The simplest way to test for sinusitis is by percussing (tapping) or pressing
over your sinuses (that is, on the forehead and cheekbones). If those areas are
tender, there is likely to be inflammation and there may be an infection.
Transillumination (shining a light through the sinuses) is another simple method
that your doctor may use to test for sinus inflammation; if the light does not
shine through, this indicates congestion.
If the diagnosis is not entirely clear, if an acute infection recurs, or if
your symptoms have been ongoing (chronic), then additional tests that your
doctor may consider include an xray, CT scan, or magnetic resonance imaging
(MRI). Sometimes, a referral to a specialist (known as an Ear Nose and Throat
(ENT) doctor [also called an otolaryngologist]) is necessary. This specialist
may perform a rhinoscopy (also called nasal endoscopy) using a fiber optic scope
to look at your sinuses or a sinus puncture to test for different organisms that
may be causing your sinusitis.
The best way to prevent sinusitis is to avoid and, if unavoidable, quickly
treat any flus or colds. Methods for trying to avoid getting the flu or a cold
Influenza immunization annually
Washing your hands frequently, particularly after shaking hands with
Eating plenty of fruits and vegetables; these foods are rich in
antioxidants and other important food chemicals that are thought to boost your
The goals of treatment for sinusitis are to alleviate symptoms by reducing
inflammation and to cure the infection. The latter requires the use of
Medications) to get rid of bacteria and
other organisms. To lessen inflammation, on the other hand, there are many
possible methods ranging from using a humidifier (see section entitled
surgical drainage. Several dietary
herbs may help prevent colds, shorten the
duration of your cold or flu, or work together with antibiotics to treat your
infection and support your immune system. How well many of these substances work
can be very individual; talk to your doctor about safety and
In addition, like many individuals, you may experience a significant
improvement in sinusitis symptoms from
homeopathy, especially if your symptoms
The following measures can help reduce the congestion in your
Use of a humidifier
Saline nasal spray
Inhaling steam 2 to 4 times per day (for example, sitting in the
bathroom with the shower running)
Antibiotics are prescribed if a bacterial infection is present or
suspected. Commonly used antibiotics for sinusitis include:
amoxicillin with clavulanic acid
trimethoprim with sulfamethoxasole
Treatment of acute sinusitis generally requires 10 to 14 days of antibiotics.
Use of antibiotics for chronic sinusitis requires longer treatment
- usually 3 to 4 weeks.
Decongestants—are used to relieve symptoms;
these come in nasal (for example, oxymetazoline, pheylephrine, and
xylometazoline) or oral (namely, pseudoephedrine, phenylpropanolamine) forms.
The problem with nasal sprays is that they can promote dependency and "rebound"
congestion (congestion that worsens if the spray is used for a prolonged period
of time); therefore, nasal decongestants should not be used for longer than 3 to
5 days in a row, unless specifically instructed by your doctor. Also,
decongestants can cause constriction of blood vessels and, therefore, should not
be used if you have heart disease, high blood pressure, migraines, or Raynaud's
disease; you should also not use decongestants if you have difficulty urinating
(for example, from an enlarged prostate), have emphysema, or take certain
medications such as antidepressants.
Nasal steroid spray— decrease inflammation,
especially if you have allergies or a structural problem contributing to the
inflammation (like a nasal polyp). Examples of this group of medications
includes beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and
triamcinolone. Occasionally, for chronic sinusitis, a short course of oral
steroids may be recommended by your doctor.
Other medications that may be used under the appropriate circumstances
include anti-fungals (in addition to
surgery) and anti-histamines (if allergies
are contributing to the problem).
Surgery and Other Procedures
To treat fungal sinus infections, surgery is needed, along with anti-fungal
medictaions. If you continue to have recurrent episodes of sinusitis, despite
appropriate medicines and other treatments, surgical drainage by an ENT
specialist may be recommended. Surgery may also be necessary to repair the
following structural problems if less invasive methods do not relieve symptoms
Nutrition and Dietary Supplements
Because supplements may have side effects or interact with medications, they
should be taken only under the supervision of a knowledgeable healthcare
Bromelain and Quercetin
Although not all experts agree, bromelain supplements may help reduce nasal
mucus associated with sinusitis. Bromelain is approved by the German Commission
E for the treatment of sinus and nasal swelling following ENT surgery.
Often, bromelain is used together with quercetin, a flavonoid (plant pigment
responsible for the colors found in fruits and vegetables) that has
anti-histamine properties and is, therefore, helpful if your sinus symptoms are
related to allergies.
Lactobacillus species (probiotics, or "friendly" bacteria) can be a useful
adjunct for the treatment of respiratory infections such as sinusitis and for
reducing your chances of developing allergies.
Cysteine is an essential amino acid found in many proteins. N-acetylecysteine
(NAC), a modified form of cysteine, appears to reduce inflammation in mucus
membranes, such as that seen with sinus congestion. Theoretically, therefore,
taking an NAC supplement may help reduce symptoms of sinusitis. This theory
needs scientific study before specific recommendations can be made.
Vitamin C is often touted as a help to prevent colds. If this is true, then,
in theory, taking vitamin C during cold and flu season might help prevent the
development of sinusitis. Despite the popular belief that vitamin C can cure the
common cold, however, the scientific evidence supporting this conviction is
More specifically, there have been a few studies suggesting that taking large
doses of vitamin C supplements at the onset of cold or flu symptoms, or just
after exposure to someone else with a cold or the flu, can shorten the duration
of the illness or ward it off altogether. However, the majority of studies, when
looked at collectively, lead researchers to conclude that vitamin C does not
prevent or treat the common cold.
Some experts suggest that vitamin C may only be useful in case of a cold if
you have low levels of this nutrient to begin with. Another possibility is that
the likelihood of success may be very individual - some
improve, while others do not. If you are amongst the 67% of people who believe
that vitamin C is helpful for your colds, there may be power in your conviction.
In other words, your experience is probably more important than what the
research is stating. Talk to your doctor about any pros and cons with regards to
using vitamin C during cold and flu season.
Zinc supplementation enhances immune system activity and protects against a
range of infections including colds and upper respiratory infections (like,
possibly, sinusitis). Several studies have revealed that zinc lozenges can
reduce the intensity of the symptoms associated with a cold and the length of
time that a cold lingers. Similarly, nasal zinc gel seems to shorten the
duration of a cold while zinc nasal spray does not. If you use zinc lozenges or
nasal gel when you have a cold, therefore, you may shorten the duration of your
symptoms and lessen the likelihood of developing sinusitis.
The use of herbs is a time-honored approach to strengthening the body and
treating disease. Herbs, however, contain active substances that can trigger
side effects and interact with other herbs, supplements, or medications. For
these reasons, herbs should be taken with care and only under the supervision of
a practitioner knowledgeable in the field of herbal medicine.
Barberry (Berberis vulgaris) and Goldenseal (Hydrastis
Barberry and goldenseal have very similar therapeutic uses because both herbs
contain active substances called berberine alkaloids. These substances can help
combat infection, stimulate the activity of the immune system, and lower fever.
Goldenseal is endangered; therefore, use of barberry is preferred.
Echinacea is used by many herbalists to treat infections like sinusitis. In
addition, there is a good amount of scientific evidence that supports the use of
this herb to treat the common cold. By shortening the duration of a cold,
echinacea may help stop you from getting sinusitis.
Ephedra (Ephedra sinica)
The decongestant pseudoephedrine is a synthetic version of this herb that has
been used traditionally to treat upper respiratory infections. The World Health
Organization supports the use of ephedra as part of treatment for the common
cold, hay fever, and sinusitis. Because of some serious risks associated with
this herb (like stroke and irregular heart rhythm), use of ephedra should only
take place under strict guidance and supervision by an herbal specialist and
physician and only for short periods of time.
Eucalyptus (Eucalyptus globulus)
Laboratory studies show that eucalyptus oil has strong antibacterial
properties. Studies in animals and test tubes also found that eucalyptus oil
acts as an expectorant (loosens excessive mucus in the respiratory passages) and
antiseptic (prevents infection). Eucalyptus leaves may reduce fever. Herbalists
recommend the use of fresh leaves in teas and gargles to soothe sore throats and
ease symptoms of sinusitis, although children should not ingest eucalyptus.
Although studies of acupuncture for sinusitis are lacking in the English
medical literature, acupuncturists report lots of success in treating this
condition. Acupuncturists usually describe sinusitis as "dampness" which creates
inflammation and congestion in the mucus membranes. This dampness is cleared by
strengthening the spleen meridian and by working with the stomach meridian.
Practitioners often perform needling therapy and/or moxibustion (a technique in
which the herb mugwort is burned over specific acupuncture points) for this
condition. Acupuncturists with specialized training may also recommend herbal
Although no studies have examined the effectiveness of chiropractic for
sinusitis, some practitioners suggest that manipulations by a well-trained
chiropractor may decrease pain and improve sinus drainage in certain
There have been few studies examining the effectiveness of specific
homeopathic remedies in general. In one study of homeopathy for sinusitis,
however, more than 80% of the 119 participants had significant improvement in
their symptoms after taking the homeopathic remedy for 2 weeks without
antibiotics or other medications. Professional homeopaths may recommend one or
more of the following treatments for sinus congestion based on their knowledge
and clinical experience. Before prescribing a remedy, homeopaths take into
account a person's constitutional type. In homeopathic terms, a person's
constitution is his or her physical, emotional, and intellectual makeup. An
experienced homeopath assesses all of these factors when determining the most
appropriate remedy for a particular individual.
Hepar sulphuricum — for the later
stages of sinus inflammation when the pain is concentrated between the eyes and
is worsened by cold or motion; nasal discharge tends to be thick and the
individual may experience sensitivity of the scalp
Kali bichromicum — this remedy is
considered the first choice homeopathic treatment for sinusitis; it is most
appropriate for individuals who have pain between the eyes or in the forehead
above one eye; nasal discharge is generally stringy; scalp and facial bones are
tender to touch and the person may feel dizzy or nauseated; pain is worse around
noon and with cold and motion, but improves with warmth and pressure
Mercurius — for sinusitis with thick,
green, foul-smelling nasal discharge which may be blood tinged; there may also
be a gripping pain around the head extending to the teeth; persons for whom
Mercurius is appropriate have symptoms that worsen with open air,
sleeping, eating, drinking, and extreme hot or cold; they may also have
difficulty regulating their temperature (the individual often fluctuates from
feeling cold and chilled to hot and sweaty)
Pulsatilla — for individuals who have
a thick, bland, yellow or greenish discharge that is often accompanied by nausea
and indigestion; symptoms tend to improve with cool air, pressure, and cool
compresses; symptoms worsen when the individual is lying down, especially in a
warm room; this remedy is appropriate for individuals who are distinctly not
thirsty and require tremendous comforting
Silicea — for individuals with chronic
congestion accompanied by head pain that tends to be worse in the right eye;
this pain is worsened by cold, movement, light, noise, and mental concentration
(such as when studying) but relieved by heat and pressure
Spigelia — for sinusitis with sharp
pains on the left side of the face, generally coming on after exposure to cold,
wet weather; symptoms are aggravated by warmth, light, noise, and movement, but
are relieved by cold compresses or cool water on the face and when the
individual is lying down with the head propped up
If you are not better in a few weeks, you may be sent to an ENT specialist
for tests to find the cause of your sinus infection.
Sinusitis often acts up during pregnancy. There are many herbs and
medications that pregnant and breastfeeding women should not use. Please check
the monographs on individual herbs and drugs discussed in this article to know
which are safe and which are not. Also, check with your doctor before using any
herbs or supplements.
Warnings and Precautions
Some serious diseases are caused by sinusitis or can have similar symptoms.
Be sure to see your health care provider if you are not feeling better or have
new symptoms. Tell your provider if you may be pregnant.
Prognosis and Complications
Sinusitis is generally a very curable condition. When you are having
recurrent attacks, you should be evaluated for underlying causes (such as nasal
polyps or another structural problem). Although very rare, complications that
may arise include:
Osteomyelitis - infection that spreads to the
bones in the face
Meningitis - infection that spreads to the
Orbital cellulitis - infection that spreads
to the area surrounding the eye
The bacteria causing your sinusitis may develop resistance to
antibiotics commonly used to treat the infection; this makes it more difficult
to find the best treatment for your sinus infection.
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Review Date: June 2003
Reviewed By: Participants in the review process include: Jacqueline A. Hart, MD,
Department of Internal Medicine, Newton-Wellesley Hospital, Boston, Ma and
Senior Medical Editor A.D.A.M., Inc.; Anne McClenon, ND, Compass Family Health
Center, Plymouth, MA; Marcellus Walker, MD, LAc, (Acupuncture section October
2001) St. Vincent's Catholic Medical Center, New York, NY; Eric Wellons, MD,
Department of Surgery, Union Memorial Hospital, Baltimore, MD; Leonard Wisneski,
MD, FACP, George Washington University, Rockville, MD; Ira Zunin, MD, MPH, MBA,
(Acupuncture section October 2001) President and Chairman, Hawaii State
Consortium for Integrative Medicine, Honolulu,
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