In Part 1 of sinusitis, we looked at what sinuses were, the signs and symptoms of sinusitis, some of the causes and conventional treatment. In this issue, we will discover some of the most effective treatments I have found to work for sinusitis. As I mentioned in Part 1, chronic recurring sinus infection is something a lot of people can relate to, and thank you to all who contacted me - wanting to know when Part 2 of this article was coming out. This tells me just how prevalent sinusitis really is, it literally is an epidemic - how many people do your hear sniffing and snorting, some in spring, whilst others almost permanently seem to need handkerchiefs. One look at TV in springtime will also tell you that the drug companies have it all worked out too, for this is the time of year that sinusitis, hayfever and allergies are at their peak.

In Part 1 of sinusitis, we looked at what sinuses were, the signs and symptoms of sinusitis, some of the causes and conventional treatment. In this issue, we will discover some of the most effective treatments I have found to work for sinusitis. As I mentioned in Part 1, chronic recurring sinus infection is something a lot of people can relate to, and thank you to all who contacted me - wanting to know when Part 2 of this article was coming out. This tells me just how prevalent sinusitis really is, it literally is an epidemic - how many people do your hear sniffing and snorting, some in spring, whilst others almost permanently seem to need handkerchiefs. One look at TV in springtime will also tell you that the drug companies have it all worked out too, for this is the time of year that sinusitis, hayfever and allergies are at their peak.

Chronic sinusitis is probably one of the most common chronic diseases in many developed countries in the world today, including Australia. Like most immune related complaints, its incidence has been increasing steadily over the last decade. Research from America a few years ago revealed that our immune systems are reducing in efficiency at the rate of between 1 - 3 % each year, depending on where you live. I think this is a reflection of the population increase on Earth, global warming and more.

For a more detailed description of what the sinuses are, the signs and symptoms and some of the causes, please refer to Part 1 in last month's edition. Like many chronic conditions that may develop in your body, the trick is to never give up!  You will have heard me say this on more than one occasion. It is all too easy to just go to the doctor and take a drug for your sinus complaints - but you have learned really nothing. And, do you really think you have fixed the problem?  Not really - you have only suppressed the symptoms, the condition will come back with a vengeance when you stop these drugs or nasal sprays, and like millions of sinus sufferers, you will probably just come to rely on drugs to help you through certain times of the year, and make it worse in the long run. Think about it like this - does it not make more sense to try to get to the bottom of your problems, whether they be financial, health or whatever? How long can you just go on "taking something" to sort a problem that really is driving you crazy? To me it is like continually seeking credit when you have financial problems, something has to break sooner or later - and it's usually you. You would be surprised at just how much your sinusitis can drag the quality of you life down. This condition can really affect your sleep, your energy, and even your moods. Just ask your friends and family, with all that sniffing, coughing, and pain you endure, all those around you who have to endure it as well.

The other point is - drugs will cause secondary complaints sooner or later, then you still have the sinus plus more than you bargained for. I never said it was going to be easy to solve your sinus problems, but you can get on top of this complaint eventually. Just imagine how good really you could feel... no more painful sinus or endless congestion. Well it can happen, but it will take time. The first step you need to take is to lessen your dependence on those drugs, to give your body's beleaguered immune system a chance to recover. While I have never seen a case of sinus resistant to treatment, I have seen quite a few patients resistant to treatment!

The Conventional Approach

Research scientists at the Mayo Clinic, one of the leading research institutes in America, found out something quite interesting about recurrent chronic sinusitis late last year: Dr. Ponikau of the Mayo Clinic: "Conventional pharmaceutical medications haven't worked for chronic sinusitis because we didn't know what the cause of the recurring problems were, but today we know different. Thousands of kinds of single-cell fungi (molds and yeasts) are found everywhere in the world. Fungal spores (the reproductive part of the organism) become airborne like pollen, and many people develop allergies to fungi". The new evidence from the Mayo study suggests that many people develop an immune response to these fungi - like a mild, moderate or even a very strong reaction.

Conventional medical treatment of sinusitis includes antibiotics and corticosteroids, with additional care generally involving decongestants and antihistamines. Surgical drainage by endoscopy of the sphenoid, ethmoid, and maxillary sinuses may be recommended to help restore the clearance of mucus and normal airflow.

Although antibiotics are often used in the treatment of recurrent sinusitis, they have been shown to offer no advantage over a placebo in acute sinusitis at all, so don't waste your time here. A 2006 Cochrane Review of 49 clinical trials reported insignificant cure rates across all antibiotic classes. Oral corticosteroids are commonly given for 2-4 weeks to blunt the inflammatory response. Because sinus infections often come back, stronger types of antibiotics (the nuclear bomb - broad-spectrum antibiotics) are used for these chronic sinus infections. And to me - this is a bit like what President Bush is trying to achieve in Iraq - keep sending in more troops in the hope that the "enemy will be conquered", well it didn't work in Vietnam, and it won't work in Iraq either. You can drop all the bombs you want, send in all the soldiers. But sometimes you don't even know who just exactly who the enemy are or where they are lurking.  They certainly underestimated the Viet Kong in Vietnam; the enemy dug themselves into trenches and just outsmarted the US soldiers because they knew their terrain. This is like drug therapy for sinusitis, the fungus knows its sinus terrain, and we have only just discovered what we think actually may be the cause. Sinus drug treatment all sounds good in theory, but the results just aren't there long term and the cost to human suffering (a wrecked digestive system and "leaky" gut) are too great to make it worth while to continue. Louis Pasteur, the scientist who discovered the process by which we eventually learned about vaccination said at the end of his days that it was more important to actually look at the terrain (the body) and to build up the host's resistance (the immune system), rather than try to "kill the germ". This man was more than qualified to know, he received microbiology's highest achievement by earning the Leeuwenhoek medal in 1895.

Nasal polyps

Nasal polyps are a common finding in late-stage chronic sinusitis.

• A French study investigated four patients with nasal polyps for allergies to Candida albicans, then treated all four with Candida antigen Immuno-therapy (homeopathy). Symptomatic improvements of 60-80 percent were seen, as well as a reduction in viral triggers and seasonal symptoms strains.
• I have found over the years that the homeopathic medicine called Teucrium (a kind of thyme) in a low potency like 6c works for many people, especially when given daily for months on end. This is particularly so when the person has an almost continual post nasal catarrh.
• The other interesting thing about nasal polyps is that there could be an allergy to salicylates, a naturally occurring compound in various plants which is like a natural aspirin, and helps the plant with invading organisms. Ask your naturopath about this possibility; you may need to go onto a salicylate free diet approach for a few weeks to find out if this is your problem.

Nasal Irrigation

I have found the following treatment most beneficial for many patients with sinusitis. When you first try nasal douching, you may find it uncomfortable because you are not used to drawing fluids in through the nostrils. But I can assure you, once you do get used to it, you will find almost certain relief, and with more experience, you can experiment by adding to the glass of water a drop or two of potassium iodide (providing you are not allergic to this!),  or tea tree oil (but you will need the "water miscible" type). I have tried with some patients, and can really vouch for the addition of a drop or two of this form of tea tree oil to the saline irrigation. Small amounts of powdered herbs like Goldenseal or Barberry can also be added to irrigation protocols. (from a capsule) These herbs exert antibacterial, antifungal, and anti-inflammatory effects. Why use steroidal nasal pumps or sprays, which suppress your immune system, when nasal douching works just as well, if not more effectively? Irrigation of the nasal mucosa with a saline solution facilitates the removal of mucoid secretions and cleanses associated nasal tissues. Irrigation with a 1-percent saline solution produces a significantly better mucus clearance, and results in significant reductions in nasal histamine concentrations for up to six hours after. Numerous studies support adjunctive use of nasal irrigation in sinusitis.

1. Observe the colour of the nasal or phlegm discharge. If it is clear, proceed to the next step. Any discolouration, usually green or yellow, visit your practitioner (herbalist or naturopath) for a course of natural antibiotic treatment. If it remains coloured continually, visit again to change the treatment.           

2. Begin rinsing your sinuses in the following manner

• Dissolve 1/4 teaspoon of pure sea salt (no additives, use Himalayan or Celtic salt) in a glass of warm tepid clean water (if any question of the water purity, use tepid filtered or bottled). 
• Apply the open top of the glass to the upper lip as it meets the nostrils and tilt the head back  allowing the water to run into both nostrils. In this position, sniff the solution up through the nose, and out through the mouth.  
• When done, bend the head into the washbasin and gently blow out the contents of the nose.Observe the colour of the discharge. Empty the glass in this manner and repeat until discharge is clear.
• This rinsing should be done (at the very least) morning and night and for better results at various times throughout the day if consecutive washings are discoloured. The aim is to have consecutive washings produce a clear discharge. When discharge remains clear, reduce the frequency to twice daily.
• This procedure is comfortable, provided the concentration of salt solution approximates just under 1%. Too low concentration may produce a little pain. Too high produces an astringent salty taste.
• Rinsing should commence immediately with the onset of any cold symptoms particularly with an itchy throat and in many cases, no further treatment is required. Nasal irrigation is a simple, inexpensive treatment that is well tolerated, effective, and could help minimise antibiotic use.
• Nasal irrigation 3 times daily has been suggested to relieve a variety of sinus and nasal symptoms.

Your diet

Naturopaths will generally tell you that some foods are more mucus forming than others, and while it is certainly true reduce these foods during sinus, there is more to it as well with this condition.

• Many foods which contain proteins (milk, banana, egg, etc; could be causing an underlying food-allergy. This could very well been the case if you have come to be reliant on broad-spectrum antibiotics. Your digestive system may have become somewhat "leaky", which could be allowing partially digested protein to interact in a complex fashion with your immune system in your small intestine.
• Starchy or sweet foods like flour, bread, banana, processed foods, pizza, chocolate, etc; may not be broken down adequately by your digestion - again causing a complex interplay between your immune system and your gut.

• Poor food combining can lead to sinus. Combinations such as a steak and vegetable meal followed by two scoops of ice cream and jelly, or what about a glass of wine (sugar) and crackers and cheese. Combinations such as these in some people can lead to an increased stress on the gut (and immunity) causing all manner of problems for different people. How do you know?  Well - if you don't feel good after a certain combination, you can try to challenge your body again. But for sinus sufferers, proteins and starches are best separate, and fruit is also best generally consumed on its own to allow for better digestion.

• Peter D'Adamo (Blood-Type Diet) suggests that dairy, wheat, and corn and many starches, especially any refined " grains" promote a more globular form of mucus, rather than a planar type. And it is the very nature of change of the type and size of mucus globules that disables the sinus drainage, causing blockage, congestion, and the pain. Most starchy foods fall into the lectin positive theory - they are best avoided.

Nose blowing - be careful

• Coughing, sneezing, and blowing the nose help remove particulate-dense mucus from the body, but do not do this - block one nostril and blow hard out through the other. You will create back pressure, forcing mucus deep into a sinus cavity and may actually perpetuate chronic sinusitis.
• Did you know this? - CAT scan analysis reveals that the tradition of blowing mucus out the nasal passages generates enough pressure to propel 1 ml. of fluid into the maxillary sinus from a single nose blow; but sneezing and coughing do not generate similar pressure?

Supplements and sinus

•·     Vitamin C - Oral dosing of vitamin C appears to reliably lower blood histamine levels. A 2004 prospective trial examined blood levels of various vitamins and minerals in children with CRS compared to healthy, age-matched controls. Vitamin C, vitamin E, copper, and zinc levels were significantly lower in the chronic sinusitis group compared to controls. Take 1000 - 2000mg per day, but for acute cases try the "bowel tolerance" method.

•·      Bromelain - , an enzyme complex from pineapple, has commonly been used in sinusitis as an anti-inflammatory and mucolytic. A 2005 German clinical study found children with acute sinusitis exhibited statistically significant faster symptom recovery compared with standard treatment. Bromelain appears to thin nasal secretions and has been shown to be an effective mucolytic. One study from the late 60's reported 85 percent of sinusitis patients receiving bromelain obtained complete resolution of inflammation of the nasal mucosa compared to 40 percent in the placebo group. Take 500 - 1000mg per day.

•·     N-acetyl-cysteine (NAC) -  This nutrient, like bromelain, is effective because it is a mucolytic. It thins the mucus secretions, and causes mucus to be subsequently broken into smaller, less viscous units. NAC has been noted to increase the mucous clearance rate by 35 percent, with no improvement from placebo. The typical adult oral dose for NAC as a mucolytic agent is 600-1,500 mg daily in three divided doses. NAC is generally safe and well tolerated, even at high doses.

•·     Quercetin - This is one of the most abundant and active of the flavonoid family. It is a potent anti-inflammatory, and it inhibits the effects of inflammation producing enzymes. I generally recommend 400 - 500 mg three times daily. Works best when given with VitaminC.

Sinusitis Treatment Plan

Once you have an acute attack of sinusitis - get onto it right away, don't let it settle in, because sinusitis can hang around for months, sometimes even for years, just ask somebody who sufferers a lot from this complaint recurrently.

Acute sinusitis - 2 weeks duration

• Reduce nasal congestion - nasal irrigation, diet change - reduce or avoid the main mucus producing foods such as  wheat and white flour products, dairy products, chocolate, etc.

• Decrease inflammation. - try some hydrotherapy. Alternate hot and cold applications to the facial areas where it hurts or feels congested. Apply quite warm facecloths directly over the sinus area. Alternate a three-minute hot pack, and one with minute a cooler pack. Repeat this three times. This is one set. Do two to three set per day, results can come quickly if you persevere. You will love me for this one!

• Decrease the immune response - check out house, your own environment.

• Enhance antibacterial defenses - herbs (see your herbalist or naturopath, there are many good dried or liquid herbs which work a treat with sinusitis) One good herb for catarrh and sinus in golden rod. Colloidal silver is also worth a try - especially in the nasal irrigation.

Chronic sinusitis - anything over 2 months duration

• Reduce nasal congestion - nasal irrigation, diet change - reduce or avoid the main mucus producing foods such as  wheat and white flour products, dairy products, chocolate, etc.

• Decrease load on the immune system - check for food allergies - and stop eating foods you may be allergic to. Reduce any chemicals around the home, watch out for aerosol & personal products. Gradually reduce your dependence on chemicals and any drugs - you are probably wasting your time (and money). Do you smoke and have sinus? Well more fool you - read Allen Carr's new book on how to stop, and please don't complain about sinus to me until you stop!

•   Decrease immune response - support and mend the digestive system - the "leaky" gut. My rule - for every week on an antibiotic, try 4 to 6 weeks on a probiotic. This will increase your immune health big time - and reduce your risk for future sinus attacks. Detoxification may well be required - see your naturopath or herbalist.

• Change the environment - check for mould!  Modern indoor living is often  perpetuating influence in sinusitis.  Decreased exposure to animal fur and dust mites, including removal of carpeting and feather bedding/pillows, often improves recurrent sinusitis. Do you have a sinus condition that you just can't seem to shake? Then take a long hard and critical look at your house, where you eat, live and particularly where you sleep - the walls, the ceilings, the soft furnishings & carpets. There is no point is getting your diet sorted, when your health is being undermined by the toxic mould in your house. Draughty, mouldy or a cold house is not the best, particularly for the sinus person. You may need a home ventilation system, get an expert in to check how well your place is ventilated - just do it.

Conclusion

You're most successful approach would appear to be a reduction of fungi and bacteria in your home environment, attention to foods you may be allergic to, or other lifestyle choices that appear to exacerbate this most annoying condition. Newer evidence points to an allergic cause in the majority of chronic cases, in which the immune system hyper reacts to fungi in the nose and sinuses. This necessitates not only removal of thick, mucus via nasal irrigation, but correction of the underlying immune and inflammatory systems as well. You can conquer this condition, but you need to tackle it on different fronts and be persistent. Let me know your tricks if you have any, I'm always on the lookout for ways to help others with complaints like this. For more information or to view more of Eric's articles you can view www.naturopath.co.nz