Sinusitis treatment by Ray Sahelian, M.D. Are antibiotics helpful in acute sinusitis?
Sinusitis is an
inflammation of the lining of one or more of the sinus cavities in the
facial bones around the nose.
Sinusitis is categorized as acute (sudden
onset) or chronic (long term, the most common type). Antibiotics are
commonly prescribed for the majority of patients with sinusitis even
though most cases are caused by a virus rather than bacteria. Overuse of
antibiotics is leading to more virulent and even drug-resistant bacteria.
Acute sinusitis
Most cases of sinusitis are acute
infectious sinusitis, which generally lasts less than four weeks. Routine
sinus infections aren’t really helped by antibiotics. In a December 2007
British study, people suffering from facial pain and a runny nose with
greenish or yellowish mucous improved within about two weeks whether they
took the standard antibiotic amoxicillin or steroid nose spray.
Antibiotics, particularly the penicillin-like drug amoxicillin, are among
the most commonly prescribed medicines for sinus infections.
Watchful waiting is a good approach in the treatment
of acute rhino sinusitis
Symptoms cannot reliably identify which patients with acute rhino
sinusitis -- infection of the nasal and sinus cavities, will benefit from
antibiotic therapy. Dr. Jim Young of the University Hospital Basel in
Switzerland and colleagues conclude that antibiotic therapy should not be
used to treat acute this common infection in adults, even if the symptoms
have lasted for up to 10 days. The overuse of antibiotics for acute rhino
sinusitis is common because doctors are often unable to determine if the
cause is viral or bacterial. Dr. Jim Young found the overall number of
patients that would need to be treated to cure one patient was 15. If
purulent discharge in the throat was present, the number needed to treat
declined to 8. There may be some benefit using antibiotics in treating
older patients, those with longer symptom duration, and those with more
severe symptoms. "Watchful waiting" and symptomatic relief are reasonable
approaches for almost all adult patients with acute rhino sinusitis-like
complaints. The Lancet, March 15, 2008.
Natural treatment for sinusitis
The herb
andrographis
has been tested in this condition.
Chronic sinusitis
If the signs and symptoms of sinusitis last more than 12 weeks, or
if there are frequent bouts of sinusitis, this could be considered a case
of chronic sinusitis. Chronic sinusitis is one of the most common chronic
diseases in the United States, affecting more than 30 million people each
year.
Chronic Sinusitis Treatment
Chronic sinusitis treatment may be with medications such as
antibiotics, or, in some cases, surgery. Natural options are also
available. It is highly recommended that a person with chronic sinus
problems stop smoking, reduce exposure to smoke or pollutants, perhaps
drink less milk or eat less dairy, reduce white bread and simple,
processed carbohydrates, drink less sugared sodas, increase fresh fruit
and vegetable intake, eat more fish, lots more fish, and perhaps take fish
oil capsules. If you use sugar with tea or coffee, consider
stevia.
Natural Chronic Sinusitis Treatment
Cod liver oil,
fish oils, and multivitamins in children may be helpful.
Nasal irrigation for chronic sinusitis
Nasal irrigations, using a large volume of saline and delivered with low
pressure, are more effective than saline sprays for chronic sinonasal
symptoms. Saline irrigation is a standard treatment for such symptoms, but
many doctors prescribe nasal sprays instead, believing that this treatment
is just as effective, but better tolerated.
Acute or Chronic Sinusitis symptom
Sinusitis can cause tenderness in the face, aching behind the eyes
and difficulty breathing through the nose. Postnasal drip is also common
leading to chronic cough.
Sign up to a FREE Supplement Research Update newsletter. Twice a month we email a brief abstract of several studies on various supplements and natural medicine topics - including sinusitis - and their practical interpretation by Ray Sahelian, M.D.
Sinusitis Treatment with Nasal Irrigation
Nasal irrigation, a traditional therapy that has been shown to help
people with chronic sinus problems, can be easily learned with a 30-minute
group training session. Patients get a sense of "empowerment" because they
can use and adjust the technique effectively on their own rather than
requiring multiple doctor visits and prescriptions. Used for thousands of
years in the Ayurvedic and Yogic traditions, nasal irrigation involves
rinsing the nasal cavity with a saline solution to get rid of mucus that
may contain allergens or infectious agents. Nasal irrigation in patients
with chronic stuffy nose (rhinitis) and sinusitis reduce symptoms and
medication use and improve quality of life. Barriers to learning the
technique include a fear of having liquid in the nasal cavity, initial
discomfort and mild side effects, the need to learn how to perform nasal
irrigation effectively, and the need to set aside time for nasal
irrigation. Annals of Family Medicine, July/August 2006.
Sinusitis symptom
A sinus infection symptom can include headache or pressure in
the eyes, nose, cheek area, or on one side of the head. A person with sinusitis
infection may also have a cough, a fever, bad breath, and nasal congestion
with thick nasal secretions.
Causes
Other people's cigarette smoke could be to blame for much of the chronic
itchy, runny nose and sinus woes - also known as rhinosinusitis -- that
plague one in every six US adults. Archives of Otolaryngology - Head &
Neck Surgery, April 2010.
Sinusitis Research Update
Therapeutic use, efficiency and safety of the proteolytic pineapple
enzyme Bromelain -POS in children with acute sinusitis in Germany.
In Vivo. 2005 Mar-Apr;19(2):417-21.
The therapeutic efficiency and safety of the proteolytic enzyme
bromelaine obtained from pineapple (Bromelain -POS, Ursapharm GmbH,
Saarbrucken, Germany) was evaluated in children under the age of 11 years
diagnosed with acute sinusitis. Data from 116 patients from 19 centres
located across Germany were analysed in a pharmacoepidemiological cohort
study. Patient cohorts were either treated with Bromelain -POS (N = 62),
in combination with Bromelain -POS and standard therapies (N = 34), or
with standard therapies (N = 20). The primary parameter measuring
effectiveness of the different treatment groups was the duration of
symptoms. The shortest mean period of symptoms was observed in patients
treated with Bromelain -POS alone (6.66 days), followed by the standard
therapy (7.95 days) and those treated with a combination of Bromelain-POS
and the standard therapy (9.06 days). Patients of the Bromelain -POS
monotherapy group showed a statistically significant faster recovery from
symptoms (p = 0.005) compared to the other treatment groups. One
10-year-old male patient, with a known pineapple allergy, showed a
self-limiting mild allergic reaction. No other unwanted side-effects were
reported. This trial documents that the proteolytic pineapple enzyme
Bromelain -POS is widely used in the treatment of young children diagnosed
with acute sinusitis in Germany and that the use of proteolytic enzymes
can benefit such patients.
Nutritional supplements as adjunctive therapy for
children with chronic/recurrent sinusitis: pilot research.
Int J Pediatr Otorhinolaryngol. 2004 Jun;68(6):785-93.
Linday LA, Dolitsky JN, Shindledecker RD.
Department of Otolaryngology, The New York Eye and Ear Infirmary, NY
Inflammation and edema of the sinonasal mucosa are important in the
pathophysiology of sinusitis. Based on the similarities between otitis
media (OM) and sinusitis, and our previous research on OM, we hypothesized
that nutritional supplements would be effective adjunctive therapy for the
treatment of children with chronic/recurrent sinusitis. We
performed a 4 month, open-label, dose-titration study; subjects were
enrolled from late January to early March 2003. Each subject served as his
own control. Study supplements were a lemon-flavored cod liver oil and a
children's multivitamin-mineral with selenium, prescribed in escalating
doses; at higher doses, fish oil was substituted for cod liver oil.
Subjects were private pediatric otolaryngology outpatients with a clinical
diagnosis of chronic/recurrent sinusitis, whose symptoms were refractory
to treatment with antibiotics. Our four subjects were Caucasian
males, ranging in age from 4.2 to 9.8 years, with chronic/recurrent
sinusitis for at least 3 years prior to entry in the study. Three subjects
had a positive response; one subject dropped out for administrative
reasons. Four, six, and eight weeks after beginning study supplements, the
responders had decreased sinus symptoms, fewer episodes of acute
sinusitis, and fewer doctor visits for acute illnesses. Their parents
reported that they had begun to recover from upper respiratory illnesses
without complications, which was unusual for these children, as was
improvement in springtime; their improvement had previously been limited
to the summer months or periods of home-schooling. Use of
flavored cod liver oil and a multivitamin-mineral with selenium as
adjunctive therapy for children with chronic/recurrent sinusitis is an
inexpensive, non-invasive intervention that clinicians can use for
selected patients, pending the performance of definitive, large,
well-controlled studies.
Chronic sinusitis: management for optimal
outcomes.
Treat Respir Med. 2004;3(2):97-105.
Chronic sinusitis is characterized by nasal purulence accompanied by
malaise, postnasal drip and nasal dryness or crusting. It is a condition
that is very difficult to treat and can be very disabling to the patients.
A clinical diagnosis is based on history and evaluation with endoscopy,
and computerized tomographic scanning. The etiology of chronic
rhinosinusitis is multifactorial and comprises a vicious cycle of
pathophysiological, anatomical, and constitutive factors. Predisposing
factors include ciliary impairment, allergy, nasal polyposis, and immune
deficiency. Treatment is aimed at reducing mucosal inflammation and
swelling, controlling infection, and restoring aeration of the nasal and
sinus mucosa. The choice of treatment is influenced by many factors
including past medication, duration of symptoms and the presence of
allergy/nasal polyps. Pharmacologic treatment, with local or systemic
corticosteroids such as mometasone furoate, fluticasone propionate,
beclometasone dipropionate or oral prednisolone coupled with nasal lavage
with isotonic saline solutions are the cornerstones of disease management.
Systemic antibiotics including amoxicillin/clavulanic acid, ciprofloxacin,
clarithromycin, and trimethoprim/sulfamethoxazole (cotrimoxazole) are
often administered to patients with chronic sinusitis and underlying
bacterial infection. In patients with underlying allergy, additional
treatment with antihistamines should be considered. Aeration of the
sinuses may temporarily be improved with local nasal decongestants such as
oxymetazoline. If symptoms persist after aggressive medical treatment,
surgery should be considered. Surgery should be functional and involve
widening the natural drainage openings of the sinuses and preserving the
ciliated epithelium as much as possible. In the case of nasal polyposis
surgery is more aggressive involving removal of the diseased polypous
mucosa. It is recommended that medical treatment should be continued post
sinus surgery.
A double blind, placebo-controlled study of
Andrographis paniculata fixed combination Kan Jang in the treatment of
acute upper respiratory tract infections including sinusitis.
Phytomedicine. 2002 Oct;9(7):589-97.
Gabrielian ES, Shukarian AK, Goukasova GI, Chandanian GL, Panossian AG,
Wikman G,
Erebuni, Medical Centre, Yerevan, Armenia.
A double blind, placebo-controlled, parallel-group clinical study was
carried out to evaluate the effect of an Andrographis paniculata (N.)
extract SHA-10 fixed combination, Kan Jang, in the treatment of acute
upper respiratory tract infections, including sinusitis. Ninety-five
individuals in the treatment group and 90 individuals in the placebo group
completed the study according to the protocol. The medication was taken
for 5 days. Temperature, headache, muscle aches, throat symptoms, cough,
nasal symptoms, general malaise and eye symptoms were taken as outcome
measures with given scores. The total score analysis showed a highly
significant improvement in the verum group versus the placebo. This result
applied to the group as a whole and to the sinusitis subgroups. The
individual symptoms of headache and nasal and throat symptoms together
with general malaise showed the most significant improvement while cough
and eye symptoms did not differ significantly between the groups.
Temperature was moderately reduced in the verum group. It can be concluded
that Kan Jang has a positive effect in the treatment of acute upper
respiratory tract infections and also relieves the inflammatory symptoms
of sinusitis. The study drug was well tolerated.
Sinusitis questions
Q. Can serrapeptase cause adverse
reactions when taking meds for high blood pressure such as norvasc and avapro?
Because my mom takes those and they really afflict her badly. And what is the
ideal serrapeptase dosage for me to take serrapeptase for chronic sinusitis.
I've had that all my life. I need relief and not drugs.
A. We personally do not have enough experience
with this nutrient to have an answer to these questions. Serrapeptase has been
used in Japan but very little in the US so we really don't know much about the
ideal dosage or what conditions it is likely to benefit, or how it interacts
with medicines.
Q. I am
interested in ascertaining the possible benefits of using turmeric to reduce
chronic inflammation in the sinuses and nasal passages that lead to frequent
acute bacterial sinusitis infections. I haven't seen any research on sinusitis
and turmeric or curcumin, but am wondering if it's reasonable to speculate that
turmeric might reduce inflammation globally? I have an immune mediated reaction
to normal molds, resulting in the production of Major Basic Protein which
inflames the mucua. Researchers are seriously studying this mechanism as the
cause of chronic rhinosinusitis. Any thoughts on using turmeric?
A. Sinusitis can be caused by many factors. We have not seen any
research regarding turmeric or curcumin for use in sinusitis.
Q. Dr Sahelian,
I have patented and now offer a natural nasal wash, unique and the most
effective nose wash on the market today. I have been teaching nose washing,
prevention and avoidance of medications for more than 20 years and Nasopure is
the result of this experience. I have written for CAM articles for WEBMD, have
several informational handouts for patients. Dr Hana www.nasopure.com
A. We have not tested this Nasopure product by Dr. Hana so we can't
comment on it. Perhaps some people may benefit if they have sinusitis or nasal
allergies. It may be worth a try.
I have
surgically chronic dry nose. My mucosa in my inferior turbinates in my
sinus is not producing mucuos. My new ENT prescribed Premarin cream
.625% and seems to be working a bit to help repair the nasal mucosa.
However I am a male and wonder if I should be taking anastrazole to
block the estrogen once it is absorbed? Or is it ok to take without
because absorbtion through nasal mucosa is not that potent? He said it
is not enough to worry about.
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