There are times when we feel as if our head is a huge, heavy block of lead and our nose some giant, useless fleshy appendage stuck in front of it! One gets quite desperate when the most basic function in life – the ability to breathe comfortably – is compromised. Dr Sandra Smit shares valuable information that will help us to manage sinusitis naturally.
Breath not only connects us with life but also with each other. It is the lightness of the air element that we crave when we feel depressed and bogged down. Imagine how dense we would be with no air circulating through our head and chest cavity. No wonder we feel so miserable when our noses are blocked, and our sinuses clogged!
WHY DO WE HAVE SINUS CAVITIES?
- The sinuses lighten the skull, which is why the head feels so heavy and dull during a sinus attack.
- The sinuses give resonance to the voice.
- The sinuses filter and moisten the air that we breathe. We are able to breathe more deeply when we utilize the turbine effect of the sinus cavities and breathe through the nose instead of the mouth. In yogic practices correct breathing through the nose (a slow, deep, audible breath with most of the tongue against the palate) regulates the endocrine system by stimulating the pituitary gland, which is situated deep behind the nose. The way we breathe therefore has a profound effect on our emotions.
WHAT ARE THE SINUSES?
The sinuses, also referred to as ‘paranasal sinuses’, are paired air cavities or space pockets in the cranial (head) bones. The sinuses are connected to the nose on the facial part of the skull through which air passes and mucus drains. We have four paired sinus cavities. Each has an opening (ostium) into the nasal passages for free exchange of air and mucus. The mucous linings have ciliated epithelium (cells with fine hairs). The cilia continuously move mucus draining from the sinus cavities into the nasal passages and the back of the throat.
The four pairs of sinus cavities are:
The ethmoid sinuses (behind the bridge, at the ‘root’ of the nose between the eyes) are present at birth and enlarge as we grow.
The frontal sinuses (above the eyes in the forehead) develop at around seven years of age.
The maxillary sinuses (on either side of the nostrils in the cheekbones) are also present at birth and enlarge as we grow.
The sphenoid sinuses (deep in the skull behind the ethmoid sinuses and the eyes) only develop during adolescence.
WHAT IS SINUSITIS?
Sinusitis is caused by an inflammation or infection of one or all of the paranasal sinuses and is categorised into three types on the basis of the duration of the inflammation/infection.
Acute sinusitis usually lasts for no more than 3 weeks. It is often triggered by flu or a head cold and causes typical ‘cold’ symptoms but lasts longer than a week.
Among people under the age of 45, chronic sinusitis is one of the most common chronic illnesses.
Chronic sinusitis usually lasts for more than 3 weeks and can continue for months or even years. It is commonly caused by allergies or bacterial infections. Over-use of antibiotics and cortisone sprays has led to more virulent forms of bacterial infections as well as new fungal infections of the sinus cavities. Asthma and allergic disorders often cause chronic inflammation of the nasal mucosa, resulting in chronic sinusitis. About 20% of patients with chronic sinusitis may develop nasal polyps, cyst-like growths that develop from sinus tissue and may further obstruct the sinuses.
Also called allergic rhinitis or rhinosinusitis, this is characterized by several separate attacks during the year. The attacks are usually caused by an allergic reaction to weather conditions or other environmental factors.
DO YOU HAVE SINUSITIS?
In general, sinusitis can be diagnosed by a combination of the following symptoms:
- Cold symptoms that don’t respond to treatment
- Persistent colds with coughs
- Head pain on waking in the morning
- A low-grade fever of 37.7oC
- Weakness or tiredness
- A cough that is more prevalent at night
- A runny nose (rhinitis)
- Nasal congestion
– Halitosis (bad breath)
- Swollen eyelids
- Postnasal drip
- Blocked or stuffy nose
- Congested feeling and pressure
- Facial pain or swelling
- Headaches that become worse on bending forward
- Voice hoarseness
- A decreased sense of smell
- A feeling of fullness in the ears
WHAT CAUSES SINUSITIS?
The body normally produces around two cups of mucus a day, which is usually swallowed unconsciously. This production can be accelerated by an infection, the presence of a foreign body, or an allergic reaction in the nasal passages and sinus cavities. This invasion of the delicate nasal passages and surrounding structures results in inflammation and an increase of white blood cells in the membrane lining the nose. The swelling of the nasal linings increases the production of mucus to help flush away the irritant or bacteria-containing particles.
As a result of the increased mucus production, the cilia are unable to transport the mucus effectively and it becomes thick and tenacious, blocking the nasal passages and sinus cavities. The sinuses drain through tiny openings called ostia. Inflammation causes these openings to become blocked, so the mucus accumulates and become stagnant – an ideal breeding ground for bacteria. In severe cases the entrapped infection leads to abscess formation. The only alternative way for the mucus to exit is via the back of the throat, which is known as postnasal drip.
Inflamed and infected sinuses may also cause systemic symptoms such as fever, fatigue and gastric discomfort from swallowing excessive mucus. The general lack of oxygen resulting from impaired breathing affects the entire body and often causes acidosis and muscle and joint aches.
THE BUGS BEHIND THE SCENES
Viral infection. This type of sinus infection is the commonest, as there are millions of viruses and new strains are constantly evolving. It generally lasts for a fortnight with symptoms similar to a common cold, i.e. a runny nose, congestion or a sore throat with postnasal drip and coughing. If left untreated a viral infection may develop into a bacterial infection such as chronic sinusitis.
Bacterial infection is most often caused by the bacteria Streptococcus pneumoniae and Hemophilus influenzae. These commonly inhabit the respiratory tract of healthy people and only result in an infection when the immune system is compromised. Swimming in contaminated water may also cause a bacterial infection of the sinuses.
Fungal infection. Fungi are plant-like organisms that are unable to produce their own food. They usually live harmlessly in our sinuses, but when the body’s resistance is low, they may become troublesome and feed on the delicate mucous membranes that line the sinuses and nasal passages, resulting in inflammation and fungal infection. The moist, warm, dark nasal passages and sinus cavities provide fungi with the ideal environment in which to thrive and propagate.
STRUCTURAL AND ANATOMICAL CAUSES
Nasal polyps. Nasal polyps develop when the connective tissue matrix that keeps the mucous membrane linings of the nose intact is damaged. The damaged lining gradually becomes detached from the underlying tissue and starts filling with mucus, which causes it to sag and develop into a nasal polyp. Polyps are jelly-like and opaque to white in color. Any inflammation or allergy affecting the mucous membranes of the nasal passages and sinus cavities will aggravate nasal polyps, causing them to swell further and block the opening to the sinuses, thereby promoting the growth of bacteria, viruses or fungi. Nasal polyps are most prevalent in people suffering from chronic sinusitis, hay fever and asthma. Symptoms include recurrent or chronic sinusitis, nasal obstruction, mouth breathing, snoring and reduced senses of smell and taste. After surgical removal, polyps regrow in about 50% of cases.
Deviated septum. The septum is a cartilaginous bone dividing the right and left nostrils. Certain injuries, such as a broken nose, can obstruct breathing and drainage of mucus and therefore lead to sinusitis. Surgery may rectify a deviated septum.
Turbinates. These are bony projections in the nasal passages that filter and warm the air that passes through. When there is irritation of the nasal passages the turbinates become inflamed and may swell, causing an obstruction in the flow of mucus and leading to a sinus infection if left untreated.
Concha bullosa is a bubble- or balloon-shaped structure that tends to develop on the middle turbinate and can exert pressure on the adjacent tissue, causing irritation, sinus pain and nasal blockage. In severe cases endoscopic sinus surgery is necessary to treat this condition.
WHAT PREDISPOSES US TO SINUSITIS?
Frequent flying or scuba diving may not only cause sinusitis but worsen current sinus infections. Changes in altitude and air pressure irritate and inflame the paranasal and frontal sinus cavities, and in severe cases bleeding of the nasal mucous linings may occur.
Frequent dental work may damage the delicate sinus cavities that lie directly above the upper teeth. Mouth infections can easily spread to the sinuses.
Nasal decongestants and cortisone nasal sprays initially have a drying effect, but the body reacts by producing more mucus, thereby promoting the development of sinusitis. Furthermore, the drying effect increases the viscosity of the mucus, resulting in stagnation and aggravation of the infection. Cortisone also compromises the body’s defense system in dealing with the infection. So, don’t overuse nasal sprays!
Swimming in chlorinated water may cause irritation and inflammation of the mucous membrane linings, increasing susceptibility to bacterial invasion. The water also makes the cilia perform poorly, reducing drainage of mucus.
Pregnancy and oral contraceptives cause hormonal changes that may lead to an increase in mucus production and postnasal drip. Furthermore, the increased blood supply associated with pregnancy causes intranasal venous congestion that gives the sensation of a blocked nose. Frequent blowing to clear the nose only irritates the already swollen mucous membranes.
Any head or facial injury may damage the delicate bones housing the sinus cavities, predisposing the sinuses to infection. Nasal intubation during surgery may damage the delicate mucous membranes, making them highly susceptible to sinusitis-causing bacteria and viruses.
A diet high in refined carbohydrates, sugar, gluten and dairy products may cause an allergic reaction and swelling of the mucous membranes. This promotes the production of excess mucus in both persistent and chronic sinusitis. Sulphur-containing foods and drinks also aggravate sinusitis.
Certain medications may predispose to sinusitis. Consult your doctor to find out whether your current prescription could be causing problems.
Smoking damages the cilia, resulting in postnasal drip and making the mucus thick and tenacious, allowing bacteria to accumulate. Non-smokers who are exposed to second-hand smoke may also be affected. Smokers are less likely than non-smokers to recover fully after sinus surgery because of the progressive damage to the cilia and the linings of the nose and sinus cavities. Asthma and respiratory infections are more common in people who regularly inhale second-hand smoke.
Dehydration, dehydrating agents such as alcohol, tea and caffeine, and a dry climate and wind can make the mucus more tenacious and cause a tendency to sinusitis.
Environmental factors include dust, house dust mites, mould and damp environments, air pollution, petrol, perfume, paint, glue and other industrial chemicals, furry or feathered pets, and plant and grass pollens.
Compromised immune system. Immunological disorders can lead to chronic sinusitis.
SELF-HELP TECHNIQUES – how to manage sinusitis naturally
■ Drink at least two litres of purified water a day. This keeps the mucus fluid, relieving congestion and sinus pressure. Hot drinks, to which cayenne pepper or ginger can be added, may bring even faster relief.
■ Excessive mucus is often a sign that your immune system is overtaxed. Try a fruit and vegetable juice fast for a couple of days. The discharge of mucus may initially increase as the body eliminates toxins, but if you persist the drainage will be complete.
■ Avoid allergens as far as possible. Environmental factors may be difficult, but your diet is under your own control. Your diet should consist of 75% raw and lightly steamed vegetables and fruit. Avoid dairy, fries, sugar and refined carbohydrates as well as tea, coffee and alcohol, especially during an infection.
■ Mix a cup of warm water, half a teaspoonful of sea salt and a pinch of bicarbonate of soda and make your own nasal spray (obtain a suitable bottle from your chemist) or do a nasal wash by drawing the fluid up through your nostrils and spitting it out through your mouth. Though uncomfortable, this is an excellent local antiseptic!
■ Steam inhalations with eucalyptus, tea tree and rosemary aromatherapy oils help to clear congestion. Drape a towel over your head and lean over a pot of steaming water.
■ Vigorous blowing of the nose forces the mucus back into the sinuses. Rather keep the mucus fluid and draw it down the back of the throat to expel orally when blowing becomes difficult.
■ Boost your immune system by taking 3 000 mg of a non-acidic form of vitamin C in divided doses each day.
■ Bioflavonoids such as quercetin help the absorption of vitamin C and have a beneficial effect on hay fever.
■ Herbs such as echinacea, golden seal, pelargonium and cat’s claw build up your body’s defences.
■ Proteolytic (protein-destroying) enzymes such as bromelain help to break down mucus.
■ Avoid antibiotics, nasal decongestants and nose drops and sprays as far as possible. These predispose to recurrent infections and undermine the immune system. The drying agents shrink blood vessels in the nose and cause them to weaken, as well as thickening the mucus, increasing the risk of infection.
■ As a rule, stick to therapies that allow drainage of the mucus by keeping it fluid.
■ Craniosacral therapy addresses the cranial bones and has decompression techniques that assist draining of the sinuses.
■ Various yoga postures and breathing techniques assist in draining the sinuses.
■ Since any chronic infection or allergy indicates that the immune system is operating either under- or over-actively, homeopathic treatment that addresses the body as a whole, bringing the immune system back into balance, is recommended. It can be used safely during pregnancy, for ‘snuffles’ of newborn babies and for snotty-nosed children.
■ Homeopathic remedies for sinusitis include Kali bich, Hepar sulph, Pulsatilla, Merc sol, Nat mur, Silica and Sulphur, among many others. These promote drainage, fight infection and mediate allergies.
Editor’s note: Confused about the difference between sinusitis and allergies,click here. Do you wonder what the difference is between a cold or a flu? See the informative article by Dr Sandi Nye: Is it a Cold, or is it the flu.