Sinusitis and Allergies – the Confusion Sorted

Sinusitis is a confusing topic, not only for patients but for many health practitioners as well. The confusion arises because of the many facets of this condition, problems with establishing the cause, and similarities between the symptoms of infection and those of allergy.

In many cases sinusitis and allergies coexist, feeding on each other, so that the allergic reaction also provides a home for micro-organisms and any infection (and its treatment) can trigger an allergic reaction.

WHAT ARE THE SINUSES?

The sinuses are hollow spaces in the bones of the face. These cavities are lined with columnar epithelial cells that are continuous with the lining cells in the nose. This sounds as if it’s going to be very technical, but please don’t skip – some really interesting facts are coming up that help to explain sinus problems and why so many people suffer from sinusitis in one form or another.

There are four basic cell types, ciliated columnar cells (fine hairs), non-ciliated columnar cells, basal cells and goblet cells. What always amazes me is what things look like when one gets to the microscopic level. The ciliated or hairy cells have about 50 to 200 cilia per cell, which beat 700 to 800 times a minute and move mucus at a rate of 9 mm a minute. The non-ciliated cells have finger-like projections (microvilli) which increase the surface area and possibly facilitate the humidification and warming of inspired air. The goblet cells produce a glycoprotein that is responsible for the viscosity and elasticity of the mucus. Both the sympathetic and parasympathetic nervous systems supply these cells, the former causing the secretions to be more watery and stimulation from the latter causing the secretion of thicker mucus. Beneath the surface are other serous and mucin-secreting glands with openings into the sinus cavity.

The sinus cavities have small openings into the nose, allowing drainage of the mucus.  If the opening gets blocked by swelling of the cells or polyps in the nose mucus accumulates, causing pressure, and can also become infected. There is what could be regarded as a minor design problem with the maxillary sinus, which is situated beneath the cheekbone – its opening is in the upper part, so the mucus must be moved upwards in order to escape into the nasal cavity.

I find all this so interesting, and there is more to come, so read on.

FUNCTION OF THE SINUSES

The sinuses have a number of interesting properties. Firstly they are hollow, which gives resonance to the voice. Anyone whose sinuses are full of loose fluid is easily identified by the changed character of their voice. The sinuses also assist in the warming and humidification of air, and the constant secretion and outward movement of mucus rich in immune cells, antibodies and antibacterial protein contributes to the body’s immune defences. The sinuses also lighten the head (which even so is quite a weight to carry on one’s shoulders), absorb shock and contribute to the shape of the face. Their abundant secretion of mucus contributes to the mucus secretions in the nose.

Of very special interest is the movement of the fine hairs in the sinuses and why surgery can often aggravate the problem instead of helping. This information has finally helped me to understand why surgery on the sinuses is much more complex than it may appear, and why cleaning and draining of the sinuses, which seems such an obvious thing to do, may sometimes not be successful.

It seems that the ciliated cells in each sinus beat in a very specific way. Clearly the mucus must be moved towards the outlet, which is quite small, and as I mentioned earlier the opening in the maxillary sinus is in the uppermost part, so that at times the mucus has to flow against gravity. Mucus secreted close to the outlet but on the wrong side, as it were, will need to travel all the way round before finding its way out, because the hairs move in one direction only. Swelling of the mucosa causing two surfaces to come into contact can interfere with the flow, causing some stagnation and eventually leading to sinusitis. Similarly, any interference due to surgery that disrupts the flow and movement of the fine cilia can cause stagnation of mucus, and this is probably is a clue as to why sinus surgery may not be any more effective than medical or other treatments.¹ In another study it was noted that surgery does not significantly improve the mucociliary function of the sinus mucosa in chronic maxillary sinusitis.²

The above information makes it clear why this is so. It also explains why chronic infections, polyps in the sinuses and anything that disrupts or interferes with ciliary function will eventually interfere with the flow of mucus, causing stagnation with the possibility of infection.

MANAGEMENT OF SINUS PROBLEMS

Once we understand the anatomy and function of the sinus, the principles of sinus problem management become more obvious. Decreasing the swelling of the lining membrane, supporting the ciliary action and helping to drain the mucus are essential.

As indicated above, allergic sinusitis and infective sinusitis often co-exist. Antibiotics used to treat infections in the sinuses can cause allergic reactions, and there is a great deal of evidence that antibiotics are not as successful in chronic infections as in acute attacks (and this may well not apply to acute attacks in children).³

Allergic responses cause swelling of the mucous membranes, and if drainage is interfered with, infections can start. A green or yellow discharge together with pain suggests that there is an infection.

The conventional management of allergic sinusitis often uses antihistamines to treat the symptoms, but these can also paralyse the cilia, preventing drainage. Cortisone sprays are used to shrink the mucous membranes, but this can also affect immune function, and as stated above antibiotics may be necessary in acute attacks but if used to treat chronic infections may cause more harm than good.

NATURAL APPROACHES TO SINUSITIS AND ALLERGIES

The more chronic the condition, the more important are basic principles of lifestyle management. If allergies are present, try an elimination diet to detect the allergens or ask your doctor about allergy tests. House-dust mites are a common allergen, but so is dust and sometimes even fungus. Attend to damp places where fungus breeds, and vacuum often to remove mites and dust. Carpets may need to be removed. Cigarette smoke is a serious aggravating problem, even for passive smokers. Ionisers produce negative ions that help to clear the air of particles. Air that is clean, moist, warm, oxygen rich and high in negative ions is the healthiest air that humans can breathe.⁴

Drainage

For successful drainage fluid needs to flow easily through the orifices of the sinus. There should be no obstruction, and the fluid should be more liquid than viscous. The following supplements and techniques are useful to manage this aspect of the problem.

• Acupuncture
• Low-energy laser therapy applied to the problem sinus
• N-acetylcysteine (NAC) is an amino acid with mucolytic properties (liquefying mucus) but also has powerful antioxidant, antiviral and antibacterial properties. The dose is 500 mg 2 to 3 times per day.
• Bromelain is an enzyme made from pineapple that can liquefy the mucus.
• Nasal saline washouts (to make your own, see below).⁵ Various devices are available to assist in nasal washouts.
• Saline nasal sprays – use daily every 2 to 3 hours if necessary in acute conditions.

Shrinking the mucosa

• Inhalations with aromatherapy oils such as eucalyptus oil 2 to 3 times a day for 15 to 20 minutes can help.
• Vitamin C is a natural antihistamine and anti-inflammatory agent that also enhances the immune response.
• Bromelain reduces inflammation and swelling. If you are allergic to pineapple, avoid this remedy. Other enzymes can be tried instead.

Treating any infection present

• Echinacea
• Propolis
• Colloidal silver
• Others: Andrographis , elder flower, hydrastis (golden seal)
• Candida and other fungal treatments may be necessary.

Treating the allergic reaction

• Acupuncture
• Albizia – a herb that downgrades allergic reactions
• Grape seed extract is widely used to treat allergic conditions.
• Selenium is another antioxidant that breaks down leukotrienes, an allergy-related promoter of inflammation.
• Others: Eyebright, nettle, skullcap, hydrastis, elder flower.

Supporting health of the mucous membranes

• Essential fatty acids nourish the mucous membranes and have anti-inflammatory actions.
• A good-quality vitamin/mineral supplement is important.

Directions: Place the mixture in a re-usable sinus rinse bottle, draw it into a nasal bulb syringe or sniff it up using the cupped hands. The best place to do this is in the shower or over a sink.

Ideally the water should pass right through the nose and around, coming out via the mouth. Some people find this too uncomfortable, in which case the water can be allowed to run out through the nose.

Keep rinsing until the water that comes out is clear of mucus.

The process can be repeated a few times during the day, but not less than 60 minutes before going to bed.

CONCLUSION

It is important to differentiate between allergic and infective sinusitis. As indicated these often co-exist, with the allergic component sometimes already in the background and sometimes precipitated by repeated use of antibiotics to treat infections. Both practitioner and patient need to get back to the basics and introduce good lifestyle management, elimination diets to work out allergic factors, exercise and nasal washouts before trying some of the protocols suggested above. In very severe cases acupuncture and/or low-energy lasers may be necessary. Homeopathy can also be very successful when the right remedy is taken. Chronic sinusitis can take many months to cure, so be patient and continue to support your health. Health will eventually heal the problem.

Editor’s Note: 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. For more information on preparing your immune system for winter, click here.

References

1. Khalil HS, Nunez DA. Functional endoscopic sinus surgery for chronic rhinosinusitis. Cochrane Database Syst Rev 2006; 19: 3:CD004458.
2. Toskala E, Rautianen M. Effects of surgery on the function of maxillary sinus mucosa. Eur Arch Otorhinolaryngol 2005; 262(3): 236-240.
3. Garbutt JM, et al. A randomized, placebo controlled trial of antimicrobial treatment for children with clinically diagnosed acute sinusitis. Pediatrics 2001; 107: 619-625.
4. Warner JA, Marchant JL, Warner JO. Double-blind trial of ionizers in children with asthma sensitive to house dust mite. Thorax 1993; 48: 330-333.
5. Harvey R, et al. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Otolaryngol Head Neck Surg 2007; 137(4): 532-534.