Sinusitis Introduction

:sinusitis.gif Sinusitis is an inflammation of the paranasal sinuses. It can be due to viral, bacterial, or fungal organisms. Sinusitis can also be the result of allergies to certain environmental factors. Sinusitis often follows an upper respiratory infection (cold, pharyngitis). Chronic sinusitis is more likely due to secondary infection in a person with long standing allergies.

The paranasal sinuses (maxillary, frontal, ethmoid, sphenoid) are normally sterile.

However if the nasal mucosa becomes edematous (fills with fluid) from allergies, a cold, hay fever, etc., then the pathogens have a place to grow.

The environment in the sinuses becomes moist and warm, propagating growth of viruses, bacteria, and fungus. The overgrowth of organisms results in immune cells migrating to the tissue. This extra cell material and edema in the nasal mucosa results in a plug. This is the most common cause of sinusitis symptoms. [1]

Sinusitis affects men and women equally. It is present in all social, racial, and ethical classes. It is, however, more likely to develop in an individual with allergies. Persons with diabetes and immunocompromise (e.g. cancer, HIV/AIDS) are more likely to have an extreme sinus infection with less well-known organisms that can develop serous complications.

Sinusitis Symptoms

The signs and symptoms of sinusitis are pretty general. The area over the affected sinus may be swollen, tender to the touch, and warm. Pain is often a symptom described as a headache or toothache. Most persons with sinusitis will complain of an increase in pressure, and can point to the sinus that is involved. There can be increased discharge from the nose. The discharge is usually green or yellow and can be very thick and sometimes have a rotten smell.

Specific symptoms of inflammation in the maxillary sinus include; pain in the maxillary area (under the cheek bones, next to the nose), toothache, and frontal headache. Frontal sinusitis presents with frontal headache and pain in the frontal area (on the forehead in between the eyes). An infection in the ethmoid sinus causes pain behind and between the eyes and a headache, often described as “splitting.” The sphenoid sinusitis presents with localized pain and tenderness that can be in the frontal area or in the occipital area (back of the head).

Systemic symptoms such as muscle aches, joint pain, fever, chills, and fatigue can be present in cases of sinusitis, but can often be a sign that the inflammation has moved beyond the sinus into other structures. [2]

Sinusitis Statistics

  • There are approximately 29.2 million cases of sinusitis diagnosed each year, which is approximately 14% of the population.
  • It is estimated that there are as many as 50 million people living in the US with chronic sinusitis.
  • Sinus infections account for more than 14 million doctor visits each year. [3]

Sinusitis Treatment

The primary goals of sinusitis treatment are drainage and killing of microorganisms. Without draining the sinuses, the organisms will still have a place to grow. Drainage can be accomplished with simple steam inhalation. If steam inhalation is not effective, intranasal sprays of phenylephrine or the administration of oral pseudoephedrine can cause drainage as well. Antibiotics should be used for both acute and chronic sinusitis. In cases of severe untreatable sinusitis, surgery can be recommended to clean out the sinus, and in some cases to obliterate the sinus so there is not place for the organism to propagate. [4]

Alternative sinusitis treatment is also focused on improving drainage and eliminating the organisms that cause the inflammation. It is also focused on preventing the recurrence of sinusitis and breaking the cycle of chronic infections. This is best accomplished by boosting the immune system and eliminating the chronic nasal congestion that provides the correct environment for certain microorganisms to grow.

Supplements helpful for Sinusitis

N-acetyl-cysteine (NAC)

NAC is useful for an adjunctive treatment for both acute and chronic sinusitis. It is a mucolytic, meaning it breaks up mucous. It is equally helpful for encouraging drainage of the sinus. NAC is also an effective antioxidant and has been shown to possess some anti-viral activity. It is not habit forming, and does not cause any side effects. In one study NAC was proven an effective adjunctive treatment to help clear mucous and drain the sinuses. Furthermore, NAC prevented chronic sinusitis in children in 98.5% of the cases. [5]


Bromelain is a plant enzyme from pineapple. It is both a mucolytic and fibrinolytic. Bromelain is also purported to have immune modulating activity. It is anti-inflammatory and anti-edematous, making it very useful for sinusitis. Bromelain is a natural substance and is non-toxic. There are no known side effects associated with the supplementation of this enzyme. [6]


Antioxidant supplementation is beneficial in many disease processes. Antioxidants play a role in the functioning of the immune system and are an integral component in our body’s natural defense processes against microorganisms. Additionally, when tissues are inflamed, oxidative stress is increased. This oxidation is, largely, due to the formation of reactive oxygen species and free radicals by the microorganisms and our bodies own defenses.

Antioxidant levels were found to be decreased in the nasal tissue of individuals suffering from chronic sinusitis. Antioxidant supplementation should be an adjunctive treatment for any case of sinusitis and that supplementation may bring a better prognosis to the course of the infection. [7] Antioxidants that may be helpful include Vitamins A and C, and the mineral, Selenium.

Botanical sinusitis treatments:

Historically, many botanical medicines have been used in the treatment of acute and chronic sinusitis. The biggest problem in botanical medicine is that not a lot of research has been done with applying a particular herb to a particular disease process. Instead, what research has been done explores only the activities of certain botanicals. That documented research then allows the medicine to be applied to certain conditions based on its physiological actions.

Sambucas, elderberry

Elderberry has historically been used for sinusitis, as well as a medicine to prevent recurrent sinusitis from an upper respiratory infection (e.g. cold, pharyngitis). In one particular study, elderberry was shown to be antiviral, protecting against influenza A and B, which are common agents that contribute to the development of sinusitis. Individuals in this study had a resolution of symptoms 4 days sooner than individuals in the control group. This study’s participants had no need for the use of stronger medications like antibiotics to resolve the sinusitis. [8]

Andrographis paniculata

Andrographis is an immunomodulating herb. It enhances the immune system, or provides support to the immune system. In the past, this herb has been used as a common treatment for sinusitis. In one study, symptoms of sinusitis such as fever, headache, malaise, sore throat, cough, and nasal discharge all improved in participants over controls. Andrographis was also shown to exhibit anti-inflammatory action in individuals with sinusitis. [9]


[1] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Sinusitis: 687-689.

[2] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Sinusitis: 687-689.

[3] National Center for Health Statistics, CDC. Health statistics for 2002. December 2004.

[4] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Sinusitis: 687-689.

[5] Boner AL, Valletta EA, Andreoli A, Vallone G, Baronio L. A combination of cefuroxime and n-acetyl-cysteine for the treatment of maxillary sinusitis in children with respiratory allergy. Int J Clin Pharmacol Ther Toxicol. 1984 Sep; 22(9): 511-514.

[6] Maurer. Bromelain: biochemistry, pharmacology, and medicinal use. Cell Mol Life Sci. 2001 Aug; 5(9): 1234-1245.

[7] Kassim SK, Elbeigermy M, Nasr GF, Khalil R, Nassar M. The role of IL-12 and tissue antioxidants in chronic sinusitis. Clin Biochem. 2002 Jul; 35(5): 369-375.

[8] Zakay-Rones Z et al. Randomized study of the efficacy and safety of elderberry extract in the treatment of influenza A and B infections. J Int Med Res. 2004 Mar-Apr; 32(2): 132-140.

[9] Gabrielian ES et al. A double blind placebo controlled study of andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory infection including sinusitis. Phytomedicine. 2002 Oct; 9(7): 589-597.


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