Sinusitis refers to inflammation of the sinuses, which is generally caused by an infection (viral, bacterial, or fungal). The sinuses are air-filled spaces around the forehead, cheeks, and eyes that are lined with mucous membranes. Healthy sinuses are sterile (meaning that they contain no bacteria or other organisms) and open, allowing mucus to drain and air to circulate in the nasal passages. When inflamed, the sinuses become blocked with mucus and can become infected. Each year, over 30 million people (adults and children alike) get sinusitis in the United States at some point. Sinusitis can be acute (lasting anywhere from 2 to 8 weeks) or chronic, with symptoms lingering even longer than that.

The classic symptoms of acute sinusitis are listed below. These symptoms usually follow a cold that does not improve, or one that worsens after 5 to 7 days of symptoms.

• Nasal congestion (rhinitis) 
• Nasal discharge (yellow or green)
• Postnasal drip (a sensation of fluid dripping down the back of your throat, particularly at night or when lying down) 
• Headache, often described as a pressure-like pain
• Pain behind the eyes 
• Facial tenderness 
• Toothache 
• Cough, often worse at night
• Sore throat (pharyngitis)
• Fever (may be present) 
• Bad breath 
• Loss of smell 
• General fatigue 
• General sense of not feeling well (malaise) 

Symptoms of chronic sinusitis are the same as acute cases of sinusitis, but are milder and last longer than 8 weeks. Chronic sinusitis is most common in people who have allergies.

Sinusitis typically follows an upper respiratory infection (for example, the common cold) or an allergic reaction (like hay fever, also called allergic rhinitis). These can cause inflammation and swelling that prevents the sinuses from draining properly. This makes the sinuses a great place for organisms like bacteria, viruses, and fungus to live and grow rapidly.

Other common causes for sinusitis include the following:

• Allergies (hay fever, tobacco smoke, dry air, pollutants) 
• Changes in atmospheric pressure (for example, from swimming or climbing high altitudes) 
• Infections from dental problems 
• Disease or an abnormal structure in the sinus area (such as nasal polyps, deviated septum, or nasal bone spur) 
• Physical injury to the sinuses 
• Bacteria, viruses, and fungi 

Poorly treated recurrent cases of sinusitis can cause chronic sinusitis.

• Young age or old age—the very young and very old are most at risk for serious upper respiratory tract infections and for complications from them 
• History of asthma
• Overuse of nasal decongestants 
• Frequent swimming and/or diving 
• Climbing or flying to high altitudes 
• Nasal polyps (swellings in the nasal passage) or nasal bone spurs (projections of bone in the nose); nasal or facial tumors; or other structural abnormalities such as a deviated septum or cleft palate 
• Dental infection 
• Conditions that compromise your immune system such as human immunodeficiency virus (HIV), being on immunosuppressive medications (for example, following an organ transplant), or cancer, especially if you are receiving chemotherapy
• People with one of a number of diseases that prevent the cilia (hairs that line the sinuses and help remove mucus) from working properly are also at risk. These diseases include: Kartagener's syndrome, cystic fibrosis, and immotile cilia syndrome 
• Exposure to air pollution and cigarette smoke 
• Pregnancy 
• Gastroesophageal reflux disease (GERD), a disorder in which the acid from the stomach backs up into the esophagus 
• Hospitalization, especially if the reason you are in the hospital is related to a head injury or you needed a tube inserted into the nose (for example, a nasogastric tube from your nose to your stomach) 

Your health care provider can generally make the diagnosis of sinusitis from your history (that is, asking you a series of specific, appropriate questions) and by examining you, with a focus on the sinuses and upper respiratory system. The simplest way to test for sinusitis is by percussing (tapping) or pressing over your sinuses (that is, on the forehead and cheekbones). If those areas are tender, there is likely to be inflammation and there may be an infection. Transillumination (shining a light through the sinuses) is another simple method that your doctor may use to test for sinus inflammation; if the light does not shine through, this indicates congestion.

If the diagnosis is not entirely clear, if an acute infection recurs, or if your symptoms have been ongoing (chronic), then additional tests that your doctor may consider include an xray, CT scan, or magnetic resonance imaging (MRI). Sometimes, a referral to a specialist (known as an Ear Nose and Throat (ENT) doctor [also called an otolaryngologist]) is necessary. This specialist may perform a rhinoscopy (also called nasal endoscopy) using a fiber optic scope to look at your sinuses or a sinus puncture to test for different organisms that may be causing your sinusitis.

The best way to prevent sinusitis is to avoid and, if unavoidable, quickly treat any flus or colds. Methods for trying to avoid getting the flu or a cold include:

• Influenza immunization annually 
• Washing your hands frequently, particularly after shaking hands with others
• Eating plenty of fruits and vegetables; these foods are rich in antioxidants and other important food chemicals that are thought to boost your immune system 
• Reducing stress

The goals of treatment for sinusitis are to alleviate symptoms by reducing inflammation and to cure the infection. The latter requires the use of antibiotics (see Medications) to get rid of bacteria and other organisms. To lessen inflammation, on the other hand, there are many possible methods ranging from using a humidifier (see section entitled Lifestyle) to surgical drainage. Several dietary supplements and herbs may help prevent colds, shorten the duration of your cold or flu, or work together with antibiotics to treat your infection and support your immune system. How well many of these substances work can be very individual; talk to your doctor about safety and appropriateness.

In addition, like many individuals, you may experience a significant improvement in sinusitis symptoms from acupuncture or homeopathy, especially if your symptoms are chronic.

The following measures can help reduce the congestion in your sinuses:

• Use of a humidifier 
• Saline nasal spray 
• Inhaling steam 2 to 4 times per day (for example, sitting in the bathroom with the shower running) 

Antibiotics are prescribed if a bacterial infection is present or suspected. Commonly used antibiotics for sinusitis include:

• amoxicillin
• ampicillin 
• amoxicillin with clavulanic acid 
• trimethoprim with sulfamethoxasole
• erythromycin 
• clarithromycin 
• azithromycin 
• cefuroxime
• cefaclor 
• ciprofloxacin 
• levofloxacin 

Treatment of acute sinusitis generally requires 10 to 14 days of antibiotics. Use of antibiotics for chronic sinusitis requires longer treatment – usually 3 to 4 weeks.

Decongestants—are used to relieve symptoms; these come in nasal (for example, oxymetazoline, pheylephrine, and xylometazoline) or oral (namely, pseudoephedrine, phenylpropanolamine) forms. The problem with nasal sprays is that they can promote dependency and "rebound" congestion (congestion that worsens if the spray is used for a prolonged period of time); therefore, nasal decongestants should not be used for longer than 3 to 5 days in a row, unless specifically instructed by your doctor. Also, decongestants can cause constriction of blood vessels and, therefore, should not be used if you have heart disease, high blood pressure, migraines, or Raynaud's disease; you should also not use decongestants if you have difficulty urinating (for example, from an enlarged prostate), have emphysema, or take certain medications such as antidepressants.

Nasal steroid spray— decrease inflammation, especially if you have allergies or a structural problem contributing to the inflammation (like a nasal polyp). Examples of this group of medications includes beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone. Occasionally, for chronic sinusitis, a short course of oral steroids may be recommended by your doctor.

Other

Other medications that may be used under the appropriate circumstances include anti-fungals (in addition to surgery) and anti-histamines (if allergies are contributing to the problem).

To treat fungal sinus infections, surgery is needed, along with anti-fungal medictaions. If you continue to have recurrent episodes of sinusitis, despite appropriate medicines and other treatments, surgical drainage by an ENT specialist may be recommended. Surgery may also be necessary to repair the following structural problems if less invasive methods do not relieve symptoms adequately:

• Deviated Septum 
• Nasal polyps 

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider.

Bromelain and Quercetin

Although not all experts agree, bromelain supplements may help reduce nasal mucus associated with sinusitis. Bromelain is approved by the German Commission E for the treatment of sinus and nasal swelling following ENT surgery.

Often, bromelain is used together with quercetin, a flavonoid (plant pigment responsible for the colors found in fruits and vegetables) that has anti-histamine properties and is, therefore, helpful if your sinus symptoms are related to allergies.

Lactobacillus species

Lactobacillus species (probiotics, or "friendly" bacteria) can be a useful adjunct for the treatment of respiratory infections such as sinusitis and for reducing your chances of developing allergies.

N-Acetylcysteine

Cysteine is an essential amino acid found in many proteins. N-acetylecysteine (NAC), a modified form of cysteine, appears to reduce inflammation in mucus membranes, such as that seen with sinus congestion. Theoretically, therefore, taking an NAC supplement may help reduce symptoms of sinusitis. This theory needs scientific study before specific recommendations can be made.

Vitamin C

Vitamin C is often touted as a help to prevent colds. If this is true, then, in theory, taking vitamin C during cold and flu season might help prevent the development of sinusitis. Despite the popular belief that vitamin C can cure the common cold, however, the scientific evidence supporting this conviction is limited.

More specifically, there have been a few studies suggesting that taking large doses of vitamin C supplements at the onset of cold or flu symptoms, or just after exposure to someone else with a cold or the flu, can shorten the duration of the illness or ward it off altogether. However, the majority of studies, when looked at collectively, lead researchers to conclude that vitamin C does not prevent or treat the common cold.

Some experts suggest that vitamin C may only be useful in case of a cold if you have low levels of this nutrient to begin with. Another possibility is that the likelihood of success may be very individual – some improve, while others do not. If you are amongst the 67% of people who believe that vitamin C is helpful for your colds, there may be power in your conviction. In other words, your experience is probably more important than what the research is stating. Talk to your doctor about any pros and cons with regards to using vitamin C during cold and flu season.

Zinc

Zinc supplementation enhances immune system activity and protects against a range of infections including colds and upper respiratory infections (like, possibly, sinusitis). Several studies have revealed that zinc lozenges can reduce the intensity of the symptoms associated with a cold and the length of time that a cold lingers. Similarly, nasal zinc gel seems to shorten the duration of a cold while zinc nasal spray does not. If you use zinc lozenges or nasal gel when you have a cold, therefore, you may shorten the duration of your symptoms and lessen the likelihood of developing sinusitis.

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

Barberry (Berberis vulgaris) and Goldenseal (Hydrastis canadensis)

Barberry and goldenseal have very similar therapeutic uses because both herbs contain active substances called berberine alkaloids. These substances can help combat infection, stimulate the activity of the immune system, and lower fever. Goldenseal is endangered; therefore, use of barberry is preferred.

Echinacea (Echinacea angustifolia/E. pallida/E. purpurea)

Echinacea is used by many herbalists to treat infections like sinusitis. In addition, there is a good amount of scientific evidence that supports the use of this herb to treat the common cold. By shortening the duration of a cold, echinacea may help stop you from getting sinusitis.

Ephedra (Ephedra sinica)

The decongestant pseudoephedrine is a synthetic version of this herb that has been used traditionally to treat upper respiratory infections. The World Health Organization supports the use of ephedra as part of treatment for the common cold, hay fever, and sinusitis. Because of some serious risks associated with this herb (like stroke and irregular heart rhythm), use of ephedra should only take place under strict guidance and supervision by an herbal specialist and physician and only for short periods of time.

Eucalyptus (Eucalyptus globulus)

Laboratory studies show that eucalyptus oil has strong antibacterial properties. Studies in animals and test tubes also found that eucalyptus oil acts as an expectorant (loosens excessive mucus in the respiratory passages) and antiseptic (prevents infection). Eucalyptus leaves may reduce fever. Herbalists recommend the use of fresh leaves in teas and gargles to soothe sore throats and ease symptoms of sinusitis, although children should not ingest eucalyptus.

Although studies of acupuncture for sinusitis are lacking in the English medical literature, acupuncturists report lots of success in treating this condition. Acupuncturists usually describe sinusitis as "dampness" which creates inflammation and congestion in the mucus membranes. This dampness is cleared by strengthening the spleen meridian and by working with the stomach meridian. Practitioners often perform needling therapy and/or moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for this condition. Acupuncturists with specialized training may also recommend herbal therapy.

Although no studies have examined the effectiveness of chiropractic for sinusitis, some practitioners suggest that manipulations by a well-trained chiropractor may decrease pain and improve sinus drainage in certain individuals.

There have been few studies examining the effectiveness of specific homeopathic remedies in general. In one study of homeopathy for sinusitis, however, more than 80% of the 119 participants had significant improvement in their symptoms after taking the homeopathic remedy for 2 weeks without antibiotics or other medications. Professional homeopaths may recommend one or more of the following treatments for sinus congestion based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Hepar sulphuricum — for the later stages of sinus inflammation when the pain is concentrated between the eyes and is worsened by cold or motion; nasal discharge tends to be thick and the individual may experience sensitivity of the scalp
• Kali bichromicum — this remedy is considered the first choice homeopathic treatment for sinusitis; it is most appropriate for individuals who have pain between the eyes or in the forehead above one eye; nasal discharge is generally stringy; scalp and facial bones are tender to touch and the person may feel dizzy or nauseated; pain is worse around noon and with cold and motion, but improves with warmth and pressure
• Mercurius — for sinusitis with thick, green, foul-smelling nasal discharge which may be blood tinged; there may also be a gripping pain around the head extending to the teeth; persons for whom Mercurius is appropriate have symptoms that worsen with open air, sleeping, eating, drinking, and extreme hot or cold; they may also have difficulty regulating their temperature (the individual often fluctuates from feeling cold and chilled to hot and sweaty) 
• Pulsatilla — for individuals who have a thick, bland, yellow or greenish discharge that is often accompanied by nausea and indigestion; symptoms tend to improve with cool air, pressure, and cool compresses; symptoms worsen when the individual is lying down, especially in a warm room; this remedy is appropriate for individuals who are distinctly not thirsty and require tremendous comforting
• Silicea — for individuals with chronic congestion accompanied by head pain that tends to be worse in the right eye; this pain is worsened by cold, movement, light, noise, and mental concentration (such as when studying) but relieved by heat and pressure
• Spigelia — for sinusitis with sharp pains on the left side of the face, generally coming on after exposure to cold, wet weather; symptoms are aggravated by warmth, light, noise, and movement, but are relieved by cold compresses or cool water on the face and when the individual is lying down with the head propped up

If you are not better in a few weeks, you may be sent to an ENT specialist for tests to find the cause of your sinus infection.

Sinusitis often acts up during pregnancy. There are many herbs and medications that pregnant and breastfeeding women should not use. Please check the monographs on individual herbs and drugs discussed in this article to know which are safe and which are not. Also, check with your doctor before using any herbs or supplements.

Some serious diseases are caused by sinusitis or can have similar symptoms. Be sure to see your health care provider if you are not feeling better or have new symptoms. Tell your provider if you may be pregnant.

Sinusitis is generally a very curable condition. When you are having recurrent attacks, you should be evaluated for underlying causes (such as nasal polyps or another structural problem). Although very rare, complications that may arise include:

• Osteomyelitis – infection that spreads to the bones in the face 
• Meningitis – infection that spreads to the brain 
• Orbital cellulitis – infection that spreads to the area surrounding the eye 
• Abscess 
• Blood clot
• The bacteria causing your sinusitis may develop resistance to antibiotics commonly used to treat the infection; this makes it more difficult to find the best treatment for your sinus infection.

Adler M. Efficacy and safety of a fixed-combination homeopathic therapy for sinusitis. Adv Ther. 1999;16(2):103-111.

Asher BF, Seidman M, Snyderman C. Complementary and alternative medicine in otolaryngology. Laryngoscope. 2001;111(8):1383-1389.

Audera C, Patulny RV, Sander BH, Douglas RM. Mega-dose vitamin C in treatment of the common cold: a randomised controlled trial. Med J Aust. 2001;175(7):359-362.

Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory infection. J Fam Pract. 1999;48:628-635.

Belongia EA, Berg R, Liu K. A randomized trial of zinc nasal spray for the treatment of upper respiratory illness in adults. Am J Med. 2001;111(2):103-108.

Berberine. Altern Med Rev 2000 Apr;5(2):175-177.

Bergner P. Goldenseal and the common cold; goldenseal substitutes. Medical Herbalism: A Journal for the Clinical Practitioner. 1996–1997;8(4) Accessed at http://www.medherb.com/84.HTM March 13, 2003.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:94-95, 122-123.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:33-35, 88-102, 111- 117, 118-123.

Braun BL, Fowles JB, Solberg L, Kind E, Healey M, Anderson R. Patient beliefs about the characteristics, causes, and care of the common cold: an update. J Fam Pract. 2000;49(2):153-156.

Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Phytomedicine. 1999;6(1):1-6.

Cohen S, Hamrick N, Rodriquez MS, Feldman PJ, Rabin BS, Manuck SB. Reactivity and vulnerability to stress-associated risk for upper respiratory illness. Psychosom Med. 2002;64(2):302-310.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 88-89.

Di Baise JK, Olusola BF, Huerter JV, Quigley EM. Role of GERD in chronic resistant sinusitis: a prospective, open label, pilot trial. Am J Gastroenterol. 2002;97(4):843-850.

Douglas RM, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2000;(2):CD000980.

Eby GA. Zinc ion availability—the determinant of efficacy in zinc lozenge treatment of common colds. J Antimicrob Chemother. 1997;40:483–493.

Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. [Review]. Ann Intern Med. 2002;136(1):42-53.

Fortes C, Forastiere F, Agabiti N, et al. The effect of zinc and vitamin A supplementation on immune response in an older population. J Am Geriatr Soc. 1998;46:19–26

Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-334.

Garland ML, Hagmeyer KO. The role of zinc lozenges in treatment of the common cold. Ann Pharmacother. 1998;32:63–69.

Gorton HC, Jarvis K. The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections. J Manipulative Physiol Ther. 1999;22(8):530-533.

Hemilia H. Vitamin C intake and susceptibility to the common cold. Br J Nutr. 1997;77(1):59-72.

Hemilia H, Douglas RM. Vitamin C and acute respiratory infections. Int J Tuberc Lung Dis. 1999;3(9):756-761.

Hirt M, Nobel Sion, Barron E. Zinc nasal gel for the treatment of common cold symptoms: A double-blind, placebo-controlled trial. ENT J. 2000;79(10):778-780, 782.

Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care. 29(2):231-261.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 206.

Kalliomaki M, Salminen S, Arvilommi H, Kero P, Koskinen P, Isolauri E. Probiotics in primary prevention of atopic disease: a randomized placebo controlled trial. Lancet. 2001;357(9262):1076-1079.

Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-334.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.

Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001;58(9):1234-1245.

Melchart D, Walther E, Linde K, Brandmaier R, Lersch C. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med. 1998;7:541–545.

Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. [Review]. Cochrane Database Syst Rev. 2000;(2):CD000530.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health Care Professionals. London, England: The Pharmaceutical Press; 1996:108.

Norregaard J, Lykkegaard JJ, Mehlsen J, Danneskiold-Samsoe B. Zinc lozenges reduce the duration of common cold symptoms. Nutr Review. 1997;55(3):82-85.

Prasad AS, Fitzgerald JT, Bao B, Beck FW, Chandrasekar PH. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2000;133(4):245-252.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:221-225.

Takkouche B, Regueira-Mendez C, Garcia-Closas R, Figueiras A, Gestal-Otero JJ. Intake of vitamin C and zinc and risk of common cold: a cohort study. Epidemiology. 2002;13(1):38-44.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 120-122.