Sinusitis

by Jiang Liu, Doctor of Oriental Medicine
Acupuncture & Chinese Medicine Clinic
701 N University Ave, Suite 101
Little Rock, AR 72205

 

Sinusitis is an inflammation of the sinuses and nasal passages. A sinus infection can cause a headache or pressure in the eyes, nose, cheek area, or on one side of the head. A person with a sinus infection may also have a cough, a fever, bad breath, and nasal congestion with thick nasal secretions. Sinusitis is categorized as acute or chronic.

Since anatomical location of sinuses, if sinusitis is left undiagnosed and untreated, the complications of sinusitis can occur that may lead to severe medical problems and possibly death. The complications may include: Infection of the frontal bone; Infection of the eye socket from ethmoid sinusitis; Formation of a blood clot in the sinus area around the front and top of the face; Infection of brain.

Causes
Acute sinusitis usually follows a viral infection in the upper respiratory tract, but allergy-causing substances or pollutants may also trigger acute sinusitis. Bacteria can cause acute sinusitis and chronic sinusitis. Fungi are also becoming an increasing cause of chronic sinusitis, especially in people with diseases that weaken the immune system, such as AIDS, leukemia, and diabetes.

Conventional treatment
Medications most often used to treat sinusitis include:

  • Antibiotics: Kill bacteria or fungi
  • Antiallergic medicine: Improve the allergy
  • Decongestants: Reduce the swelling of the mucous membranes in the nose
  • Analgesics: Relieve pain
  • Mucolytics: Thin the mucus
  • Corticosteroids: Reduce inflammation in the nasal passages
  • Sinus surgery is generally a last line of defense for medical doctors

Chinese medicine
Acupuncture or/and herbal formula work very well on sinusitis. They can be used alone or combined with each other. There are several kinds of sinusitis and the following are commonly observed in clinical practice.

Wind-heat

  • Symptoms: Stuffy nose, nasal discharge (yellow/green, thick), headache, inability to smell, aversion to cold, or fever
  • Tongue:  Red on tip or sides
  • Pulse:  Floating and rapid
  • Treatment principle:
    • Expel wind-heat
    • Induce diaphoresis
    • Restore the descending and dispersing functions of the lung qi

Liver/gallbladder heat

  • Symptoms: Yellow discharge, red face, headaches at frontal or temporal, irritability, and bitter taste in the mouth
  • Tongue:  Red on the sides, greasy yellow tongue coating
  • Pulse:  Wiry, slippery and fast
  • Treatment principle:
    • Clear liver and gallbladder fire
    • Restore the descending and dispersing functions of the lung qi

Heat in the lung

  • Symptoms: Thick nasal discharge, tender sinus area, heat signs – flushed face, thirst, and feelings of heat
  • Tongue:  Red with sticky yellow coating
  • Pulse:  Slippery, full
  • Treatment principle:
    • Clear lung-heat
    • Restore the descending and dispersing functions of the lung qi 

Spleen deficiency – Stomach/spleen damp-heat

  • Symptoms: Heavy/foggy feeling in the head, sticky /yellow discharge, red cheeks, thirst, dry lips, frontal headache, chest/epigastrium oppression.
  • Tongue:  Sticky yellow coating in the stomach or spleen area
  • Pulse:  Slippery
  • Treatment principle:
    • Clear heat
    • Resolve dampness
    • Tonify  stomach and spleen

Studies of Chinese medicine for sinusitis

The root and development of otorhinolaryngology in traditional Chinese medicine. Yap L ea al. European Archives of Oto-Rhino-Laryngology. 2009;266(9):1353-9. There is an increasing trend in society to look beyond conventional medicine to find answers to problems in health. Traditional Chinese medicine (TCM) is one of the most popular alternative, complementary therapies worldwide. It is becoming a popular alternative in otorhinolaryngology where its use in the treatment of sinusitis, tinnitus, deafness and Meniere’s disease is growing. Despite the general awareness of TCM, the literature relating specifically to otorhinolaryngology is relatively scarce. In this review, we have traced the origin and development of otorhinolaryngology with respect to TCM and have provided a few interesting insights into otorhinolaryngology, as it used to be practised. Archaeological sources have shown that diseases affecting the ear, nose and throat were of medical concern as early as the 18th century BC. The first practising otorhinolaryngologist can be traced back to the 5th century BC. Acupuncture, moxibustion, herbal therapy and massage were amongst his treatments. Otorhinolaryngology was recognised as a major specialty when formal medical education began in the 7th century AD. Therapeutic measures since then expanded to include exercise, food therapy and surgery. References to using oesophageal speech as a substitute voice generator, the use of copper wire to excise nasal polyps, procedures for removal of sharp foreign bodies in the oropharynx, repair of lacerated trachea and treatment of cancer of lips can be found in historical notes. In conclusion, from its primitive roots, TCM has developed into a distinct branch of health care system in China today that works alongside Western medicine.

Treatment of acute rhinosinusitis with the preparation from Pelargonium sidoides EPs 7630: a randomized, double-blind, placebo-controlled trial. Bachert C ea al. Rhinology. 2009;47(1):51-8. OBJECTIVE: To evaluate the efficacy and safety of the herbal drug preparation from the roots of Pelargonium sidoides (EPs 7630) compared to placebo. DESIGN: Double-blind, randomized, placebo-controlled, parallel-group, multicenter trial with a group-sequential adaptive design. SUBJECTS: Patients with sinonasal symptoms of at least 7 days duration, and radiographically and clinically confirmed acute rhinosinusitis of presumably bacterial origin with a Sinusitis Severity Score (SSS) of at least 12 out of 24 points at inclusion. INTERVENTIONS: EPs 7630, a herbal drug preparation from the roots of Pelargonium sidoides (1: 8-10; extraction solvent: ethanol 11% (w/w)), or matching placebo at a dose of 60 drops three times daily for maximum 22 days. MAIN OUTCOME MEASURES: Change in the SSS after 7 days. RESULTS: 103 patients were recruited until the planned interim analysis. The mean decrease in the SSS was 5.5 points in the EPs 7630 group compared to 2.5 points in the placebo group, a difference of 3.0 points (95% confidence interval 2.0 to 3.9, p < 0.00001). This result was confirmed by all secondary parameters indicating a more favourable course of the disease and a faster recovery in the EPs 7630 group. According to the pre-specified decision rule, the study was stopped after obtaining proof of efficacy for EPs 7630. CONCLUSIONS: EPs 7630 was well tolerated and superior in efficacy compared to placebo in the treatment of acute rhinosinusitis of presumably bacterial origin.

Treatment of perennial allergic rhinitis using Shi-Bi-Lin, a Chinese herbal formula. Zhao Y et al. Journal of Ethnopharmacology. 122(1):100-5, 2009 Feb 25. AIM OF THE STUDY: Shi-Bi-Lin (SBL) is modified from the classic formula Cang-Er-Zi-San which has been used to treat chronic rhinitis, paranasal sinusitis and allergic rhinitis by herbal practitioners. The present study aimed at patients with moderate to severe perennial allergic rhinitis. SBL which has been shown effective in treating a guinea-pig model of allergic rhinitis, was evaluated for its efficacy and safety. MATERIALS AND METHODS: 126 allergic rhinitis patients were recruited in a double-blind randomized control trial. Half of the patients received SBL capsules and the others half received placebo for 4 weeks. Symptoms scores, physician’s evaluation, nose examination, quality of life, adverse effects, serum cytokines were evaluated before and after treatment. RESULTS: SBL was found to be safe and effective in relieving some symptoms of perennial allergic rhinitis, improving the nose condition, and enhancing some domains of quality of life when compare to placebo, (p<0.05). In the 2 weeks follow up after treatment completion, the SBL enjoyed a prolongation of symptom control (p=0.05). CONCLUSION: SBL relieved symptoms of nose blockage among patients with perennial allergic rhinitis, and some aspects of the quality of life were also improved. The improvement was sustained for at least 2 weeks after treatment. No serious adverse events were encountered.

The value of herbal medicines in the treatment of acute non-purulent rhinosinusitis. Results of a double-blind, randomised, controlled trial. Tesche S et al. European Archives of Oto-Rhino-Laryngology. 2008;265(11):1355-9.  In a prospective, randomised, double-blinded controlled study, we compared the efficacy and safety of two different treatment options with the herbal medicines cineole and a combination of five different components for acute viral rhinosinusitis. One hundred and fifty patients with acute and viral rhinosinusitis (75 patients in each treatment group) were enrolled. The diagnosis rhinosinusitis was made according to a defined symptoms-sum-score which was based on rhinoscopic and clinical signs which are characteristic for rhinosinusitis. The primary endpoint was the amelioration of the symptoms-sum-score, which includes all relevant characteristics for rhinosinusitis as headache on bending, frontal headache, sensitivity of pressure points of trigeminal nerve, impairment of general condition, nasal obstruction, rhino-secretion, secretion quantity, secretion viscosity and fever in a treatment period of 7 days. The mean reduction of the symptoms-sum-score after 4 days was 6.7 (+/-3.4) and after 7 days 11.0 (+/-3.3) in the cineole group and 3.6 (+/-2.8) after 4 days and 8.0 (+/-3.0) after 7 days in the control group. The differences between both groups were clinically relevant and statistically significant after 4 and 7 days (P < 0.0001). This result is validated by the amelioration of the secondary endpoints headache on bending, frontal headache, sensitivity of pressure points of trigeminal nerve, impairment of general condition, nasal obstruction and rhino-secretion. These findings correlate with the statistically significant difference of the estimation of B-scan ultrasonography. It is safe to use both medications for 7 days in patients with acute viral rhinosinusitis. Treatment with cineole is clinically relevant and statistically significant, more effective in comparison to the alternative herbal preparation with five different components.

Chemistry and bioactivity of Flos Magnoliae, a Chinese herb for rhinitis and sinusitis. Shen Y et al. Current Medicinal Chemistry. 2008;15(16):1616-27. Flos Magnoliae (FM, Chinese name: Xin-yi) is one of the most commonly used Chinese medicinal herbs. It has a long history of clinical use for managing rhinitis, sinusitis and headache. More than 20 different FM species have been used clinically, which makes species identification and evaluation of pharmacological effects of individual chemical ingredients difficult. In this review, we have summarized the current knowledge on FM phytochemistry and its bioactivity activities. The bioactive compounds in FM include both lipid and water-soluble components. More than 90% of the essential components of FM species are terpenoids, including monoterpenes and sesquiterpenes. Lignans and neolignans including tetrahydrofurofuran, tetrahydrofuran and aryltetralin are also present in FM species. A small number of water-soluble compounds have been isolated from Magnolia flower buds, including a benzylisoquinoline alkaloid magnoflorine, an ester ethyl-E-p-hydroxyl-cinnamate and a flavonoid biondnoid. A wide range of pharmacological actions of FM have been reported, including anti-allergy, anti-inflammation and anti-microbial activity. The structure-activity relationship analysis revealed the influence of methylation at position 5 on the 3,7-dioxabicyclo-(3,3,0)-octane backbone of six lignans in antagonistic activities against platelet-activating factor. In addition, the trans stereoisomer fargesin had a much lower bioactivity than the cis stereoisomer demethoxyaschantin. Recent studies have been directed towards the isolation of other bioactive compounds. Further studies on FM may help to develop new anti-inflammatory and anti-allergic drugs.

Electroacupuncture in combination with surgical intervention in the treatment of patients with polypous rhinosinusitis. Mikhireva MM et al.  Vestnik Otorinolaringologii. 1990;2:40-2. In 36 patients with polypous rhinosinusitis the olfactory function, mucociliary transport, humoral and local immunity were investigated before and after treatment that combined surgical intervention and electric acupuncture. The points were selected on an individual basis using diagnostic data, i.e. measurement of electric conductivity of representative points. In most cases the combined treatment led to improvement of the olfactory function, mucociliary transport and local immunity. During two-year follow-up recurrent polyps were detected in 4 patients whose general health condition remained good. These observations indicate the electric acupuncture can be recommended for the combined therapy of polypous rhinosinusitis.

Acupuncture therapy in the outpatients-department of the University Clinic Heidelberg. Fischer MV. Anaesthesist.1982;31(1):25-32. Encouraged by the good results obtained using acupuncture anaesthesia, we started therapeutic acupuncture in our institute of anaesthesiology four years ago. In the meantime acupuncture is as important a therapeutic method in our out-patients department as are therapeutic local anaesthesia, transcutaneous electrical nerve stimulation and biofeedback. The results in 520 patients who have been treated with acupuncture for different diseases are reported. The success of treatment, the number of sessions and the recurrence-rate within one and a half years are discussed for the different diseases. Acupuncture treatment was regarded successful when 1, the patient had no complaints at all without medication, and 2, when there was significant improvement (no long term medication, only mild complaints with unusual strain, which were responsive to minimal medication). Thus treatment in cephalgia was successful in 83% with no recurrences (NR) in 84%. In cervical pain syndromes the respective percentages were 80% (NR = 74%) in constipation 80% (NR = 72%), sinusitis 86% (NR = 100%), insomnia 100% (NR = 100%). Good results, albeit with high recurrence rate were achieved in cases of trigeminal neuralgia in 90% (NR = 23%), colitis ulcerosa in 100% (NR = 0%), in bronchial asthma 70% (NR = 50%) and in tumour pain 61% (NR = 0%). Treatment in patients suffering from parathymic conditions were unsatisfactory and results in cases of tinnitus were negative.

Electro-acupuncture in otolaryngology. Heimann H. HNO. 1978;26(8):278-81. As an introduction to electro-acupuncture, the author discusses the basic theory of classical acupuncture as well as the therapeutic applications of low frequency positive or negative half-waves. Electro-therapy using specific points of acupuncture which refer to selected organs can now be carried out with a compact apparatus called ELBION. This instrument had originally been designed by the author for reliable and uncomplicated applications in oto-rhino-laryngology. ELBION thus permits the realization of a complete electro-acupuncture (EAP). Typical indications for EAP, as confirmed by the author, include influenzal anosmia, Bell’s paralysis and central equilibrium disturbances of the neurovascular type. EAP serves as a most helpful additional treatment in cases of frontal sinusitis, various kinds of neuralgia, cervical otalgia, as well as sialoses of obscure or chronic genesis.