Sinusitis and Allergies: Sorting out the confusion
Sinusitis is a confusing topic, not only for patients but for many health practitioners as well. The confusion arises due to the many facets of the condition, problems with establishing the cause, and similarities between the symptoms of infection and those of allergy. In many cases allergy and infection coexist, feeding on each other, so that 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 cells lining the nose. There are four basic cell types: ciliated columnar cells (fine hairs), non-ciliated columnar cells, basal cells and goblet cells. The ciliated or hairy cells have about 50-200 cilia per cell, which vibrate 700-800 times a minute and move mucus at a rate of 9mm 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 the parasympathetic nervous systems supply these cells, the former causing the secretions to be more watery, and stimulation of the latter causing 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 accumulated polyps in the nose mucus pressure increases and can also lead to infection. There is what could be regarded as a minor design problem with the maxillary sinus, situated beneath the cheek bone: its opening is in the upper part, so that mucus must be moved upwards in order to escape into the nasal cavity.
Functions of the sinuses
The sinuses have a number of interesting properties. Firstly they are hollow, which gives resonance to the 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 that contributes to the body’s immune defences. The sinuses also lighten the head, absorb shock and contribute to the shape of the face. Their abundant secretion of mucus contributes to the mucus secretion in the nose.
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 mentioned earlier, the opening in the maxillary sinus is in the uppermost part, so that at times the mucus has to flow against gravity. Because the hairs move in one direction only, mucus secreted close to the outlet, but on the wrong side, will need to travel all the way around before finding its way out. Swelling of the mucosa causes two surfaces to come into contact, and this can interfere with the flow and movement of the fine cilia. This can lead to the stagnation of mucus. It explains why chronic infections, polyps in the sinuses, and anything else disrupting or interfering with ciliary function, will eventually interfere with the flow of mucus and cause stagnation, which could also lead to infection.
Management of sinus problems
Decreasing the swelling of the lining membrane, supporting the ciliary action and helping to drain the mucus are essential functions. 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 indicating that antibiotics are not as successful in chronic infections as in acute attacks (and this may well not apply to acute attacks in children).
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.
Antibiotics may be necessary in acute attacks but if used to treat chronic infections, it may cause more harm than good.
Natural Approaches
The more chronic the condition, the more important are basic principles of lifestyle management. If allergies are present, try an elimination diet to detect allergens or ask your doctor about allergy tests. Domestic dust mites are a common allergen, but so is dust or even fungus. Attend to damp places where fungus breeds, and vacuum often to remove mites and dust. Cigarette smoke is a serious aggravating problem, even for passive smokers.
Drainage:
* Acupuncture
* Low-energy laser therapy
* Quercetin
* N-acetylcysteine (NAC): Has powerful anti-oxidant, antiviral and anti-bacterial properties. The dose is 500mg 2 – 3 times per day.
* Bromelain: An enzyme made from pineapple that can liquefy the mucus.
* Nasal saline washouts
* Saline nasal sprays
Shrinking the mucosa:
* Inhalation with aromatherapy oils such as eucalyptus oil
* Vitamin C: A natural antihistamine and anti-inflammatory agent that enhances the immune response
* Bromelain: Reduces inflammation and swelling
* Quercitin: Reduces symptoms across the board
Treating any infection present:
* Echinacea
* Propolis
* Colloidal silver
* Elder flower
* Quercitin
Treating the allergic reaction:
* Grape seed extracts widely used to treat allergic conditions
* Selenium is another antioxidant that breaks down allergy-related promoters of inflammation
* Quercitin reduces allergic symptoms across the board
Supporting health of the mucous membranes:
* Essential fatty acids nourish the mucous membranes and have anti-inflammatory properties
* A good quality vitamin/mineral supplement
Malani du Toit
Dietician
