Maintaining Respiratory Health
Emerging Strategies: Sinus Health
by Subhuti Dharmananda, Ph.D, DirectorInstitute for Traditional Medicine, Portland, Oregon
from IEP Newsletter: Summer 1997
Sinus disorders are common in people regardless of their HIV sero-status: over 50% of one group tested showed thickening mucosa indicative of irritation. However, sinus disorders, some of them extremely serious, become an increasing problem as the immune system is compromised in advanced HIV disease. | ||
Doctors have observed that once the tendency for sinus infection is established, recurrence is much more likely with each stimulus, such as common cold or allergy. HIV tends to cause immune dysfunctions that include a higher than average incidence of elevated IgE, a systemic condition that makes one prone to allergic sinusitis. The IgE levels and the severity of sinus problems increase with HIV disease progression, and may be related to viral load. As long as the flow of mucus from the sinus membranes continues freely, there is relatively low likelihood of infection. However, if the mucus thickens and stagnates, or its production is too high and blockage occurs, then there is an opportunity for infection to develop. Clinical experience reveals that many patients infected by HIV complain of persistent nasal congestion with thick, tenacious postnasal drainage even in the absence of a diagnosable sinus infection. | ||
| In early HIV infection, sinus allergy and infection may be intermittent problems. However, with continued disturbance of the sinuses, coupled with falling humoral immune function, eventually the sinus infections become persistent and serious. Antibiotic therapy, directed either at the sinus infection itself or at some other infection, eventually results in the growth of drug-resistant bacterial strains, so that persistent and worsening sinus infection that is untreatable by standard technique arises. This occurs also in the general population, in those persons who experience repeated bouts of sinus infection and are treated with antibiotics. | ||
| Eventually, the sphenoid and other deep sinuses may become infected and obstructed and there is risk of complication, including brain infection and death in those with severely compromised immunity. Dealing with sinus problems as early in HIV infection as possible is a critical concern, because of the tendency of simple sinus problems to become more complex later. Each time an infection occurs, there is disruption of the microcirculation. This disorder may reduce the ability of the immune system to fight the infection and may prevent drugs from getting to the bacteria within the sinus cavity. Surgical procedures also further disrupt the circulation, often bringing only a temporary resolution of the sinus problems. | ||
When allergy without infection produces sinus congestion, it should be treated aggressively in persons with a history of recurrent sinus infections and those with HIV infection in particular. Attempts should be made to reduce exposure to allergens (inhaled or in the diet), and the  allergy should be treated symptomatically as necessary to reduce the chance of infection from stagnation of mucus in the sinus cavities. In addition to drug decongestants (e.g., antihistamines, pseudoephedrine, and the other common drugs), one can try ingestion of high dose quercetin (500 mg each time, up to 2 grams/day), locally collected bee pollen to desensitize pollen allergies, or Chinese herbal formulas offered by acupuncturists and some other health professionals. At the earliest sign of infection (coloration of the mucus from pus is an indicator), attempts should be made to treat the infection without relying on anti-biotics (e.g. herbal therapy). Antibiotics should be given when other methods fail, but prompt action is necessary to minimize damage to sinus membranes. In one clinical report, it was found that antibiotic therapy produced complete resolution of symptoms in only 15% of patients treated, confirming the frequent experience of persisting sinus congestion. | ||
| For chronic sinusitis, inhalant therapies may prove to be helpful. Mucolytic agents, such as NAC (Mucomist) and glyceryl guaiacolate (guaifenisin), and broad-spectrum antiseptic agents (liquid garlic extract) can be administered by nebulizer, a specialized pump or spray top on bottles of liquid. Nose drops combining an antibiotic with the transport agent DMSO may succeed in getting the antibiotic to obstructed sinuses where other methods fail. Chinese researchers reported in 1996 on an inhalant powder made primarily of four Chinese herbs (agastache, mentha, angelica, and magnolia flower, in equal quantities) that aided many sufferers of sinus disorder, including recurrent sinusitis. | ||
 Tobacco smoking is a risk factor for sinus diseases and emphasis should be placed on a stop smoking program, for which acupuncture is often effective. Care should be taken to avoid any unnecessary exposure to environmental pollutants, including second hand smoke, since the irritation caused by chemicals, smoke and dust can make the individual more susceptible to infection. Nutritional supplements such as vitamin C, vitamin E, calcium, magnesium and zinc, as well as flavonoids may reduce allergy responses and irritation that can yield a predisposing condition for infection. Finally, a program of regular exercise should be encouraged to promote natural sinus dilating action. |