The Infectious Disease Society of America advises against the routine use of antibiotics for acute sinusitis, because most cases are viral [i].
Symptom relief for viral sinusitis include hydration, Tylenol or NSAIDS, warm or cool compresses & steam inhalation; topical decongestants, steroids, and anticholinergics. There is inconsistent evidence that zinc, or vitamins C and E help. And there is poor evidence for the benefits of saline spray & irrigation, and antihistamines. Decongestant use can precipitate sinusitis with 25% of allergic rhinitis sufferers at risk. Oral antihistamines should be avoided (restricted to allergic rhinitis). While very effective for allergic rhinitis, steroids may in fact increase the viral load associated with viral sinusitis.
How does one determine if sinusitis should be treated with symptom relief for a viral infection, antibiotics for a bacterial infection, or Chinese herbs for either one? These are important questions because untreated, partially treated or inadequately treated sinusitis may lead to worse problems. For example, approximately 75% of orbital and peri-orbital infections are due to sinusitis [iv].
Viral sinusitis usually lasts less than 4 weeks [ii] and usually follows a common upper respiratory infection. It may turn into a bacterial sinusitis in 2% of all cases. The probability of bacterial sinusitis increases with the number of the following symptoms that are present [iii]:
Other symptoms can include:
Serious symptoms to follow-up on:
COMPLICATIONS OF SINUSITIS
Complications require prompt medical attention. They prolong suffering & medical expense at their least; and are potential emergencies at their worst. However, the risk for these complications is rare to low:
ANTIBIOTICS OR CHINESE HERBS?
Antibiotics are NOT going to be effective for viral sinusitis, but may be prescribed to prevent secondary bacterial infection. The type of antibiotic used depends on the bacteria most likely implicated [the epidemiological risk factors]. Whether the problem is acute, subacute, chronic, or recurrent. As well if antibiotic resistance, or immunodeficiency exists. There is also fungal sinusitis, which requires medical attention.
Chinese herbs can be used for, (1) a viral or bacterial infection, (2) reluctance to use antibiotics, (3) symptom relief, and (4) to prevent progression of viral to bacterial sinusitis. You may use antibiotics in conjunction with herbs, but they may help or hinder the antibiotics.
Chinese medicine doesn't differentiate sinusitis as viral vs. bacterial, but rather by the pattern of symptoms a person presents with. A pattern includes Western medical symptomology (e.g. cough, fever, color of discharge) plus tongue & pulse diagnosis. These reveal for example Wind-Heat, Cold, Damp, or Blood & Qi stagnation. Further, certain channels, and organ systems are involved (Lung, Gallbladder or Spleen). Jim McDonald (Western herbalist) differentiates sinusitis in a similar way- by “tissue states” that include hot (increased activity), cold (decreased activity), damp (congestion), dry, relaxation (laxity) and constricted (tension & spasm).
Many Chinese herbs are anti-microbial against either bacteria, virus, or both. For example, jin yin hua & lian qioa are antiviral, ban lan gen & da qing ye are anti-bacterial [Chen, n.d.]. Ban Lan gen is also the herbal basis for sulfa antibiotics [Chen, n.d]. Some herbs are valued for their potency against specific organisms. For example, star anise is the basis for Tamifu, a drug used for Avian flu [Chen, n.d]. Some herbs synergistically moderate harmful inflammatory responses, or mediate beneficial immune responses (a few antibiotics can do this too). These herbs create a terrain in which the problem, or another problem is less likely to occur. Inharmony, they clean-up metabolic debris created by a disharmony and/or from correcting a disharmony. Ultimately, herbs clear the way for the body to heal itself.
CHINESE HERBAL FORMULAS FOR SINUSITIS
PREVENTION IS THE BEST MEDICINE. Warm and moist secretions from upper airway mucosa is the first barrier against upper airway infections such as sinusitis. Many of the formulas specifically for sinusitis are not very MOISTENING. Sinus and respiratory problems that are precipitated by "warm or cool dryness" may become worse with some of the more drying formulas. This is particularly the case in high altitude, windy and/or arid regions like New Mexico where the use of moistening, yin nourishing, and jinye [fluid] generating substances are beneficial to prevent sinusitis:
Warm & Cool Dryness Injuring the Lung
Here are base formulas used for the patterns of disharmony associated with sinusitis. Some of them are sold in health food stores as patents (pills). Companies may produce different versions of each. Pill/patent formulas are prescribed based on individual presentation and can be modified in the form of loose herb, or powdered teas.
In Functional Medicine, there are many methods and tests to get to the root of chronic upper respiratory problems, due to immune dysregulation. The best time to nip an upper respiratory problem in the bud is in the early stages. This is a problem because in most cases the symptoms are vague and can go unnoticed (e.g a feeling of chilliness, headache, malaise). This is when to start regulating, not necessarily boosting the immune response [see Influenza & Cytokine Storm).
TH!:TH2 Immune Responses
The TH1 immune response attacks virus and intracellular bacteria (e.g. mycoplasma & chlamydia). Substances that boost TH1: Astragalus, Medicinal Mushrooms, licorice, Melissa (Lemon balm), Echinacea, Panax Ginseng, Chlorella, and Grape Seed Extract. If one feels better when taking these herbals it is more likely a viral problem.
The TH2 immune response attacks bacteria, and allergens. Substances that boost TH2 [anti-bacterial pathway]: caffeine, green tea extract, pine bark extract, white Willow Bark, Lycopene (in tomatoes and red fruits excluding strawberries and cherries), Resveratrol (found in grape skin, sprouted peanuts, and cocoa), Pycnogenol (found in the extract of the French maritime pine bark and apples), Curcumin (found in turmeric], Genistin (found in soybeans) Quercitin (a flavanoid in onions/ scallions, berries and kale). If one feels better taking these, it is likely a bacterial problem.
It is optimal [and safest] to help the body swing back and forth between TH1 and TH2 immune responses as needed. Substances that balance TH1:TH2 [anti-viral & anti-bacterial pathways]: Probiotics, Colostrum, Vitamin A, Vitamin E, EPA & DHA. The vitamin D receptor assists with regulating TH1 and TH2. So the point is to support the receptor, not necessarily to supplement with vitamin D.
Cong Bai Dou Chi San is a Chinese formula that boosts TH2 and balances TH1:TH2- preventive of secondary bacterial infections. This combination of green scallion [quercitin] & fermented soybean [probiotic] is a traditional home remedy for very early stages of an upper respiratory tract infection when one can't yet tell if it is cold or heat in nature- very roughly equivalent to viral or bacterial.
Integrative Medicine Tip:
CRP is a protein- an acute phase reactant- that tends to be elevated in bacterial infections AND NOT VIRAL infections, thus an underused lab marker to rule out viral infections and/or rule-in the need for herbal or pharmaceutical antibiotics [Ludell, 2013]. Any elevation of CRP is abnormal, the degree of elevation is important. Persistent low level elevation of 0.5- 7 means chronic/ systemic inflammation linked to cardiovascular disease risk [e.g atherosclerosis]. Whereas levels >7 is suspect for bacterial infections. The higher the elevation, the more acute the inflammation or trauma.
CRP is produced by the liver, and is a non specific marker of cytokines [IL6] production. It is elevated in most but not all cases of inflammation . It is also elevated in specific response to antigen-immune complexes indicating an auto-immune process [Rheumatoid arthritis, lupus, collagen vascular diseases]; methylation pathway defects; cancers.
Chen, J. [n.d.] An intro to pros and cons of drugs & Chinese medicine. In Lotus Institute of Integrative Medicine.
Lundell, B. (2013). Holistic Blood chemistry and urinary analysis reference manual.