SINUS PAIN - SINUSITIS (SINUS INFECTION) AND ALLERGY, AND?

Sinus pain arises from the cavities in our hollow facial bones.
We have frontal sinuses in our forehead, maxillary sinuses in our cheeks and ethmoid and sphenoid sinuses further back alongside our nasal passages.

Sinusitis refers to these cavities, and rhinitis to the nasal passages themselves.

Diagnostic clues

Blocked sinuses can cause lots of very odd feelings in the head3, as well as sinus pain. No matter what you’re feeling there, it is worth checking for this condition.

A clue to sinus headache symptoms is they tend to come on at the same time each day.

Relieving sinus headaches by inhaling the vapor of something like Vicks, or using a nasal spray, is a simple way of diagnosing them. Observing the effects of a trial of therapy, is often used for diagnosis in medicine.

Different mechanisms for sinus pain

Sinus infection symptoms include pain which can be caused by a sinus full of pus under increased pressure because of blockage, and with inflammation spreading beyond the actual cavity.

Often this is not so, and it is a "vacuum" headache due to the blockage and the air in the sinus being taken up by our blood stream, resulting in reduced sinus pressure.

Sometimes the swelling can cause pressure between the septum and your nasal turbinates. These are thin, curled bones on the sides of the nasal cavity. This contact can cause quite severe pain, which mimics sinus pain.

Causes

The lining of the nose has the jobs of cleaning, warming and humidifying the air you breath in. It is designed to swell, to narrow the passage and make this job more efficient in cold weather for instance.

Various circumstances can increase this swelling and cause blockage of the ostia of the sinuses, or of the osteomeatal complex.

Allergy is a very common mechanism for the swelling, as is mechanical disturbances of the cervical spine.

It is out of fashion in chiropractic circles these days, to claim benefits in lots of different diseases. They have unfortunately “thrown out the baby with the bathwater.” This is a case in point.

When I do neck muscle stretching on myself, after some time a blocked nostril regularly unblocks.

Another very important factor is our emotional state. Feeling sorry for ourselves is a potent factor in sinus congestion.



The cavity of your nose has a septum dividing the two sides, which should be in the mid line.

You may have had this cartilage down the middle of your nose pushed to one side during childbirth. You may have had your nose broken, causing this cartilage to grow crooked.

This condition of deviated nasal septum, can help cause sinus symptoms by narrowing the passages on one side.



Pain from your eye or from your frontal sinus

As elsewhere, your pain may be in your eye or behind it, but not coming from your eye itself.

Frontal sinus pain is often felt in the eye. Pain from your upper neck can also be here.

Press upwards with the pulp of your thumb, underneath the bone at the top of your eye socket, rubbing around as you do. This is often a bit tender, so compare your two sides.

pressing on frontal sinus via orbit



Tenderness here can be from frontal sinus or neck. I then compare the two sides when rubbing firmly on the skull at the back immediately above the neck. If the person is tender on the same side, front and back, it is usually a neck problem.

pressing on occipital bone



I have seen one person where the tenderness was on the eyeball itself, but the problem was in her neck. Pain from the eye itself is almost always obvious because the eye is red as well. Frontal sinusitis can cause a little reddening of the eye, but usually more swelling of the eyelids.

As well as tenderness of the floor of the frontal sinus, tapping over the sinus is likely to hurt on that side.

tapping over frontal sinus





Your ethmoid, sphenoid and maxillary sinuses

The ethmoid sinuses are alongside your eye. You can check the front ones for tenderness by pressing over the bone on the inner side of the eye socket...

pressing over anterior ethmoids



Ethmoid sinus pain can be felt at your temple or ear and sphenoid sinus pain at the back of your head. The sphenoid sinus is behind your eye socket.

Your face bones are all hollow, including your cheeks. The maxillary sinus here, can cause toothache, even if nothing is wrong with the tooth.


Sinusitis - sinus infection

Sinus infection is likely to have followed a cold in the nose. After a few days the initially clear watery nasal discharge has become thick and colored. Sinus pain is felt, and in the case of the frontal sinus, swelling may be evident around the eye.

People often feel nausea, due to swallowing infected mucus.

There may however, be no pain at all. One example is when bronchitis persists for weeks after a cold. This may be due to sinusitis, particularly if there is colored phlegm mixed with clear, and mainly coughed up in the mornings.

Sinusitis is often associated with swelling of the lining (mucosa) of your nose caused by allergy. This can bock the opening (ostium) between the sinus from your nose, preventing the normal discharge of mucus. The mucus then provides a good place for germs to multiply.


Sinusitis treatment

Unblocking your sinus is an essential part of effective management, and may be all that is necessary.

Your doctor may offer you cortisone tablets4 as well as antibiotic. I know cortisone is a dirty word, conjuring up thoughts of stomach ulcers and broken bones. Two or three days on it, however, is very safe, as long as you don't have an active peptic ulcer. It is certainly very useful for unblocking sinuses.

I put some sunbreeze essential oil on one end of some paper tissue and roll it up so it is inside the 1/4 inch wide roll. People put these pledgets up inside their nostrils, just out of site.

Whatever treatment you are using, acupuncture often is a useful addition, giving quick relief of symptoms.

Bromelain from pineapple stems, is used for a number of inflammatory conditions, including sinusitis1.


Sinus allergy

You can become allergic to inhaled particles or gases, but also to things you eat or drink. Cow’s milk is the commonest, but any food can be involved.

Allergy (or better “intolerance”) can cause just about any symptom, including physical feelings and psychological, and sinus pain!

Lots of diseases are in part caused or aggravated by food intolerance, including bedwetting in children, rheumatoid arthritis and Schizophrenia.

See food intolerances page for an example.



A very simple test you can apply to yourself, is Coca’s pulse test.

Arthur Coca developed this test from personal experience with his wife’s palpitations.

He wrote a little book “the Pulse Test”

The test involves measuring your pulse before and at 30,60 and 90 minutes after meals. Eating something you react to, can put the pulse up by 8 or more beats per minute.

Measure your pulse with your index finger lightly at your wrist an inch above the thumb, while sitting down. Count the beats for exactly sixty seconds.



This same test may point to house dust mite allergy.

This is a microscopic animal we go to bed with each night.

The pulse will be 8 or more/minute faster on awakening than later on before breakfast.

This is because our major exposure to dust mite is in our bedding. Our nose picks up the mite (and it’s droppings) from our pillow.

Whether or not you suspect house dust allergy, it is a good idea to put your pillow and doona out in the hot sun every so often. If you can park your car closed up in the sun all day, it is a perfect vehicle to heat treat bedding in.

Do likewise with your mattress if this is possible. The heat and drying out kill the mite. In winter, a large tumble dryer can be used to heat treat your pillow.


Either because of over-exposure to antibiotics, or because of ideal living conditions, fungi are often present5 in chronic rhinosinusitis. They may have a primary or later aggravating role.

Allergy management in sinus pain

If it is practicable, avoiding things you are allergic or intolerant to, makes sense.

If this is foods, I always encourage people to introduce two new foods into their diet, for every one they avoid.

Diversity is good for interest and enjoyment, and for overall nutritional value.

In this context it is very important, as the alternative involves eating more of a restricted range of foods - tailor made way of encouraging further allergies.


Simple nasal saline lavage with a neti pot, may be very useful6 for inhalant allergy affecting your nose and sinuses.


Spraying fine cellulose powder into your nose to form a protective layer, is apparently useful. I have no experience of using this Nasaleze preparation.


Dr. Jonathan Wright recommends Xylitol nasal spray, which again I've no personal experience with.


Apart from avoidance of allergens and irritants, there are local treatments with include drugs in sprays such as vasoconstrictors, steroids and anti-histamines.

If drugs are used, these sprays greatly reduce the dose needed, so the rest of your body isn't affected.


Our immune system can be abnormally skewed in favour of allergy and this can be a focus for treatment.
Asthma, eczema, hives, hay fever and immediate food allergy (the atopic diseases) are characterized by Th2 dominance2 over Th1.

This imbalance can be reduced by various herbs, nutrients etc. Examples are the herb Astragalus membranaceus, the enzyme complex bromelaine (from the Bromeliad pineapple,) acidophilus germs, Reiishi mushrooms and zinc supplements.



Notes and references for sinus pain page

1. Ryan RE. A double-blind clinical evaluation of bromelains in the treatment of acute sinusitis. Headache 1967;7(1): 13-7.

2. Th2 refers to Thymus derived helper lymphocytes, class 2.

We have red blood cells which carry our oxygen and white blood cells which are part of our immune system for protecting us from all sorts of dangers from the outside world.

White cells come in various categories, including lymphocytes. There are two groups of lymphocytes, B and T (for thymus derived.) These T cells in turn come in various types, including helper, suppressor, regulatory, natural killer etc.

Th cells secrete a variety of cytokines and can be subdivided into three different types based these...
IFN-γ-secreting Th1, IL-4/IL-5-secreting Th2, and IL-17-secreting Th17 cells.

[ Th17 cells appear to be important in a variety of human autoimmune diseases including multiple sclerosis, rheumatoid arthritis, respiratory disease, systemic lupus erythematosus, psoriasis, systemic sclerosis, and chronic inflammatory bowel disease.]

Th1 responses are for fighting bacteria and viruses. Th2 response is for fighting parasites. To dislodge a parasite, mucous and itch/scratch are useful. When the system is imbalanced in favour of Th2, these aren't, and are called allergy.

http://www.jimmunol.org/content/181/3/1908.full

3. See example number two on the case histories page.

4. ditto (example number 3)

5 http://www.ncbi.nlm.nih.gov/pubmed/10488788
http://www.sciencedaily.com/releases/1999/09/990910080344.htm

6 http://www.med.umich.edu/opm/newspage/2007/sinus.htm





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