Sinus Congestion

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The sinuses are hollow spaces located inside the bones in the skull to either side of the nose, behind and in between the eyes, in the forehead and at the back of the nasal cavity. The sinuses are lined with a moist, thin layer of tissue called a mucous membrane, which not only humidifies the air as you breathe it in, but also produces mucus to trap irritants such as dust, pollen and bacteria. The sinuses are lined with microscopic hairs called cilia. The function of cilia is to move mucus to flush the sinuses and nasal passageways of trapped irritants.

Sinus congestion is the blockage of one or more of the nasal passageways as a result of inflammation and swelling of the sinus tissues, secretion of mucus or a deviated septum (meaning obstruction of the nasal passage by the membranous ridge of cartilage in the nose that separates the nasal cavity into the two nostrils). Sinus congestion leads to impaired flow of mucus out of the sinuses. The build up of mucus in the sinuses causes increased pressure. Also, bacteria can become trapped and infect the mucous membrane, a condition termed sinusitis.

Many people notice nasal blockage at night when lying in bed. One side of the nose is “plugged”, causing them to have to alternate sides they sleep on to breath comfortably. This is called the nasal cycle, a well-recognized normal physiological phenomenon where each side of the nose alternates through phases of congestion and decongestion. The cycle varies from person to person, taking one to four hours, and has been suggested to synchronize with the sleep cycle [1].

There are two types of sinus congestion:

• Acute sinus congestion is most often caused by the common cold.
• Chronic sinus congestion often results from environmental irritation.

Causes

One of the principle causal factors of chronic sinus congestion is subtle food allergies. Allergic food reactions can result in the expansion of blood vessels in the mucous membrane and typically occur one hour after consumption of the food allergen. Although people can be allergic to any food, the following accounts for the majority of all food allergic reactions:

• Pasteurized dairy
• Cooked eggs
• Peanuts
• Tree nuts
• Wheat
• Soy
• Shellfish

Another common cause of sinus congestion is inhalation of allergens such as pollen, mold, dust mites or animal dander. Exposure to various household cleaning chemicals may also contribute to sinus congestion; the Household Products Database of the National Library of Medicine is an excellent resource to research products based on chemical ingredients. Twenty two years ago in 1985, an EPA report concluded that “toxic chemicals in household cleaners are three times more likely to cause cancer than outdoor air pollution” and the Consumer Product Safety Commission reported that “150 common household chemicals have been linked to allergies, birth defects, cancer, and psychological abnormalities” [2]. Further, the National Institute of Occupational Safety and Health analyzed 2,983 chemicals used in personal care products and found 884 to be toxic [3]. Indoor and outdoor air pollution may also be a factor in susceptible people. Smoking and secondhand exposure to tobacco smoke have been implicated in chronic sinus congestion [4]. Clearly, each of us are exposed to a great number of allergens and toxic chemicals on a daily basis, any of which could cause sinus congestion.

Medications

Decongestants are frequently used to reduce sinus inflammation and relieve congestion. Decongestants come in both nasal and oral form. Nasal decongestants such as oxymetazoline (Afrin) and phenylephrine (NeoSynephrine) may provide relief from sinus congestion, but they should only be used for short periods of time. When used for a long time and then discontinued, symptoms often worsen (a rebound effect) because the mucous membrane tissue becomes dependent on the medication. Decongestants constrict blood vessels and reduce blood flow to the mucous membranes, thus reducing swelling. However, oral decongestants affect blood vessels in other parts of the body and can cause side effects such as nervousness and high blood pressure. Oral decongestants should not be used if you have heart disease, high blood pressure, migraines, Raynaud’s disease, difficultly urinating (for example, from an enlarged prostate), emphysema or take certain medications such as antidepressants.

Steroid nasal sprays decrease inflammation and are especially effective at relieving the symptoms of allergic rhinitis (meaning hay fever). Steroid nasal sprays such as fluticasone propionate (Flonase), triamcinolone (Nasacort AQ) and mometasone furoate (Nasonex) deliver a precise dosage of medication directly to the area of your body that needs it and are far safer than oral steroids. However, the risks of adverse effects are increased by excessive dosing or simultaneous inhaled or topical corticosteroid therapy [5]. Typical side effects of nasal steroid sprays are minor and include burning, dryness or irritation inside the nose, or increased sneezing. However, the longer you use steroid nasal sprays, the more side effects you risk. If your doctor prescribes nasal steroids for more than a few weeks, make sure you get regular checkups.

Your doctor may prescribe antibiotics if a bacterial infection is suspected or present.

Nasal Irrigation

In contrast to steam inhalation, which has been shown to have no beneficial effect on symptoms of the common cold [6], irrigation of the nasal passages with heated water or saline decreased nasal secretion [7].

Nasal irrigation with warm water or (preferably) saline can help to reduce sinus congestion. A recent study showed that daily nasal irrigation with hypertonic saline improves chronic sinusitis symptoms [8]. During the study, a number of patients actually decreased or eliminated medication altogether. A comfortable saline solution can be made by mixing 1/4 teaspoon of non-iodized salt into one cup of warm water. Mucous membranes are sensitive and the ideal solution for nasal irrigation should be similar to your body’s blood temperature, salinity and pH.

The following technique may provide relief to some people suffering from nasal and sinus congestion:

1. Prepare a comfortable saline solution (see above). Nasal irrigation is commonly done using a small vessel called a neti pot, however other types of irrigators are available, including ear wash bulbs, hand squeezed nasal irrigators, electrical pump nasal irrigators and nasal attachments for water picks.
2. Stand over the bathroom sink, tilt your head slightly to one side and let the saline solution flow into the upper nostril. Do not to open your mouth or swallow during the procedure as it could cause infectious material to move from the nasal passage into the sinuses or the ear.
3. Allow the solution to drain from your nose out the lower nostril. As the solution runs out of your nostril, you can blow gently to help remove any mucous and waste materials that are in your nasal passageway.
4. Repeat 2 — 3 times for each side of your nose.

Vitamins and Herbs

Histamine is associated with increased nasal and sinus congestion. In one study, vitamin C supplementation (1,000 mg three times per day) reduced histamine levels in people with either high histamine levels or low blood levels of vitamin C [9]. Another study found that 2,000 mg of vitamin C helped protect people exposed to a histamine challenge test [10]. Although preliminary evidence supports the use of vitamin C when injected into the sinuses of people suffering with acute sinusitis, the effect of oral vitamin C specifically on symptoms of sinusitis as well as generally on sinus congestion has yet to be formally studied [11].

Mint plants such as spearmint and peppermint have a long history of medicinal use, dating to ancient Egypt, Greece, and Rome. Peppermint is hybrid mint, a cross between spearmint and water mint. Menthol, a constituent of peppermint oil, is sometimes included in inhaled preparations for nasal congestion; eucalyptus oil can also be used. Eucalyptus oil is said to function in a fashion similar to menthol by acting on receptors in the nasal mucous membranes, leading to a reduction in the symptoms of nasal stuffiness [12].

References

1. Atanasov and Dimov. Nasal and sleep cycle–possible synchronization during night sleep. Med Hypotheses. 2003 Aug;61(2):275-7.
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2. Dadd, DL. Home Safe Home. Tarcher, 1997.
3. Berns, J, The Cosmetic Cover-up. Human Ecologist Fall 1989;43.
4. Benninger, MS. The impact of cigarette smoking and environmental tobacco smoke on nasal and sinus disease: a review of the literature. Am J Rhinol 1999;13:435-8.
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5. Allen DB. Systemic effects of intranasal steroids: an endocrinologist’s perspective. J Allergy Clin Immunol. 2000 Oct;106(4 Suppl):S179-90.
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6. Macknin et al. Effect of inhaling heated vapor on symptoms of the common cold. JAMA 1990 Aug 22-29;264(8):989-91.
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7. Georgitis JW. Nasal hyperthermia and simple irrigation for perennial rhinitis. Changes in inflammatory mediators. Chest 1994 Nov;106(5):1487-92.
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8. Heatley et al. Nasal irrigation for the alleviation of sinonasal symptoms. Otolaryngol Head Neck Surg. 2001 Jul;125(1):44-8.
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9. Clemetson, CA. Histamine and ascorbic acid in human blood. J Nutr 1980 Apr;110:662-8.
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10. Bucca et al. Effect of vitamin C on histamine bronchial responsiveness of patients with allergic rhinitis. Ann Allergy 1990 Oct;65(4):311-4.
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11. Nikolaev et al. Clinical and biochemical aspects in the treatment of acute maxillary sinusitis with antioxidants. Vestn Otorinolaringol 1994 Jan-Feb;(1):22-6.
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12. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy, 3rd ed. Berlin: Springer Verlag, 1998, 146-7.