Sinusitis is a swelling and infection of the sinuses near the nose. About 31 million adults and children in the United States have sinusitis each year. Sinusitis usually begins with an acute sinus infection that lasts for two to four weeks. A chronic sinus infection is one that continues for four weeks or longer.

• Nasal discharge (yellow or green), postnasal drip
• Headache, pain, sinus tenderness, or toothache
• Cough or sore throat
• Fever, in half of patients
• Loss of smell
• General tiredness

The sinuses cannot drain properly and become infected. Some common causes for this include the following.

• Common cold (upper respiratory tract infection)
• Allergies (hay fever, tobacco smoke, dry air, pollutants)
• Infected tooth
• Swimming
• Disease or an abnormal structure in the sinus area
• Physical injury to the sinuses

Your health care provider will give you a physical examination and will prescribe an antibiotic. You may need to have special tests to determine the cause of your sinusitis if it does not go away.

Treatment for sinusitis includes antibiotics, decongestants, and avoiding the things to which you are allergic. Sinus infections often come back. Inhaling steam or mist helps mucus to drain and relieves symptoms. It is important to drink plenty of water because it thins mucus secretions. Surgery may be needed when all other treatments fail.

• Antibiotics—amoxicillin is usually prescribed first; broad-spectrum antibiotics (for example, cefuroxime, cefaclor, clarithromycin, or azithromycin) are prescribed for chronic sinusitis; take for 10 to 14 days or for up to six weeks in chronic cases; various side effects�
• Decongestants—oral or by nasal spray; relieve symptoms; do not take decongestants if you have problems urinating or have a heart condition; use nasal sprays only for the prescribed amount of time (usually three to five days), since they can be addictive and make your sinuses worse if used for too long; various side effects
• Nasal steroid spray—for allergic and chronic sinusitis

A combination of physical medicine and herbal or homeopathic treatment is often effective for treating both acute and chronic sinusitis.

• Vitamin C (250 to 500 mg two times a day), zinc (30 to 60 mg per day), beta-carotene (15,000 IU per day) to support immunity
• Bromelain (500 mg three times a day between meals) and quercetin (500 mg three times a day between meals) are anti-inflammatory
• Avoid mucus-producing foods, such as dairy products, bananas, and any known food allergens
• Drink plenty of fluids and decrease sugar intake

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.

• Wild indigo (Baptisia tinctoria)—specific for sinus infections
• Eyebright (Euphrasia officinalis)—reduces inflammation, specifically for sinus problems
• Licorice (Glycyrrhiza glabra)—antiviral, soothing, especially with exhaustion or heartburn. Do not use if you have high blood pressure.
• Coneflower (Echinacea purpurea)—stimulates the immune system
• Goldenseal (Hydrastis canadensis)—antiviral, antibacterial

A combination of all of the above herbs, equal parts, may be very effective. 1 cup tea or 30 to 60 drops tincture every two to four hours. May add:

• Jamaica dogwood (Piscidia piscipula) or St. John's wort (Hypericum perforatum), in equal parts, may be added for pain relief.
• Garlic/ginger tea—two to three cloves of garlic (Allium sativum) and two to three slices of fresh ginger (Zingiber officinale). Steep 5 to 15 minutes and drink, breathing in the steam. Stimulates immune system and drainage.
• Essential oils may be used for bath or steam. For a steam, place two to five drops in a pot, bring to a simmer, and hold your head over the pot. For a bath, add 5 to 10 drops of oil to the bath. Eucalyptus (Eucalyptus globus), lavender (Lavandula angustifolia), and thyme (Thymus vulgaris) are specific for upper respiratory infections. Lavender and rosemary (Rosmarinus officinalis) are also very calming.

There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for sinus congestion based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Hepar sulphuricum — for the later stages of sinus inflammation when the pain is concentrated between the eyes and is worsened by cold or motion; nasal discharge tends to be thick and the individual may experience sensitivity of the scalp
• Kali bichromicum — this remedy is considered the first choice homeopathic treatment for sinusitis; it is most appropriate for individuals who have pain between the eyes or in the forehead above one eye; nasal discharge is generally stringy; scalp and facial bones are tender to touch and the person may feel dizzy or nauseated; pain is worse around noon and with cold and motion, but improves with warmth and pressure
• Mercurius — for sinusitis with thick, green, foul-smelling nasal discharge which may be blood tinged; there may also be a gripping pain around the head extending to the teeth; persons for whom Mercurius is appropriate have symptoms that worsen with open air, sleeping, eating, drinking, and extreme hot or cold; they may also have difficulty regulating their temperature (the individual often fluctuates from feeling cold and chilled to hot and sweaty)�
• Pulsatilla — for individuals who have a thick, bland, yellow or greenish discharge that is often accompanied by nausea and indigestion; symptoms tend to improve with cool air, pressure, and cool compresses; symptoms worsen when the individual is lying down, especially in a warm room; this remedy is appropriate for individuals who are distinctly not thirsty and require tremendous comforting
• Silicea — for individuals with chronic congestion accompanied by head pain that tends to be worse in the right eye; this pain is worsened by cold, movement, light, noise, and mental concentration (such as when studying) but relieved by heat and pressure
• Spigelia — for sinusitis with sharp pains on the left side of the face, generally coming on after exposure to cold, wet weather; symptoms are aggravated by warmth, light, noise, and movement, but are relieved by cold compresses or cool water on the face and when the individual is lying down with the head propped up

• Contrast hydrotherapy. Alternate hot and cold applications. Apply wet washcloths over the sinus area. Alternate three minutes hot with one minute cold. Repeat three times. This is one set. Do two to three sets per day.
• Nasal wash. Rinse each nostril by holding your head sideways over the sink and letting water run from the upper nostril to the lower nostril. Keep nostrils lower than throat to prevent salt water from draining into the back of the throat.

Although studies of acupuncture for sinusitis are lacking in the English medical literature, acupuncturists report success in treating this condition. Acupuncturists usually describe sinusitis as "dampness" which creates inflammation and congestion in the mucus membranes. This dampness is cleared by strengthening the spleen meridian and by working with the stomach meridian. Practitioners often perform needling therapy and/or moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for this condition. Acupuncturists with specialized training may also recommend herbal therapy.

If you are not better in a few weeks, you may be sent to an ear, nose, and throat specialist for tests to find the cause of your sinus infection.

Some serious diseases are caused by sinusitis or can have similar symptoms. Be sure to see your health care provider if you are not feeling better or have new symptoms. Tell your provider if you may be pregnant.

Barkin R, Rosen P, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. St. Louis, Mo: Mosby-Year Book; 1996.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:122-123.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 88-89.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:684-685.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 206.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:286-290.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Middleton E, ed. Allergy:�Principles and Practice. 5th ed. St. Louis, Mo: Mosby-Year Book; 1998.

Rakel RE. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB Saunders Co; 1998.�

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 120-122.