Sinusitis and ear infections
By Dr Manik G Hiranandani
Introduction
Hari is a talkative young man who works in a marketing job in Delhi. His job requires him to meet clients in different areas of Bombay. He has irregular hours of work meeting clients and goes in and out of air-conditioned offices and cars.
Hari came to consult me with complaints of always being tired, he suffered from frequent headaches which started above his eyes and spread to the back of his head. He also had a constant dry cough which often disturbed his sleep. He was constantly clearing his throat, and he frequently had an upset stomach. He often had blurred vision and pain in his upper teeth, which had not resolved with numerous visits to the dentist, root canal treatments and antibiotic courses. Hari had been diagnosed with sinusitis and migraine. He had been through many courses of treatment with antibiotics, and even had a surgery to drain his sinuses. All these treatments had failed to give him any permanent relief from these problems.
He was desperate for an answer when he came to consult me. I examined him fully, made a diagnosis and advised him that the only cure for his problem was to take a holistic view of his problems. This involved changes in his life style and diet along with treatment.
I advised him to take steam inhalations with holy basil (tulsi) leaves 5 to 6 times a day, and advised him to use an ionizer in his house, in his office and in his car to reduce the effects of air pollution. I treated him with acupuncture which relieved his pain and congestion and helped the sinus to start draining. I advised him to avoid rapid changes in temperature by switching off his car air-conditioning 5 minutes before reaching his destination; to set his office air-conditioning at a temperature of 25 degrees C, so the change in temperature would not be too sudden when he went in and out of his office.
I advised Hari to avoid alcohol and foods which increase mucous formation which are described later on in this article. After a couple of weeks of treatment he was comfortable and pain free. As he was feeling better, I advised him to continue the measures I had advised, and to see me again after six months.
When he came back to see me after six months he was a lot better. His sinuses were no longer tender, his cough had reduced. His stomach was better, he was sleeping better, he was not tired, and he was feeling stronger and better. I advised him to come back and see me again after another year. When he came back to see me he was feeling good, his cough had resolved, he had no headaches for eight months and there was no tenderness over any of the sinuses.
Sinusitis is a disease strongly influenced by your diet, lifestyle and environment. To recover from sinusitis requires you to modify your lifestyle, diet and environment so your body has a chance to heal. Sinusitis is a very common problem in polluted urban areas all over the world. It is also common in areas where people live in artificially heated or cooled environments.
Many people who live in the urban world have chronic sinusitis and ear infections due to pollution, dust, mould, air-conditioning and rapid changes in temperature. These sinus infections are very hard to treat and can take up to 2 years to resolve with the correct treatment. Staying in a polluted environment causes continual irritation of the sinuses and prevents healing.
What are the sinuses
The sinuses are spaces which lie above the eye, below the eye, behind the eye and on the side of the nose. The sinus which lies above the eyes is called the frontal sinus because it lies inside the frontal bone. The sinus which lies under the eyes and above the teeth of the upper jaw in the maxillary bone is called the maxillary sinus. The sinus which lies on the side of the nose in the ethmoid bone is called the ethmoid sinus. The sinus which lies behind the eyes in the sphenoid bone is called the Sphenoid sinus.
The sinuses drain into the nose through a small tube which is about the thickness of a ball-point pen refill. It is easy for this small tube to get blocked.
The ears have a chamber called the middle ear which carries out the function of hearing. This chamber communicates with the throat, through a tube called the eustachian tube which can get blocked, leading to a loss of hearing. The fluid in the middle ear can get infected leading to otitis media and eventually to infection in the bone behind the ear called mastoiditis.
Infections from the sinus often spread to the ears, throat and lungs as well as vice versa. If you have a sinus infection, all these other areas should also be checked.
Function of the sinuses
The function of the sinuses is to clean, purify and humidify the air we breathe in. It also adjusts the temperature of the air bringing it to the temperature of the body.
The air we breathe in, comes into close contact with the blood in the lungs, so any bacteria, virus or suspended particle can be directly absorbed into the blood stream. If the air is too dry it can damage the delicate membranes which line the alveoli of the lungs. The air we breathe in has a humidity which varies from a 0% to 100%. The sinuses increase the humidity of the air we breathe in to bring it close to 100 percent. They also regulate the temperature of the air bringing it close to 37 degrees C, the temperature of the body.
They act as a filter to remove dirt, the particles of air pollution, the pollen, smoke, and any other suspended particles. Each sinus has a number of folds of thin mucous membrane rather like the filter of a car, and has many, many hairlike projections which serve to clean, purify and humidify the air. The total surface area, available in each sinus to clean, warm and humidify the air is more than 100 - 300 square metres.
Charged particles repel each other when they come close to each other, thus staying in motion because of a phenomenon called Brownian motion. Charged particles are also called ions. Electrons are examples of negatively charged particles. Dust, smoke, bacteria viruses, mold, pollen etc all have a positive charge. An excess of positively charged ions in the air allows them to stay in motion. When a positively charged particle comes into contact with a negatively charged particle the charge on both particles is neutralized and the particle sinks to the ground.
In certain environments like by the sea side, in forests and mountains there are an excess of electrons in the air. This excess of electrons reduces the particulate matter in the air, which settle down thus cleaning up the air. When the air is clean, the sinuses and lungs are no longer under continuous attack and they have a chance to heal. This fact was made use of in the pre antibiotic era when people went to the sea side, mountains or forests to help themselves heal.
Ionizers can help to reproduce this effect in your environment as they generate large numbers of negative ions which combine with the positively charged particles of dust, smoke, bacteria, viruses, fungal spores etc causing them to settle down. They improve the quality of the air allowing the sinuses to heal.
The lining of the nose and sinuses has a negative charge to attract the positively charged particles which are in motion in the air we breathe. The positively charged particles in the air include the particles of air pollution, pollen, smoke, lead, carbon, dust, mould, bacteria, viruses and any other suspended particles. These particles can irritate and attack the lining of the nose and sinuses causing colds, sinusitis and nasal allergies.
Air pollution is an important cause of air cause of sinusitis. The World health organization recommends particle counts of less than 20 micro grams/cubic metre of air of particles between 2.5-10 microns in size and less than 10 micro grams/cubic metre of air for particles less than 2.5 microns in size. http://www.who.int/phe/health_topics/outdoorair_aqg/en/
In contrast most Indian cities have particle counts of between 100-350 micro grams/cubic metre of air. Air pollution is also a significant cause of Bronchitis, asthma, eczema and lead poisoning.
The sinuses do their work in sequence. All the sinuses do not function at the same time. We have all noticed that we some times breathe more through each side of the nose at different times. This is because the nasal septum moves from side to side to open and close the sinuses and allow them to act as a filter. At any one time, only one or two of the sinuses are open while the others are cleaning themselves, to prepare to filter the air when their turn comes up in sequence.
When you have surgery to repair a deviated nasal septum you lose the flexibility of the nasal septum and this predisposes to chronic sinusitis. An effective way to correct a deviated nasal septum and retain its function is with cranial osteopathy. The sinuses also add depth and timbre to your voice as the spaces can allow resonance of the sound to take place. This is lost in sinusitis.
Symptoms of sinusitis
A characteristic symptom of sinusitis is post nasal drip causing a dry cough. A person with sinusitis has to repeatedly to clear his throat, to remove the irritation at the back of the throat. If one takes a torch and look at the back wall of the throat when there is sinusitis, it is often red and shows a clear, white or yellow pus-like fluid draining down the back wall of the throat.
Headaches are a common symptom of acute sinusitis. Low grade headaches occur with chronic sinusitis which can aggravate into severe headaches with the aggravating factors described below. Headaches from the frontal sinus start above the eyebrows and radiate to the top or back of the head. Maxillary sinusitis causes pain in the cheeks or teeth. Ethmoid sinusitis causes eye pain. Sphenoidal sinusitis causes pain behind the eyes in the centre of the skull and can be agonizing. Sinusitis is often misdiagnosed as Migraine.
Chronic sinusitis causes tiredness, weakness and a feeling of being unwell.
Complications & side effects of sinusitis
The infected fluid flowing down the throat into the stomach often causes gas, indigestion, abdominal discomfort, dysbiosis and poorly formed stools.
Lung infections. People with chronic sinusitis are more prone to infections of the throat and lung infections like bronchitis and pneumonia because the filter which protects the lungs is not working and the sinuses can often become a source of infection.
Meningitis. Infections from the sinus may also spread into the brain, and cause a brain infection called meningitis.
Nasal Polyps. Chronic sinusitis causes irritation of the adjoining nasal lining which can cause the development of nasal polyps. Nasal polyps obstruct the breathing causing the voice to have a nasal tone. They also lead to a loss of smell and taste.
Toothache. Infections from the sinus can also spread into the roots of the upper teeth and into the ear and mastoid bones.
Eye Problems
1.Sinusitis often causes pain, swelling, puffiness and dark circles around the eyes.
2. The optic nerve lies under the Sphenoidal sinus, and infection in this sinus can compress the optic nerve causing reduction or loss of vision.
3. Chronic sinusitis is also associated with glaucoma and other problems in the eye as chronic infection on all sides of the eye can lead to infections and problems in the eye.
Snoring often accompanies sinusitis and can lead to sleep apnea. Treatment of these conditions is possible with cranial osteopathy and has to be accompanied by treatment of the sinusitis.
Halitosis. Sinus infections are a common cause of bad breath. Sinusitis also causes a coating on the tongue.
Ear infections cause pain in the ears, loss of hearing, tinnitus and loss of balance. They may cause headaches and difficulty in opening the mouth.
How does sinusitis occur
When we get a cold, the lining of the nose swells up and blocks the opening of the sinus. The fluid secreted by the sinuses to humidify the air accumulates in the sinus instead of draining into the throat as normally happens. The bacteria, fungi or viruses (which have been filtered by the sinus) infect this accumulated fluid. The infection leads to redness and congestion in the sinuses due to release of the substances formed by the body fighting the infection. The accumulation of this infected fluid causes pressure on the sinus and can cause a headache, a toothache, and can affect the vision. This is called acute sinusitis and usually cures itself or responds to treatment with antihistamines or steam inhalation.
If the acute sinusitis does not resolve over 2-3 weeks it then becomes chronic sinusitis which can persist for years. Over time, fibrosis occurs in the sinuses as the body attempts to wall off the infection. The bacteria, fungus and their spores get entangled in the scars and healing is then very difficult.
Sinusitis may also be caused by injuries to the head, nose and face which block the drainage of the sinus. Sinusitis is very common in children delivered with the help of forceps. Any injury on the head should ideally be corrected by cranial osteopathy. If that is not available surgery may be considered but the results with surgery are poor over the long term due to scarring which often follows the surgery, distorts these fine tubes and blocks the drainage of the sinus.
Diagnosis of sinusitis
Clinical Examination is the best and easiest way to make a diagnosis. It reveals tenderness over the sinuses, dark circles and or puffiness under the eyes and a post nasal drip.
X-rays, CT scan & MRI scan may show fluid levels in the sinuses if they are properly exposed.
Laboratory findings are a raised Erythrocyte sedimentation rate (E.S.R) and an increase in the number of lymphocytes in the blood.
Diagnosis of ear infections.
Clinical Examination is the best and easiest way to make a diagnosis. If you have an ear infection there may be tenderness both in front and behind the ear and a post nasal drip. Examination with an otoscope may reveal congestion of the ear drum and a clear, opaque or pus-filled fluid behind the eardrum.
X-rays, CT scan & MRI scan may show fluid levels or a darkening of the bones around the ear.
Laboratory findings are a raised Erythrocyte sedimentation rate and increase in the number of lymphocytes in the blood.
Prevention of sinusitis
Try to avoid rapid changes in temperature. If you are sleeping in an air-conditioned room, switch off the air conditioner a few minutes before you leave the room and let the temperature in the room equalize with the temperature outside the room.
If you are in a room with central heating, and you are going outside into the cold, first go into another room which is not heated. This gradual change in temperature allows the body to gradually adjust. Rapid changes in temperature can cause vasomotor changes causing the nose to swell very rapidly. This can block the opening of the sinuses causing an attack of sinusitis.
Avoid sitting under a fan or air-conditioning when your hair is wet.
Treatment of sinusitis & ear infections.
The best way to treat sinus and ear infections is to help the sinuses and ears to drain. This happens by helping the lining of the nose, sinus canals and Eustachian tube to shrink, and then to liquefy the accumulated secretions in the sinus or ears so this can drain into the throat.
The following measures can help you to cure your sinusitis.
Steam inhalation taken 5 to 6 times a day with holy Basil or cardamom or tea tree oil for 5 min at a time, through the nose can help to treat sinusitis. In case of an acute sinus problem the steam may be required for between seven to ten days. In chronic and long-standing sinus problems the steam may need to be continued for up to 24 months.
For ear infections breathe the steam in through the mouth.
Salt water inhalations either by the seaside, in a salt chamber or through Jal Neti (putting Salt water in one nostril & bringing it out from the other nostril) are both useful in shrinking the lining of the nose and the sinus canals.
Doing Pranayam (yogic breathing) in the form of Kapal Bharathi (forceful exhalation) can help drain the sinuses. This should not be done without supervision and never by people with high blood pressure.
If this does not work try acupuncture treatment.
Avoid mucous forming foods:-dairy products, bananas, guavas and oily food.
Avoid cooling foods like cold drinks, cucumber, coconut water, ice-creams.
Avoid rapid changes in temperature and air conditioning.
Vacuum your mattress, blanket, quilt & pillows once a month outside your house & keep them in the sun for a few hours. Wash or vacuum clean your carpets and curtains regularly at least once every 2 months. This will help reduce dust mites & help your nose & allergies.
Keep an ionizer on wherever you spend time, in your office, in every room in your home in which you spend time, and in your car.
Antibiotics especially ampicillin in a dose of 30-40mgm/kg of body weight may be useful in treating acute sinusitis. Most other antibiotics do not penetrate the sinuses in adequate quantity to be effective.
Antibiotics are of little use in chronic sinusitis as this is often caused by fungal infections or by mixed bacterial and fungal infections.
Homeopathy and Ayurveda also have effective treatments for sinusitis and ear infections.
Factors which aggravate sinusitis and ear infections
Air pollution: Air pollution and smoke are major causes of irritation of the sinuses. People who work in industry, on construction sites, thermal power plants, major roads with heavy traffic, and industrial areas are places where people are exposed to air pollution from to dust, solvents, paints, and to chemicals. They often suffer from chronic sinusitis.
Air conditioning also irritates the sinuses because the aluminum fins in the air conditioning condenser, strip electrons from the air. This leaves an excess of positively charged particles in the air which attach themselves to the lining of the nose. This irritates the nose and sinuses and can lead to sinusitis.
Rapid Changes in Temperature: The lining of the nose and sinuses are very sensitive to changes in temperature. Going in and out of air-conditioned or heated rooms frequently is a cause for sinusitis.
Dust Mites: Dust mites and their faeces accumulate in pillows, mattresses, quilts, blankets, sofas, curtains and carpets causing allergies.
Dust and Mold also aggravate sinusitis. Going into damp rooms and cellars where mold flourishes can aggravate sinusitis.
Smoking and cigarette smoke irritate the sinuses and nose
Cold & cooling Foods like ice cream, cold drinks, bananas, guavas, coconut water & oily food aggravate sinusitis.
Alcohol aggravates sinusitis and all infections in the body. If you have sinusitis or any other infection you should not drink alcohol. If you do drink you will notice an increase in the problem a few hours after you have taken alcohol. Drinking alcohol with an infection is like pouring the alcohol on a fire!
Colds cause swelling of the lining of the nose and aggravate sinusitis by blocking their drainage.
Hay fever, caused by allergy to pollen and other particles in the air can cause or aggravate sinusitis.
Food allergies especially to milk, gluten and nuts increase mucous secretion and aggravate sinusitis.
Bright sunlight aggravates sinusitis causing headaches and photophobia.
Facilities at “The Clinic” for treating sinusitis and ear infections.
“The Clinic” has the first and only salt inhalation chamber in India. I have built this unique facility of salt & steam inhalations specially to treat patients suffering from chronic sinusitis & ear infections. Using this facility speeds up your recovery from sinusitis & ear infections.
Salt air and salt water help shrink the lining of the nose, allowing the sinuses to drain. Spending time on the beach helps the sinuses to drain. The salt inhalation chamber works on the same principle, helping to shrink the lining of your nose and helps the sinuses to drain. This followed by taking 15 minutes of steam which liquefies the accumulated secretions in the sinuses and allows it to flow out. The steam also helps to detoxify the skin and bring out the toxins from the lymphatic system.
The chamber has been designed to have wheelchair and handicapped access.