Sinus Congestion

Also indexed as: Nasal Congestion, Rhinitis, Stuffy Nose

Sinus congestion (also called nasal congestion or rhinitis) involves blockage of one or more of the four pairs of sinus passageways in the skull. The blockage may result from inflammation and swelling of the nasal tissues, obstruction by one of the small bones of the nose (deviated septum), or from secretion of mucus. It may be acute or chronic. Acute sinus congestion is most often caused by the common cold. Sinus congestion caused by the common cold is not discussed here. Chronic sinus congestion often results from environmental irritants such as tobacco smoke, food allergens, inhaled allergens, or foreign bodies in the nose.

Sinus congestion leads to impaired flow of fluids in the sinuses, which predisposes people to bacterial infections that can cause sinusitis. At least two serious disorders have been associated with chronic nasal congestion: chronic lymphocytic leukemia and HIV.1 2 For this reason, chronic nasal congestion lasting three months or more should be evaluated by a medical professional.

Checklist for Sinus Congestion

Rating Nutritional Supplements Herbs
1Star   Ephedra
Eucalyptus
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of sinus congestion? Sinus congestion typically causes symptoms of pressure, tenderness, or pain in the area above the eyebrows (frontal sinus) and above the upper, side teeth (maxillary sinus). Other symptoms include nasal stuffiness sometimes accompanied by a thick yellow or green discharge, postnasal drip, bad breath, and an irritating dry cough.

How is it treated? Decongestants, mucolytics (drugs that thin mucus secretions), pain relievers, and antibiotics are generally prescribed for sinus congestion. With prolonged use (more than three days), nasal decongestants typically become ineffective and can lead to dependency. Corticosteroid nasal sprays, such as beclomethasone (Beconase®, Vancenase®), flunisolide (Nasalide®), or triamcinolone (Nasacort®), may also be prescribed to reduce inflammation. Surgery may be used to unblock the sinuses and drain thick secretions if drug therapy is ineffective or if there are structural abnormalities.

Dietary changes that may be helpful: Food allergy appears to play an important role in many cases of rhinitis, which is related to sinus congestion. In a study of children under one year of age with allergic rhinitis and/or asthma, 91% had a significant improvement in symptoms while following an allergy-elimination diet.3 In the experience of one group of doctors, food allergy was the most common cause of chronic rhinitis.4 Two other researchers have found food allergy to be a contributing factor to allergic rhinitis in 25%5 and 39%6 of cases, respectively. Food allergies are best identified by means of an allergy-elimination diet, which should be supervised by a doctor.

Lifestyle changes that may be helpful: The most common cause of nasal congestion is allergy to inhalants, such as pollen, molds, dust mites, trees, or animal dander. Exposure to various chemicals in the home or workplace may also contribute to allergic rhinitis. 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 nasal congestion7 and the prevalence of chronic rhinitis among men has been shown to increase with increasing cigarette consumption.8 People exposed to chlorine, such as lifeguards and swimmers, may also be at risk of developing nasal congestion.9

Careful evaluation by an allergist or other healthcare professional may help identify factors contributing to nasal congestion. Sometimes strict avoidance of the triggering agents (e.g., thoroughly vacuuming house dust or using dust covers on the mattresses) may provide relief. Where complete avoidance of irritants is not possible, desensitization techniques (immunotherapy [allergy shots]) may be helpful.

Nasal irrigation with warm water or saline may be helpful for reducing symptoms of sinus congestion, although steam inhalations appear to be less useful. In a study of people suffering from the common cold, steam inhalation did not improve sinus congestion any better than placebo.10 In a similar controlled study, irrigation of the nasal passages with heated water or saline, decreased nasal secretions, although inhalation of water vapor did not.11

Herbs that may be helpful: Ephedra (Ephedra sinica, also known as Ma huang) has a long history of use as a nasal decongestant. Ephedra contains the alkaloid pseudoephedrine, which has decongestant properties.12 13 14 The pseudoephedrine content of ephedra, however, often varies considerably among different products,15 making it difficult to calculate a safe and appropriate amount of the herb needed to achieve nasal decongestion. Clinical trials of ephedra for nasal decongestion are lacking.

Eucalyptus oil is often used in a steam inhalation to help clear nasal and sinus congestion. Eucalyptus oil is said to function in a fashion similar to that of menthol by acting on receptors in the nasal mucous membranes, leading to a reduction in the symptoms of nasal stuffiness.16

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful : Acupuncture may be useful for decreasing chronic sinus congestion. In one clinical study, most participants experienced at least temporary relief after acupuncture needles were inserted alongside the nose.17

References:

1. Amir R, Dowdy YG, Goldberg AN. Chronic rhinitis: a manifestation of chronic lymphocytic leukemia. Am J Otolaryngol 1999;20:328–31.

2. Lin RY, Lazarus TS. Asthma and related atopic disorders in outpatients attending an urban HIV clinic. Ann Allergy Asthma Immunol 1995;74:510–5.

3. Ogle KA, Bullock JD. Children with allergic rhinitis and/or bronchial asthma treated with elimination diet: a five-year follow-up. Ann Allergy 1980;44:273–8.

4. Rowe AH, Rowe A Jr. Perennial nasal allergy due to food sensitization. J Asthma Res 1965;3:141–54.

5. Derlacki EL. Food sensitization as a cause of perennial nasal allergy. Ann Allergy 1955;13:682–9.

6. Davison HM. The role of food sensitivity in nasal allergy. Ann Allergy 1951;9:568–72.

7. 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.

8. Annesi-Maesano I, Oryszczyn MP, Neukirch F, Kauffmann F. Relationship of upper airway disease to tobacco smoking and allergic markers: a cohort study of men followed up for 5 years. Int Arch Allergy Immunol 1997;114:193–201.

9. Leroyer C, Malo JL, Girard D, et al. Chronic rhinitis in workers at risk of reactive airways dysfunction syndrome due to exposure to chlorine. Occup Environ Med 1999;56:334–8.

10. Macknin ML, Mathew S, Medendorp SV. Effect of inhaling heated vapor on symptoms of the common cold. JAMA 1990;264:989–91.

11. Georgitis JW. Nasal hyperthermia and simple irrigation for perennial rhinitis. Changes in inflammatory mediators. Chest 1994;106:1487–92.

12. Jawad SS, Eccles R. Effect of pseudoephedrine on nasal airflow in patients with nasal congestion associated with common cold. Rhinology 1998;36:73–6.

13. Taverner D, Danz C, Economos D. The effects of oral pseudoephedrine on nasal patency in the common cold: a double-blind single-dose placebo-controlled trial. Clin Otolaryngol 1999;24:47–51.

14. Empey DW, Young GA, Letley E, et al. Dose-response study of the nasal decongestant and cardiovascular effects of pseudoephedrine. Br J Clin Pharmacol 1980;9:351–8.

15. Gurley BJ, Gardner SF, Hubbard MA. Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm 2000;57:963–9.

16. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy, 3rd ed. Berlin: Springer Verlag, 1998, 146–7.

17. Hu Y, Liu J. 200 cases of chronic rhinitis treated by acupuncture at nei ying xiang. J Tradit Chin Med 1997;17:53–4.