Reprinted from Living + Magazine, Jan/Feb 2001
A publication of the BC Persons With AIDS Society, www.bcpwa.org
It's that time of year when many of us with HIV become stricken with sinusitis and other upper respiratory illnesses that often seem to drag on for weeks, sometimes months. Sinusitis is one of the most common afflictions of PWAs in the late winter and early spring, although it can occur anytime throughout the year. Increased concentrations of airborne environmental toxins, particularly in urban areas, are a major factor leading to higher rates of respiratory illness in the general population. HIV infection further increases vulnerability because of depleted immune capacity. Although sinusitis is relatively common among people with HIV, it can be very debilitating and painful. Sinus infections become chronic (last more than 30 days) in about half of all cases.
What Are Sinuses?
Sinuses are hollow cavities in the bones in the front of the skull. Their function is to protect the lungs by warming and humidifying the air that we breathe. Sinuses are lined with membranes where mucous is produced to filter and flush bacteria and other pathogens from the air. When sinuses are healthy, the mucous drains easily through small passages into the nostrils or throat. Sinusitis is inflammation of the sinus membranes.
Four individual sinuses collectively compose the network of paranasal sinuses. They are named after the skull bones where they are situated. The largest are the maxillary sinuses, which are in the cheek areas on both sides of the face extending from the bottom of the eye socket to the upper jaw bone. The sphenoidal sinuses are behind and below the eye orbits (the bony cavity where the eye is located) toward the base of the skull. Ethmoidal sinuses are immediately in front of and below the sphenoidal sinuses on either side of the top of the nose. The frontal sinuses are located above the eyebrows.
Each sinus is lined with tissue called ciliated upper-respiratory epithelium. The epithelium lies on top of a mucous membrane. The mucous membrane is well supplied with blood and mucous-secreting goblet cells that keep the membrane moist. This enables the membrane to warm and hydrate the air we breathe. Small inhaled particles are captured in the mucous and are then moved toward the back of the throat to be swallowed or coughed.
Symptoms and Diagnosis
Acute sinusitis is usually preceded by a viral infection such as cold or flu. Symptoms include nasal congestion, colored discharge, pain, headache, and, frequently, fever. Movement, especially bending forward, usually amplifies pain. The location of the pain can be an indicator of which sinuses are inflamed. Pain can occur in the cheeks, lower forehead, behind the eyes, and on the sides of the nose. Teary eyes and sensitivity to light can also occur.
The symptoms of chronic sinusitis are usually similar but less severe and seldom include fever. They can also include postnasal drip (drainage from the sinus passages into the back of the throat). This postnasal drip frequently causes throat irritation and persistent cough.
Diagnosis of sinusitis is usually based on symptoms and individual medical history rather than on laboratory tests, although x-rays, CT scans, MRIs, cultures, and endoscopies may help in further evaluation.
Bacterial pathogens and, to a lesser extent, viruses are the most common causes of sinusitis. In persons with severe immunosuppression, aspergillosis, a fungal infection, can also be a cause.
Infection is not the only cause of sinus problems. Both food and airborne allergens can aggravate the sinuses. Underlying dental infections, smoking, snorting cocaine, overuse of nasal sprays, rapid changes in air pressure (airplane travel, deep-sea diving) may also be contributing factors.
Prevention and Treatment
Successful treatment of sinusitis is largely dependent on identifying the cause. And in the case of allergy-induced sinusitis, treatment starts with prevention. Reducing exposure to dust and pollens can effectively reduce allergens. Plants, cut flowers, animals, and house dust can all be factors. Removing rugs and stuffed toys, vacuuming frequently, damp mopping, changing air filters in heating systems regularly, and installing free-standing air filters can all help to control house dust which may contain a variety of allergens. Eliminating milk products from the diet may be helpful since they thicken mucous and can impair normal drainage.
Naturopathic physicians recommend supplementing the diet with Vitamins A, C, and E, as well as zinc, selenium, bioflavinoids, and essential fatty acids (evening primrose oil, blackcurrant oil, or flaxseed oil), for regulation of sinus function.
Antihistamines may also be considered, although they can also cause mucous to thicken and may, therefore, impede proper drainage.
Optimal treatment for acute sinusitis requires accurate diagnosis of the cause. Fever and colored mucous may indicate a need for antibiotics. The main aim of treatment is to promote proper drainage of the sinus cavities. Decongestants are usually recommended as adjuncts to antibiotics. They may be topical nasal sprays or systemic oral decongestants such as pseudoephedrine. Providing adequate hydration with steam (with thyme or eucalyptus oil added) or a cool mist humidifier and using hot and cold compresses may help to promote drainage and reduce inflammation. Sniffing warm salted water through the nose and then expelling it is another way to remove infectious material. Be warned -- this method can be extremely unpleasant and painful.
If persistent bacterial infection is thought to be the cause of chronic sinusitis, then more aggressive antibiotic therapy may be indicated. Intranasal steroids in the form of a spray are also prescribed to reduce inflammation.
Occasionally, surgery is required as a last resort to widen the nasal passages.
A variety of suggested alternative therapies are included in the table below. Herbs and homeopathic remedies should only be used under the guidance of a qualified practitioner. Always inform your medical doctor when using any of these remedies.
BETA, Leslie Hanna; March 1996
POZ Magazine, Lark Lands, Ph.D.; 9/97
Body Positive Information Room, Tony Davies
Positively Aware, Scott McCallister, M.D.; Jan/Feb 1995
- STEP Perspective, Laury McKean, R.N.
|Antibiotics for Sinusitis|
||Traditional Chinese Medicine
- arsenicum album
- kalium bichromium
- nux vomica
- mercurius iodatus
- nasal flush with either salt water or one tsp. powdered goldenseal mixed with a cup of water
- purple coneflower
- Oregon grape
- wild indigo
- stinging nettle
- Pe Min Kan Wan (a mixture of concentrated rare herbs)
Back to the GMHC Treatment Issues February/March 2001 contents page.