Each year, around 2% of the UK population consults their GP about a suspected sinus infection (Ashworth 2005). Most people with acute sinusitis recover with or without treatment within 10 days of seeing a GP (Williamson 2007), but about 92% are prescribed an antibacterial, even though it makes little difference to outcome.

 

(Ashworth 2005) Acute sinusitis is defined as inflammation of the nose and sinuses characterised by the existence, for 12 weeks or less, of two or more of the following symptoms: blockage/congestion; discharge (anterior or posterior nasal drip); facial pain or pressure; and reduced or loss of smell. (Fokkens 2005) Other symptoms can include toothache (involving the upper teeth), tenderness, swelling, malaise and fever. (Ah-See 2007) Sinusitis is considered to be chronic if it lasts for more than 12 weeks, and is associated with similar symptoms.

 

Acute sinusitis can be due to viral or bacterial infections (Fokkens 2005). Predisposing factors include upper respiratory infections, allergic rhinitis, smoking, diabetes mellitus, dental infections, and mechanical abnormalities such as deviation of the nasal septum. (Ah-See 2007) Potential complications include spreading of the infection around the eye, which possibly leads to blindness, infection of the frontal bone, and meningitis. (Ah-See 2007)  Symptoms and signs of such potentially serious complications include swelling of the eyes or lids, eye redness, displacement of the eye, double vision, reduced vision, severe frontal headache, and signs of meningitis. (Scadding 2008) Chronic sinusitis is uncommon, usually develops from acute sinusitis and can be due to poor drainage of the affected sinus, inflammatory changes to the lining of the sinus that result from infection, and a flare-up of infection from time to time as a result of these changes. Sometimes other factors may cause, or contribute, to the development of chronic sinusitis. For example, a persisting allergy that causes inflammation in a sinus, and swelling or blockage of the drainage channel.

 

Management of sinusitis includes paracetamol or ibuprofen for pain relief, with the addition of codeine if necessary. Steam inhalation and saline nasal solution are also sometimes used. Antibacterial therapy is appropriate only for patients who are systemically very unwell, and have symptoms and signs of, or are at high risk of, serious complications.

 

References

Ashworth MA et al. Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK general practices 1995-2000. Br J Gen Pract 2005; 55: 603-8.

Williamson IG et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA 2007; 298: 2487-96.

Fokkens W et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005; 60: 583-601.

Scadding GK et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy 2008; 38: 260-75.

Ah-See KW, Evans AS. Sinusitis and its management. BMJ 2007; 334: 358-61.

 

How acupuncture can help

Evidence from randomised controlled trials suggests that acupuncture may help relieve symptoms of sinusitis such as nasal congestion (Sertel 2009), though it may not be as effective as conventional medication (Rossberg 2005; Stavem 2008). However, research is very limited and more high-quality randomised controlled trials are needed to assess the effectiveness of acupuncture for sinusitis (see Table below)

  

Acupuncture may help to relieve pain and congestion in people with sinusitis by

  • increasing endorphins  (Ham 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states
  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zhao 2008; Cheng 2009);
  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)