Hari (name changed for confidentiality) is a talkative young man who works as a marketing executive in Bombay. His job requires him to meet clients in different areas of the city. He works irregular hours and goes in and out of air-conditioned offices and cars.
Hari consulted me with complaints of frequent headaches which, starting above his eyes spread to the back of his head. He also had a constant dry cough, which often disturbed his sleep. He was always clearing his throat, he sometimes brought up thick yellow mucous. He frequently had an upset stomach and was always being tired. He had blurred vision on some days, which did not improve by wearing spectacles. He often had 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, as well as surgery to drain his sinuses. All these treatments had failed to give him any permanent relief.
He was desperate for an answer when he came to consult me. I examined him fully, made a diagnosis and advised him that the cure for his problem was to take a holistic view of his problems which 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. He was treated with acupuncture which relieved his pain and congestion by helping to drain his sinuses. He was advised to avoid rapid changes in temperature by switching off his car air-conditioning a few 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 (described later on in this article). After a couple of weeks of treatment he was comfortable and pain free.
When he consulted me again six months later he was a happy man. His sinuses were no longer tender, his cough had reduced. His stomach was comfortable, he was sleeping well, he was not tired, and he was feeling well. I advised him to continue the treatment, and see me again after another year. When he returned to see me he was feeling good, his headaches and cough had resolved,. His teeth were no longer troubling him.
Sinusitis is a 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. A large percentage of people (30-50%) who live in the urban world have chronic sinus and ear infections due to pollution, dust, mould, air-conditioning and rapid changes in temperature. Sinus infections are difficult 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 retards healing.
Sinusitis is a disease strongly influenced by diet, lifestyle and environment. To cure your sinusitis requires modification of your lifestyle, diet and environment so your body has a chance to heal.
What are the sinuses?
The sinuses are spaces which lie above, below, 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. When this is blocked, sinus fluid accumulates in the sinus. When this gets infected it causes sinusitis.
The ears have a chamber called the middle ear which helps hearing. This chamber communicates with the throat, through a tube called the Eustachian tube which can get blocked, leading to a loss or alteration 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. Mastoiditis leads to a loss of bass in your hearing. Infections and accumulation of fluid in the middle ear can lead to loss of balance, nausea, dizziness (vertigo), and tinnitus. This may sometimes be misdiagnosed as Meniere's Syndrome.
Infections from the sinus often spread to the ears, teeth, throat and lungs as well as vice versa. If you have a sinus infection, all these other areas should also be checked and treated if necessary.
Function of the sinuses
The function of the sinuses is to clean, purify, humidify and warm the air we breathe in. The sinuses add depth and timbre to your voice as the sinus spaces allow resonance of the sound to take place. This timbre is lost in sinusitis giving your voice a nasal twang.
The air we breathe, 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.
The Sinuses act as a filter to remove dirt, particles of air pollution, 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 hairlike projections to help clean, purify and humidify the air. The total surface area, available in each sinus to perform this function is more than a hundred square meters.
The internal surface of the nose and sinuses is negatively charged to attract the positively charged particles which are present in the air we breathe. This charge allows it to attract and remove these particles from the incoming air, so clean air can go into our lungs. The positively charged particles in the air include the particles of air pollution, pollen, smoke, lead, acid, carbon, dust, mould, bacteria, viruses and any other suspended particles. These particles irritate and attack the lining of the nose and sinuses causing colds, sinusitis and nasal allergies.
In certain environments like the sea side, forests and mountains there are an excess of electrons (negative ions) in the air. These electrons reduce the particulate matter in the air, which settles down, cleaning up the air. In clean air the sinuses and lungs have a chance to heal as they are no longer under continuous attack from pollution. This fact was made use of in the pre antibiotic era, when patients were sent to sanatoriums at the sea side, the countryside, to mountains or forests to help themselves heal.
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. More air enters through one side of the nose at any time. 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.
Surgery to repair a deviated nasal septum, impairs the flexibility of the nasal septum and predisposes to chronic sinusitis. An effective way to correct a deviated nasal septum while retaining its function is cranial osteopathy.
Dry air can damage the delicate membranes which line the alveoli of the lungs. The humidity of air varies from a 0% to 100% depending on the place and climate. 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 the body’s temperature.
Diagnosis of Sinusitis
Clinical Examination is the best and easiest way to make a diagnosis of sinusitis. Tenderness over the sinuses, dark circles or puffiness under the eyes and a post nasal drip all indicate the presence of sinusitis.
X-rays, CT scan & MRI scan may show fluid levels in the sinuses if they are properly taken. Over exposure of the film prevents the physician from seeing the fluid levels. Laboratory findings of a raised Erythrocyte Sedimentation Rate (E.S.R) and an increase in the number of lymphocytes in the blood can point to sinusitis.
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 or MRI scan, may show fluid levels or a darkening of the bones around the ear confirming the diagnosis. An audiogram may show reduced air conduction indicating fluid in the ear. A tympanogram may also help make the diagnoses in some patients.
Laboratory findings are a raised Erythrocyte Sedimentation Rate (E.S.R) and increase in the number of lymphocytes in the blood.
The image below shows the audiogram of a gentleman who had severe loss of hearing and had been advised a hearing aid. This image shows the improvement in his hearing before & after treatment where his hearing has returned to normal.