Sinusitis: Ayurvedic treatment, Remedies, Preventive tips

Article by Dr Raghuram Y.S. MD (Ay)
When you have an annoying nose (nasal discharges or congestion) with headache of variable degree (mild to severe) along with facial pain, you may have swelling in your sinuses. Yes, you are suffering from Sinusitis..Sinusitis is one of the common forms or causes of headache.

Definition

How Sinusitis happens?
There are some cavities (empty spaces) within the face bones. These are connected to cavities in your nose. These spaces make your skull light. These spaces are called Sinuses.

Inflammation of these sinuses causes headache, face pain, thick mucus in your nose, plugged nose and other symptoms. This condition is called Sinusitis.

Sinusitis presents with headache, face pain, nasal discharges, stuffy nose, fever, loss of smell, sore throat, nasal congestion, cough, fatigue, eye pain etc symptoms.

Lifestyle changes, precautions

Lifestyle changes and precautions for sinusitis:
Sinusitis can be prevented by following the below mentioned tips –

• Wash your hands frequently to keep the germs and infection away
• Avoid smoking
• Follow immunization schedule of your child strictly.
• Take early precaution when afflicted with cold and upper respiratory infections and taking treatment for the same
• Take extra precaution during cold seasons. Use only hot water to drink during winter. Follow this Ayurvedic winter regimen
• Wherever possible, guard yourself against dust, smoke, pollution, irritants by wearing masks.
• Give early care and attention for tooth infections and pain
• Keep yourself hydrated by regular consumption of water

Prevention tips

• Avoid Kapha aggravating foods and activities – Cold food, drinks and places, cold water shower or bath, especially head bath, day sleep, excessive sleep, sedentary life, foods which are oily, sweet, sour and salty in taste, heavy to digest foods, etc
• Take seasonal fruits like pomegranate, orange, sweet orange, papaya, apple, pears etc
• Avoid milk, sugar, coffee, fried products, refrigerated products, sweets, oily products, dishes prepared with flour, fast food, carbonated drinks, cigarette, chocolates, white flour, liquor, meat, bread, junks etc
• Do good exercise and walking
• Garlic and onion as a part of diet
• Follow Vata-Kapha pacifying diet. They are responsible for accumulation / stagnation of morbidity in the body (sinuses in this case).
• Eat foods that are neither too hot nor too cold.
• Favour cooked warm meals that are light, nurturing and easy to digest.
• Kichdi (light and nourishing porridge) or Pongal (south) prepared with green gram, rice and kitchen spices like ginger, cumin seeds, turmeric, fennel seeds, pepper and cinnamon is good for sinusitis
• Keep your bowels clear – Eat fibre rich vegetables (green leaves), organic fruits and vegetables, avoid brinjal (egg-plant), banana, tomato, curds etc which can clog your channels
• Don’t skip or delay meals – They will disturb your gut fire (agni) and cause errors of digestion. This will supply less nutrition to your tissues and also will form lot of ama in the cells (intermediate products of metabolism with a sticky nature and capacity to block the body channels). Ama will further predispose to the formation of many diseases including sinusitis.
• Best options in kitchen – Regularly use – Cinnamon, Black pepper, cumin seeds, mint, onion, basil, garlic, honey, coriander, rock salt, fennel, clove, turmeric, ginger, liquorice, etc
• Use well fitting eyeglasses, if your glasses pinch your nasal bridge, your symptoms may get worse

Things to avoid

• Cigarette smoke
• Air pollutants
• Swimming in the pool treated with chlorine
• Air travel – too is a risk factor for exacerbation of sinusitis since the air pressure changes. Take caution and some medicine during air travel
• Rainstorm and damp weather – Symptoms of sinusitis worsen before a rainstorm due to changes in air pressure. Protect yourself during windy and rainy seasons.
• Dust, mould, pollens or any known food allergies; know your allergies with the help of your doctor
• Curds, banana, ice-cold drinks, beverages
• Frequent head baths
• Mosquito repellents

Home remedies

Home remedies for sinusitis:
External / local remedies for sinusitis: 

• Tulsi steam – Steam inhalation with decoction of holy basil (Tulsi) or water boiled with it. Doing it for many days will help in acute sinusitis. It might not help you very much in chronic forms of the disease.
• Hot water steaming / vapours – Add mint / eucalyptus oil / clove oil to the hot water and take vapours twice daily. Spit out the secretions coming to your mouth. Have a salt water gargle after that to clear your throat. You can use electrical sauna also to take vapours. Application of oil like Ksheerabala taila or sesame oil over your face before taking vapours will add to the relief.
• Chop some onions and boil it with water, take its steam / vapour
• Nasal wash with lotion prepared from fried Tankana Bhasma (borax) is also effective
• Mustard drops – Boil 1 tsp of mustard in 1 glass of water and reduce the quantity to half. When it is lukewarm take 3-4 drops in a sterile dropper. Pour them gently into the nostrils. 1-2 drops of warm mustard oil can be used instead.
• Shadbindu taila or Anu taila can be used as nasal drops (take doctor’s advice)
• Garlic snuff – Peel 5-6 garlic buds, crush them and sniff them (inhale) or tie the crushed garlic in a sterile cloth so as to form a bolus, inhale the bolus by keeping it close to your nose
• Turmeric fumes – A small quantity of turmeric powder (more than couple of pinches or ¼ tsp is put on burning charcoal and its fumes / smoke is inhaled. Alternatively, turmeric powder is put on a piece of sterile cotton piece, the cotton piece is burnt and the fumes inhaled
• Inhale cumin seed powder – Take 1 spoon of cumin seed powder (black variety preferably) and tie it in a sterile cloth so as to form a bolus. Keep placing the bolus near your nose and inhale many times in a day.
• Cinnamon paste for application – Mix 1-2 spoons of cinnamon powder in warm water. Apply the paste over your forehead and nose to remove congestion
• Damp cloth dipped in boiled water or water boiled with mint or made warm in microwave is kept over the face (care should be taken not to cause burns)
• Saline rinse – ¼ tsp table salt is mixed in 200ml of warm water is used for rinsing. This moistens dry nasal membranes, helps to make the mucus wet and eases its removal.

Turmeric for allergic rhinitis Video

Internal home remedies

Internal home remedies for sinus problem: 

• 1 tsp crushed garlic, 1 tsp turmeric powder and 2 spoon honey mixed together – once or twice daily (ginger can be used in place of garlic), garlic juice can be used instead of paste
• Lemon juice with honey
• Orange juice with warm water
• Ginger juice ½ spoons with honey 1 spoon – 3-4 times daily
• Ginger powder ½ spoons with jaggery 1 spoon – 3 to 4 times in a day
• Basil-ginger decoction / infusion – Boil 1 glass full of water with – 8-10 leaves of basil leaves (Tulsi), 8-10 crushed powder of pepper, 15-20 grams of sugar candy, ginger – small piece crushed. When the ingredients reduce to half, strain it through a sieve or a sterile cloth and consume warm.
• 1 teaspoonful cumin powder with 1 tablespoon honey – twice daily
• ¼ tsp cinnamon powder with 1 tsp honey – once or twice daily
• Take ¼ to ½ tsp of grated horseradish – keep in the mouth and keep sucking its juice until you don’t feel its taste anymore. Later you can chew and swallow the same.
• Fenugreek decoction – Take 1 tsp fenugreek seeds, Boil in 4 glasses of water until half remains. Strain it through a sterile cloth or sieve. Consume hot. (3-4 servings per day)

Other things and home remedies for sinus pain –
Apple cider vinegar – ¼ cup of ACV is mixed in 2 cups of water, this is sipped in small quantities throughout the day. 2-3 drops added to hot water is used for inhalation.
Echinacea (belonging to sunflower family) tea is used in US
Oregano oil – 1-2 drops added to 1-2 tsp water and kept under the tongue
Lemon balm
Click to Consult Dr Raghuram Y.S. MD (Ayu)

Yoga for sinusitis

• Practice Pranayama and Kapal Bhati (forced exhalation techniques) – They will not only help you to breathe ease and maintain a good oxygen levels in your lungs and tissues but also help in eliminating the stagnant morbidity from your sinuses. Learn how to do Pranayama
• Practice – Kunjal, Jalneti, Rubberneti and Ghritaneti regularly in the early hours of the morning
• Meditation for at least 10 minutes daily
• Perform these asanas regularly – Janu-shirasana, Ardhamatsyendrasana, Dhanurasana, Chakrasana, Shalabasana, Bhujangasana, Sarvangasana, Halasana, Matsyasana, Shavasana – as per your comfort. Take the opinion of your Yoga instructor before doing any asana’s.

Video’s for useful Yoga’s in Sinusitis –
Jaanu-shirasana

Ardhamatsyendrasana

Dhanurasana

Chakrasana

Shalabasana

Bhujangasana

Sarvangasana

Halasana

Matsyasana

Shavasana

Pranayama

Kapalbhati

Kunjal Kriya

Jal Neti

Sinusitis – Disease Review

Sinusitis is the inflammation of the sinuses or air spaces (cavities in the bones surrounding the nose). It is one of the major causes for headache and stuffy nose.

Synonyms, classification

Synonyms –
Sinus infection
Rhino-sinusitis

Classification of Sinusitis
Classification on the basis of periodicity:
Sinusitis (Rhino-sinusitis) is defined as an inflammation of the mucous membrane that lines the paranasal sinuses. It is classified as enlisted below

Acute Rhino-sinusitis –
New infection
Lasts up to 4 weeks (12 weeks according to some)
It is of 2 types – Severe and Non-severe

Recurrent acute rhino-sinusitis –
4 or more separate episodes of acute sinusitis within one year

Sub-acute Rhino-sinusitis –
Infection lasting between 4 and 12 weeks
Represents a transition between acute and chronic infection

Chronic Sinusitis –
Signs and symptoms last for more than 12 weeks

Subtypes of Chronic sinusitis –
CS with polyps (chronic hyperplastic sinusitis) – may be caused by allergy, environmental factors like dust or pollution, bacterial infection or fungus
CS without polyps
EMRS (Eosinophilic Mucin Rhino-sinusitis) – Eosinophils are demonstrated in the mucous lining of nose and paranasal sinuses. It is again of 2 types – Allergic and Non-allergic EMRS

Acute exacerbation of chronic rhino-sinusitis –
Signs and symptoms of chronic sinusitis exacerbate
They return to baseline after treatment

Classification on the basis of sinus cavity affected:
Maxillary Sinusitis – Sinusitis affecting the cavity of cheek bones
Frontal Sinusitis – Sinusitis affecting the cavities in the forehead
Ethmoidal Sinusitis – Sinusitis affecting the spaces in ethmoidal bones, forming the roof of the nose
Sphenoidal Sinusitis – Sinusitis affecting the cavities in the Sphenoid bone located within the skull

Classification based on causative agents:
Viral Sinusitis –
Caused by Virus, ex. rhinovirus, coronavirus, influenza virus etc
Typically lasts for 7-10 days

Bacterial sinusitis –
Caused by bacteria, ex. Streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis etc
More persistent than viral sinusitis
Approximately 0.5-2% viral cases result in subsequent bacterial sinusitis (nasal irritation from nose blowing leads to secondary bacterial infection)

Other classifications:
Infected sinusitis – usually caused by uncomplicated virus infection. Bacterial cause is less frequent and fungal infection is infrequent
Non-infectious sinusitis – caused by irritants and allergic conditions

Note:
All types of sinusitis have similar symptoms. It is difficult to distinguish between them.
Acute sinusitis is very common
Around 90% of adults have had sinusitis at some point in their life

Causes

Sinus infections or sinusitis may be caused by anything that interferes with airflow into the sinuses and the drainage of mucus out of the sinuses. The sinus openings may be blocked by swelling of the tissue lining and adjacent nasal passage tissue

Acute sinusitis –

• Upper respiratory tract infection – usually viral (rhinovirus, coronavirus, influenza virus etc) and sometimes bacterial (Streptococcus pneumonia, Haemophilus influenza and Moraxella catarrhalis etc)
• Common colds and repetitive episodes of cold, running nose or blocks
• Seasonal intolerance especially to cold
• Allergies – Frequent allergies or sensitivity to allergens like dust, smoke, pollens, web etc
• Fungal invasion – in patients with diabetes or other immune deficiencies (AIDS or transplant patients on immunosuppressive anti-rejection medications)
• Chemical irritation – OTC nasal sprays, cocaine, Cigarette smoke and chlorine fumes
• Tooth infection (rare)

Chronic Sinusitis –

• CS can be caused by many diseases that share chronic inflammation of the sinuses as a common symptom
• Fungi
• Smoking
• Second hand smoking
• Maxillary sinusitis – 20% cases have dental origin (periapical or periodontal infection of a maxillary posterior tooth), the maxillary sinus infection may spread to the orbit or to ethmoid sinus
• Abnormality within the auditory or Eustachian tube (which is connected to the sinus cavities and the throat)

Other causes:

• Tumours or growths
• Dehydration
• Diseases
• Drying medications
• Lack of sufficient humidity
• Thickening of mucous secretions
• Decrease in hydration (water content) of mucous brought on by diseases (ex. cystic fibrosis), drying medications (antihistamines) and lack of humidity in air
• Stagnated mucus – provides for growth of bacteria, viruses and fungus within sinus cavities
• Immune-depressed people
• Victims of multiple traumas in disasters like tsunamis, hurricanes, earthquakes, tornadoes etc
• Allergic rhinitis
• Nasal polyps
• Deviated nasal septum
• Low immunity

Signs and Symptoms

Headache / Facial pain / Pressure of a dull, constant or aching sort over the affected sinuses
Pain is typically localized to the involved sinus
Pain worsens on bending or lying down
Pain often starts on one side of the head and later progresses to both sides

Acute Sinusitis:

• Thick nasal discharge– usually green in colour, may contain pus or blood
• Often a localized headache or toothache is present
• Fever
• Nasal stuffiness (block by thick plug of semisolid mucus)
• Headache of varying intensity (especially early in the morning)
• Facial pain
• Loss of smell
• Bad breath
• Body pains / fatigue
• Tooth pain

Chronic Sinusitis:

• Headache / Facial pain
• Post-nasal drip – mucus overproduction from sinusitis that flows to the throat and causes throat irritation. Thick green or yellow discharges dropping down from nose backwards into the throat. It may become difficult to blow down the secretions since they are more solidified. This creates an urge to pull the secretions backwards. We may spit it out when we are awake. But we may tend to swallow when we are asleep or when in the middle of a busy schedule or work.
• Pus in nasal cavity – when the secretions in the sinuses get further infected, the formation of pus is obvious
• Sore throat – inflammation of throat tissue caused by post nasal drip
• Halitosis (bad breath)
• Nasal congestion
• Cough / Night cough – is a response to post nasal drip
• Increase in previously minor or controlled asthma symptoms
• General malaise
• Loss of appetite and indigestion, occasional nausea (sensation to vomit)
• Thick green or yellow discharge
• Feeling of facial fullness or tightness that may worsen when bending over
• Fever
• Fatigue
• Dizziness
• Tooth ache
• Ear pain
• Eye pain
• Itching of eyes and sneezing
• Bad breath
• Anosmia (inability to smell things)
• Dental infection (rare, in acute or chronic maxillary sinusitis)
• Vertigo, Light headedness, Blurred vision (not typical)
• Ulceration in the nose

Symptoms on the basis of sinus cavity affected:
Maxillary Sinusitis – Pain or pressure in the cheek area (e.g. toothache or headache)
Frontal Sinusitis – Pain or pressure in the frontal sinus cavity (above the eyes), headache particularly in the forehead
Ethmoidal Sinusitis – Pain or pressure pain between / behind the eyes, the sides of the upper part of the nose (medial canthi) and Headaches
Sphenoidal Sinusitis – Pain or pressure behind the eyes but often refers to the skull vertex (top of the head) over the mastoid processes or back of the head

Complications

• Infection of eye socket is possible. It may lead to loss of sight and accompanied by fever and severe illness.
• Infection of the bones (osteomyelitis) of the forehead and other facial bones (Pott’s puffy tumour)
• Middle ear problems – Presents with dizziness, ‘a pressurized or heavy head’ or vibrating sensations in the head
• Infection of the brain by the invasion of anaerobic bacteria through bones or blood vessels
• Abscesses
• Meningitis
• Personality changes
• Headache
• Altered consciousness
• Visual problems
• Seizures
• Coma
• Death (possible)
• Orbital complications – Periorbital cellulitis, Sub-periosteal abscess, Orbital cellulitis, Orbital abscess
• Central Nervous System – Cavernous sinus thrombosis, Retrograde meningitis, Epidural, Subdural and Brain abscesses
• Sino-bronchitis
• Maxillary osteomyelitis
• Frontal bone osteo-myelitis
• Periostitis of frontal sinus which produces a tender, puffy swelling of the forehead

Diagnosis

Acute Sinusitis:
Diagnosis is usually done on the basis of signs and symptoms
If symptoms last less than 10 days, it is generally viral sinusitis
When symptoms last more than 10 days, it is bacterial sinusitis
Imaging (X-ray, CT or MRI) generally not recommended unless complications develop

Chronic Sinusitis:
CT scan – Sinusitis lasting for more than 12 weeks
Nasal endoscopy and clinical symptoms are also used to make diagnosis
Tissue sample for histology and cultures
Sinusoscopy

Ayurvedic concept

Since headache is the most prominent symptom of Sinusitis, it can be closely compared to Shiro-Roga or Shira-Shula (both terms meaning headache).

Causes of sinusitis as per Ayurveda: 
Among various causes (common for all the type of Shiro-Roga’s), the below said may be considered causative towards Sinusitis –

• Raja – Exposure to dust (allergens)
• Tushara – Fog, Dew
• Ambukreeda – Playing in water (swimming etc)
• Atisvapna – Excessive sleep
• Atijagara – Excessive awakening at night
• Utsedha – Swelling / inflammation in the sinuses
• Atipurovata – excessive exposure to breeze
• Bashpanigraha – Habit of controlling tears
• Rodana – Excessive weeping
• Atyambupana – Drinking lot of water (when not needed, like while hungry)
• Atimadhyapana – Excessive consumption of alcohol
• Krimi – Affliction / infection by microorganisms
• Upadhana – Sleeping with elevated pillows (using many pillows and sleeping with high head position)
• Asatmyagandha – unwholesome smell / irritating odours
• Dushtaanna – Contaminated / unwholesome foods

Due to the close resemblance of the symptoms the below said types of Shiro-Roga can be considered in comparing with Sinusitis –

Krimija shiroroga

Krimija Shiroroga – {headache caused due to affliction of microorganisms}

Symptoms of Krimija Shiroroga:
Ati toda – Severe pricking / throbbing pain in the head
Sambhakshyamanam – Feeling as if some worms are eating the brain inside the head
Sphota – Blasting type of pain
Rudhira-pooya pravritti – discharge of blood and pus from the nose
Almost all these symptoms are seen in Sinusitis and the major causes of Sinusitis is an infection

Kaphaja shiroroga

Kaphaja Shiro-Roga –

Symptoms of Kaphaja Shiro-Roga:

• Kaphopadigdham shira – Head (sinuses) filled with kapha (phlegm) {Nasal congestion / stuffiness}
• Shiro guruta – heaviness in the head
• Pratishtabda shira – stiffness of head
• Himam – cold headedness
• Shoonakshikootam – Swelling around the orbit
• Shoonavadanam – Swelling of the face
• Mandaruja – Mild / dull pain (Charaka)
• Stimitam – Feeling as if the face is covered with wet clothes (Charaka)

Sannipataja shiroroga

Sannipataja Shiro-Roga – (Headache caused due to the aggravation of all the 3 Doshas)
It is said that all the headaches have an association with Tridoshas, with predominance of one or the other. In Sannipataja Shiroroga the symptoms of all the 3 Dosha morbidity will be found

Symptoms of Sannipataja Shiro-Roga
Vata symptoms – Shula (pain), Bhrama (giddiness), Kampa (Tremors)
Pitta symptoms – Daha (burning sensation), Mada (intoxication), Trisha (Thirst)
Kapha symptoms – Gurutvam (Heaviness), Tandra (drowsiness)
Frontal sinusitis generally presents with symptoms similar to Sannipataja Shiro-Roga

Ardhavabhedaka

Though this form of headache is compared to Hemi-crania or Migraine, most of its symptoms resemble with that of Sinusitis. Therefore I have taken it for correlation. Moreover even in Sinusitis, the pain starts on one side initially and later spreads to become bilateral or generalized. Even in modern medicine it is said that all forms of Sinusitis are actually Migraines with slight difference in clinical presentation.

Severely aggravated Vata either alone or in association with morbid Kapha occupies the head and causes Ardhavabhedaka

Symptoms of Ardhavabhedaka:
Ardha bhaga shula – Pain in half portion of the head
Ativedana – Severe pain in half portion of manya (neck side), bhru (eyebrow), shanka (temple), karna (ear), akshi (eye), lalata (forehead)
Nayana vinasha – Destruction of eyesight (complication of sinusitis)
Shrotra vinasha – Destruction of hearing ability (complication of sinusitis)

Suryavarta

This is another form of headache explained in Ayurveda which resembles with clinical picture of Maxillary sinusitis and / or Sub-acute sinusitis

Symptoms of Suryavarta:

• The symptoms especially headache follows the diurnal course of the Sun.
• At Sunrise, the person will have mild pain head, eyes and eyebrows
• At mid noon, as the Sun (light and heat) becomes intense towards noon, the pain too increases and gradually worsens
• With Sunset, the pain typically comes down
• The pain sometimes pacifies due to cold comforts and sometimes with hot comforts

Ayurvedic treatment

• Removing or avoiding the causative factors,
• Controlling or eliminating the source of inflammation (morbid kapha and vata),
• Relieving the symptoms,
• Re-establishing drainage of nasal passages,
• Improving the general immunity,
• Improving the local nasal immunity

General line of treatment

External treatment –
Lepa – Application of medicinal pastes
Seka – Stream pouring of medicated liquids
Upanaha – Poultices
Kavala / Gandusha – Gargles

Internal treatment –
Nasya therapy: Nasya means nasal instillation of medicaments. It is the best treatment for all types of headaches including Sinusitis. It is done in 3 stages –

Purvakarma (Pre-treatment procedures): This includes –
Thorough examination of the patient and the disease
Procuring the medicines and materials needed for Nasya beforehand
Preparation of the patient and counselling – Deepana (Appetizers, medicines for metabolic correction) and Pachana (medicines which digest ama – intermediate products of digestion, endotoxins) medicines are given before the treatment
Immediate Purvakarma – Massage to the face and neck (abhyanga) is given with medicated oils like Ksheerabala Tailam etc followed by facial steaming (swedana)
Pradhana Karma (main procedure) – Nasal drops are instilled with medicated oils like Anutailam, Shadbindu Tailam etc in seated or lying down position. The patient is instructed not to swallow the medication and spit it in a spit-bowl.

Paschat Karma (Post-treatment procedure) –
Patient is kept under observation for an hour or so
Patient is given a salt water gargle
Patient is discharged with instructions regarding diet, lifestyle, and medicines to be taken etc

Related: learn how to do Nasya at home

Note:
The above said procedure is followed when the treatment is done with patient as out-patient. In-patients are not discharged.
The treatment is carried on for 7-10 days depending on the nature and intensity of the disease
Purvakarma may not be required when the medicament is a herbal powder or juice or processed milk

Virechana – Therapeutic purgation
Vamana – Therapeutic Emesis

Specific line of treatment

Krimija Shiro-Roga treatment:
Vyoshadi Nasya –
The below said drugs should be ground in ajamutra (goat urine) and instilled in the nose:

• Pippali – Piper longum
• Maricha – Piper nigrum
• Shunti – Zingiber officinale
• Karanjabeeja – Seed of Pongamia pinnata
• Shigru beeja – Seeds of drumstick – Moringa oleifera

Vidangadi Taila Nasya (nasal drops)

Suryavarta-Ardhavabhedaka treatment:
Ksheera-sarpi nasya / pana – Ghee and milk are mixed and instilled into the nose as drops. The same combination shall be used for drinking
Virechana – Therapeutic purgation

Suryavarta specific treatment:
Bhringarajadi Nasya – Juice of Eclipta alba and milk of goat are mixed in equal portions, heated in the Sun and used for nasal instillation in Suryavarta

Jangala mamsa upanaha – Poultice prepared from the flesh of animals and birds living in desert and dry lands in Suryavarta

Ardhavabhedaka specific treatments:

• All treatments mentioned in Suryavarta can be given in Ardhavabhedaka too
• First of all Snehana (oleation) and Swedana (steaming/fomentation) should be given followed by medicines
• Later virechana (therapeutic purgation) should be administered
• Dhupa – Fumigation
• Snigdha-Ushna bhojana – Unctous (oily) and hot foods
• Vidanga (Embelia ribes) and sesame seeds should be made into paste and applied
• The powder of Vidanga and sesame powder should be used as snuff
• Ghee should be processed with milk and coconut water, used for nasal instillation
• Ginger should be grinded with water and applied
• Sugar mixed milk is given to drink
• Coconut water is given to drink
• Cold water for drinking

Generalized treatment in all the above said headaches (Sinusitis)
Nasya (nasal instillation) with
Shadbindu Taila
Guda nagara – Jaggery and ginger
Ksira nagara – Milk and ginger

Wholesome diet and habits

Pathya (beneficial / wholesome things) in Sinusitis

• Swedana – fomentation / sweating treatment / sudation with medicated decoctions or processed milk
• Nasya – Instillation of herbal decoctions, processed milk, powder, juices etc in the nose
• Dhumrapana – Herbal smoking
• Virechana – Therapeutic purgation
• Lepa – Application of pastes made with medicinal drugs
• Seka – Stream pouring of medicated fluids
• Langhana – Fasting
• Upanaha – Poultices
• Purana ghrita – old ghee
• Shali – rice
• Yusha – Soups
• Dugdha – milk
• Patola – Pointed gourd
• Shigru – Drumstick
• Draksha – Raisins
• Karavellaka – Bitter gourd
• Amalaki – Indian gooseberry
• Dadima – Pomegranate
• Taila – oil
• Takra – Buttermilk
• Narikelakam – Coconut
• Pathya – Terminalia chebula
• Bhringaraja – Eclipta alba
• Kumara – Aloe vera
• Musta – Cyperus rotundus

Unwholesome diet and habits

Apathya (unwholesome things) in Sinusitis

• Vega dharana – Forcibly controlling the impending urges (reflexes) of sneeze, yawning, tear, urine and faeces
• Viruddha bhojana – Incompatible foods
• Dugdha – Milk
• Jalam – Water
• Vibuddha jalamajjanam – Diving into water with head-down position
• Dantakashtam – Brushing with brush made of herbal sticks (twigs)
• Divaswapna – Sleeping during day time

Ayurvedic medicines

Kashayam (herbal decoctions):

• Dashamula kashayam
• Dashamulakatutrayadi kashayam
• Guggulutiktakam kashayam
• Pathyakshadhatryadi kashayam
• Varanadi kashayam
• Amritottaram kashayam
• Pathyadi Kadha / Pathyadi Kashayam

Vati and Gulika (Tablets):

• Khadiradi Vati
• Vyoshadi Vati
• Kanchanara Guggulu
• Laxmi vilas rasa
• Mahalaxmi vilas rasa
• Chitrakadi vati
• Tribhuvana kirti rasa
• Anandabhirav rasa
• Shirastoda vati
• Shirashoolari vajra rasa

Rasayana and Leha (Confections / Immune-modulators)
Chyavanaprash
Agastya haritaki
Chitraka haritaki

Vatakam etc:
Haridra kanda
Vyoshadi vatakam

Bhasma:
Abhraka bhasma
Shringa Bhasma

Single drugs

Single drugs which are beneficial in Sinusitis –

• Pippali – Piper longum
• Maricha – Piper nigrum
• Shunti – Zingiber officinalis
• Yashtimadhu – Glycyrrhiza glabra
• Chitraka – Plumbago zeylanica
• Twak – Cinnamomum zeylanicum
• Haridra – Curcuma longa
• Daruharidra – Berberis aristata
• Lavanga – Syzygium aromaticum (clove)
• Saindhava lavana – Rock salt
• Dhanyaka – Coriandrum sativum
• Mishreya – Foeniculum vulgare (Fennel)
• Madhu – Honey
• Lashuna / Rasona – Allium sativum
• Palandu – Allium cepa
• Tulasi – Ocimum sanctum
• Pudina – Mentha piperita (Mint)
• Jeeraka – Cuminum cyminum (cumin seeds)
• Krishna Jeeraka – Carum carvi (black cumin)

Medicinal Yogas For Urdwajatrugata roga from Sahasra Yoga Text Book
Triphaladi Taila
Bala Dhatryadi Taila
Anu Taila
Nasika Choorna
Mayura Ghritam

Modern line of Treatment

• Rest
• Drinking enough water to thin the mucus
• Pain and fever medications
• Decongestants
• Mucolytics
• Antibiotics not recommended for most cases
• Breathing low-temperature steam such as from a shower
• Gargling
• Decongestant nasal sprays

Antibiotics:

• Most sinusitis cases are caused by viruses and resolve without antibiotics.
• If symptoms do not resolve within 10 days, antibiotics should be used
• Amoxicillin is the most preferred antibiotic. If symptoms do not improve after 7 days of its use, amoxicillin and clavulanate should be given as a combined prescription
• Antibiotics should not be given for those with mild / moderate disease during the first week of infection due to risk of adverse effects, antibiotic resistance and cost
• Other antibiotics used are –

Fluoroquinolones, Clarithromycin, Tetracycline, Doxycycline etc
Amoxicillin-Clavulanate – initial antibiotic in bacterial sinusitis
Course – Usually they are given for 3-7 days (10-14 days in severe cases), 10-14 days in children

Corticosteroids:
Intranasal corticoids are sometimes advised along with antibiotics

Surgery:
Chronic or recurrent sinusitis may be referred to otolaryngologist. Surgery may be the option in these cases.
Surgery is preferred when medication fails
Maxillary antral washout – Sinus are punctured and flushed with saline to clear the mucus
FESS (Functional Endoscopic Sinus Surgery) is a popular surgery
Balloon Sinuplasty – is a recently developed treatment option

Research and Studies

According to a study in 2004 – About 90% of sinus headaches are actually migraines. Confusion occurs because Migraine involves activation of the trigeminal nerves which innervate both sinus region and meninges surrounding the brain. Therefore it is difficult to accurately determine the site from which the pain originates. In migraines there will be absence of thick nasal discharges.

Sinusitis often occurs as a part of a spectrum of diseases that affect the respiratory tract (one airway theory) and is often linked to asthma. All forms of sinusitis may either result in or be a part of a generalised inflammation of the airway, so other airway symptoms such as cough, may be associated with it.

Study of Maxillary antral washout in chronic sinusitis patients in 1996 has conferred no additional benefits over antibiotics alone

Based on recent theories on the role that fungus may play in the development of chronic sinusitis, anti fungal treatments have been used, on a trial basis. These trials have had mixed results.

Epidemiology

Sinusitis is a common condition. It affects about 10-30% of people each year in USA and Europe
Women are more affected than men
Chronic Sinusitis affects approximately 12.5% of people
Treatment costs for Sinusitis is more than 11 billion USD in US

Conclusion

Ayurveda has the best treatment and medicine options for Sinusitis. They not only cure your disease and make you fit and healthy, but also provide you long time immunity. Home remedies are not the ultimate remedies. Your sinusitis may be of a serious nature and might need more than that. Self-medication is dangerous. See your Ayurvedic doctor. He or she is the best person to take care of your Sinusitis.
Click to Consult Dr Raghuram Y.S. MD (Ayu)