Chronic Sinus Problems?

by Mila McManus MD

Chronic sinus problems affect millions of people, causing ongoing discomfort, congestion, and a reduced quality of life. While acute sinus infections are often short-lived, chronic sinus issues are often resistant to standard treatments. Ignoring them is not wise either, and many options are available for thorough assessment and identifying the best treatment solutions.  You need not suffer!

Common Symptoms and Factors that Cause Them

Chronic sinus issues often manifest with nasal congestion, facial pain or pressure, reduced sense of smell and taste, and post-nasal drip. In some cases, headaches, fatigue, and cough are also present. Unlike acute infections caused by transient viral or bacterial pathogens, chronic sinusitis (aka ongoing inflammation of the sinuses) is often caused by anatomical or structural issues of the nasal passages, environmental and food reactivity, biofilm formation, and/or fungal colonization of the sinuses.

Common Anatomical (Structural) Sinus Problems

Certain structural variations in the nasal and sinus anatomy can predispose individuals to chronic sinusitis. The most common anatomical issues include deviated septum, nasal polyps, and narrow sinus openings.

These structural abnormalities can lead to stagnant mucus, creating an environment where bacteria, fungi, or mold can thrive. For some patients, surgical correction may be necessary to restore proper sinus drainage and reduce chronic inflammation.

Environmental Causes

Environmental allergies or sensitivities to food, pet dander, dust, cockroaches, pollen from trees and grasses are common causes of chronic sinus issues.  Also, air pollutants such as fragranced room spray, detergents, and candles are other common contributors. Without addressing environmental exposure, medical treatments alone may provide only temporary relief. This requires a thorough assessment to identify all possible exposures and address symptoms effectively. Allergy medication for a lifetime is NOT a solution and can be dangerous (read about the dangers of allergy meds).

Repeated or prolonged antibiotic use may increase the risk of fungal sinus colonization, complicating treatment and prolonging symptoms. Antibiotics reduce bacterial diversity, disrupting the delicate balance of the nasal microbiome and potentially allowing opportunistic fungi and mold to overgrow. This can lead to persistent sinus inflammation and recurrent or chronic infections.

Finally, and common in our area, people living in hot, humid climates are particularly susceptible to mold exposure, both indoors and outdoors. Individuals in these regions are more likely to inhale mold spores, which can adhere to the sinus mucosa and trigger chronic inflammation or allergic reactions. Mold-related sinusitis may present with congestion, sinus pressure, and a thick, discolored nasal discharge.

Thorough Assessment

With so many causes of chronic sinus problems, perhaps it is easier now to understand that assessment can be complex.  It is critical to assess the places you spend the most time (work and home, for most of us) for mold, pet dander, dust, and chemical fragrances.

Our immune system is constantly responding to countless protein exposures from the air we breathe and the foods we eat. Cross-reactivity often occurs in the immune system, for example, between a food and a pollen, or a chemical and a food.  This is one reason why it is ideal to test both environmental allergies (IgE) and food sensitivities (IgA, IgG). We offer these tests in our office, along with nutrition guidance, gut support, supplements that support immune function and histamine clearance, and SLIT (sublingual immunotherapy, aka allergy drops).  Strategically addressing all of these can eliminate symptoms and resolve chronic issues.

We also recommend reducing or eliminating chemically fragranced home and body products for anyone suffering from chronic sinus problems, skin rashes, as well as headaches, poor sleep, or irritability. Removing excess chemical fragrances from the home can dramatically improve chronic sinus problems. The main culprits include dryer sheets, laundry detergent, dish soap, trash can liners, air fresheners, carpet and fabric fresheners, lotions, lip balms, soaps, and sanitizing agents. While essential oils and natural fragrances are often less likely to cause sinus problems, even these can be irritating for some people.

Treatments and Ongoing Sinus Care

Start with these four assessments:

• Start a fragrance elimination program in your home and office if possible.
• Take a Food Sensitivity Test (IgA and IgG). Learn more here.
• Get tested for environmental allergens (IgE), and if needed, utilize sublingual immunotherapy to lessen your allergic responses over time. Read about it here.
• Remove dairy (milk, cheese, yogurt, sour cream, etc) from your diet for 2 weeks to determine if dairy is having a congesting effect on your mucous production, a common aspect of eating dairy.

Next, other strategies:

• Nebulize medical-grade hydrogen peroxide solution available at our office.
• Nebulize vitamin C, magnesium, and DMSO, also available at our office.
• Talk to your provider about a compounded nasal spray that will treat and protect your sinuses. Antibiotics, antifungals, and biofilm busters are all available by prescription.
• Vitamin C is a natural antihistamine and anti-inflammatory. It’s available in capsule form, nebulizer solution, injection, and IV.
• D-Hist is a useful supplement with antihistamine effects for a stuffy nose and seasonal allergies.
• Optimize your vitamin D levels for a healthy and strong immune response.
• Consider using a neti pot and appropriate rinses. Your provider can guide you regarding solutions that can be very helpful.

You don’t have to live with chronic sinus issues!   We would be honored to help you. Be well!

References:

1. Fokkens WJ, et al. “European Position Paper on Rhinosinusitis and Nasal Polyps 2020.” Rhinology, 2020;58(Suppl S29):1–464.
2. Brook I. “Microbiology and management of chronic rhinosinusitis.” Journal of Antimicrobial Chemotherapy, 2005;56(6): 984–991.
3. Ponikau JU, et al. “The role of fungi in chronic rhinosinusitis.” Clinical Reviews in Allergy & Immunology, 2006;30(2–3): 163–180.
4. Schleimer RP. “Immunopathogenesis of chronic rhinosinusitis and nasal polyposis.” Annual Review of Pathology, 2017;12: 331–357.
5. Dykewicz MS, Hamilos DL. “Rhinitis and sinusitis.” Journal of Allergy and Clinical Immunology, 2010;125(2 Suppl 2): S103–S115.