Sinus Conditions

September, 2006

Definition of the Problem
Chronic sinusitis is a long-term inflammation of the sinuses, the moist air spaces located in the bones of the upper face. The purpose of the sinuses is to warm and filter incoming air in order to protect the airways and lungs. It is the job of the mucus to trap pollutants, allergens, and infectious agents. Sometimes, however, infections, swelling, allergic reactions, or blockages can block the proper flow of the mucus.

When this happens, mucus (and sometimes pus) builds up and causes sinus pressure (Ivker, 1995). In addition to facial pressure and pain, symptoms can include fatigue and difficulty concentrating (Dykewica and Fineman, 1998; Grossan and Bruce, 2001). Chronic sinusitis can significantly affect patients’ quality of life, and increase doctor visits and use of medication.

Scope and Cost of the Problem
Sinusitis is either the first or second most common chronic condition in the United States, with sinusitis developing in 31 million people annually, and chronic sinusitis affecting approximately 35 million adults; it is responsible for 18 million office visits, $5.8 billion in medical costs, and an average of four sick days per person annually (Patient/Public Education: Fast Facts, 2006). Chronic sinusitis is particularly prevalent in polluted urban centers. Greater Los Angeles has one of the highest rates of sinusitis in the world (Ivkar, 1995).

Medical Treatment
Chronic sinusitis can have many components, such as infections, allergies, swelling, obstructives and, probably, psychological factors (Addolorato, Ancona, et al, 1999; Weir and Stephens, 1976). Treating just one aspect (as with extended courses of antibiotics) rarely works (Ivkar, 1995; Grossan and Bruce, 2001).

Antihistamines, often used to control the allergic aspect of sinusitis, can dry the mucus and make it harder to drain. Anti-inflammatories, usually in the form of steroid nasal sprays, can only relieve symptoms but not the cause of the swelling. Oral steroids are sometimes prescribed for severe chronic sinusitis, but only when other medications have failed.

Surgery on an obstruction does greatly reduce symptoms in some patients, especially those whose sinuses are blocked by polyps or nasal deformities. These surgeries can now be done by endoscope on an outpatient basis. A new and promising treatment approach is the use of antifungal drugs such as fluconazole.

Non-pharmacologic treatment including Imagery and Self-Hypnosis
As in any chronic condition, self-care measures play a large role in determining patient quality of life, disease progression and resource utilization in sinusitis. Environmental modification, such as removing carpets and drapes, using a humidifier, or setting up an air-cleaning device can promote sinus healing.

Behavior changes such as stopping smoking, avoiding sinus triggers, drinking more fluids, and irrigating the nose daily with saline solution can help, sooth, and heal (Ivkar, 1995; Grossan and Bruce, 2001). Relaxation, guided imagery and self-hypnosis can reduce reactivity to allergens and decrease inflammatory response Klein, Ziering, et al, 1985; Madrid, Rostel, et al, 1995; Zachariae, Kristensen, et al, 1990).

In one study, researchers taught a two-session course in self-hypnosis to a group of 34 patients with a variety of allergies, with 76% of subjects reporting improvement, and 86% able to reduce medication usage. Improvement was maintained through two years of follow-up (Madrid, Rostel, et al, 1995).

Mind/body measures such as imagery and relaxation can also help patients cope with their symptoms. Pain in the head and face is the most troubling symptom for most sinusitis patients. Pain control, and accompanying reduction in medication use, through imagery, relaxation and suggestion has been documented in patients with headaches of various types (Blanchard, Jaccard, et al, 1985; Ilacqua, 1994; Mannix, Chandukar, et al, 1999).

Guided imagery can improve patients’ ability to cope with sinus problems, and may reduce sinus symptoms, office visits, and medication usage in many cases.

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Blanchard EB, Jaccard J, Andrasik F, Guarnieri P, Jurish SE. Reduction in headache patients' medical expenses associated with biofeedback and relaxation treatments. Biofeedback Self Regul. 1985 Mar;10(1):63-8.

Dykewicz, M.S., Fineman, S. Executive Summary of Joint Task Force Practice Parameters on Diagnosis and Management of Rhinitis. Ann Allergy Asthma Immunol. 1998 Nov;81(5 Pt 2):463-8.

Grossan, Murray MD and Bruce, Debra. (2001). The Sinus Cure: 7 Simple Steps to Relieve Sinusitis and Other Ear, Nose, and Throat Conditions New York, NY: Ballantine Books.

Ilacqua GE. Migraine headaches: coping efficacy of guided imagery training. Headache. 1994 Feb;34(2):99-102.

Ivker, Robert DO. (1995) Sinus Survival (3rd Edition). New York: Jeremy Tarcher.

Klein GL, Ziering RW, Girsh LS, Miller MF. The allergic irritability syndrome: four case reports and a position statement from the Neuroallergy Committee of the American College of Allergy. Ann Allergy. 1985 Jul;55(1):22-4.

Madrid A, Rostel G, Pennington D, Murphy D. Subjective assessment of allergy relief following group hypnosis and self-hypnosis: a preliminary study. Am J Clin Hypn. 1995 Oct;38(2):80-6.

Mannix LK, Chandurkar RS, Rybicki LA, Tusek DL, Solomon GD. Department of General Internal Medicine, Headache Wellness Center, Greensboro, NC, USA. Effect of guided imagery on quality of life for patients with chronic tension-type headache. Headache. 1999 May;39(5):326-34.

[no authors listed] Patient/Public Education: Fast Facts. American Academy of Allergy, Asthma and Immunology. 2006.
Accessed September, 2006.

Weir NF, Stephens SD. Personality measures in E.N.T. outpatients. J Laryngol Otol. 1976 90(6):553-60.

Zachariae R, Kristensen JS, Hokland P, Ellegaard J, Metze E, Hokland M. Effect of psychological intervention in the form of relaxation and guided imagery on cellular immune function in normal healthy subjects. An overview. Psychother Psychosom. 1990 54(1):32-9.