The title of a 2008 article in the Wall Street Journal??Waiting it Out: Antibiotics Are Unlikely to Help Sinusitis??notes what many of us have known for years: Antibiotics do little or no good in treating many sinus infections. Increasingly, doctors are turning to alternative, arguably more effective treatments.
Many of us have probably experienced the more common symptoms of sinusitis, including stuffiness, congestion, a runny nose, and facial pain or pressure. But what exactly are our sinuses? And why do we have them?
The sinuses are simply air-filled pockets within the skull; one pair sits on each side of the nose (the maxillary sinuses), one pair just between and above the eyebrows (the frontal sinuses), and two sets behind the nasal cavity (the ethmoids and sphenoids).
These air pockets contribute to conditioning the air we breathe, give resonance to our voice, assist in absorbing shock, reduce the weight of the skull, and contribute to facial growth. If we did not have sinuses, our skulls would be too heavy to carry around; sinuses lighten our load and influence our facial form.
Sinuses at Work
Like the nose, sinuses secrete mucus; they also contain cilia, organelles present in the sinuses that work to move dirt and mucus in wave-like sweeps outward, toward the opening. The movement of mucus is known as mucociliary clearance, or transit time. This clearance protects the lungs from the inhalation of pollutants, allergens, and pathogens. It?s a vital defense mechanism; some sinuses drain through an opening at the top of the cavity rather than the bottom, so the cilia must move mucus against gravity.
Tucked between the lower two nasal turbinates is the osteomeatal complex, or sinus drainage area, which empties into the back of the throat. This important system of sinus openings collects mucus discharge from the various sinus cavities. When all is working well, the sinuses are clear and empty of stagnant mucus.
But there is a phenomenon called stagnation that can occur at the osteomeatal complex, the main intersection of the drainage system. Stagnation occurs when the nose lining swells, blocking the osteomeatal complex and disrupting normal mucus clearance. This results in an unhealthy sinus environment.
Clearance of the nose and sinuses is accomplished when free-flowing secretions, open draining ports, and freely moving cilia have been restored. If this is not possible, acute or chronic sinusitis can occur.
What is Sinusitis?
Sinusitis is one of the most commonly diagnosed chronic illnesses in the United States, affecting 40 to 50 million Americans each year. It begins with an inflammation of the mucous membranes in the sinuses, often attributed to toxic overload: pollutions, allergens, chemicals, bacteria, fungi, viruses, and other irritants. This inflammation causes fluid buildup, which eventually plugs the sinus cavity and prevents normal mucus drainage.
Sinusitis can be caused by infections of the upper respiratory tract, but there are noninfectious triggers also. Allergies are a common cause, and anatomical problems such as a deviated nasal septum or polyps (abnormal tissue growth on a mucous membrane) can increase the risk of chronic sinusitis.
Most cases of sinusitis are considered acute, meaning they clear up in less than four weeks; these are the cases characterized by symptoms like congestion and a runny nose. However, when the condition recurs or lasts longer than 12 consecutive weeks, it is considered chronic.
Chronic sinusitis can be a miserable condition that significantly impairs quality of life. In addition to the more mild symptoms of acute sinusitis, people with chronic sinus infections may have difficulty breathing through their nose, experience frequent headaches and tenderness in the face, and have persistent aching behind the eyes. They may also have frequent yellow or greenish discharge from the nose or drainage down the back of the throat. Bad breath, fatigue, lack of concentration, and depression are other common symptoms of this chronic condition.
The Role of Biofilms
Once bacteria set up shop in the nose, they will sometimes go further and create a community of bacteria combined with the body?s own white blood cells. This community is called a biofilm?a protective slimy matrix often stuck to the mucous membranes like plaque on teeth or the slippery slime on river stones.
Biofilms allow bacteria to not only easily multiply, but also recruit other bacteria to join them. Two common culprits in sinus infections?Staphylococcus aureus and Pseudomonas aeruginosa?are especially good at creating biofilms. Biofilms also make bacteria resistant to our own immune system.
To rid the sinus and nose of chronic infection, the biofilm must be broken. Recent studies have shown that a simple surfactant can do just that. A common and easily obtainable surfactant is baby shampoo free of perfume and additives. Just a few drops added to a saline nose wash can break up biofilms, allowing the immune system to do its job. This can also be used occasionally for prevention. For those suffering from chronic infections, daily use of one or two drops of surfactant in an eight-ounce nasal wash solution can prevent biofilms from forming in the first place.
Antibiotics: For Better or Worse?
Visit the doctor?s office with a sinus infection, and the typical course of treatment many doctors prescribe is an antibiotic. Although antibiotics can and do benefit both acute and chronic infections, those benefits may be minimal and short-lived.
?There are hazards of antibiotics as well,? explains Michael Cooperstock, MD, MPH. ?First, antibiotics promote overgrowth of antibiotic-resistant bacteria, requiring the use of more potent (and expensive) antibiotics the next time. At the same time, antibiotics also greatly suppress healthy bacteria. Each person has on the order of a billion ?good? bacteria that normally populate the nose and throat; these normal bacteria almost surely keep infectious bacteria in check. It may take roughly six weeks to re-populate the area after it has been depleted by a course of antibiotics.?
Andrew R. Talbot, MD, and David S. Parsons, MD?two eminent ear, nose, and throat specialists who have published many well-designed research papers?are convinced that they have found an alternative to antibiotics that truly works: hypertonic saline nasal irrigation. The term hypertonic refers to a saline solution that is more concentrated than a normal solution, which has the same salt concentration as blood. A buffered solution also includes bicarbonate, or baking soda, to increase alkalinity.
In their 1997 study, the doctors evaluated the ciliary function in various saline environments and concluded the following: ?The outcome showed buffered hypertonic saline nasal irrigation to improve mucociliary transit times, while buffered normal saline had no such effect. Buffered hypertonic saline nasal irrigation is an important addition to the care of sinus disease.? Since then, both specialists have incorporated buffered hypertonic saline nasal irrigation into the care of their patients with acute and chronic sinusitis.
Research suggests that nasal irrigation is useful in the treatment of sinusitis, with improvements in quality of life, decreases in symptoms, and decreases in medication use. Recall the previous mention of mucociliary clearance, the movement of mucus, then note this: Hypertonic saline nasal irrigation has been shown to improve this transit time by 17 percent. If patients use a wash system that encourages an effective and comfortable technique, they may be glad to forego those prescriptions for antibiotics, decongestants, antihistamines, and nasal steroids.
Be well, and happy breathing!