Chronic Sinusitis

Chronic Sinusitis

What is it?

Chronic Sinusitis is defined by persistent inflammation of the sinus cavities lasting longer than 3 months. It can present in both adults and children. You are more at risk of developing sinusitis if you have conditions such as infections, nasal polyps, asthma, cystic fibrosis, or immune conditions. Signs you may have chronic sinusitis include pressure or pain behind the cheeks and eyes, pain in the top teeth, headache just under the eyebrows, green/yellow nasal drainage and increased post-nasal drip.

Assessment:

When you come to see an osteopath, they will carry out testing of the neck, jaw, paranasal sinuses, and skull. They will ask questions about your health history and if you have not yet been referred to a general practitioner or received scans may write a referral.

Treatment:

There are several treatment options for chronic sinusitis.

Conservative treatment:

Saline irrigation using a netty pot did improve pain, polyp scores and reoccurrence. It was found to be most effective in combination with other treatments.

Other forms of manual therapy such as non-abrasive cups and jade stones can have a benefit Evidence showed these movements are repeated 7 times per session minimum every day over a period of two weeks decreased pain and increased quality of life. This is as through specific technique fluid is moved from the sinus to the lymph nodes encouraging drainage.

Medication:

In cases where infection is suspected imaging (CT/MRI/X-ray), nasal endoscopy and cultures are taken. From there medication is prescribed such as the use of amoxicillin antibiotics for a period of 3-7 days.

Topical and systemic glukocorticosteroids and antibiotics are used as long-term therapy alongside saline irrigation. While this does not stop symptoms it helps manage them increasing quality of life. If polyps are present it is recommended, they be removed and then the patient prescribed corticosteroids to be taken orally or sprayed.

Osteopathic Treatment:

Osteopathic manual therapy that lasted for a period of 14 minutes was found to cause decreased sinus congestion, postnasal drop, sinus pain/headache, fatigue and increase sense of smell. Lymphatic drainage of the system through a treatment that lasts 18 minutes was shown to have improvement in the signs and symptoms of rhinitis (inflammation of the nasal passages vs sinuses) and as such the same thinking can be used to see its effectiveness in treating sinusitis.

Techniques used by osteopaths may include direct pressure, sinus drainage, facial massage, manipulation of the neck/back and osteopathy in the cranial field.

Your osteopath may recommend lifestyle changes that include modifying behavior, household products and others.

Should none of the conservative, pharmaceutical or manual therapy be affective surgical treatment such as functional endoscopic sinus surgery (FESS) or Balloon Sinuplasty can be used.

Reference List:

Bachert, C. and Holtappels, G. (2015). Pathophysiology of chronic rhinosinusitis, pharmaceutical therapy options. GMS Current Topics in Otorhinolaryngology Head and Neck Surgery 14. https://doi.org/10.3205/cto000124

Baisakhiya, N. (2018). Efficacy of Osteopathic Manipulative Treatment in the patient of Chronic Rhinosinusitis: A Case Report. Clinical Rhinology An International Journal 11 (3), 58-60. https://doi.org/10.5005/jp-journals-10013-1346

Gandhi, M. & Gurudut, P. (2022). Comparative Effectiveness of Jade Stone Mobilisation, Non-abrasive Cupping, and Manual Drainage Technique in Subjects with Chronic Sinusitis: A Randomised Clinical Trial. The Internet Journal of Allied Health Sciences and Practice 20 (3),

Lee, E., Lo, J., Tran, J., Redding, D. (2022). Osteopathic manipulative treatment for sinusitis relief: a pilot study. Osteopathic Family Physician 14(2), 10 – 14. https://doi.org/10.33181/13065

Lintonbon, D. (2019). A Study to Investigate the Effect of ‘Frontal Lift’ Osteopathic Manipulative Technique (OMT) in Patients with Chronic Sinusitis. American Journal of Biomedical Science and Research 3 (3), 213-222. https://doi.org/10.34297/AJBSR.2019.03.000665

Mustafa, M., Hanif, M.I., Shimmi, S.C. (2015). Acute and Chronic Rhinosinusitis, Pathophysiology and Treatment. International Journal of Pharmaceutical Science Invention 4 (2), 30 – 36. https://www.researchgate.net/publication/274639622_Acute_and_Chronic_Rhinosinusitis_Pathophysiology_and_Treatment

Rudmik, L. and Soler, Z.M. (2015). Medical Therapies for Adult Chronic Sinusitis. JAMA 314 (9), 926-939. https://doi.org/10.1001/jama.2015.7544

Wu, S.S., Graven, K., Sergi, M., Hostoffer, R. (2020). Rhinitis: The Osteopathic Modular Approach. Journal of the American Osteopathic Association 120 (5), 351-358. https://doi.org/10.7556/jaoa.2020.054

Walen, J., Yao, S., Leder, A. (2018). A Short Review of the Treatment of Headaches Using Osteopathic Manipulative Treatment. Current Pain and Headache Reports 22 (82). https://doi.org/10.1007/s11916-018-0736-y