Editing Treatments

[[Rhinosinusitis]] treatments come in a wide variety of formats. Each approach suits a different level of severity, type of [[cause]], and so forth. Here are several categories of treatments. Their purpose is to assist in remedying the underlying problem, or at least to provide some symptomatic relief.

==Pharmaceutical==

[[File:Rhino horn.jpg|thumb|Numerous [[saline sprays]] and [[rinses]] send a mixture of water and salt, and sometimes other ingredients like baking soda, through the nasal passages. This rhino horn assists the user.]]

Pharmaceutical remedies claim to offer intermediate relief for severity between herbal and surgical remedies. Some are systematic (affecting the entire body), while others are local (applied directly to the nose and upper respiratory tract). Topical drugs in the affected areas have fewer side effects. Pharmaceuticals often have serious side effects, and some drugs are only available with a prescription. Drugs often only work for a few hours at a time, and for a few days in a row, making them problematic for chronic rhinosinusitis.

* [[Non-steroidal anti-inflammatories]] (NSAIDs) include aspirin, ibuprofen, naproxen, and others. These reduce inflammation throughout the entire body. These are inexpensive and widely available, although they do have severe side effects [https://www.ncbi.nlm.nih.gov/pubmed/16531187] and as such are not ideal for extended use.
* [[Steroids]] can be applied topically or ingested. These require a few days, weeks, or months to take effect, although unlike most pharmaceuticals can be taken for extended use. They work by reducing inflammation and encouraging blood flow in the affected area. Spray steroids are now available without a prescription, and do not carry the same side effects as the systemic steroids that some athletes take, although still are not recommended for children. Steroids have some side effects, although they do not have rebound effect like most sinus sprays.
** All varieties of steroid spray are equivalently effective. [https://www.ncbi.nlm.nih.gov/books/NBK279484/]
* [[Oxymetazoline]] acts quickly, and lasts up to twelve hours. However, it is only intended for temporary relief, and extended use can causes [[rhinitis medicamentosa]], i.e. inflammation of the nose caused by the medicine.
* [[Levomethamphetamine]] and other related compounds are variants of methamphetamine, available as nasal inhalers (along with herbal ingredients). These also aim to increase blood flow to the affected areas. However, they only last a few hours, and have side effects, making them unsuitable for extended use.
* Numerous [[saline sprays]] and [[rinses]] send a mixture of water and salt, and sometimes other ingredients like baking soda, through the nasal passages. [http://www.neilmed.com/neilmedblog/2014/03/the-use-of-irrigations-with-topical-additives-for-the-treatment-of-chronic-rhinosinusitis/] The mixtures can be dispensed from a plastic squeeze bottle, a traditional neti pot, or the hands. According to a review of scientific research, weak evidence supports the long-term benefits of nasal rinses, although with side effects such as nose bleeds. [https://www.cochrane.org/CD011995/ENT_saline-irrigation-chronic-rhinosinusitis]
* [[Sodium chlorite]] is another alternative, mild nasal spray.
* [[Hydrogen peroxide]] is a common household chemical, used as a debriding agent to remove dead skin cells. Some people report using a diluted mixture of this as a nasal rinse, although this could be dangerous.
* [[Guaifenisen]] thins and loosens mucus, and as such is sold as an expectorant. It can assist in clearing mucus. Some singers use guaifenisen prior to performing, to clear mucus.
* [[Dextromethorphan]] is a cough suppressant, often found in cough syrups. It is also a dissociative.
* [[Pseudoephedrine]] is a stimulant that used to be the most common ingredient in sinus drugs. Because of its role in the production of recreational drugs, it has been made more difficult to buy. Has some side effects and not meant for long term use.
* [[Phenylephrine]] has largely replaced pseudoephedrine in oral sinus medications. A nasal spray is also available. There is controversial evidence as to whether this has any effect or not, with some studies showing no more effect than a placebo, while the US Food and Drug Administration argues that it should be sold.
* [[Immunomodulators]] alter how the body responds to pathogens. This can prevent excessive production of symptoms by the body itself. Macrolides are immunomodulators that have shown some evidence of reducing sinus symptoms, although ceasing after the medicine is withdrawn. [https://www.ncbi.nlm.nih.gov/pubmed/28894821]
* [[Antifungal]] agents have recently been tested, on the basis of cases of sinusitis having to do with fungal infections. [https://linkinghub.elsevier.com/retrieve/pii/S009545430700084X]
* Antibiotics are often prescribed. However, they have no effect on viral pathogens, they can have side effects include worsening the sinus symptoms, and overuse can breed resistant strains of bacteria. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251963/]
* Lidocaine is a throat numbing agent, found in some cough treatments. These can also include dextromethorphan, menthol, or other ingredients.
* There are other nasal sprays on the market, some available only in certain countries. For example, there is a nasal spray containing the minerals copper, manganese, and sulfur in addition to herbal ingredients. There is also a spray containing cyclamen.

==Surgical==

Surgery is generally considered a last resort. It has serious risks for the body, and is expensive, and still may not fully treat the condition. Usually a doctor will first prescribe various medications and perform diagnostic tests before any surgery. Sinus surgery aims to improve the flow of mucus. [http://s3.amazonaws.com/media.american-rhinologic.org/Resources/VirtualAnatomy.pdf?AWSAccessKeyId=AKIAIDWCCD6DNOE2DAJQ&Expires=1540580332&Signature=n%2B032Om%2BqdCIdMq8KEfuNnr6V9A%3D] Presently, medical approaches (including surgery and drugs) can offer some symptomatic relief, and in some cases a resolution of the underlying issue. However, even the most extensive surgery often remains insufficient to address sinus issues.

* [[Functional Endoscopic Sinus Surgery]] (FESS) is a modern approach that has replaced its antecedents. This involves inserting a tube into the nose with a camera.
* [[Balloon sinuplasty]].
* Antral sinus window was a previous standard, significantly more harmful and less effective than FESS.

==Herbal==

[[File:Spices of Saúde flea market, São Paulo, Brazil.jpg|thumb|[[Pungent herbs]] can provide mild relief with few side effects, and taste great.]]
[[File:" 15 - ITALY - Oli essenziali puri naturali e fragranze ipoallergeniche - Pure natural essential oils and hypoallergenic fragrances.JPG|thumb|[[Vapors]] can be inhaled, from an inhaler or in the shower or otherwise. Different ingredients such as essential oils can add to the potency.]]

Herbal remedies have existed since long before modern medicine, although often without significant scientific evidence. As such, these remedies tend to offer milder relief, although with fewer side effects. This makes herbal remedies an appropriate place to start experimenting, and especially suitable for milder cases of rhinosinusitis.

* [[Pungent herbs]] can provide mild relief with few side effects, and taste great.
** Capsaicin (hot pepper) can be eaten or used in a nasal spray. Scientific evidence supports its use for non-allergic rhinosinusitis. [https://www.ncbi.nlm.nih.gov/pubmed/21802026][https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971034/] Capsaicin can even work better than steroids. [https://www.ncbi.nlm.nih.gov/pubmed/26171907]
** Garlic
** Black pepper
** Turmeric
** Ginger
* Apple cider vinegar is a traditional remedy. [https://homeremediesforlife.com/apple-cider-vinegar-sinus-infection/]
* Oil pulling is a traditional Eastern remedy. [https://www.earthclinic.com/sinus-infection/oil-pulling.html]
* [[Vapors]] can be inhaled, from an inhaler or in the shower or otherwise. Different ingredients such as essential oils can add to the potency. These products are commercially available or can be made at home. Some products can also be put in the mouth (lozenges) or rubbed on the chest and neck (gels) for the vapors to get inhaled.
** Menthol
** Eucalyptus
** Lavender
** Siberian fir
** Oil of wintergreen
** Tea tree
** Oregano [http://theresanoilforthat.blogspot.com/2009/04/sinus-infection.html]
** Rosemary [http://theresanoilforthat.blogspot.com/2009/04/sinus-infection.html]
** Peppermint [http://theresanoilforthat.blogspot.com/2009/04/sinus-infection.html]
** Lemon [http://theresanoilforthat.blogspot.com/2009/04/sinus-infection.html]
* [[Caffeine]] and other stimulants.
** Coffee
** Tea
* Glucosamine supports joint health, and could also play a role in improving rhinosinusitis.
* Bromelain is an enzyme from pineapples. Has widespread effects on the body, which could include the sinuses.
* St. John's Wort or other herbs to improve mood could indirectly affect the sinuses.
* [[Zinc]] has been applied to chronic sinusitis. [https://www.ncbi.nlm.nih.gov/books/NBK279484/] However, it is questionable whether it works, and it has side effects. [https://www.medscape.com/answers/232791-42224/what-is-the-role-of-zinc-in-the-prevention-of-chronic-sinusitis]
* [[Xylitol]] is a sugar alcohol that can be added to nasal spray.

==Physiological==

[[File:Valsalva maneuver.jpg|thumb|[[Valsalva maneuver]] is a technique that can balance the pressure in the ears and sinuses, when performed carefully.]]

Certain bodily adjustments can alter how sinus fluids move.

* [[Valsalva maneuver]] is a technique that can balance the pressure in the ears and sinuses, when performed carefully.
* Standing [[upside down]] and in other positions can affect sinus drainage. The sinuses drain through small holes called ostia, which are located in places that make drainage difficult while standing upright.
* [[Massage]], whether of the face, neck, back, skull, or whole body, can assist the body in clearing sinus fluids. In particular, rubbing or tapping the areas of the face directly over the sinuses can assist in this process. Other sensitive areas include the perineum (between the genitals and the anus).
* [[Crying]], [[yawning]], and other actions can affect the head configuration, thus enabling more sinus drainage.
* [[Eating]] a balanced diet, [[drinking]] plentiful water, and [[exercising]] regularly can all contribute to rhinosinus health.
* [[Sleeping]] allows the body to clear the nose and sinuses, while resting in a different position. Elevating the head can allow mucus to drain.
* [[Nasal strips]] hold the nose open to allow more air through. Greater air flow can prevent sinusitis.

==Alternative==

Some alternative medical approaches claim to have different methods of resolving sinus issues.

* [[Osteopathy]] is an alternative medicine founded in the American frontier.
* [[Homeopathy]] is an approach based on a supposed dilution of herbal treatments.
* [[Chiropractic]] involves manipulating the body.
* [[Traditional Chinese Medicine]] (TCM) advocates for various remedies such as fungi and acupuncture.

==Diagnostic==

[[File:Sinuses and Sinusitis (5937085231).jpg|thumb|[[Computed Tomography]] (CT) scan combines numerous X-ray images to produce a 3D map.]]

Diagnostic tests such as imaging are not treatments per se, however these can reveal underlying anatomical or physiological problems. As such, they are generally performed before surgery, and can also be conducted simply to gain a better understanding.

* [[Computed Tomography]] (CT) scan combines numerous X-ray images to produce a 3D map. The X-rays contribute enough radiation to cause health concerns in extreme cases, however are generally tolerated. Because this is a more common and affordable imaging modality, it is one of the first approaches.
* [[Positron Emission Tomography]] (PET) scan is a more advanced form of imagery that costs more yet produces fewer harmful effects.
* [[Allergy]] testing can reveal whether or not allergies play an important role. Note that allergies can be systemic (in the entire body), or local (only in the nose area). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971034/]
* [[Palpation]] over the sinuses can reveal the presence of problems.
* [[Tracking]] symptoms can assist in discovering the causes of rhinosinusitis.
** The mere act of tracking draws one's attention to possible causes and effects.
** Seeing the data from the big picture view, numerically or as charts and graphs, can reveal surprising relationships.
* Genetic testing of the biome of the upper respiratory tract could potentially provide insight. For example, [https://ubiome.com/clinical/smartflu/ SmartFlu] by [https://ubiome.com/ uBiome].

==Speculative==

Several possible ideas that have not yet been invented or tested could offer sinus improvements.

* One could design a device that automatically compensates for weather-related causes, for example adjusting the humidity of inhaled air.
* One could design a vacuum or syringe for the nose, to remove mucus.
* An automatic pressure pack that massages the face or other relevant areas.
* Improvements to the vasculature and other tissues to give the sinuses preventative strengths.
* Ultrasound has been tested therapeutically. [https://clinicaltrials.gov/ct2/show/NCT00934830]
* Infrared light has also been tested therapeutically. [https://www.ncbi.nlm.nih.gov/books/NBK279484/]
* Lasers could apply highly focused electromagnetic radiation at the sources.
* The synthetic glycosaminoglycan GM-1111 has shown effectiveness in mice. [https://www.ncbi.nlm.nih.gov/pubmed/30252910]
* A new treatment class is called ''biologics''. [https://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CBER/ucm133077.htm]
* Probiotics could strengthen the microbial community of the airways, preventing infection and inflammation. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251963/]
** The same source cites "mucus transplantation.

[[Category:Treatments]]