A Common yet often overlooked cause of chronic cough

Sinuses

Sinuses are four pairs of air-filled cavities located in the skull in the region around the nose and the eyes. These sinuses are:

• Frontal sinuses; located above the eyes, in the center region of each eyebrow
• Maxillary sinuses; located within the cheekbones, just to either side of the nose
• Ethmoid sinuses; located between the eyes, just behind the bridge of the nose.
• Sphenoid sinuses; located just behind the ethmoid sinuses, and behind the eyes.

Sinusitis

Inflammation in the inner layer of these cavities in known as sinusitis.  This is also known as a sinus infection or rhino-sinusitis. When this happens, the sinuses get swollen and mucus secretion gets blocked inside the sinuses. The sinusitis can be infectious as well as non infectious. This can be nagging discomfort all the time or can have severe attacks which are varied for different patients.

Prevalence

It affects about between 10% and 30% of people each year. Women are more often affected than men. Chronic sinusitis affects approximately 12.5% of people.

Causes of sinusitis:

• Obstruction of the various ostia
• Allergic reaction to pollens, animal fur, certain foods and beverages
• Deviated nasal septum, nasal polyp
• Impairment in ciliary function(there are small hair like parts in our nose which prevent travelling of infectious agents or harmful substances to sinuses)
• Impaired immunity
• Bacterial infection or fungi (in rare cases like immune comprised cases). 

Symptoms of sinusitis:

Different people come down with different symptoms when it comes to sinusitis, patients can present with any of the following group of symptoms:

• Runny nose – the discharge being thick and yellowish or greenish
• Nasal obstruction, blocked nose, obstructed sensation in the nose
• Soreness in throat
• Sensation of pressure in the face and head/ Headache
• Passage of mucus from the back of the nose into the throat (called post nasal drip or discharge) which causes tendency to hawk or clear the throat often
• Bad breath and bad taste in the mouth
• Ansonia or reduced sense of smell
• Cough with mucus production (more at night when lying down)
• Blocked sensation in one or both ears

People with Chronic sinusitis will have following symptoms:

• Nasal discharge and irritation
• Hawking of mucous or clearing throat often.
• Dull Headache especially in frontal region.
• Facial pain or pressure
• Fever and halitosis
• Cough (worse when lying down)

Diagnosis:

can be confirmed clinically as well as getting a par nasal sinuses x ray done. CT might be needed in certain cases.

Complications:

The blocked secretions can become infected due to growth of bacteria, fungi, etc. Infection of surrounding structures is uncommon complications of sinusitis. These structures include eye, the brain, the bone, overlying skin and nearby blood vessels.

Differential Diagnosis:

Pharyngitis: History of chronic rhinitis

Laryngitis: Paroxysms of cough, often associated with stridor

Drug side-effect: For example, Angiotensin-converting enzyme (ACE) inhibitors Dry cough

Treatment:

General management: Sinusitis can be well managed by medical treatment and self care. The conventional line of medicines offers decongestants, anti allergic and sometimes antibiotics as line of treatment.

Home treatment and self management include:

1. To carry out flushing of nasal passages and clear the nose in morning
2. Steam –add few drops of eucalyptus oil which can be beneficial
3. Take a hot shower
4. Take increased quantity of liquids which should be more of water and fresh juices, avoid tea and caffeine
5. Remove material from the house which can have allergy triggers, this sometimes helps as there might be triggering factors, like carpets, mould on walls, some plants
6. Avoid humid areas
7. Jal neti- a yoga activity can be helpful but shall be done under supervision only (not during acute sinusitis)

Homeopathic treatment:

Acute and chronic sinusitis both fall under the scope of Homeopathy For acute attacks are various remedies which can be prescribed based on symptoms of the case. Some examples are given below. For complete treatment of chronic or recurrent sinusitis one must see a homeopathic practitioner. A homeopath in such a case will prescribe a holistic remedy covering the physical symptoms and emotional attributes of patient so as find the remedy based on totality which will boost immunity and reduce or remove the tendency to sinusitis.

Few homeopathic remedies for acute sinusitis are:

Bryonia Alba: Nose catarrh extends to frontal sinuses. Frontal headache, frontal sinuses involved.

Kali bichromicum: Pressing in frontal sinuses, catarrh in frontal sinuses. Pain at the root of nose, as if in the bones. Chronic inflammation of frontal sinuses with stopped up sensation.

Kali iodum: Acrid, burning watery or greenish discharge. Aggravated open air sneezing. Allergy, hayfever with dyspnea. Sinusitis. Pain and pressure at the root of the nose. Sensitive nostrils.

Hepar sulph: Ailments after exposure to cold air, sinusitis. Post nasal discharge with much hawking of mucous. A noisy cough aggravated by cold draft of air and better by warm drinks.

Hydrastis canadensis: Thick tenacious discharge from posterior nares. Child is aroused suddenly from sleep by post nasal dropping. Obstructed, inclination to constantly blow the nose.

Sticta pulmunaria: Headache will dull pressure in forehead, at root of nose. Catarrhal headache before discharge appears.

Phosphorus: Cough from irritation in the throat agg. Talking, laughing, evening, left side. Change of temperature or weather. Nervous dry cough, aggravated presence of strangers and strong odours.

Pulsatilla pratensis – Congestion of blood to head and engorgement of the sinuses. Coryza with loss of smell and taste; dry and fluent alternately, or stopped up in evening, with loss of smell and taste and appetite; obstruction of nose in evening; yellow or yellow-green in morning; nostrils sore; frontal headache.

References:

• Ralston S.H., Penman I.D., Strachan M.W.J., Hobson R.P. Davidson’s, Principles and Practice of Medicine. 23^rded. Edinburgh; Churchill Livingstone/Elsevier; 2018. 1417p.
• Kasper D.L., Fauci A.S., Hauser S.L., Longo D.L., Jameson J.L., Loscalzo J. Harrison’s Manual of Medicine. 19^thed.United States: McGraw Hill; 2016, 1222p.
• Boericke W, Boericke O. E. New Manual of Homoeopathic Materia Medica & Repertory [with relationship of remedies]. B. Jain Publishers (P) Ltd
• Hering, C., The Guiding Symptoms of our MateriaMedica Vol. 1 to 10, Reprint Edition 1993, B. Jain Publishers (P) Ltd
• Gupta, R. Directory of disease and cure in homeopathy, B. Jain Publishers (P) Ltd
• Satya, P. Analogy of Pain

Author:

Dr Geeta Rani Arora

BHMS, MD

Chief Consultant, Heal with Homeopathy

www.healwithhomeopathy.co

Faculty -London College of Homeopathy

Former- Technical Head- B.Jain Pharmaceuticals Pvt. Ltd