SINUSITIS OR DUSHTA PRATHISYAYA

SINUSITIS/ RHINO SINUSITIS

Inflammation of Para nasal sinuses is called Sinusitis (Rhino sinusitis). It can also be defined as inflammation of mucus membrane that lines the Para nasal sinuses. Usually sinuses are filled with air, but when it is infected with bacteria, viruses, etc, it is blocked with mucus or germs and it will ultimately lead to Sinusitis. It may causes symptoms like cold. headache, dizziness,etc.

What is Sinus:

The Sinuses or Para nasal sinuses are air filled spaces in the skull. They are located behind the forehead, nasal bones, cheeks, and eyes.

There are four pairs of Para nasal sinuses are there:

1. Frontal Sinuses: Over the eyes in the brow area. If it is effected may produce symptoms like Pain above the eye, forehead, head ache, etc.
2. Ethmoidal Sinuses: Two are there (Anterior and Posterior). Behind the bridges of the nose and between the eyes. Symptoms may produce like pain behind the eyes, sides, upper part of nose head ache, etc.
3. Maxillary sinuses: Inside each cheek bones.Pain over each cheek.
4. Sphenoid sinuses: Behind the ethmoid in the upper region of the nose and behind the eyes. Pain behind the eyes refers to vertex, over mastoid process and back of the head.

Each sinuses has opening into the nose for free exchange of mucus and air and also joined with the nasal passage by continuous mucus membrane lining. So it thus helps for continuous pressure maintenance, air filtering etc. These sinuses also protects the internal organ of skull by acting as shock absorber. These also ensures free air circulation and helps to maintain internal equilibrium.

Paranasal sinuses

What causes Sinusitis?

It can caused by infections like bacterial, viral, etc.May be due to allergies, Auto immune diseases, changes in climate,structural abnormalities like DNS, small sinus ostia. Sometimes it may be due to smoking, Dental diseases etc.

Signs and Symptoms:

• Headache, fever, etc
• Feeling of nasal stiffness, sore throat, etc.
• Discoloured nasal discharge.
• Tooth ache, bad breath, etc

Pain may be localised depending on the type of sinus affected.May worsen when the affected person bends over or lying down. Pain often starts on one side of the head and progress to both sides. Nasal discharge that is usually green in colour and may contain pus or blood.

Pathophysiology:

Sinuses are the cavities that has the connection to the nose and brain. So anything that causes blockage due to swelling infection,etc may cause development of sinus problems. Air trapped in sinuses along with pus, mucus,etc will cause pressure on the sinus wall will lead to pain.

Classifications of Sinusitis:

It can be classified into 

1. Acute Sinusitis: May last up to 4 weeks and can be due to Viral or bacterial,etc.
2. Recurrent Acute: 4 or more separate episodes of acute sinusitis.
3. Sub acute Sinusitis: Infection that lasts between 4 and 12 weeks and represents a transition between acute and chronic type.
4. Chronic Sinusitis: Lasts more that 12  weeks.

 How to diagnose the condition?

Usually diagnosis is made by symptoms,radiological findings, etc.

Bacterial and viral acute sinusitis are difficult to diagnose. However if symptoms last less than ten days it is considered as Viral. If it is more than 10 days it is considered as bacterial.

• Increased pain while tilting the head towards separates sinusitis from other conditions.
• tapping the facial area and inducing the tenderness is one method to distinguish.

Chronic cases: 

• CT Scan is recommended.
• Nasal endoscopy and clinical symptoms.
• Tissue samples for histology and culture.
• In rare cases sinoscopy may be made (Nasal endoscopy).

Nasal Endoscopy: Inserting a flexible fibre optic tube with a light and camera at its tip into the nose to examine nasal passages and sinuses.

Investigations and radiological findings:

X-RAY: To evaluate symptoms of possible sinusitis X-Ray of the sinuses may be taken from several directions. Before CT it was the standard technique to diagnose the acute sinusitis,etc.

Abnormal finding on an x-ray of the sinuses may show evidences of fluid in a sinus or thickened mucus membrane.

X- Ray of Sinusitis

CT sinusitis

CT Scan:

It is the best method for viewing para nasal sinuses. CT Scan are recommended for acute sinusitis only if there is sever infection, complication or high risk for complications.

They show inflammation and swelling and the extend of infection that may cant see through X-Ray. May also detect presence of fungal infection also.

MRI - Sinusitis:

It is not effective as CT. It can help rule out fungal sinusitis and may help differentiate between inflammatory diseases, malignant tumours, and complications within the skull. It is also helpful for showing soft tissues.

MRI sinusitis

Complications:

Close proximity of the brain to the sinuses increase complications, particularly involving frontal and ethmoid sinuses. Infection of the brain by invasion of the bacteria through bone or blood vessel. Abscesses, meningitis, mild personality changes, sleeplessness,seize rs, etc.

Sinusitis may extend to CNS where it may cause Brain abscesses,etc.

Treatments:

There are different approaches:

• Nasal irrigation.
• Nasal Sprays. Eg-Oxymetazoline- longer use may cause rebound sinusitis.
• Apply moist warm cloths on affected area.
• Drink more water.
• Antibiotics.
• Surgery.
• corticosteroids.

Antibiotics:

In viral sinusitis it will subside without antibiotics. If symptoms do not resolve in 10 days amoxycillin/ clavulanate combinations can give.

(Antibiotics are specifically not recommended in those with mild or moderate diseases during the first week of infection due to risk of adverse effects like antibiotic resistance, etc.).

Corticosteroids can give in chronic cases.

Surgery:

Surgery should only be considered for those patients who do not experience sufficient relief from other medical treatments.

Maxillary Antral Washout:

Puncturing the sinuses and flushing with saline to clear the mucus.

Functional endoscopic sinus surgery (FESS).

Balloon sinoplasty.

Cladwell- LUC radical antrostomy. 

Incision in the upper gum opening the anterior wall of the antrum removal of entire diseased maxillary sinus mucosa and drainage.

Dushtaprathisyaya (Sinusitis) and its Ayurveda Management

In Ayurveda the treatment for sinusitis or other nasa roga are beautifully explained. Because the nose is considered as an important structure of the Siras/ head and it is the entry point to skull. It is the pathway of the Pranavayu. Thus any obstruction in this region should be treated immediately.

What are the causes?

• sudden temperature changes.
• changes in Food habit , etc.
• Intake of unwholesome foods and regimen.etc

Signs and Symptoms According to Ayurveda:

1. Agnimaandya - Indigestion.
2. Jwara (Fever), Kasa (cough), Swasa (dyspneoa),etc.
3. Ura- Paarswa veda (head ache, chest pain,back pain etc.).
4. Mukha Dourgandyam - Bad breath.
5. Asya sopha - inflammatory swelling over face.
6. nasal obstruction.
7. loss of smell.
8. Kapha/ mucous becomes yellow or greenish and thick.etc.

Patho physiology:

In Ayurveda it is considered as a Kaphaja disease. It can be correlated to Dhushtaprathisyaya. Due to Nidana factors/ causative factors Kapha get aggravated and affected by ama. and further by vata. Pranavata is a sub type of Vata Dosha present in respiratory tract also affects due to this vitiated kapha.

Treatments:

Samprapthi Vighattana and Nidana Parivarjana are the basic principles of treatments in Ayurveda. So the mode of line of treatment should be:

1. Nidana Parivarjana (Removal of causative factors).
2. Correct digestive fire and clearing the amavastha.
3. Normalizing the vitiated kapha by Shodhana/ Purification therapies (via Panchakarma).
4. Clear the Srothas/ Channels for Pranavayu.

We can achieve all this by 

• Using Deepana - Pachana- Shodhana medicines and aharaviharas (food habits and exersices).
• Kapha Vata hara oushadas/ medicines to pacify Kapha.
• Shodhana therapy- to clear the channels. 

Treatment Modalities:

Talam, Nasyam, Lepa, Swedanam, Naadi sweda, Siro abyanga, Dhumapana, Kabala, Takra dhara, Kashaya dhara, Snehapana, Vamana, etc.

Acute cases:

In acute stages avoid taila nasya instead use swedam, lepa etc.

Acute cases can be treated with internal medicines, steam inhalation, and hot formentation over the painful parts of the face etc.

Chronic Cases:

Can be treated with shodhana therapy or Panchakarma Therapy.

• Shodhana Nasya  with Anutailam.
• Dhumapana with Haridra churnam.
• Jalaneti - yoga procedure, etc.

Internal medicines:

Kashaya:                                                                                    Arishta/Asava:

1.Amrithotharam Kashayam                                                     1.Amritarishtam

2.Dasamoola Kadutrayam                                                        2.Punarnavasavam.etc

3.Pathyashadangam.

4.Gulguluthikthakam.

5.Varanadi kashayam.

6.Indukantham Kashayam.etc

Tailam:                                                                                     Churnam:

1.Asaneladi Tailam.                                                                  1.Avipathi churnam.

2.Anu tailam                                                                             2.Gomutrahareethaki.

3.Amrutadi Tailam.                                                                   3.Rasnadi churnam.

4.Nagaradi Tailam.                                                                   4.Taleesapatradi churnam.

5.Nirgundyadi Tailam.etc                                                          5.Sudarsanam churnam.etc,

Ghritham:                                                                                 Gulika/ Tablets:

1.Gulgulu thikthakam                                                                 1.Kaisora gulgulu.

2.Indukantham                                                                          2.Kanchanara gulgulu.

3.Varanadi                                                                                3.Vettumaran, etc.

4.Shadpala ghrtham, etc.

Lehyam:                                                                                      Other:

1.Agasthya rasayna                                                                   1. Kold off

2.Dasamoola hareehaki.                                                            2.Saina tab.

3.Haridrakhantam, etc.                                                              3.Dologran Tab, etc.

Diet and Life Style:

1. Avoid cold, oily, heavy foods and use light foods.
2. Head bath with cold water should be avoided.
3. Use Rasnadi churna after head bath- on the vertex of the head.
4. Avoid ice creams and cold beverages.
5. Regular use of nasya.
6. Use steam inhalation twice daily.
7. Regular practice of yoga and pranayama.
8. Avoid exposure to cold, wind,rain, swimming etc.

Yoga and Pranayama (breathing exercises) for Sinusitis:

Patients having chronic and recurrent sinusitis will be greatly benefited by yoga and Pranayama. Pranayama will help to proper circulation of Prana vata and prevent blockages.

Some of the techniques are:

• Jalaneti kriya.
• Balasana.
• Uttanasana.
• Pavanamukthasana.
• Bhujangasana, etc.

Jalaneti Kriya:

Jalaneti pot

It is a way of nasal irrigation or washing of the sinuses in a unique manner through a special pot called jalaneti pot or the neti pot.

Procedure:

Fill the jalaneti pot with warm saline water and put the spout into the right nostril while tilting your head to the left. Breath normally through the mouth. The water will flow out from the left nostril. Repeat on the opposite side.

Benefits:

Beneficial in cold, mental tension,sinusitis, head ache and poor eye sight, etc. It clears the throat and the nose, makes respiration easy and also strengthens the brain cells.

jala neti kriya

Dhuma Pana or Dhoopanam:

It is a therapeutic smoking procedure using a dhumayantra, within this herbal preparations are burnt and smoke emitted is inhaled. It can clear the pathway and reduce the kapha.

Effects:

Kapha samana, vata kapha hara, sroto sodhana, etc.

Indications: kasa, sinusitis, etc.

Procedure:

Patient is made to sit comfortably on an knee high chair. The lighted dhumayantra is placed in front of the patient on a small table. Then he asked to inhale the smoke through mouth. He should exhale the smoke only through mouth. Repeat this for several times. If sputum comes out spit it. Asked the patient to suck smoke through the nostrils and inhale. He must exhale through mouth. (Exhale only through mouth).

Post operative: Take rest for few minutes. no strict diets and regimen.
(exhale through nostrils is harmful to eyes).

Dhumapanam with Haridra churnam/ turmeric powder: make a paste of haridra churna with anutaila and apply it on a cloth and role it. burn this and off the fire inhale the smoke.
method 2: Simplest method is take a piece of dry turmeric burn in fire. off the fire and inhale the smoke.

Published by: Dr. Rimin Razak

Resources:

• umm.edu.
• wikipedia
•