Posts Tagged ‘sinus cavities’

Yeast-free Diets
Sultana, hazelnut and rosemary bread
In terms of its traditional use, yeast is not really a food — it is a microscopic but hardworking

domesticated creature that has helped us with the business of food preparation for many thousands of

years. The ability of yeast to turn sugar into alcohol and carbon dioxide gas has long made it a

valuable ally in the manufacture of both bread and alcoholic drinks.
In addition to this traditional use, yeast has, in the past 50 years, found a role as a true foodstuff

in the form of yeast extract. This derivative of yeast, with its strong flavour, has also become an

ingredient of stock cubes and ‘meat extracts’.
These are the most concentrated sources of yeast — foods to which yeast has been deliberately added

(such as bread and wine), plus the modern extracts of yeast.
People with an intolerance reaction to yeast usually need to avoid only these concentrated sources of

yeast.
In addition to foods containing domesticated yeasts, there are many foods which become naturally

colonised by wild yeasts, invisible scavengers whose spores are in the air all around us, like

microscopic wasps, just waiting for a pot of jam to be opened.
Wild yeasts quickly multiply on fruit, fruit juice, jam or any other sweet food, but unless the food is

obviously fermenting (i.e. it smells ‘yeasty’) the levels of yeast it contains are relatively low.

However, there are also some foods that contain wild yeasts in quite significant numbers even before

you buy them. They include dried fruits, such as raisins and sultanas,
and manufactured foods that are fermented or which take a while to mature, such as soy sauce, yoghurt

and cheese. In all cases, the slow production process inadvertently encourages the growth of wild

yeasts. Again, the amount of yeast in the food is far less than that in bread, wine or yeast extract.
Do these wild yeasts matter? For people with yeast intolerance, probably not. In the case of true

allergies to yeast, however, wild yeasts might be sufficiently numerous in some foods to evoke a

reaction from the most highly sensitive individuals.
Wild yeasts may also be significant for anyone with the controversial condition known as yeast

overgrowth (see p. 82). Some of those suffering symptoms which suggest this condition, and who are

following a no-yeast-nosugar diet (see p. 205), may need to avoid all sources of yeast for a while,

including foods containing wild yeast.
Concentrated sources of yeast include:
•    beer, wine, cider and vinegar
•    Marmite, Vegemite, or any other brand of yeast extract
•    yeast-based vitamin tablets; also most B-complex vitamin tablets unless specified as

‘yeast-free’
•    stock cubes, gravy powder, Oxo, Bovril and other ‘meat extracts’
•    bread (except unleavened breads such as soda bread, matzos, pitta bread and chappatis)
•    all other forms of leavened dough, including breadsticks, pizza, bread rolls, croissants,

teacakes, doughnuts, Danish pastries and Chelsea buns
•    some packaged food labelled with synonyms for yeast (see p. 174).
Low-level sources of yeast include:
•    distilled drinks such as whisky, gin, brandy and vodka
•    spirit (distilled) vinegar
•    yoghurt, sour cream, buttermilk, cheeses
•    dried fruits and vegetables
•    sauerkraut (pickled cabbage) and possibly other pickled vegetables
•    soy sauce, miso, tofu
•    tea (but not green tea, jasmine tea etc.)
•    any fruit if unpeeled; very ripe fruit even though peeled
•    jam, fruit juice or wine that has been open for a while; many commercial fruit juices also

contain a significant amount of yeast – dead but still allergenic – at time of purchase
•    leftovers that have been in the
refrigerator for more than two days. Note that some of the ingredients in the recipes that follow, such

as raisins, yoghurt and sun-dried tomatoes, may contain wild yeasts and therefore not be suitable for

those on a strict yeast-avoidance diet. You should adjust the recipes to suit the kind of diet you are

following.
Home-made stock
A good stock is essential for many recipes. As well as being yeast-free, this home-made stock tastes a

great deal better than most ready-made stock cubes.
PREPARATION TIME: 10 minutes
COOKING TIME: about 2 hours (or 45 minutes in a pressure cooker) MAKES: 850ml (1112 pints)
1 carrot
1 onion
1 stick of celery
fresh thyme or other herbs, or a bouquet gami of dried herbs
the remains of a carved roast chicken
1.5 litres (2314 pints) water
salt and pepper
dry sherry (optional)
Peel and slice the vegetables. Tie the fresh herbs together with fine string. Put the chicken into a

large saucepan, cover with the water, and add the other ingredients.
Bring to the boil, cover and simmer for 2 hours. Or cook in a pressure cooker, at high pressure for 45

minutes; in this case, use only 1 litre (12/3 pints) water.
Allow to cool a little, then pass through a coarse sieve and discard everything except the liquid. When

cold, skim off the fat from the surface. Heat through until liquid again, then add salt and pepper to

taste, and a dash of sherry.
This stock will keep in the refrigerator for 2-3 days, or in the freezer for three months. When

freezing, allow room in the container for expansion. If space is limited In the freezer, simmer the

stock further until very concentrated, then freeze in an ice-cube tray, to make frozen stock cubes.

Enclose in a plastic bag once frozen.
Easy brown bread
This yeast-free brown bread is based on a traditional Irish soda bread recipe.
PREPARATION TIME: 10 minutes COOKING TIME: about 45 minutes MAKES: 2 small loaves
450g (11b) 100% wholemeal bread flour 225g (8oz) white bread flour
2 tsp bicarbonate of soda
1 tsp salt
2 x 284ml cartons buttermilk, or natural yoghurt, thinned with a little milk, to make the same quantity
Place the wholemeal flour in a large bowl. Sift the white flour, bicarbonate of soda and salt over it

and mix well. Stir in the buttermilk and enough cold water to make a fairly soft dough. Divide the

mixture between two 450g (I lb) buttered loaf tins and cook in a preheated oven at 200′C/400′F/gas mark

6 for about 45 minutes until risen and firm to the touch.
Remove from the tins and check that the loaves sound hollow when tapped on the base – if not, put back

into the tins and return to the oven for 5-10 minutes more. When ready, cool on a wire rack.
Corn bread with chillies    Seeded muffins    Layered potato pizza
Corn bread with chillies
If you need to avoid wheat as well as yeast, try replacing the wheat flour with rice flour or soya

flour - or use all cornmeal.
PREPARATION TIME: 20 minutes COOKING TIME: 45 minutes MAKES: 1 large loaf
150g (5Y2oz) plain flour, sieved
150g (5Y2oz) fine cornmeal (maize flour), sieved
40g (1 112oz) sugar
V2 tsp salt
4 tsp baking powder
2 large mild fresh chillies (red or green), de-seeded and finely chopped, or one dried chilli
4 tbsp olive oil
1 large egg, beaten
150ml (/4 pt) natural yoghurt
150ml (Y4pt) milk
25g (1 oz) Cheddar cheese, grated (optional)
Mix all the dry ingredients in a large bowl then stir in the chillies and remaining ingredients and mix

to a soft dough. Transfer the mixture to a buttered 20cm (8in) round cake tin, sprinkle with cheese if

desired, and cook in a preheated oven at 200°C/ 4007/gas mark 6 for about 45 minutes until risen,

golden and firm to the touch.
Leave in the tin for 15-20 minutes, then turn out onto a wire rack to cool completely.
Variations: add 100g (31/2oz) sauteed chopped bacon; or 1008 (31/2oz) sweetcorn kernels; or 4 finely

chopped spring onions.
Sultana, hazelnut and rosemary bread
This bread is delicious with cheese. It is best eaten within a day or two of making. Store in a cool

place.
PREPARATION TIME: 1 hour soaking time, plus 15 minutes
COOKING TIME: about 45 minutes MAKES: 1 large loaf
100g (3Y2oz) sultanas
150ml (’14 pint) hot tea
approx. I 75ml (6fl oz) natural yoghurt 50g (1-,14oz) skinned hazelnuts
250g (9oz) plain flour, sieved
250g (9oz) wholemeal flour, sieved 40g (1′12oz) sugar
2 tsp baking powder
1 tsp bicarbonate of soda
1 tsp salt
1 large egg, beaten
4 tsp freshly chopped rosemary
Soak the sultanas in the hot tea for about 1 hour then drain, reserve the tea and make up to 300ml (/2

pint) with the yoghurt. Roughly chop the hazelnuts and toast in a dry frying pan. Mix the dry

ingredients together in a large bowl then stir in the egg, yoghurt mixture, sultanas and rosemary, and

work to a firm dough. Knead lightly and shape into a long loaf. Cut slashes in the top of the loaf and

transfer to an oiled baking tray.
Cook in a preheated oven at 200°C/ 400′F/gas mark 6 for about 45 minutes until risen and firm to the

touch. Cool on a wire rack.
Mediterranean scones
Serve fresh with butter or cream cheese.
PREPARATION TIME: 15 minutes COOKING TIME: 15 minutes MAKES: 9
250g (9oz) self-raising flour, sieved 1 tsp baking powder
Y4 tsp ground black pepper
50g (13/4oz) butter
50g (~1,ioz) sun-dried tomatoes, chopped
50g (1314 oz) pitted green olives, chopped 1 tbsp freshly chopped basil or 1 tsp dried basil, or other

herbs to taste I large egg beaten with 5 tbsp milk milk for brushing (optional)
3 tbsp grated cheese - Parmesan or any other hard cheese (optional)
Sift the flour and baking powder together then add the pepper and rub in the butter until the mixture

resembles fine crumbs. Stir in the tomatoes, olives and herbs and mix to a fairly soft dough with the

egg and milk mixture.
Roll out to about 2.5cm (1 in) thickness on a lightly floured surface and stamp out 6cm (21/2in)

rounds. If wished, brush the top of each scone with milk and sprinkle with 1 tsp grated cheese before

baking.
Place on a baking tray and cook in a preheated oven at 220°C/425°F/gas mark 7 for about 15 minutes

until risen, golden and firm to the touch. Cool on a wire rack.
Seeded muffins
These seeded American-style muffins make an excellent breakfast.
PREPARATION TIME: 15 minutes COOKING TIME: 20 minutes MAKES: 12
300g (10%2oz) self-raising flour, sieved
2 tsp baking powder
pinch salt
100g (3Y2oz) soft brown sugar
50g (13/4oz) pumpkin seeds
50g (13/4oz)) sunflower seeds
25g (I oz) each sesame seeds and linseed
4 tbsp vegetable oil or 50g (13/4oz) butter,
melted
2 large eggs beaten with 200ml (7fl oz)
milk
To serve: marmalade or jam
Place all the ingredients in a large bowl and beat well until evenly mixed. Spoon into a muffin tray

lined with paper cases, or use paper cases on their own. Cook in
a preheated oven at 200°C/400°F/gas mark 6 for about 20 minutes until risen and just firm to the touch.

Serve warm -not hot - with marmalade or jam.
Spinach and cheese polenta
Polenta can be served warm with a ’sloppy’ consistency to go with stewed meat or vegetables, or left to

set firm (as here) then sliced and fried. It’s delicious served with cooked ham, bacon or tomatoes.
PREPARATION TIME: 30 minutes MAKES: 10-12 slices
250g (9oz) fresh spinach
25g (1oz) butter
1 small onion, finely chopped
175g (6oz) cornmeal, sieved
1 tsp salt
V2 tsp ground nutmeg
2 egg yolks
40g (1 Y2oz) each freshly grated Parmesan and mature Cheddar cheeses
Wash the spinach, remove the stalks, squeeze out the excess water and shred. Melt the butter and cook

the onion over medium heat for 5 minutes to soften. Increase the heat, add the spinach and cook until

wilted and there is no free liquid. Add 850ml (1 Y2 pints) boiling water then slowly stir in the

cornmeal, salt and nutmeg. Cook over a low heat for 10 minutes, stirring frequently until thickened.

Remove from the heat and stir in the egg yolks and cheeses. Allow to cool slightly then transfer to a

cling-film-lined 450g (11b) loaf tin. There should be sufficient cling film for it to be folded over

the top of the tin. Shape the mixture and cover with the cling film. Leave until cold, then slice, and

fry or grill.
Layered potato pizza
Layered sliced potatoes form the base for this ‘pizza’.
PREPARATION TIME: 40 minutes COOKING TIME: 25 minutes MAKES: 3-4 servings
1 kg (21b 4oz) waxy potatoes, peeled and thinly sliced
2 cloves garlic, crushed (optional)
1 tsp finely chopped fresh rosemary or thyme
3 tbsp olive oil
400g can chopped tomatoes
125g pack mozzarella cheese, thinly
sliced
salt and freshly ground black pepper
To serve:
fresh basil or rocket leaves
Toss the potatoes with the garlic and herbs, and season very generously with salt and pepper. Pour 2

tbsp of the oil into a 30cm (12in) non-stick frying pan and arrange the potatoes in overlapping slices.

Set over medium heat for 10 minutes until lightly browned. Do not move the potatoes around, but allow

them to stick together into a big circular ‘pizza’ base. Brush the remaining oil on a baking tray.

Place the pizza base on this and cook in a preheated oven at 230°C/450°F/gas mark 8 for 15 minutes

until tender.
Meanwhile, cook the tomatoes over medium heat until all the liquid has evaporated. Season generously

then spread over the potato base. Top with the mozzarella and return to the oven for about 10 minutes.

Serve sprinkled with fresh basil or rocket leaves.
Variations: after adding the mozzarella, top with classic pizza combinations, e.g. anchovies and

olives, or pepperoni, or mushrooms and ham.

Sinus cavities are something that most people just don’t know they have. It’s only when they start to

hurt that you find out where they are. ‘There is this terrible throbbing pain above and around my eyes,

and in my cheeks. It’s the most unpleasant feeling, but it’s hard to describe to anyone who hasn’t felt

it,’ says Gina, who suffers from chronic sinusitis (long-term inflammation of the sinus cavities).

There are no figures, but chronic sinusitis seems to be increasingly common.
A sinus cavity has no function, it is just empty space without which our skulls would be much heavier.

In other words, these airy spaces seem to have evolved simply to help us feel more ‘light-headed’. If

you have sinusitis, unfortunately, you feel just the opposite. ‘I had sinusitis for years,’ says Dr

Wellington S. Tichenor, a New York allergist who now specialises in treating chronic sinusitis. ‘I kept

working but felt like I wanted to die.’
Sinus cavities are lined with a membrane which is essentially similar to that lining the nose. It

contains immune cells and can produce mucus when necessary. Most of the time it doesn’t need to produce

much, because relatively few microbes or foreign particles get into the sinus cavities.
Any mucus that is produced should escape from the sinus cavities through narrow drainage channels,

called Ostia, leading to the nose. Unfortunately, the Ostia are very narrow – the diameter of a

pin-head – and U-shaped, making them prone to blockage. And that is not the only problem. These

drainage channels are situated at the top rather than the bottom of the main sinus cavities – this

arrangement was fine for our ancestors who walked on all fours, and therefore did not have to fight

gravity when clearing their sinuses. Sadly for
us, natural selection has not got around to reorganising things yet. It would be a completely hopeless

arrangement if not for the tiny hairs known as cilia, which lie like a carpet across the membranes

lining the sinus cavities. The cilia beat rhythmically. 18 times a second, to waft the mucus upwards to

the top of the sinus cavity.
This is a far-from-perfect system, and it is hardly surprising that it sometimes goes wrong. Chronic

sinusitis can begin in at least three different ways:
• The sinus membranes become inflamed due to an allergic reaction – 28 for likely airborne

allergens.
• The drainage channels from the sinus cavities become blocked due to events in the nose

(infection or allergy) or due to the growth of polyps (non-cancerous jelly-like lumps that can block

the drainage channels). When mucus cannot drain away, it stagnates in the sinus cavities encouraging

infection by bacteria or fungi. These infections cause inflammation.
• A bout of acute sinusitis (see box on p. 31), due to bacterial infection, never really goes

away and the persistent infection causes longterm inflammation. Note that this is unlikely: it is rare

for acute sinusitis not to clear up.
Whether the problem begins through allergy or blockage or infection, once it has begun a vicious circle

can be set up all too easily. Mucus output increases when there is inflammation, blocking the drainage

channels even more, so the sinus cavities become clogged up and increasingly uncomfortable. More mucus

pooling in the sinus cavities perpetuates any existing infections and fosters new ones.
All this infection results in more severe inflammation, causing the membranes which line the sinus

cavities to swell up. Inflammation also makes polyp growth more likely. The cilia may be lost or

severely depleted, and the mucus gets thicker. All this means yet more blockage. To cap it all, there

can be allergic reactions to some of the microbes involved (see right), fuelling the inflammation

further.
The body’s own attempts to clear the sinuses are defeated, and the problem is also very resistant to

medical treatment. This may make depressing reading, if you have chronic sinusitis, but don’t despair.

Understanding the complexities of the problem is a large part of the battle. Chronic sinusitis is not

invincible, if you have a good doctor to help you - that means a doctor who also understands these

complexities.
The symptoms of sinusitis are:
• pain and a sense of swelling or unpleasant fullness around the cheeks, or over and between the

eyes
• earache or headache; pain around the teeth
• reduction in the senses of smell and taste
• sore throat
• coughing, particularly at night
• post-nasal drip (mucus from the back of the nose running into the throat and airways)
• bad-smelling breath
• feverishness
• for some people, severe fatigue, poor concentration and even (but very rarely) psychiatric

symptoms
• irritability, especially in children.
Note that any of these symptoms can be caused in other ways, and even if you have several of them, you

may not necessarily have sinusitis. On the other hand, sinusitis can go unrecognised - to some people

it may seem like nothing more than a lingering cold.
Acute or chronic?
In medical terms, ‘acute’ means short-lived, while ‘chronic’ means long-lasting.
Acute sinusitis — a short, sharp dose of it, lasting less than 3-4 weeks - usually follows on from a

cold. Colds are caused by viruses, but a bacterial infection can follow, and it is the bacteria that

move into the sinus cavities and cause trouble. Some people are far more susceptible than others and

have an attack of sinusitis after every cold.
Chronic sinusitis means symptoms lasting more than three months, according to some authorities, but the

time point is a little arbitrary. This article deals with chronic sinusitis.
If your sinusitis has been going on for between four weeks and three months you will obviously be

asking ‘Is this acute or chronic?’ At this point, no one can say, but you would certainly be wise to

seek some expert medical treatment now, on the basis that it could be the start of chronic sinusitis.

Tackling chronic sinusitis before the problem becomes
entrenched and complex is a good plan.
Allergy and chronic sinusitis
Chronic sinusitis is not necessarily an allergic disease, but it can be connected with allergies (or

other forms of immune sensitivity) in various ways:
• Allergic reactions can occur in the sinuses, usually in conjunction with allergic reactions in

the nose.
• Even if the allergic reaction does not affect the sinuses directly, allergic reactions in the

nose can block the drainage channels from the sinuses, causing an accumulation of mucus there. This may

lead to sinus infections.
• Once sinusitis has begun, infectious fungi (moulds) in the sinuses may provoke allergic

reactions, or other forms of immune sensitivity. This allergy to ‘the enemy within’ fuels more

inflammation and more mucus production. Right now, allergic fungal sinusitis (as it is known) is a

source of heated debate - 32. Allergic reactions to some of the bacteria that are present may also

occur.
• Chronic sinusitis - however caused - can contribute to asthma. Research on children with both

sinusitis and asthma found that 80% no longer needed asthma drugs once their sinusitis had been

treated, and 85% no longer wheezed. The link may be due to post-nasal drip, increased mouth-breathing,

or to a nerve-connection between the sinuses and the airways (the sinobronchial reflex) which can

stimulate airway inflammation. Alternatively, the sinusitis may simply fire up the immune system with

messenger chemicals in the bloodstream, resulting in more powerful responses throughout the body.
• Chronic sinusitis can also be the root cause of long-standing nettle rash (chronic urticaria),

and treating the sinusitis can result in a prompt and remarkable clearance of the skin symptoms.
• Some people who have chronic sinusitis are sensitive to aspirin (see box on p. 28) - a

sensitivity which is also linked with asthma, nasal polyps, rhinitis and chronic urticaria. Avoiding

aspirin and all other aspirin-like drugs (151) may substantially improve the sinusitis.
Diagnosis
Because so many different factors can play a part in chronic sinusitis, diagnosis should, ideally,

consider the problem from several different angles:
• The sinuses are viewed using X-rays and CT scans (computed tomographic scans - they use X-rays

but give a much more precise picture). These reveal how badly swollen the sinus membranes are, which

sinus cavities are blocked, and how much mucus has collected in the sinuses.
• Endoscopy (92) may be used to look inside the sinus cavities. Polyps are best located by this

method.
• Where allergies seem to be part of the picture, the doctor may employ skin-prick tests (91) to

identify allergies to airborne allergens (from house-dust mites, moulds, pets, pollen, cockroaches,

etc.)
• Laboratory tests on samples taken from your sinus cavities will be used to show which bacteria

and/or fungi have set up home there. There may also be a hunt for the immune cells known as eosinophils

(19) or the typical debris which they generate. The presence of large numbers of eosinophils is one

indication of allergic fungal sinusitis (see below).
• Skin testing with fungi (moulds) found growing in the sinus cavities may also be tried if

allergic fungal sinusitis is suspected.
• In severe cases, there may be tests of immune function, to see whether this is depressed in any

way.
• Children may be tested for an inherited disorder affecting the cilia, or for cystic fibrosis -

mild forms may escape detection, and can produce both chronic sinusitis and wheezing.
The enemy within
The biggest controversy in sinusitis research at the moment concerns allergic fungal sinusitis. The

orthodox view of this condition is that:
• It affects a small minority of chronic sinusitis patients -fewer than 10%.
• There is a true IgE-mediated allergic reaction to the fungus (mould) growing in the sinus

cavities. This allergic reaction is detectable with a skin-prick test (91). Immune cells known as

eosinophils (19) are also key players in the inflammatory reaction to the fungus, but it is an

IgE-response to the fungus that draws the eosinophils into the sinuses.
• There is clear evidence of fungal infection in the mem- banes of the sinus cavities.
• There may also be ‘fungus balls’ - a solid mass of fungus inside the sinus cavity. Or there may

be ‘allergic mucin’, a dark sticky mucus containing fragments of the fungus.
A rare complication
In rare cases, the fungi involved in allergic fungal sinusitis can be invasive, spreading from the

sinuses to the surrounding bone. This problem needs prompt and thorough treatment with anti-fungal

drugs.
In 1996, researchers at the Mayo Clinic in Rochester, Minnesota, USA, caused a rumpus by claiming to

have identified a different form of allergic fungal sinusitis which is overlooked by standard

diagnostic techniques, and which affects 96% of patients with chronic sinusitis.
This is a staggering figure - 96% means, in effect, that they are claiming to have found the

fundamental cause of virtually all chronic sinusitis. ‘Up to now, the cause of chronic sinusitis has

not been known. Our studies indicate that, in fact, fungus is the likely cause of nearly all of these

problems,’ states Dr David Sherris, one of the researchers.
According to the Mayo Clinic team:
• The fungi (moulds) are growing in the mucus of the sinus cavities, not generally in the

membrane itself. They are not detected by normal diagnostic methods which tend to ignore the mucus. A

special method of collecting the mucus is required to detect the fungi.
• The immune reaction to the fungi is not usually an IgEmediated reaction, so skin-prick tests

are often negative.
• Finding evidence of unusual numbers of eosinophils is adequate for diagnosis of allergic fungal

sinusitis because the eosinophils are the prime movers in this sensitivity reaction to the fungi, as in

several other diseases (19).
‘We can now begin to treat the cause of the problem instead of the symptoms,’ says Dr Eugene Kern, head

of the research team. There is a lot of scepticism about these claims among other sinusitis

specialists, and so far no new treatment for chronic sinusitis has emerged.
The Mayo Clinic researchers say that they are in the process of developing a drug treatment, but that

it will take several more years before it is generally available. Existing anti-fungal drugs (taken in

capsule form) could not work on this particular form of allergic fungal sinusitis (if it exists)

because the drug does not get into the mucus. Any new treatment would probably involve inserting an

anti-fungal drug directly into the sinus cavities, which is far from easy.
All we can do for now is wait and see what emerges from the ongoing research. The current treatment for

allergic fungal sinusitis involves all the usual methods (see right) with special emphasis on steroids

to calm the inflammation, plus anti-fungal drugs where fungal infection is detectable in the membrane.

In some countries, immunotherapy is also used to reduce the immune reaction to the fungus, but this is

difficult to obtain in Britain (164).
Clearing moulds from your home may help (34). So may reducing the humidity in the house (119), as humid

conditions seem to be linked with allergic fungal sinusitis.
Treatment
Sinusitis can be very hard to treat, particularly if it has been going on for a long time. You need a

really committed attitude if treatment is to be successful.
All these treatments should be given at the same time:
1 Antibiotics for 2-3 weeks minimum (it takes this long because the antibiotic has such trouble getting

into the sinus cavities – if you are offered a shorter course, this suggests that the doctor does not

have enough expertise with chronic sinusitis, so you might be better off with someone else). It must be

the right antibiotic – commonly used ones such as penicillin, tetracycline and erythromycin are

unlikely to work because the bacteria are usually resistant to them.
2 Steroid drops in the nose to combat the inflammation. It is important to put these in correctly, so

that they have maximum effect (144) especially if you have polyps.
3 Irrigating the nose and sinus cavities daily with sterile salt water (saline). Your doctor will show

you how to do this.
4 Tablets that reduce the congestion in the nose.
5 Nose drops that reduce congestion, but for three days only (29).
6 Steam inhalations to loosen the mucus. There are special steam vaporisers on sale (ask at a

pharmacy), but you can just inhale steam from a bowl of boiling water, with a towel over your head to

keep the steam in. Adding eucalyptus oil to the water may help. For a quick-and-easy version, warm up a

damp flannel in the microwave and place it over your nose. Some doctors recommend having a steam

vaporiser beside the bed at night, when nasal blockage is most likely to occur, but if you have

allergies to house-dust mite or moulds this is not a good idea in the long term, as a damp bedroom will

favour both (and could encourage allergic fungal sinusitis).
7 A drug called guaifenesin which thins the mucus is used in some countries but rarely in Britain.

Alpha-methyl-cysteine is another drug that breaks up mucus. It is mainly used in chronic bronchitis but

some doctors also find it valuable in chronic sinusitis. If steam inhalations didn’t work – suggesting
that the mucus is too solid to be shifted – these drugs may be worth trying.
8 Anti-fungal drugs (taken by mouth) if allergic fungal sinusfis is suspected. Sometimes these have a

dramatic effect on chronic sinusitis that has previously resisted treatment.
You may also be given other drugs, such as steroid tablets. The new anti-leukotriene drugs (149) are

also being tried, with some success. As well as being taken by mouth, they can be applied directly to

the nose in an irrigation fluid, and may be helpful for those with nasal polyps.
Problems with nose drops
Nasal drops and washes contain preservatives and other non-drug ingredients. Some of these may act as

irritants – or the pH (acidity or alkalinity) of the preparation might cause problems. If you

experience burning or irritation after inserting drops or irrigating the sinuses, ask your doctor or

pharmacist about trying a different preparation.
Antibiotic resistance
Bacteria are becoming resistant to the effects of antibiotics: it is probably the biggest headache

facing modern medicine.
This is emerging as a particular problem in chronic sinusitis because many patients have been dosed

very regularly with antibiotics. Although most of the bacteria have been killed each time, the fact

that the sinus cavity is so clogged up with mucus, and so badly accessed by the bloodstream anyway,

means there is always some nook or cranny where a few bacteria survive because they have not been

exposed to the full lethal dose of the antibiotic. As you might expect, these survivors tend to be the

‘tough ones’ – those bacteria that are not just well hidden but also the least sensitive to the

antibiotic.
Repeat this process many times, with frequent courses of antibiotics (separated by intervals during

which the hard-to-kill bacteria multiply in numbers) and what happens? Eventually you breed a race of

bacteria that are completely resistant to one or more of the antibiotics taken.
If you ever get to this point with your sinusitis, treatment is going to be extremely difficult. That’s

why it is so important to treat infections really thoroughly, and get rid of them completely. Expert

medical help is essential for this treatment campaign.
Too many people with chronic sinusitis are careless about taking their antibiotics regularly, or feel

ambivalent about them and stop the course before it’s complete, or don’t see the doctor again when the

tablets are used up. This is courting disaster.
Don’t start antibiotic treatment for chronic sinusitis until you are sure you can see it through. If

you have doubts about taking antibiotics, try all the other treatments and self-help measures first.

They may be sufficient, especially if you find you have an allergy underlying the chronic sinusitis and

can tackle this successfully.
Should there be no improvement, you could then go on to the antibiotic programme: delaying this

treatment for a few months will do no harm. What is hazardous is starting the antibiotic programme and

then stopping, or not taking the drugs consistently.
Antihistamines may be prescribed to treat any allergic reactions, but some specialists feel that they

can also aggravate the problems. In their experience, antihistamines dry out the mucus so that it

sticks to the walls of the sinus cavities, rather than being ushered out by the cilia. Drying out the

mucus may make you feel better initially, by reducing the pressure inside the sinus cavities, but it

makes matters worse in the long run.
Anti-chollnergic drugs (156) are sometimes prescribed for chronic sinusitis, but they too can dry up

the mucus and should be used cautiously.
After three weeks, if the sinusitis has not improved substantially, a different antibiotic is given. If

there are any bacteria resistant to the first antibiotic infesting your sinus cavities, the new

antibiotic is intended to kill them off.
Should you still have sinusitis after another three weeks, you will be given yet another antibiotic.

Changing the antibiotic, and taking prolonged courses, is the best way of exterminating the bacteria

completely, which prevents the development of antibiotic-resistant bacteria (see box at left).
It is crucial that you always see the doctor promptly at the end of each course, so that there is no

gap between the courses – do not give the bacteria any opportunity to build up their numbers again. The

last antibiotic treatment should continue for at least a week after symptoms clear up.
Dealing with allergic reactions is also important:
• If you cannot get allergy tests, try to work out for yourself if an allergen is playing a part.

Ask yourself if there were any changes in your life before the sinusitis began, such as getting a new

pet, moving house, increased exposure to moulds or house-dust mite, or starting a new job with exposure

to allergens. When thinking about this, remember that allergies to newly encountered allergens do not

develop immediately – it may take up to two years. Try avoiding the allergen concerned and seeing if

you improve.
• Should you discover that an allergen is at the root of the problem, but have difficulty

reducing your exposure to the offending item, try to obtain immunotherapy (164) or another form of

desensitisation treatment (210).
• If you suspect allergic fungal sinusitis (32), it is well worth eliminating any mould growth in

your home (120). One research study showed that the moulds growing in a patient’s sinus cavities were

often the same as those growing in the patient’s house. It is possible that, by inhaling the mould

spores from moulds in their houses, sinusitis sufferers are continually reinfecting their sinuses.
Various other self-help measures can be valuable during this medical treatment:
• Reduce your exposure to cigarette smoke (including other people’s) to an absolute minimum.

Cigarette smoke acts as an irritant to the nose and sinuses, but, more importantly, it paralyses the

cilia, preventing them from shifting mucus out of the sinus cavities.
• Avoid breathing other irritants, especially ozone (130). Think about the chemicals you use both

at work and at home – could any of these be irritants that are aggravating your sinusitis?
• Don’t drink too much alcohol – it dries out the sinus membranes and makes matters worse.
• Drink plenty of water, to keep your mucus from becoming too dry and therefore hard to shift.
• Try to breathe through your nose as much as possible. The amount of oxygen in your sinus

cavities drops drastically if you breathe through your mouth, and the low oxygen level probably fosters

the growth of certain bacteria. Devices, such as nose clips, that help keep the nose open at night may

be worth trying.
• Spicy food can help to clear nasal and sinus congestion, so try eating chilli or hot curry

regularly.
• Some people find that garlic helps – either eaten or sniffed.
• If you suspect that your sinusitis might be related to food sensitivity (68) consider trying an

elimination diet to identify the culprit food.
• Observe your reactions immediately after eating – some foods, such as yeast and red wine, can

cause an immediate swelling of the nasal membranes in certain people. So can sulphite food additives.

Avoid such items if you are affected.
• Treating gastro-oesophageal reflux (acid regurgitation from the stomach after meals) can

improve sinusitis.
• See an osteopath. By gently manipulating parts of your face, a good osteopath may be able to

improve the drainage from the sinus cavities.
• Some patients experience good effects from acupuncture although there are no observable changes

on CT scans. Other alternative therapies, such as homeopathy or Chinese herbal medicines, have not been

investigated scientifically, but some patients report good results.
Prolonged courses of antibiotics destroy many of the beneficial bacteria in the intestine, and may

cause long-term bowel problems. It makes sense to take a bacterial replacer (205).
Surgery for sinusitis
Chronic sinusitis sufferers may be offered surgery to remove polyps, or to correct anatomical problems

such as a deviated septum (the central division of the nose).
These operations can be very useful, but if you have asthma try all other options first, because

surgery to the nose can sometimes make asthma much worse.
Surgery on the sinus cavities themselves is also a possibility, when sinusitis does not respond to

medical treatment. The operation enlarges the natural drainage channels, so that mucus drains away more

easily. This rarely cures chronic sinusitis completely, but it usually makes it much easier to manage.

Once the drainage channels are larger, antibiotics can be put directly into the sinus cavities, for

example, avoiding the need for antibiotic tablets.
Don’t agree to surgery unless other forms of treatment, such as allergen avoidance or immunotherapy,

have been tried to the full. Patients for whom surgery seemed to be the only answer have sometimes

found they did not need an operation once their allergies were treated.
If you decide on having an operation, make sure your surgeon has a proven track-record with this type

of surgery. Don’t be afraid to ask searching questions about how many operations of this kind the

surgeon has done, how many he or she carries out per year, and the complication rates (how often things

go wrong). It’s a delicate job, and you want a real expert.