Is there a permanent cure for chronic sinusitis?

Q: My friend is a 50-year-old woman. She has been suffering from chronic sinusitis for five to six years and from otitis media (middle ear infection) for three years now. She has undergone two operations to rectify her nasal and ear problems.

The latest operation was carried out about two years ago. A tiny plastic tube was inserted inside her right ear to drain off fluid and her right nasal passageway was enlarged so she could breathe better and regain her sense of smell.

The surgery brought some relief until lately when her conditions returned. She has been getting frequent bouts of nose and ear infections, resulting in blocked ears (especially the right ear) and nose, with frequent nightly discharge of much liquid from her right ear, and discharge of much yellowish mucus from the nose.

This is even though she has consulted her doctors who treated her with nose spray and, on occasions, antibiotics.

As her ears are often blocked, this causes echoing when she speaks.

Often, she suffers from light-headedness and giddiness and is also frequently sleepy in the day. She has low blood pressure (90mmHg/50mmHg), feels cold easily and sweats easily.

Is there any treatment that can permanently solve her problems?

Also, what types of food and drinks should she consume or avoid to alleviate her conditions?

A: Chronic sinusitis is an infection of the sinuses (cavities in the bones of the face around the nose) within the facial skull, for more than 12 weeks.

It is mostly due to an anatomical obstruction, such as a deviated nasal septum (partition of the nose called the nasal septum that has deviated from its correct position), swollen turbinates (spongy bone structures on the inner walls of the nose that clean and moisten inhaled air) and polyps (abnormal growths).

Chronic sinusitis can also result from severe allergies.

An allergic reaction can be triggered by inhaling an allergen, such as grass pollen or dust mites in the environment, into the nasal passage or eating certain types of food.

The allergic reaction causes the release of histamines in the nasal mucosa (nose skin). This results in sneezing and the production of mucus.

Chronic sinusitis may cause recurrent nose discharge, which may then lead to recurrent ear problems.

As the post-nasal space is connected to the ear by the eustachian tube, the mucus can block the eustachian tube, resulting in infection of the middle ear cavity, or otitis media.

The middle ear is the part of the ear behind the eardrum and before the cochlea (auditory nerve).

Otitis media is mainly due to sinus problems.

This might persist for months and cause hearing loss. This is especially common in children.

Patients with chronic sinus problems have difficulty breathing, especially at night as they are supine, which results in more sinus congestion.

When the patient is lying down, the heart and the nose are at the same level. Hence, there is a back flow of venous pressure resulting in more nasal congestion. Therefore, the patient cannot breathe properly at night, disrupting sleep.

In addition, as the patient is supine, the mucus flows backwards by gravity and drips down to the throat, resulting in irritation to the throat and persistent coughing at night, which also disrupts sleep.

Your friend's ear infection may be a recurrent problem, rather than it persisting for three years continuously.

A course of antibiotics would help clear the ear infection. Some nasal decongestants and sinus saline rinse might also help.

Some drainage of the fluid in the ear may also be needed.

It seems that the ear issues may be secondary to the recurrent sinusitis that she is suffering from, so the most important thing is to treat her sinus problem.

She might benefit from another consultation with an ear, nose and throat surgeon, and perhaps some allergy testing to delineate what sort of allergies she has.

An attempt to avoid these allergens would help.

DR KENNY PANG
Ear, nose and throat surgeon at Asia Sleep Centre at Paragon

What TCM says

A: In traditional Chinese medicine (TCM), otitis media is probably caused by the deficiency of the lungs, spleen and liver.

Good circulation of qi (energy) and blood are needed for good health.

The lungs control respiration and are the most vulnerable among the organs to external pathogens, such as "wind", "heat", "cold", "dampness" and phlegm.

These pathogens disturb the flow of qi of the lungs, causing abnormal secretions in the respiratory tract. These then trigger otitis media with ear pain, tinnitus (ringing in the ears), impaired hearing, blocked or runny nose, sore throat, cough, headache and fever.

When the pathogens attack the lungs for a prolonged period, it can create internal "heat" and convert fluid into phlegm that blocks the ears. This triggers otitis media with impaired hearing, blocked nose, dry throat and cough. It also causes yellow phlegm, mucus and urine.

When the spleen is dysfunctional, it converts food nutrients into phlegm and "dampness", instead of qi and blood. These block qi in the lungs, causing otitis media with tinnitus, impaired hearing, blocked nose and cough. The phlegm and mucus will be white.

Negative emotions such as fear, anxiety, worry or stress can lead to stagnation of qi in the liver, which generates "heat" and "fire" there. These and internal "dampness" rise to the ears and trigger otitis media with impaired hearing, bitterness in the mouth, distension around the ribs, constipation and yellow urine.

Chinese herbal medicine, acupuncture and cupping (placing heated cups on the skin to enhance qi and blood circulation) can help to improve your friend's condition by strengthening her organs and dispelling the pathogens.

Chinese herbs such as safflower, peach seed, nutgrass galingale rhizome and turmeric root-tuber enhance qi and blood circulation.

Peppermint, honeysuckle flower, chrysanthemum flower, weeping forsythia capsule and platycodon root strengthen the lungs, and dispel "wind" and "heat".

Biond magnolia flower, Siberian cocklebur fruit, Sichuan lovage rhizome, grassleaf sweetflag rhizome and dahurian angelica root reduce the amount of mucus. Plantain seed and oriental waterplantain rhizome reduce the amount of ear discharge.

Cablin patchouli herb, fortune eupatorium herb, Indian bread, dried tangerine peel, codonopsis root and milkvetch root strengthen the spleen and dispel "dampness" and phlegm.

Cape jasmine fruit, Chinese gentian, Chinese thorowax root and baical skullcap root dispel "heat" and "fire" in the liver.

Your friend should avoid spicy, deep-fried, cold and raw food and alcohol and eat easily digested food such as porridge, barley and leafy vegetables to strengthen the spleen.

She should avoid negative emotions and slow down her lifestyle to enhance qi circulation.

She should exercise regularly by brisk walking, swimming or doing yoga, to improve her immune system and prevent respiratory infections such as cold, flu and sinusitis.

She should also avoid smoking, exposure to second-hand smoke and having the fan or air-conditioning blow directly at her.

MS LIM LAY BENG
Traditional Chinese medicine practitioner at YS Healthcare TCM Clinic at The Adelphi

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