Medical Advisor Journals : Sinusitis - Headache/Sinus headache

I. Sinusitis is defined as a condition of inflammation of the paranasal sinuses of which can develop headache as a result of exposure to a cold or flu virus, or an allergic reaction to pollen, mold, dust or smoke, etc..Sinusitis affects 37 million people each year.

II. Symptoms
1. Congestion
In children, congestion is more likely to treat with Nasal saline as a result of diagnosed with rhinorrhea from sinusitis. Unfortunately, nasal saline irrigation have been found in children. In the study of 61 Children met inclusion criteria. 73% of parents initially thought that nasal saline irrigation would be helpful, but only 28% thought that their children would tolerate the treatment. 93% of children made an attempt to use nasal saline irrigation and 86% were able to tolerate the treatment. 84% of parents whose children attempted nasal saline irrigation noted an improvement in their child's nasal symptoms. 77% of children that attempted nasal saline irrigation continue to use this treatment for symptom relief. 93% reported an improvement in their child's overall health that they attributed to this treatment(1)

2. Cough
Cough is a symptom of sinusitis, but one can rarely expect isolated persistent or recurrent cough as the only symptom(2)

3. Runny nose
Runny nose is common symptoms of Sinus headache as a result of nasal cavity filled with a significant amount of mucous fluid. Some researchers found that Runny nose may sometime but not frequent caused by infection of the paranasal sinuses(3), a group of four paired air-filled spaces that surround the nasal cavity.

4. Headache
Sinus headache may be actually migraine, in a study of Prevalence of Migraine in Patients With a History of Self-reported or Physician-Diagnosed "Sinus" Headache, Dr. Curtis P. Schreiber, MD and the team showed that 88% of patients with a history of "sinus" headache were determined to have migraine-type headache. In patients with recurrent headaches without fever or purulent discharge, the presence of sinus-area symptoms may be part of the migraine process. Migraine should be included in the differential diagnosis of these patients(4)

5. In the review of mechanisms of the symptoms of rhinosinusitis, here are many symptoms(4), all of them are caused by inflammation of the sinuses and inflammation of the lining of the nose.
a. four primary symptoms used to diagnose rhinosinusitis: nasal obstruction, nasal discharge, facial pain and loss of sense of smell
b. cough, sneezing, sore throat and voice changes, epiphora, fever, and psychological effects and fatigue(5a)
c. Others suggested that Migraine may be responsible for many headaches thought to be caused by the sinuses. Patients complaining of "sinus headache" must have a complete ear, nose, and throat examination. Occasionally, chronic headaches may arise from the sinuses; a thorough history is important to search for symptoms of facial pain and pressure along with other nasal sinus symptoms(5b)

6. Etc.

III. Causes and risk factors
A. causes
1. Structure abnormalities
structure abnormalities of the growths of benign tumors in the sinuses or nasal polyps in the nasal cavity or sinuses, can restrict and obstruct the movement of mucus from the sinuses of which can lead to a headache. In a case, a 59 year old man had ectopic teeth in both sinus maxillaris which obstructed the left ostium, causing dumbness of the left cheek and severe headache.(6)

2. Allergens
Allergens are one of the major causes of sinus headache and can be divided divided into seasonal and perennial. Seasonal rhinitis is a disease particularly of teenagers and young adults and appears to be less common in primary and pre school age children(7)

3. Second hand smoke
In the study of recruited 30 adult volunteers (17 males, 13 females; average age = 41 y, range = 19-79 y) from a university laboratory complex and from the general community, and In univariate analyses, geometric mean carbon dioxide thresholds differed significantly with respect to smoking status (36% carbon dioxide in smokers versus 25% in nonsmokers; p < .005), but not with respect to age, gender, or self-reported history of allergic rhinitis(8)

4. Maxillary sinuses
Maxillary sinuses which is the largest of the paranasal sinuses, and drains into the nose, are susceptible to infection as a result of fungal infection, cyst, inverted papilloma, hemorrhagic necrotic polypsosteomas of that can lead to obstruction of mucus. In severe case, surgery may be necessary(9)

5. Odontogenic origin
Odontogenic etiology is said to account for 10% to 12% of cases of maxillary sinusitis. Some researchers suggested that an odontogenic source should be considered in individuals with symptoms of maxillary sinusitis and a history of dental or jaw pain; dental infection; oral, periodontal, or endodontic surgery; and in those people resistant to conventional sinusitis therapy. An odontogenic infection is a polymicrobial aerobic-anaerobic infection, with anaerobes outnumbering the aerobes(10)

6. Fungii
In the study of allergic mucin from 17 definitive and 10 probable AFS patients histologically examined for fungal elements. Sera from 18 definitive AFS patients, 10 probable AFS patients, 6 chronic sinusitis patients, and 5 A. fumigatus-allergic patients were tested for specific IgE to A. fumigatus and five rAsps, conducted by Medical College of Georgia, showed that most definitive AFS patients have A. fumigatus-specific IgE and many have specific IgE to rAsps. Many also demonstrate Aspergillus spp. or Fusarium spp. in situ. Findings suggests that A. fumigatus is an important causative agent in AFS in the southeast United States(11)

7. Bacteria and Virus
Rhinosinusitis (RS) is an inflammatory condition of the contiguous nasal and paranasal sinuses that is accompanied by a viral or bacterial infection. And Controlling the inflammation will attenuate many of the symptoms of RS, including nasal blockage discharge, facial discomfort, headache, and hyposmia, and promote the clearance of the infectious agent(12)

8. Immune deficiency
Some researchers suggested that sinus headache may be also be result of immune deficiency, Dr. Kern RC, in the study conducted by Northwestern University Feinberg School of Medicine, said that
There are evidence from laboratory and others indicated that chronic rhinosinusitis (CRS) is associated with a failure of the mechanical and immunologic barriers across the nasal mucosa(13)

9. Asthma
Asthma is said to be associated with Sinus headache. In the study of Rhinosinusitis and asthma, Dr.Marseglia GL, and the team said that chronic rhinosinusitis and asthma are not simply localized disease processes, but part of a systemic inflammatory disease affecting the respiratory tract. There is a correlation between severity of asthma and the clinical and imaging features of rhinosinusitis. It is very important to understand that in patients with chronic sinus disease, both upper and lower airways need to be evaluated and treated and that in patients with moderate or severe asthma, the sinus area should always be investigated, regardless of the presence or not of nasal symptoms(14)

10. Vas deferens obstruction
Vas deferens obstruction cause Young's syndrome (YS)od which is a triad of bronchiectasis, chronic rhinosinusitis and infertility as a result of gene mutation.(a)

11. Etc.

B. Risk factors
1. Diving and 2. Swimming
Swimming can cause increased risk of sinusitis, in the abstract of The relationship of swimming and diving to sinusitis and hearing loss, Dr. HITSCHLER WJ, said that the relationship between swimming and diving and sinusitis, hearing loss or upper respiratory infection has been existed and recognized for years.(b)

3. Air travel
Dr. Javan R, and team at the Baptist Memorial Hospital, Department of Radiology, Memphis, said that Changes in aircraft cabin pressure likely resulted in rupture of dura and arachnoid layers beneath the pre-existing bony defect, predisposed by existing sinus disease(c)
4. Smoking
In the study of 100 patients (84 men and 16 women; mean age, 49.5 years; range, 21-75 years) who underwent surgery for chronic sinusitis, indicated that smoking-induced olfactory dysfunction in chronic sinusitis(d)

5. Certain foods
Chocolates, foods that contain MGS (Monosodium glutamate), cakes, biscuits and cheese can cause the production of thick, viscid mucus in the mucus membrane lining of the nose and sinuses.

6. Pet
Dr. Slavin RG, Leipzig JR, Goodgold HM. at Saint Louis University School of Medicine in the study of "Allergic sinusitis revisited" said "we were unable to demonstrate inflammation of the sinuses in patients with allergic rhinitis"(e)

7. Mountain climbing
Headache is the cardinal symptom of acute mountain sickness (AMS). The headache normally worsens, with increased cerebral affection and the development of high-altitude cerebral edema (HACE) (f) of which can cause frontal sinusitis (g)

8. Stress
Stress can cause reduced immune function of which can promote the invasion of virus and bacterial cause of sinusitis(13)

9. Alcohol
In certain people, alcohol may cause an allergic reaction as a result of intolerance of that can lead to the production of histamine, leading to nasal and sinus membranes to swell resulting of
sinusitis (h)

10. Drug abuse

Drug abuse can suppressed the immune system of that can increase the risk of infectous and inflammatory cause of sinusitis. Study from the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, Rockville, MD, indicated that the prevalence rates of a broad range of health conditions by duration of use of specific illicit drug among persons 35 to 49 years of age in the United States were estimated and compared. After adjustment for potential confounding factors, the results of 20 multivariate logistic regression models indicated positive associations between duration of marijuana use and anxiety, depression, sexually transmitted disease (STD), bronchitis, and lung cancer; between duration of cocaine use and anxiety and pancreatitis; between duration of heroin use and anxiety, hepatitis, and tuberculosis; between duration of hallucinogen use and tinnitus and STD; and between duration of inhalant use and anxiety, depression, HIV/AIDS, STD, tuberculosis, bronchitis, asthma, sinusitis, and tinnitus(i)

11. Constant use of nasal decongestants sprays
The medication can be contraindicated in patients on certain drugs or with certain conditions and for a limited period to avoid rebound congestion.(j) Use natural herbal and homeopathic medicines, vitamin supplements etc. instead.

12. Etc.

IV. Types of Sinus headache
1. Acute Sinus headache
Acute rhinosinusitis (ARS) is triggered by viral or, uncommonly, bacterial infection, causing inflammatory symptoms for ≤12 weeks(15), other suggested that if symptoms last less than 10 days, it is generally considered viral sinusitis. When symptoms last more than 10 days, it is considered bacterial sinusitis. Usually 30% to 50% of cases are bacterial. MFNS 200 μg twice daily significantly increased minimal-symptom days vs amoxicillin or placebo in patients with ARS. Results of this intranasal corticosteroids (INS) therapy indicate it can improve outcomes and potentially reduce inappropriate antibiotic use in treatment of acute sinus headache(15)

2. Chronic Sinus headache
Chronic Sinus headache is defined as a condition with symptoms lasted longer than 8 weeks. Although chronic sinusitis is not a life-threatening disease, it has a severe impact on a individual’s quality of life. Most case of chronic sinus headache are caused by structure abnormality, such as the growths of benign tumors in the sinuses or nasal polyps in the nasal cavity or sinuses, but in some case it can be caused by others, including chronic invasive sinusitis caused by dematiaceous fungi(16), allergic fungal sinusitis(17)

3. Subacute sinusitis
Subacute sinusitis is defined as a condition of symptoms of 4 to 8 weeks’ duration. In most cases, it is treated with antibiotics therapy, but according to Dr. Dohlman AW and the team in the study of Sixty-seven of the 96 subjects (70%) responded: 58 (87%) in 3 weeks and 9 (13%) in 6 weeks. Fifty-five of the responders were in the antimicrobial treatment group, and 12 were prescribed no antimicrobial medication. Twenty-nine of the 96 subjects (30%) did not respond to treatment; 22 received an antimicrobial and seven received no antimicrobial medication. The number of responders and nonresponders was similar in the antimicrobial- and nonantimicrobial-treated groups (p = NS), and no single antimicrobial medication demonstrated greater treatment effectiveness(18)

4. Recurrent acute sinusitis
Recurrent acute sinusitis is defined as a condition of reoccurring of sinusitis, three or more episodes per year, with each episode lasting less than 2 weeks. In most cases, it is caused by scar tissue formation at the surgical sit, if patient have previous surgery. Others causes can be differentiated according symptoms and the respond to medical treatment. Researchers suggested that the addition of intranasal corticosteroid, MFNS 400 microg twice daily, to antibiotics significantly reduces symptoms of acute sinusitis compared with antibiotic treatment alone(19)

V. Diagnosis
1. Diagnosis is based on symptoms, family history and a physical exam, including endoscopy
to rule abnormality of structure cause of chronic sinusitis including nasal drainage ,tumor, polyps, or other sinus obstruction by an endoscopy, a flexible or rigid tube with a lens system for visualization and a light for illumination to examine the interior of cavity of several paired paranasal sinuses.

2. CT scan
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the abnormalities, including a cystic fibrosis or a tumor. and it is used not only in the initial visit but also at a later time after medical treatment has been initiated. Dr. McMurphy AB and the team in the study conducted by 96th Surgical Operations Squadron/SGCXL, Eglin Air Force Base, said that CT scanning of the sinuses does not appear to be useful in determining outcomes of intervention in CF patients(29). Other indicated that CT scan assessment of chronic rhinosinusitis is a reliable test. The CT findings in patients with chronic rhinosinusitis remain consistent over time(30)

3. Diagnosis and management of acute sinusitis by pediatricians
In a national random sample of 750 general pediatricians from the American Medical Association Master File. RESULTS. The response rate was 45% (N = 271). Pediatricians reported first considering acute sinusitis at the ages of 0 to 5 (6%), 6 to 11 (17%), 12 to 23 (36%), 24 to 35 (21%), and > or =36 (20%) months. Symptoms thought to be "very important" in the diagnosis of acute sinusitis included prolonged symptom duration (93%), purulent rhinorrhea (55%), and nasal congestion (43%); 60% reported that symptom duration is more important than symptom combination. Symptom durations expected before considering the diagnosis were 1 to 6 (3%), 7 to 9 (17%), 10 to 13 (37%), 14 to 16 (38%), and > or =17 (6%) days. Fifty-eight percent reported using sinus computed tomography scans "occasionally" or more often in the diagnosis of acute sinusitis. Ninety-six percent reported treating acute sinusitis with an antibiotic "frequently" or "always." Fifty-three percent reported using contingency antibiotic prescriptions "occasionally" or more often for acute sinusitis. Adjuvants used "frequently" or "always" included saline washes (44%), systemic decongestants (28%), nasal corticosteroids (20%), and systemic antihistamines (13%)(31)

4. Medical management and diagnosis of chronic rhinosinusitis
In a 15-item survey was mailed to a random sample of 200 members of the American Academy of Otolaryngology-Head and Neck Surgery, 73% defined CRS as lasting >12 weeks. Seventy-three percent also believed radiological imaging was necessary for definitive diagnosis, but only 30% believed nasal endoscopy was necessary. Regarding treatment, respondents reported use of oral antibiotics (94%) and nasal corticosteroids (94%) as part of maximum medical management; oral decongestants, oral mucoevacuants, and allergy testing were used only by about one-half of the respondents, and less frequently topical decongestants (38%), oral corticosteroids (36%), and oral antihistamines (27%) were used. Oral corticosteroids were more likely to be used by specialists that self-classified as rhinologists than by other otolaryngologists (p = 0.005), but rhinologists were less likely to use radiological imaging (p = 0.04) as a diagnostic criterion. Pediatric otolaryngologists used allergy testing in medical management more frequently than other otolaryngologists (p < 0.001). Overall, the basis for choice of maximal medical management was personal clinical experience (74%), rather than clinical research results or expert recommendations(32)

5. In a Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines, for the diagnosis and management of RS and its subtypes, including acute viral RS, acute bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal polyposis, and allergic fungal RS. The Joint Task Force on Practice Parameters, the Clinical Practice Guideline: Adult Sinusitis, the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the British Society for Allergy and Clinical Immunology. Points of consensus and divergent opinions expressed in these guidelines regarding classification, diagnosis, and management of adults with acute RS (ARS) and CRS and their various subtypes are highlighted for the practicing clinician. Key points of agreement regarding therapy in the guidelines for ARS include the efficacy of symptomatic treatment, such as intranasal corticosteroids, and the importance of reducing the unnecessary use of antibiotics in ARS; however, guidelines do not agree precisely regarding when antibiotics should be considered as a reasonable treatment strategy. Although the guidelines diverge markedly on the management of CRS, the diagnostic utility of nasal airway examination is acknowledged by all. Important and relevant data from MEDLINE-indexed articles published since the most recent guidelines were issued are also considered, and needs for future research are discussed(33)

5. Etc.

VI. Complications and Diseases associated with Sinus headache
A. Complications
As a result of inflammation and infection of several paired paranasal sinuses, including the frontal, ethmoid, maxillary and sphenoid sinuses that make Sinus headache as one of most dangerous complication if infection of the brain by the invasion of anaerobic bacteria went through the bones or blood vessels.
1. Abscesses
Abscesses is defined as a collection of dead neutrophils that has accumulated in a cavity formed by the tissue as a result of an infectious process. In the study of Microbiology of Intracranial Abscesses
and Their Associated Sinusitis, Intracranial Abscesses is a rare but serious complication of paranasal sinusitis, Because of its life-threatening nature, IA must be managed as a medical and surgical emergency(24)

2. Meningitis
In a national survey associated with sinusitis or otitis media, among 372 cases of bacterial meningitis within our nationwide 17 years survey, 201 cases were community acquired (CBM) and in 40 (20%) otitis media or sinusitis acuta/chronica were reported 1-5 weeks before onset of CBM(25). Other study suggested that almost one fifth of all bacterial meningitis appear in patients with acute or after treated chronic otitis media or sinusitis. A main causative agent is Str. pneumoniae in about half of all cases and those cases appear significant more among diabetic, alcoholic and traumatic patients(26)

3. Orbital cellulitis
Orbital cellutitis is defined as medical condition of an acute infection that cause acute onset of periorbital pain and swelling of the tissues surrounded the eye, including the eyelids, eyebrow, and cheek as a result of accumulation of debris in both frontal sinuses, causing increased intracranial pressure due to a space-occupying lesion with potential long-term disabilities and death(27)

4. Cranioencephalic complications
In the investigation of 58 children were hospitalized with sinusitis, and eight (13.8%) had cranioencephalic complications for an annual incidence of 1.6% and a sex ratio of 5 boys to 3 girls by Hôpital d'instruction des armées Omar Bongo Ondimba Service, disorders of consciousness were found in five cases, with a mean Glasgow score of 9 (range: 7-13). Seven children had multifocal sinusitis and one frontal sinusitis. Five children had a subdural empyema, two associated with thrombophlebitis of the sagittal sinus, one with a brain abscess with thrombophlebitis of the sagittal sinus, and another with meningitis and thrombophlebitis of the sagittal sinus. Two children had osteomyelitis of the frontal sinus table, including a frontal lobe abscess for one. Another had multiple cerebral abscesses. Five children had sinus and neurosurgical drainage, two sinus drainage only, and one neurosurgical drainage only. Microbiology was positive for microbes in four cases: Streptococcus eqinus (one case), Staphylococcus aureus (one case), both S. pneumoniae and Haemophilus influenzae (one case), and Aerococcus viridans (one case). Outcome was favourable in seven cases, including four without sequelae. Two children had recurrences, and one died(28)

5. Etc.

B. Diseases associated with Sinus headache
1. Humoral immunodeficiency and granulomatous disease
Although there are many similarities of allergic rhinitis and Sinus headache, Patients with allergic rhinitis do not necessarily have more severe chronic rhinosinusitis as assessed by symptom scores, nasal endoscopy, or computed tomography staging. However, at least in pediatric patients with chronic rhinosinusitis who undergo surgery, consideration of allergy and allergy treatment appears to improve surgical results. . Rhinosinusitis is among the most common infectious complications of humoral immunodeficiency, and humoral immunodeficiency is not uncommon in patients with refractory chronic rhinosinusitis. Patients with granulomatous disease causing rhinosinusitis, such as Wegener's granulomatosis, appear to suffer from a symptom burden that is equivalent to the broader population of chronic rhinosinusitis patients(20)

2. Nasal polyps and asthma
Chronic rhinosinusitis (CRS) with and without nasal polyps represent different stages of one chronic inflammatory disease of the mucosa of the nasal cavity and paranasal sinuses. In a study conducted by Kaunas University of Medicine, Dr. Staikūniene J, and the team indicated that patients with chronic rhinosinusitis compose clinically heterogeneous group and when associated with nasal polyps and asthma constitutes the most severe form of unified respiratory tract disease, which is characterized by older age of the patients, greater duration of nasal symptoms, extent of sinus radiological changes, more prominent systemic inflammation markers, greater bronchial obstruction, incidence of perennial allergic rhinitis.(21)

3. Allergy and sinus
A retrospective review of 200 consecutive patients conducted by University of California was carried out on patients who had chronic rhinosinusitis refractory to medical therapy and who subsequently underwent functional endoscopic sinus surgery. Allergy testing for common perennial and seasonal inhalant allergens showed that each patient had sinus CT imaging before undergoing the surgery. Allergy testing indicated that 84% of all patients tested positive for allergies. Moreover, 60% of all patients had significant allergic sensitivity; 52% of all patients had multiple allergen sensitivities(22)

4. Perennial or seasonal allergic rhinitis
There are universally accepted, allergic rhinitis (AR) may play an important role in the occurrence of rhinosinusitis. As in the investigation of the frequency and severity of rhinosinusitis among patients with seasonal or perennial AR, conducted by Süleyman Demirel University, fifty-two of the 73 patients (71.2%) were shown to have findings of rhinosinusitis. Of these 52, twenty-four patients (77.4%) had perennial AR and 28 (66.7%) patients had seasonal AR.(23).

5. Etc.

VI. Preventions
A. Do and do not list
1. Eat more fruits and vegetables
Fruits and vegetable contain measure amount of antioxidants of many kinds of which prevent the forming of free radicals that can result of abnormal structures causes of sinusitis such as cysts, polyp, etc. and protect our body against foreign virus and bacteria invasion cause of infective and inflammatory cause of sinusitis.(34). In fact, while the water soluble antioxidants prevent oxidative forning in the cell cytosol and the blood plasma, the insolvable antioxidants protect cell membranes from lipid peroxidation.
Antioxidants also enhance the immune system in prevention of the chronic rhinosinusitis (CRS) caused by a failure of the mechanical and immunologic barriers across the nasal mucosa(35)

2. Allergic effects
Allergy is the over reaction of immune system to harmless substances after entering our body affecting 1 in every 3 people in the world, as a result of over production of antibody Immunoglobulin E (IgE) of immune system in responding to harmless ingredients such as dust, pollution, alcohol, peanut, shrimp, crayfish, lobster, walnuts, peanuts, soy, legume, etc., after contacting or eating. In certain people, allergic effect can be a result of sinusitis as the result of the production of histamine cause of nasal and sinus membranes to swell resulting of sinusitis(36). Other such as wood dust is considered as a chronic irritative agent on the mucous lining of the nose and paranasal sinuses(39)

3. Improvements in air quality
In the study of A total of 313,982 patients were studied over the 10 calendar years 1997-2006, conducted by Brigham and Women's Hospital, Boston, showed that the prevalence of hay fever and sinusitis are correlated with air quality. Improvements in air quality are associated with decreased prevalence of both hay fever and sinusitis(37). Electrostatic filters attached to heating and air conditioning equipment are helpful in improving air quality.

4. Occupational sinusitis
There are reported that working in the occupation with high risk of exposure to irritants and sensitizers are increased risk of sinusitis. if you are working in such environment please dress yourself to the safety code.(38)

5. Good hygiene
Good hygiene reduce the risk of Bacterial and viral infections causes of sinusitis

6. Avoid foods
Such as Chocolates, milk product of which can cause the production of thick, viscid mucus in the mucus membrane lining of the nose and sinuses.

7. Drink a equate amount of water
Dehydration can increase risk of nasal congestion as a result of the blockage of the nasal passages usually due to membranes lining the nose becoming swollen.

8. Get an influenza vaccine each year
Influenza vaccine can reduce the risk of getting cold and flu and reduce the severity if you get one, thus decreasing the risk of sinusitis.

9. Please refer to the causes and risk factors above for more information

10. Etc.

B. Diet against Sinusitis
Fruits and vegetable contain measure amount of antioxidants of many kinds of which prevent the forming of free radicals that can result of abnormal structures causes of sinusitis such as cysts, polyp, etc. and protect our body against foreign virus and bacteria invasion cause of infective and inflammatory cause of sinusitis.(34). In fact, while the water soluble antioxidants prevent oxidative forming in the cell cytosol and the blood plasma, the insolvable antioxidants protect cell membranes from lipid peroxidation.
Antioxidants also enhance the immune system in prevention of the chronic rhinosinusitis (CRS) caused by a failure of the mechanical and immunologic barriers across the nasal mucosa(35). there are evidence that decreased levels of both reduced glutathione and uric acid in patients with chronic sinusitis lead to a diminished antioxidant defense, which may be associated with the pathogenesis of upper respiratory tract disorders. This finding may offer perspectives for pharmacotherapeutic intervention with antioxidants.(40)
1. Orange
a. In the reserach of Bioavailability and antioxidant effects of orange juice (OJ) into habitual diet found that after the 3 week intervention, plasma concentrations of vitamins A and E did not change. 8-Hydroxydeoxyguanosine in white blood cells declined by 16% (p = 0.38; n = 11), and in individuals with high baseline concentrations by 29% (p = 0.36; n = 7), respectively. Low-density lipoprotein (LDL)-/high-density lipoprotein (HDL)-cholesterol ratios decreased but cholesterol (HDL, LDL, total) and thiobarbituric acid reactive substance plasma concentrations did not change significantly, according to "Bioavailability and antioxidant effects of orange juice components in humans?" by Franke AA, Cooney RV, Henning SM, Custer LJ.(41)

b. Vitamin C is considered as on of most powerful free radical scavenger, it helps to enhane the immune system fighting against forming of free radical cause of irregular cells growth due to mutation of cells' DNA, including tumors and cancers, according to the study of "Vitamin C and cancer: what can we conclude--1,609 patients and 33 years later?" by Cabanillas F.(42)

2. Lime
a. In the analyzing the dichloromethane, ethanol and water extracts prepared from celery [Apium graveolens L. (Umbelliferae)], Jerusalem artichoke [Helianthus tuberosus L. (Compositae)], spinach [Spinacia oleracea L. (Chenopodiaceae)], chard [Beta vulgaris L. var. cicla (Chenopodiaceae)], purslane [Portulaca oleracea L. (Portulacaceae)], ispit, or borage [Trachystemon orientale (L.) G. Don (Boraginaceae)], garden rocket [Eruca sativa Mill. (Brassicaceae)], red cabbage [Brassica oleracea L. var. capitata f. rubra DC. (Cruciferae)], lime flower [Tilia tomentosa Moench (Tiliaceae)], cinnamon [Cinnamomum cassia Presl. (Lauraceae)], and rosehip [Rosa canina L. (Rosaceae)], found that the dichloromethane, ethanol and water extracts of cinnamon showed the best antioxidant effect among the extracts of the tested plants. The ethanol extract of cinnamon exhibited 63.02% inhibition against acetylcholinesterase and 85.11% inhibition against butyrylcholinesterase (BChE) at 200 µg/mL, according to "Antioxidant and anticholinesterase activities of eleven edible plants" by Boğa M, Hacıbekiroğlu I, Kolak U.(43)

b. Besides is essential in preventing the breaking off small vein cause of hardening of the vessel wall, vitamin C also improves the digestive system in maximum absorption of vital nutrients. Overdoses can cause diarrhea, It also plays an important role in enhancing immune system fighting against the forming of free radicals that cause muscle damage, according to the study of "Does antioxidant vitamin supplementation protect against muscle damage?" by McGinley C, Shafat A, Donnelly AE., posted in PubMed (44)

c. Since it contains high amount of flavonoid, it helps to improve the immune system fighting against forming of free radical causes of tumor and cancer, according to the study of "Dietary intake of selected flavonols, flavones, and flavonoid-rich foods and risk of cancer in middle-aged and older women" by Wang L, Lee IM, Zhang SM, Blumberg JB, Buring JE, Sesso HD., posted in PubMed(45)

3. Carrot
a. Purple carrot juice (usually orange inside) has demonstrated the antioxidant and anti-inflammatory properties in improving glucose tolerance as well as cardiovascular and hepatic structure and function, according to the study of "Comparison of purple carrot juice and β-carotene in a high-carbohydrate, high-fat diet-fed rat model of the metabolic syndrome" by Poudyal H, Panchal S, Brown L. (46)

b. Carot juice may have a possible preventive effects in disease causation and progression caused by Oxidative DNA damage due to its antioxidant properties, according to the study of "Oxidative DNA damage in human white blood cells in dietary antioxidant intervention studies" by Møller P, Loft S.(47)

4. Whole wheat
In the classification of Anthocyanins of whole purple wheat, unpolished red rice, and partially polished red rice before and after processing to produce infant cereals and it antioxidant efect found that purple wheat infant cereals had higher cellular antioxidant activity than unpolished red rice ones (p < 0.05). Whole purple wheat infant cereals showed higher antioxidant activity than the commercial infant cereal, suggesting a possibility of improving infant antioxidant status by incorporating this grain in their diet, according to "Comparative Evaluation of the Antioxidant Potential of Infant Cereals Produced from Purple Wheat and Red Rice Grains and LC-MS Analysis of Their Anthocyanins" by Hirawan R, Diehl-Jones W, Beta T.(48)

5. Oat
a. In the investigation of beta-glucan of Oats and its effect in heart health found that the polyphenols of oats have also recently been shown to exhibit anti-inflammatory, antiproliferative, and anti-itching activity, which may provide additional protection against coronary heart disease, colon cancer, and skin irritation, according to "Potential health benefits of avenanthramides of oats" by Meydani M.(49)

b. Selenium in Oat improves the immune system in fighting the foreign invasion of virus and bacteria causes of infection and inflammation, according to the study of "Selenium in the immune system" by Arthur JR, McKenzie RC, Beckett GJ., posted in PubMed(50)

6. Sun flower seed
a. In the investigation of Plant foods belonging to different food groups such as cereals, legumes, oil seeds, oils, green leafy vegetables, other vegetables, spices, roots and tubers and theirs effect on cardiovascular diseases found that antioxidant activity (AOA) and phenolic content (PC) was the highest in black pepper (0.43 mg food required for 50% inhibition of the coupled auto-oxidation of beta-carotene and linoleic acid in a mixture in vitro) and it had the highest PC (191 mg gallic acid equivalent/100 g food). The AOA (18.4 mg) as well as the PC (not detectable) were the lowest in sunflower oil. PC in oil seeds was higher than that in the oil, which could be due to the hydrophilic nature of phenolics and suggests the need for greater use of oil seeds than oils, according to "Antioxidant activity of commonly consumed plant foods of India: contribution of their phenolic content" by Saxena R, Venkaiah K, Anitha P, Venu L, Raghunath M.(51)

b. Manganese superoxide dismutase (MnSOD), an enzyme located in mitochondria, is the key enzyme that protects the energy-generating mitochondria from oxidative damage caused by free radicals, according to the study of `The role of manganese superoxide dismutase in inflammation defense`by Li C, Zhou HM.(52)

7. Olive oil
a. In the investigation of albumin, a serum protein present in the developing brain, stimulates the synthesis of oleic acid by cultured astrocytes by inducing stearoyl-CoA 9-desaturase, the rate-limiting enzyme in oleic acid synthesis, found that oleic acid induces neuronal differentiation, as indicated by the expression of growth associated protein-43. Here, we report that the expression of growth associated protein-43 mRNA peaks at about day 7 after birth, following the maximal expression of stearoyl-CoA 9-desaturase-1 mRNA that occurs between days 3 and 5 postnatally, according to "Role of oleic acid as a neurotrophic factor is supported in vivo by the expression of GAP-43 subsequent to the activation of SREBP-1 and the up-regulation of stearoyl-CoA desaturase during postnatal development of the brain" by Velasco A, Tabernero A, Medina JM.(53)

b. In the analyzing the influence of a Mediterranean dietary pattern on plasma total antioxidant capacity (TAC) found that Mediterranean diet, especially rich in virgin olive oil, is associated with higher levels of plasma antioxidant capacity. Plasma TAC is related to a reduction in body weight after 3 years of intervention in a high cardiovascular risk population with a Mediterranean-style diet rich in virgin olive oil, according to "A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain" by Razquin C, Martinez JA, Martinez-Gonzalez MA, Mitjavila MT, Estruch R, Marti A.(54)

8. Flax seed
a. Omega 3 fatty acidsBesides well known for its benefits for the maintenance of a healthy cardio-vascular system, according to the study of "Omega-3 Fatty acids for cardiovascular disease prevention" by Defilippis AP, Blaha MJ, Jacobson TA, posted in PubMed(I) and proper ratio of Omega 3 and 6 fatty acid and prevent blood clotting, it also extends the portion of your cycle in which you are fertile, by promoting natural ovulation, according tothe study of "Postpartum ovarian activity in multiparous Holstein cows treated with bovine somatotropin and fed n-3 fatty acids in early lactation" by Carriquiry M, Dahlen CR, Weber WJ, Lamb GC, Crooker BA., posted in pubMed (55)

b. Free radicals
Flax seed contains a high amount of antioxidant that helps to guard the body from forming of free radicals by promoting the proper DNA replication and cells division, according to "Free radicals, metals and antioxidants in oxidative stress-induced cancer" by Valko M, Rhodes CJ, Moncol J, Izakovic M, Mazur M.(56)

9. Onion
a. Antioxidant and anti-apoptotic effects
In the research of onion (Allium cepa) (ACE) extracts onion (Allium cepa) extracts and theirs antioxidant and anti-apoptotic effects found that the biochemical and histological disturbances were effectively attenuated on pretreatment with ACE. The present study showed that ACE may be a suitable cardioprotector against toxic effects of (DOX) doxorubicin, according to "Antioxidant and anti-apoptotic effects of onion (Allium cepa) extract on doxorubicin-induced cardiotoxicity in rats" by Alpsoy S, Aktas C, Uygur R, Topcu B, Kanter M, Erboga M, Karakaya O, Gedikbasi A.(57)

b. Vitamin C
In the evaluation of pulmonary dysfunction. and it effects on pulmonary dysfunction found that At present, evidence from randomised-controlled trials is insufficient to recommend a specific role for vitamin C in the treatment of asthma. Further methodologically strong and large-scale randomised controlled trials are needed in order to address the question of the effectiveness of vitamin C in children with asthma but some outcome data showed effectiveness on lung function, symptom scores, IgE levels and inhaled steroid use. One small study showed a significant difference in % drop in FEV1 post-exercise, according to the study of "Vitamin C supplementation for asthma" by Kaur B, Rowe BH, Arnold E.(58)

10. Garlic (59)
a. Garlic to fight COLD and FLU. The natural compoud Allicin is released when garlic is crushed. Allicin works to fight cold, flu and other infections by breaking down into smaller chemicals called Sulfur compounds. They wake up your inmuune system, helping your body to get rid of toxins and microorganisms naturally.

b. Garlic is the natural superfood healer for its natural antibiotic with antiviral, antifungal, anticoagulant and antiseptic properties. Garlic cooked is fine but it loses many of its health-giving powers. Raw garlic does most of its antibiotic and preventive medicines. Here are some of effective use of garlics for PROVEN DISEASE CURED.

11. Soybeen seeds
Extract from Virginia-grown soybean seeds had exerted its antioxidant effect when compared for their total phenolic contents (TPC), oxygen radical absorbance capacity (ORAC), and 2,2-diphenyl-1-picrylhydrazyl radical (DPPH(*)) scavenging activities, according to "Comparison of different strategies for soybean antioxidant extraction" by Chung H, Ji X, Canning C, Sun S, Zhou K.(60)

12. Etc.

C. Nutritional supplements against sinus headache
Phytochemicals in food have been found to contain vary antioxidants of which can help not only relieve the symptoms of sinus headache, but also prevent and treat sinus headache.
1. Antioxidant scavengers (61)
a. Quercetin
Quercetin is a plant-derived flavonoid found in fruits, vegetables, leaves and grains and studies show that quercetin may have anti-inflammatory and antioxidant properties as a antioxidant, quercetin scavenges free radicals, which damage cell membranes, cause mutation of cells with tampering DNA.

b. Rutin
Rutin is a citrus flavonoid glycoside found in buckwheat and glycoside of the flavonoid quercetin. It inhibits platelet aggregation, decreases the capillary permeability, makes blood thinner and improves circulation. As an antioxidant, it can reduce the cytotoxicity of oxidized LDL cholesterol caused by free radical that lowers the risk of heart diseases.

c. Vitamin A
Vitamin A occurs in the form retinol and is best known for its function in maintaining the health of cell membrane, hair, skin, bone, teeth and eyes. It also plays an important role as an antioxidant as it scavenges free radicals in the lining of the mouth and lungs; prevents its depletion in fighting the increased free radicals activity by radiation; boosts immune system in controlling of free radicals; prevents oxidation of LDL and enhances the productions of insulin pancreas.

d. Vitamin C
Vitamin C beside plays an important role in formation and maintenance of body tissues, it as an antioxidant and water soluble vitamin, vitamin C can be easily carry in blood, operate in much of the part of body. By restoring vitamin E, it helps to fight against forming of free radicals. By enhancing the immune system, it promotes against the microbial and viral and irregular cell growth causes of infection and inflammation.
Vitamin C also is a scavenger in inhibiting pollution cause of oxidation.

e. Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols discovered by researchers Herbert Evans and Katherine Bishop. It beside is important in protecting muscle weakness, repair damage tissues, lower blood pressure and inducing blood clotting in healing wound, etc, it also is one of powerful antioxidant, by moving into the fatty medium to prevent lipid peroxidation, resulting in lessening the risk of chain reactions by curtailing them before they can starts.

f. Vitamin D
Reseacher found that vitamin D, a group of fat-soluble secosteroids is also a membrane antioxidant, with the ability to inhibit iron-dependent lipid peroxidation in liposomes compared to cholesterol.

2. Luteolin
a. Inflammatory diseases and immune disorders
In the examination of the PRRs recognize pathogen-associated molecular patterns (PAMPs) or danger-associated molecular patterns (DAMPs) in regulating the innate and adaptive immune responses found that TBK1 kinase can be a target for certain flavonoids such as EGCG, luteolin, quercetin, chrysin, and eriodictyol to regulate TRIF-dependent TLR pathways. This review focuses on the features of PRR signaling pathways and the therapeutic targets of intrinsic and extrinsic regulators in order to provide beneficial strategies for controlling the activity of PRRs and the related inflammatory diseases and immune disorders, according to "Intrinsic and extrinsic regulation of innate immune receptors" by Jeong E, Lee JY.(62)

b. Anti-allergic effects
In the analyzing the structure-activity relationships of 45 flavones, flavonols and their related compounds, luteolin, ayanin, apigenin and fisetin and theirs anti-allergic effects, found that flavonoids inhibit histamine release, synthesis of IL-4 and IL-13 and CD40 ligand expression by basophils. were the strongest inhibitors of IL-4 production with an IC(50) value of 2-5 microM and determined a fundamental structure for the inhibitory activity. The inhibitory activity of flavonoids on IL-4 and CD40 ligand expression was possibly mediated through their inhibitory action on activation of nuclear factors of activated T cells and AP-1., according to "Flavonoids and related compounds as anti-allergic substances" by Kawai M, Hirano T, Higa S, Arimitsu J, Maruta M, Kuwahara Y, Ohkawara T, Hagihara K, Yamadori T, Shima Y, Ogata A, Kawase I, Tanaka T.(63)

3. Omega 3 fatty acid
a. Antioxidative, anti-inflammatory, and anticarcinogenic activities
In the examination of the inhibition of inflammation as well as of cancer formation and growth in the lung and colon in animal models., using a tocopherol mixture that is rich in gamma-T (gamma-TmT, which contains 57%gamma-T), found that when given in the diet at 0.3%, gamma-TmT inhibited chemically induced lung tumorigenesis in the A/J mice as well as the growth of human lung cancer cell H1299 xenograft tumors. gamma-TmT also decreased the levels of 8-hydroxydeoxyguanosine, gamma-H2AX, and nitrotyrosine in tumors. More evident anti-inflammatory and cancer preventive activities of dietary gamma-TmT were demonstrated in mice treated with azoxymethane and dextran sulfate sodium. These results demonstrate the antioxidative, anti-inflammatory, and anticarcinogenic activities of tocopherols, according to "Inhibition of inflammation and carcinogenesis in the lung and colon by tocopherols" by Yang CS, Lu G, Ju J, Li GX.(64)

b. The antioxidant and anti-inflammatory activities
In the investigation of the antioxidant and anti-inflammatory actions of tocopherols in mice and determination of whether the nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is involved in these activities, indicated that the antioxidant and anti-inflammatory activities of γ-TmT in the colon are mostly due to the direct action of tocopherols in trapping reactive oxygen and nitrogen species, independent of the antioxidant enzymes and anti-inflammatory proteins that are regulated by Nrf2; however, Nrf2 knockout appears to affect the serum levels of tocopherol metabolites, according to "The antioxidant and anti-inflammatory activities of tocopherols are independent of Nrf2 in mice" by Li G, Lee MJ, Liu AB, Yang Z, Lin Y, Shih WJ, Yang CS.(65)

4. Allyl sulfides (66)
a. Irregular cells growthIn a study of "Allyl sulfides modify cell growth." by Knowles LM, Milner JA. In response to Extensive evidence points to the ability of allyl sulfides from garlic to suppress tumor proliferation both in vitro and in vivo. researchers found that Allyl sulfides are also recognized for their ability to suppress cellular proliferation by blocking cells in the G2/M phase and by the induction of apoptosis. This increase in the G2/M and apoptotic cell populations correlates with depressed p34cdc2 kinase activity, increased histone acetylation, increased intracellular calcium and elevated cellular peroxide production. While impressive pre-clinical data exist about the antineoplastic effects of allyl sulfur compounds, considerably more attention needs to be given to their effects in humans. The composition of the entire diet and a host of genetic/epigenetic factors will likely determine the true benefits that might arise from allyl sulfur compounds from garlic and other Allium foods.

b. Immune system
According to the article of "GARLICTHE BOUNTIFUL BULB" by Carmia Borek, Ph.D. posted in Life extension magazine, the author indicated that human studies confirm immune stimulation by garlic. Subjects receiving aged garlic extract at 1800 mg a day for three weeks showed a 155.5% increase in natural killer immune cell activity that kills invaders and cancer cells. Other subjects receiving large amounts of fresh garlic of 35g a day, equivalent to 10 cloves, showed an increase of 139.9%. In six weeks, patients with AIDS receiving aged garlic extract showed an enhancement of natural killer cells from a seriously low level to a normal level.

c. Antioxidant against oxidation
According to the study of " Antioxidant Health Effects of Aged Garlic Extract" by Carmia Borek, posted in (Journal of Nutrition. 2001;131:1010S-1015S.)© 2001 The American Society for Nutritional Sciences, researcher found that AGE contains a wide range of antioxidants that can act in synergistic or additive fashion and protect cells against oxidative damage, thus helping to lower the risk of heart disease, stroke, cancer and Alzheimer’s disease and protect against toxic, tissue-damaging effects of ROS-producing radiation, including UV light, drugs used in therapy and chemicals in the environment and industry.

5. Etc.

VII. Treatments
A. Non medical treatments
In the study of three hundred adults aged 18 to 50 years with self-report of a physician diagnosis of asthma (n = 125) or rhinosinusitis without concomitant asthma (n = 175), showed that alternative treatments, including herbal agents, ingestion of caffeinated beverages, homeopathy, acupuncture, and massage therapies. are frequent among adults with asthma or rhinosinusitis and should be taken into account by health-care providers and public health and policy analysts(67)
1. Aromatherapy
People are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as well as for general health and well being. In sinusitis, aromatherapy used volatile plant materials, known as essential oils, and other aromatic compounds to unclogs the nasal passages and sinuses and relieve pain. The concept of aromatherapy will be explored in relation to its effects on the pain pathways, methods of administration and therapeutic effects(68)

2. Hydro Pulse Nasal Irrigation therapy
Hydro Pulse Nasal Irrigation therapy are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as well as for general health and well being and is the method of post nasal drainage & chronic sinusitis treatment for symptoms caused by sinus infections, allergies and the common cold by clearing the cavities of nasal and draining accumulated mucus of sinuses and mucous membrane

3. Acupuncture therapy
In the study of Acupuncture is commonly used to treat chronic sinusitis in traditional Chinese acupuncture, the data (presented as mean +/- SD) show a significant reduction (P < or = .05) of reduced glutathione levels (0.3 +/- 0.1 mumol/g wet weight) and uric acid levels (2.7 +/- 0.4 mumol/g wet weight) in mucosa samples obtained from patients with chronic sinusitis compared with healthy controls (0.6 +/- 0.2 and 3.4 +/- 0.6 mumol/g wet weight, respectively)(69)

4. Etc.

B. Treatments in conventional medicine perspective
B.1. Medical treatments
1. Antibiotics
a. Some studies found that in most cases sinusitis accompanies viral cold infections where antibiotics are ineffective, but the few cases that have additional bacterial infections (one or two of every 100 patients with sinus symptoms) could benefit. Six of the studies (747 participants) compared antibiotics to placebo and found that most of the participants got better within two weeks, regardless of whether they received the antibiotic or not. When antibiotics were given they somewhat speeded up recovery from sinusitis symptoms with (like skin rash and gastrointestinal problems, for example, diarrhoea, abdominal pain and vomiting), side effects include the risk of increased resistance to antibiotics among community-acquired pathogens(70)

2. In a study of Effectiveness of antibiotics for acute sinusitis, Dr. Blin P, and the team said "Most acute sinusitis cases not prescribed antibiotics resolve spontaneously. Antibiotics reduced by 3.3-fold the risk of failure within 10 days, without impact on later recurrence. The greatest benefit of antibiotics was found for patients with poor oro-dental condition or with antibiotic use within the previous 2 months(71)

2. Antihistamines
a. Antihistamines also known as Histamine antagonist, are commonly used for the relief sinus caused by allergies by inhibiting the action of histamine as it is blocked from attaching to histamine receptors. In the study conducted by Elblandkliniken Radebeul, HNO-Abteilung, Dr. Reiss M and Dr. Reiss G. showed that long-term therapy with oral macrolides might improve median to severe symptoms of chronic rhinosinusitis without nasal polyps. An additional therapy with antihistamines is possible in patients with an allergy(72)

b. Side effects are not limit to
b.1. Drowsiness,
b.2. Dizziness,
b.2. Headache,
b.3. Loss of appetite
b.4. Gastrointestinal discomfort
b.5. Vision changes
b.6. Irritability
b.7. Dry mouth and nose
b.8. Etc.

3. Pain relievers
a. Ibuprofen (Advil)
a.1. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used as as an analgesic for relief of symptoms pain as aresult of inflammation of certain diseases. In adult, researchers found that ibuprofen 200 and 400 mg are effective in reducing headache intensity and rendering patients pain-free at 2 hours. Photophobia and phonophobia improved with 400 mg dosing(73)
a.2. Side Effects are not limit to
a.2.1. Common side effects include nausea, dyspepsia, gastrointestinal ulceration/bleeding, headache, dizziness, rash, etc.
a.2.2. Less common side effects include esophageal ulceration, heart failure, renal impairment, confusion, etc.
a.2.3. Etc.

b. Acetaminophen
b.1. Acetaminophen is a pain reliever to treat moderate to moderately-severe pain. Some researchers suggested that Tramadol/acetaminophen reduces the severity of pain, photophobia, and phonophobia associated with migraine headache, but does not reduce migraine-associated nausea. Tramadol/APAP might be an appropriate option for the management of moderate-to-severe migraine headache(74)

4. Topical corticosteroids
a. In the assessment of the effects of topical steroid in patients with CRS without nasal polyps and perform a meta-analysis of symptom improvement data, including subgroup analysis by sinus surgery status and topical delivery methods conducted by Macquarie University, researchers found that Topical steroid is a beneficial treatment for CRS without polyps and the adverse effects are minor. It may be included in a comprehensive treatment of CRS without polyps. Direct delivery of steroid to the sinuses may bring more beneficial effect. Further studies comparing different topical drug delivery methods to the sinuses, with appropriate treatment duration (longer than 12 weeks), are required(75)

b. Side effects
b.1. Skin wrinkled, and shiny
b.2. Stretch Marks are permanent and irreversible.
b.3. Alternation of the immune system functions, causing skin rash
b.4. It may cause allergic effects
b.5. Etc.

5. Oral and nasal decongestants
a. Oral and nasal decongestants medications is often used to relieve headaches associated with sinus infections as they constrict blood vessels that cause headache pain. In the study of assess the efficacy of dexpanthenol nasal spray compared with normal saline spray in the postoperative treatment of patients with chronic rhinosinusitis (CRS) conducted by Med Assoc Thai. The majority of the postoperative symptom scores and all of the endoscopic scores of the dexpanthenol group were not statistically different from those of the normal saline group. However, dexpanthenol nasal spray has superior efficacy compared with normal saline nasal spray on improvement of mucociliary clearance and nasal discharge in the postoperative care of CRS patients after ESS(76)

b. Side effects are not limit to
1. Fever,
2. Rash, or a
3. Persistent headache
4. Etc.

5. Triptan
a. Triptan are a family of tryptamine-based drugs used in the treatment of migraine headache and cluster headache. In the comparison of subcutaneous sumatriptan and oral administration formulation, subcutaneous formulation has a faster time of onset and high rate of efficacy when compared with the oral formulation, but the oral formulation appears to be better tolerated.(77). In the article by Ed Susman, posted in ENT Today, June 2008, researchers recommended that otolaryngologists might empirically treat selected patients with sinus headaches as if these patients actually had migraines, following study results illustrating that the use of triptans brought relief to more than 80% of these individuals(78)

b. Side effects of Triptan are not limit to
b.1. Nausea
b.2. Dry mouth
b.3. Tingling
b.4. Burning,
b.5. Dizziness
b.6. Drowsiness
b.7. Warm or cold sensations
b.8. Feelings of heaviness, pressure, or tightness
b. Other severe symptoms include coronary spasm, heart disease, shortness of breath, changes in vision, etc.

6. Etc.

B.2. Surgical treatment
If the diagnosis found the sinus headache are caused by abnormalities of strusture or failed to respond to conservative medical therapy, then Endoscopic sinus surgery may be necessary. Endoscopic sinus surgery with the removal of pressure points with reestablishment of a competent airway, and revision of sinus passageways to facilitate mucociliary drainage and ventilation of the obstructed cavity can benefit patients with chronic headaches(79). but for some patient, endoscopic sinus surgery provides significant symptom relief for the nasal and facial symptoms associated with CRS. Patients will often still require topical nasal corticosteroids for the management of their CRS, but can expect decreases in antibiotic requirements after ESS (80)

C. In herbal medicine perspective

1. Peppermint
Peppermint contains high amounts of menthol which have long been used in herbal medicine to treat various pain conditions including headache. In a randomised, triple-blind, placebo-controlled, crossed-over study conducted in the neurology Clinic of Nemazee Hospital, affiliated with Shiraz University of Medical Sciences, Shiraz, southern Iran, from March 2007 to March 2008. Menthol solution can be an efficacious, safe and tolerable therapeutic option for the abortive treatment of migraine(81)

2. Feverfew
In the article of Feverfew Benefits, the writer wrote that Feverfew has been used to stimulate appetite, and improve digestion and kidney function. It may also relieve dizziness, tinnitus, and painful or sluggish menstruation. Its extracts have been claimed to relieve asthma, coughs, dermatitis and worms(82)

3. Ginger roots
Even though there are no scientific research to confirm the benefits of ginger root for sinus congestion, but the herb may has been used in herbal medicine in treating viral and nasal congestion. the anti-inflammatory effect of ginger may also reduce swollen sinus membranes that can clear sinus passages and reducing sinus pressure.

4. Cinnamon
Cinnamon contains Myristicin (1-allyl-5-methoxy-3,4-methylenedioxybenzene), an active aromatic compound has anti-inflammatory properties related with its inhibition of NO, cytokines,chemokines, and growth factors in dsRNA-stimulated macrophages via the calcium pathway(83) of which can reduce swollen sinus membranes that can clear sinus passages and reducing sinus pressure.

5. Bromelain
In the study of the crude extract from the pineapple that contains, among other components, various closely related proteinases, demonstrating, in vitro and in vivo, conducted by Freie Universität Berlin, Dr.Maurer HR indicated that, a wide range of therapeutic benefits has been claimed for bromelain, such as reversible inhibition of platelet aggregation, angina pectoris, bronchitis, sinusitis, surgical traumas, thrombophlebitis, pyelonephritis and enhanced absorption of drugs, particularly of antibiotics.(84)

6.Etc.

C. In traditional Chinese medicine perspective(85)(86)
Traditional Chinese medicine define sinus hesdache as a condition of the lack of free flow of Blood
and Qi. due to
1. Wind-Heat of Lung, mainly caused by weather changes
a. Wind Heat: This type of sinusitis has yellow thick runny nose accompanied with a severe headache.
Symptoms include: Sore throat, possible tooth ache, fever, red face, sweating, etc.
b. Chinese herbal formula Chuan Xiong Cha Tiao San
b.1. Bo he
b.2. Chuan xiong
b.3. Jing jie
b.4. Qiang huo
b.5. Bai zhi
b.6. Gan cao
b.7. Fang feng

2. Stagnated Heat of Gallbladder, mainly caused by emotions.
a. Liver and Gall Bladder Damp heat: This type of sinusitis has a thick turbid yellow discharge accompanied with the pain of sinusitis.
Symptoms include: Fever or sensation of heat in the afternoons and evenings, a heaviness of the body, irritability, loose or greasy stools with possible burning sensation of the anus.
b. Chinese herbal formula Long Dan Xie Gan Tang
b.1. Long Dan Cao
b,2 Huang Qin
b.3. Zhi Zi
b.4. Mu Tong
b.5. Che Qian Zi
b.6. Ze Xie
b.7. Chai Hu
b.8. Sheng Di Huan
b.9. Dang Gui
b.10. Gan Cao

3. Damp Heat of Spleen/Stomach This type of sinusitis is a result of over intake of greasy and spicy foods.
a. Symptoms include: heaviness of the body, yellowish urine, loose stool profuse and yellowish leukorrhea, yellowish and sticky tongue coating, nasal congestion, and stuffy nose with phlegm, etc.
b. Chinese herbal formula Bi Yan Pian
b.1. Cang er zi
b.2. Xin yi hua
b.3. Lian qiao
b.4. Fang feng
b.5. Bai zhi
b.6. Zhi mu
b.7. Gan cao
b.8. Jing jie
b.9. Ye ju hua
b.10. Wu wei zi
b.11. Jie geng

4. Deficiency of Spleen can be a result of improper diet
a. Symptoms include: a runny white or clear discharge, the nasal congestion are the result of diary foods, gluten products or excessive amounts of sugar, diarrhea, mild fatigue, etc.
b. Chinese Herbal Formula: Yi Yi fu Zi Bai Jiang San
b.1. Yi Yi Ren
b.2. Fu Zi
b.3. Bai Jiang Cao

5. Qi and Blood Stasis as a result of polyps cause of sinusitis nasal congestion
5.1. Symptoms included: a loss of smell, nose bleeds, thick white or yellow nasal discharge, heavy and foggy head with possible sharp pain in the nose and sinuses, headaches, etc.
5.2. Herbs for Qi and Blood Stasis
5.2.1. Herbs for qi stagnation
Qi stagnation can be classifies into 3 groups
a. Spleen and stomach qi stagnation
a.1. Mu Gua (quince fruit)
Besides helping to increase spleen function in food digestion, it increases the kidney function in qi and fluids regulation, thereby, reducing the dampness accumulated caused by kidney qi stagnation and preventing its the moving downward tendency, causing abdominal pain and spasms during menstrual cycle.

a,2. Chen Pi (tangerine peel)
Chen pi is Spleen and kidney tonic herb. It presentation besides improves the Spleen qi function moving downward, thereby, reducing spleen stagnation causes of abdominal distention, fullness, bloating and digestive disorder, it also increases of the function to dry dampness, thus decreasing the kidney congestion, leading to coughs with stifling sensation in the chest.

a.3. Zhi Shi (immature bitter orange)
Zhi shi has been used for thousand of years in traditional Chinese medicine in treating qi stagnation in kidney caused by accumulated of phlegm due to kidney deficiency, thereby reducing the dampness causes of abdominal cramps and pain and distention. Since it cool in nature, it helps to improve the abdominal pain and constipation caused by accumulation and stagnant qi.

b. Liver qi stagnation
b.1. Xiang Fu (nut grass rhizome)

It is one the herbs helped to regulate the qi flow by smoothing the liver and congestion of Spleen qi caused by excessive yin or yang, thus reducing qi stagnation caused by disharmonization of liver and Spleen causes of abdominal cramps and pain. It is said that xiang fu also has a function impromoting regular menstruation.

b,2. Zhi Ke (ripe fruit of zhi shi)
Zhi ke promote healthy liver, it promotes a strong liver qi function, thereby, increasing its function in blood formation and transportation to the heart for circulation.

b.3. Wu Yao (lindera root)
Wu yao is one the warm with the main function of warming the kidney caused by kidney yang defieciency. It is only used for patient with evidence of liver qi stagnation caused by prolong intake of cold foods or working in a cold environment. Since its function is to restore the liver qi flow due to cold constraint, it reduces the blood stagnation causes of menstrual pain.

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Saturday, April 7, 2012

Sinusitis - Headache/Sinus headache

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