People with sinusitis who don’t get better with conventional therapy often try alternative treatments, such as acupuncture, herbs, vitamins, homeopathy, and more. If you’re contemplating entering the world of alternative therapies, you’re probably wondering, “Do they work?”

This is a tricky question to answer. Unfortunately, few rigorous studies have examined whether alternative therapies actually benefit people with sinusitis (or other chronic diseases, for that matter).

Alternative therapies are not strictly regulated by the federal government, so practitioners and manufacturers have little incentive to conduct costly studies proving their techniques and products are safe and effective.

Without research, we’re left with anecdotal evidence, which makes it hard for me as a physician to give a ringing endorsement of any particular alternative therapy. That does not mean I oppose alternative therapies.

There is much that modern medicine does not understand and cannot account for, so I don’t discourage anyone from trying something that might relieve symptoms, so long as it won’t make things worse.

It’s worth noting that many of today’s accepted treatments are derived from plants and at one time would have been considered alternative. For example, digitalis, a drug used to treat heart disease, is made from the leaves of the foxglove plant.

In the sinus arena, the widely used mucus-thinning agent guaifenesin was developed from the resin of guaiac wood. So what’s considered alternative today may one day become a mainstay of conventional treatment.

Using Common Sense

When patients ask me about trying an alternative therapy, I encourage them to give it a try with three caveats:

• Make sure the treatment is not potentially dangerous. The majority of alternative treatments are not, but reports of problems occasionally surface, such as those that led the FDA to ban sales of dietary supplements containing the herb ephedra in 2003.

• Alternative therapies should be used in conjunction with established treatments, not in place of them. If your doctor gives you a four-week prescription of an antibiotic, do not stop taking it halfway through because you’ve decided to try an herbal supplement or vitamin.

• Let your doctor know if you’re using an alternative therapy. This is most crucial with herbs but is a good idea in general, in case the alternative treatment is known to diminish or otherwise affect the conventional therapy you’re receiving.

Following is a rundown of the alternative treatments most often used by people with sinusitis.

Acupuncture

This centuries-old Chinese practice is based on the theory that your physical and mental health depends on a natural flow of energy called qi (pronounced “chee”), which courses along fourteen pathways known as meridians.

When this flow becomes blocked, disease and pain including sinusitis and sinus pain develop. Acupuncture is intended to relieve this blockage and provide relief. An acupuncturist inserts fine, sterile needles through the skin along the various meridians.

Certain points, particularly those at the side of the nose and in the web of the hand between the thumb and index finger, are thought to be most effective in treating sinus disease.

Many of my patients who have tried acupuncture report that it does indeed help relieve the headache and pain associated with sinusitis when medications haven’t worked.

A much smaller percentage have found it improves congestion and drainage. Acupressure is based on the same principle as acupuncture, but direct finger pressure is used to stimulate the meridian points instead of needles.

Herbal Therapy

Herbs have been and remain the mainstay of indigenous healing practices throughout much of the world. In the United States, herbal supplements are the leading form of alternative health therapy, and their use drives a multibillion-dollar industry.

Even so, FDA regulation of herbs remains limited. According to the 1994 Dietary Supplement Health and Education Act, herbs do not require FDA review.

As long as the label does not make unsupported scientific claims, manufacturers have much leeway in promoting the alleged benefits of their products. The FDA must prove an herb unsafe to remove it from the market.

So consumers need to exercise care when making a purchase. Because supplements’ ingredients and purity can vary greatly among manufacturers, it’s best to buy products that say “standardized extracts” on the label.

Note that a supplement’s effectiveness may vary from brand to brand, even if the dosage is the same. That’s because differing crops and processing methods yield varying strength and purity.

A good analogy is the different taste and qualities of wines. Despite starting with the same grapes, different vineyards end up producing very different bottles of wine.

Among the herbs most frequently claimed to alleviate sinus symptoms are the following:

• Echinacea. Thought to enhance the immune system and help prevent infections, this popular herb is used widely to reduce the symptoms and duration of colds and flulike illnesses.

Laboratory studies have suggested that it enhances the body’s replication of T cells, white blood cells used to fight infection. Clinical trials looking at the efficacy of echinacea for infections have yielded mixed results.

• Goldenseal. Referred to as nature’s antibiotic because of its presumed antibacterial and anti-inflammatory properties, this herb was introduced to early settlers by Cherokee Indians, who used it as a wash for skin diseases and wounds.

After the Civil War, it became an ingredient in many patent medicines, and today its adherents use it to treat everything from sore throats to canker sores to premenstrual syndrome.

Goldenseal’s benefits are often attributed to berberine, an active ingredient.

• Bromelain. Thought to reduce inflammation, bromelain is a compound present in pineapples.

Three studies performed in the 1960s showed that patients who took bromelain tablets with an antibiotic reported greater sinusitis symptom relief (reduced nasal inflammation, mucus discharge, and congestion) than people who took the antibiotic alone.

If you take herbs to ease sinus symptoms or with other goals in mind (increased energy, enhanced memory, and so on), I want to stress the importance of keeping your doctor posted, for two reasons.

First, like conventional medications, herbs often have side effects. They can affect preexisting health conditions, including hypertension and diabetes, and interact with medications you may be taking.

Second, herbs can increase bleeding during surgery, so it’s crucial that your doctor know what you’re taking if you’re planning sinus surgery (or any type of surgery, for that matter).

Be especially aware of the Four Gs garlic, ginger, ginkgo, and ginseng all of which are known to increase bleeding. Ginseng, for example, inhibits the function of platelets, a blood component required for clotting.

I advise my patients to stop taking these herbs at least two weeks before sinus surgery. For detailed, objective information on herbal supplements, I recommend looking at the website run by the American Herbal Products Association.

Nutritional Supplements

Vitamin C and zinc are the two supplements most often claimed to prevent infections. Research in this area has focused on colds; whether these products have any beneficial effect on sinusitis in terms of either warding off infections or shortening their duration is not known.

In the 1970s, Nobel Prize–winning chemist Linus Pauling became a vocal advocate for taking large doses of vitamin C at the first signs of a cold. Despite his claims, controlled studies failed to show any effect of this vitamin on decreasing the severity or duration of cold symptoms.

There is, however, some evidence to supports zinc’s infectionfighting properties. Zicam, a zinc-containing nasal gel, has been shown to reduce a cold’s duration if you start using it within the first twenty-four hours of the onset of symptoms.

The drawback of this over-the-counter preparation is that it must be sprayed into the nose every four hours for one to two weeks to be effective. Zinc is also available in lozenge form, as the product Cold-Eze, but the use of this oral preparation for reducing colds has yielded mixed results.

Homeopathic Medicine

Devised more than two hundred years ago by the German physician Samuel Hahnemann, homeopathy is based on the principle of “Like cures like.” In other words, the same substance that in large doses causes a symptom will in small doses alleviate that symptom.

People who go to homeopathic doctors typically receive a highly diluted medicine (or medicine combination) designed to alleviate their symptoms.

A number of homeopathic sinus remedies are available over the counter, including the nasal spray Sinu-Free and the zinc-based Zicam (mentioned earlier). The modern practice of homeopathy in the United States is regulated, and homeopathic medicines must be approved by the FDA.

Stress Reduction Techniques

In case you haven’t noticed, we live in an increasingly stressful world. Chronic illnesses in general, and sinus symptoms in particular, tend to worsen during times of emotional and physical stress. Who can argue with the concept of stress reduction?

The challenge is to find something you enjoy doing each day that can temporarily remove you from the world of cell phones, computers, carpools, and coworkers. In 1975 Dr. Herbert Benson of Harvard Medical School authored The Relaxation Response, which described a simple breathing exercise for mind-body relaxation.

The book became a bestseller, and Benson’s method continues to help stressed-out people today. Others find relaxation through different channels, such as yoga, tai chi, meditation, and biofeedback.

Regular exercise (for example, jogging, working out at the gym, or swimming laps in a pool) is also an effective stress reliever. Whatever your source of relaxation, it must be something you enjoy doing, not a chore, so that you’ll be able to stick with it for the long haul and reap the physical and mental health benefits.

What do you do when none of the conventional and alternative treatments we’ve discussed offer symptom relief? For some people perhaps one in five surgery is a viable option. Next, we’ll look at the factors that can help you decide whether you would make a good sinus surgical candidate.