Sinusitis (Pinas/Dushta Pratishyaya)


Sinusitis is a common inflammatory condition affecting the sinuses, often resulting in discomfort and difficulty breathing. This article provides a comprehensive overview of sinusitis, including its epidemiology, types, underlying mechanisms, risk factors, signs and symptoms, diagnostic methods, treatment options, and preventive measures.


Sinusitis, also known as rhinosinusitis, is a prevalent condition characterized by inflammation of the sinuses, which are air-filled cavities located in the skull bones around the nose and eyes. Sinusitis can vary in severity and duration, and understanding its causes, symptoms, and management is essential for improving quality of life.

Epidemiology of Sinusitis:

Sinusitis is a widespread condition, affecting millions of people worldwide. It can occur as an acute, subacute, or chronic condition, with varying degrees of impact on daily activities.

Types of Sinusitis:

Sinusitis is categorized based on duration and underlying causes:

  1. Acute Sinusitis:

    • Acute sinusitis is a short-term inflammation of the sinus cavities, often caused by viral infections (such as the common cold) or bacterial infections.
    • Symptoms include facial pain, nasal congestion, thick yellow or green nasal discharge, and reduced sense of smell.
  2. Subacute Sinusitis:

    • Subacute sinusitis is an inflammation that lasts for 4 to 12 weeks, often following a cold or respiratory infection.
    • Symptoms are similar to acute sinusitis but may persist for a longer duration.
  3. Chronic Sinusitis:

    • Chronic sinusitis is characterized by inflammation lasting for more than 12 weeks, often accompanied by persistent symptoms.
    • Symptoms may include facial pressure, nasal congestion, postnasal drip, fatigue, and reduced sense of taste and smell.
  4. Recurrent Sinusitis:

    • Recurrent sinusitis refers to multiple episodes of acute sinusitis within a year or persistent symptoms despite treatment.
  5. Allergic Fungal Sinusitis:

    • This type of sinusitis is often seen in individuals with allergies and is caused by exposure to fungi.
    • Symptoms include nasal congestion, polyps, thick mucus, and sometimes a reduced sense of smell.
  6. Ethmoid Sinusitis:

    • Ethmoid sinusitis involves inflammation of the ethmoid sinuses, located between the eyes.
    • Symptoms may include pain and pressure between the eyes, nasal congestion, and headache.
  7. Maxillary Sinusitis:

    • Maxillary sinusitis affects the maxillary sinuses, located on either side of the nose below the eyes.
    • Symptoms can include pain and pressure in the cheeks, teeth, or upper jaw, as well as nasal congestion.
  8. Frontal Sinusitis:

    • Frontal sinusitis affects the frontal sinuses, located above the eyes and behind the forehead.
    • Symptoms may include forehead pain, pressure, and discomfort.
  9. Sphenoid Sinusitis:

    • Sphenoid sinusitis affects the sphenoid sinuses, located deep within the skull behind the nose.
    • Symptoms can include headache, neck pain, and earaches.

Pathophysiology of Sinusitis:

Sinusitis occurs when the lining of the sinuses becomes inflamed and swollen, leading to blockages that prevent proper drainage. This can result in the accumulation of mucus, leading to discomfort and potential infection.

Risk Factors and Triggers:

Several factors increase the risk of developing sinusitis:

  1. Respiratory Infections: Previous or ongoing viral infections, such as colds or the flu, can lead to sinusitis.

  2. Allergies: Individuals with allergies, particularly to pollen, dust mites, pet dander, or mold, are at a higher risk of developing sinusitis.

  3. Nasal Abnormalities: Structural issues like deviated septum, nasal polyps, or narrow sinus openings can obstruct normal mucus flow, increasing susceptibility to sinusitis.

  4. Asthma: People with asthma are more prone to chronic sinusitis due to airway inflammation and compromised respiratory function.

  5. Weakened Immune System: Conditions like HIV/AIDS, autoimmune disorders, and immunosuppressive treatments can impair the body’s ability to fight infections.

  6. Environmental Factors: Exposure to pollutants, irritants, and chemicals in the environment can contribute to sinus inflammation.

  7. Smoking and Secondhand Smoke: Smoking and exposure to tobacco smoke can damage the lining of the nasal passages and impair the immune response.

  8. Dental Infections: Dental infections, especially in the upper back teeth, can spread to the sinuses and lead to sinusitis.

  9. Gastro-oesophageal Reflux Disease (GERD): Acid reflux can cause stomach acid to flow back into the throat, leading to irritation of the sinuses.

Triggers for Sinusitis:

  1. Viral Infections: Common colds, flu, and other viral infections can lead to inflammation of the sinus linings.

  2. Bacterial Infections: Bacterial infections can occur as a secondary complication after a viral illness or due to other factors.

  3. Airborne Irritants: Exposure to pollutants, chemicals, and irritants in the air can irritate the sinus linings.

  4. Climate Conditions: Dry or humid climates, temperature changes, and fluctuations in humidity can contribute to sinusitis.

  5. Frequent Swimming or Diving: Frequent exposure to water in swimming pools, oceans, or lakes can increase the risk of sinusitis.

  6. Foreign Objects: Introduction of foreign objects into the nasal passages, such as nasal sprays or cotton swabs, can cause irritation and inflammation.

Sign & Symptoms of Sinusitis:

Symptoms of sinusitis can include:

  1. Nasal Congestion: Difficulty breathing through the nose due to swollen nasal passages and mucus buildup.

  2. Facial Pain and Pressure: Dull or throbbing pain and pressure around the eyes, cheeks, forehead, or other areas of the face.

  3. Headache: Pain that may resemble a headache, often concentrated in the forehead or around the eyes.

  4. Postnasal Drip: Excess mucus dripping down the back of the throat, leading to coughing or a sore throat.

  5. Thick Nasal Discharge: Discharge from the nose that is thick, yellow or green in colour, often indicating infection.

  6. Reduced Sense of Smell and Taste: Sinus inflammation can lead to a diminished sense of smell and taste.

  7. Cough: A persistent cough, especially at night, may result from postnasal drip or throat irritation.

  8. Fatigue: Feeling tired and lacking energy due to the body’s immune response and disrupted sleep.

  9. Bad Breath (Halitosis): Foul-smelling breath caused by bacterial growth in the sinuses and postnasal drip.

  10. Fever: In acute sinusitis, fever may be present, indicating an infection.

  11. Dental Pain: Pain in the upper teeth can be referred from inflamed sinuses.

  12. Ear Pressure or Fullness: Ears feeling full or experiencing pressure due to congestion affecting the Eustachian tubes.

  13. Swelling and Tenderness: Swelling and tenderness over the affected sinuses when touched or pressed.

  14. Worsening Symptoms: Symptoms often worsen when leaning forward or when lying down.

  15. Coughing at Night: Coughing may worsen at night due to the accumulation of mucus in the throat.

  16. Sore Throat: Throat irritation and discomfort due to postnasal drip.

  17. Eye Symptoms: Eye redness, tearing, or discomfort may occur if the ethmoid sinuses (between the eyes) are affected.

Investigation & Diagnosis of Sinusitis:

Diagnosing sinusitis involves:

  1. Physical Examination: Thorough examination of the head, neck, and facial areas to assess for signs of sinus inflammation.

  2. Nasal Endoscopy: Insertion of a thin, flexible tube with a light and camera (endoscope) into the nasal passages to visualize the sinuses.

  3. Imaging Studies:

    • X-rays: Radiographic images of the sinuses to identify structural abnormalities or fluid accumulation.
    • Computed Tomography (CT) Scan: Detailed cross-sectional images of the sinuses to assess inflammation and complications.
    • Magnetic Resonance Imaging (MRI): Imaging using magnetic fields and radio waves to visualize soft tissues and detect sinus issues.
  4. Nasal Culture: Collecting a sample of nasal discharge to identify the presence of bacteria or fungi causing the infection.

  5. Allergy Testing: Evaluating allergic sensitivities through skin or blood tests to identify potential triggers.

  6. Blood Tests: Blood samples to assess for infection, inflammation, or underlying health conditions.

  7. Nasal Secretion Analysis: Testing nasal secretions for markers of inflammation and infection.

  8. Sinus Aspiration: Removing a sample of sinus fluid through a needle for analysis, especially in chronic or severe cases.

Treatment of Sinusitis in Modern Medical Science:

Treatment options for sinusitis depend on its type and underlying cause:

  1. Pain and Fever Relief: Over-the-counter pain relievers (NSAIDs) and fever reducers can help reduce pain and fever associated with sinusitis.

  2. Nasal Decongestants: Short-term use of nasal decongestant sprays can help relieve nasal congestion and improve breathing. Oral decongestants are also available.

  3. Nasal Saline Irrigation: Rinsing the nasal passages with saline solution using a neti pot or squeeze bottle helps clear mucus and reduce inflammation.

  4. Antibiotics: Antibiotics may be prescribed for bacterial sinusitis, particularly if symptoms persist or worsen.

  5. Allergy Management: Treating underlying allergies with antihistamines, decongestants, or allergy shots can help prevent recurrent sinusitis.

  6. Warm Compresses: Applying warm compresses over the sinus areas can help reduce pain and pressure.

  7. Surgery (In Certain Cases): Endoscopic sinus surgery may be considered for chronic or recurrent sinusitis to remove obstructions, polyps, or correct structural issues.

  8. Steam Inhalation: Inhaling steam from a bowl of hot water or using a steam inhaler can help relieve congestion.

Prevention & Precaution for Sinusitis:

Preventive measures include:

  1. Maintain Good Hygiene: Wash hands regularly to prevent the spread of germs and reduce the risk of upper respiratory infections.

  2. Avoid Irritants: Minimize exposure to airborne irritants such as cigarette smoke, strong odors, and pollutants.

  3. Stay Hydrated: Drink plenty of fluids to keep the nasal passages moisturized and promote healthy mucus production.

  4. Manage Allergies: Identify and manage allergens that trigger allergic reactions and sinus inflammation.

  5. Use Humidifiers: Use a humidifier in dry environments to maintain adequate humidity levels in indoor spaces.

  6. Vaccination: Get vaccinated against influenza (flu) and other respiratory infections to reduce the risk of sinusitis.

  7. Avoid Cold and Windy Environments: Protect your face and nasal passages from cold and windy conditions that can dry out the sinuses.

  8. Practice Nasal Breathing: Breathe through the nose rather than the mouth to filter and humidify air before it reaches the sinuses.

  9. Manage Stress: Stress reduction techniques like exercise, meditation, and relaxation can support overall immune health.

  10. Avoid Smoke Exposure: Avoid smoking and exposure to secondhand smoke, as it can irritate the nasal passages.

  11. Balanced Diet: Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to support immune function.

Ayurvedic Perspective on Sinusitis:

In Ayurveda, sinusitis is often linked to an imbalance of the Kapha and Vata doshas. Poor digestion, accumulation of toxins (ama), and improper lifestyle can lead to congestion and inflammation in the sinuses. Ayurveda emphasizes restoring dosha balance and promoting healthy nasal passages.

Ayurvedic Treatment Principles for Sinusitis:

Ayurvedic treatments for sinusitis focus on reducing Kapha congestion, improving digestion, and enhancing immunity. Some treatment principles include:

  1. Diet and Nutrition: Emphasize warm, light, and easily digestible foods to pacify aggravated Kapha and reduce congestion.

  2. Hydration: Drink warm herbal teas, ginger-infused water, or herbal soups to keep the body hydrated and promote mucus flow.

  3. Nasal Irrigation (Nasya): Administering medicated oils or herbal preparations into the nasal passages (nasya) helps clear congestion and balance Kapha.

  4. Steam Inhalation: Inhaling steam infused with eucalyptus or mint oil can provide relief by opening the nasal passages.

  5. Herbal Remedies: Ayurvedic herbs like Trikatu (a blend of ginger, black pepper, and long pepper) and Triphala can help reduce congestion and inflammation.

  6. Neti: Nasal irrigation with warm saline water using a neti pot helps cleanse the nasal passages and alleviate symptoms.

  7. Gargling (Gandusha): Gargling with warm salt water or herbal decoctions can relieve throat discomfort and reduce congestion.

  8. Panchakarma: Therapeutic detoxification procedures like Nasya (nasal administration of herbs), Virechana (purgation), and Swedana (steam therapy).

  9. Herbal Formulations: Ayurvedic formulations like Sitopaladi Churna, Talisadi Churna, and Yashtimadhu (licorice) are used to alleviate sinusitis symptoms.

  10. Nidana Parivarjana: Avoidance of causative factors such as cold foods, excessive exposure to cold wind, and excess sweets.

Ayurvedic Lifestyle Recommendations for Sinusitis:

Ayurveda suggests lifestyle practices to prevent and manage sinusitis:

  1. Oil Massage (Abhyanga): Regular self-massage with warm sesame oil to promote circulation and reduce congestion.
  2. Hydration: Drinking warm fluids and herbal teas to keep the nasal passages hydrated.
  3. Sleep Hygiene: Ensuring adequate, restful sleep to support overall immunity.
  4. Breathing Exercises: Practicing Pranayama to improve respiratory health and promote clear breathing.

The Role of Ayurveda in Sinusitis Prevention:

Ayurveda plays a significant role in preventing sinusitis by promoting balanced doshas, healthy digestion, and proper nasal hygiene. By following Ayurvedic guidelines, individuals can reduce the risk of sinus congestion and related issues.

Ayurvedic Researches on Sinusitis:

Ayurvedic texts highlight the use of herbs and practices for managing sinusitis. While scientific research on specific Ayurvedic treatments is limited, studies have explored the efficacy of nasal irrigation and herbal formulations in reducing nasal symptoms.

Challenges and Future Directions:

Integrating Ayurveda into mainstream healthcare for sinusitis management requires addressing challenges such as standardization, evidence-based research, and collaboration between traditional and modern medical systems. Further studies are needed to validate the effectiveness of Ayurvedic approaches.


Ayurveda provides holistic insights into preventing and managing sinusitis by addressing dosha imbalances, promoting nasal health, and adopting a mindful lifestyle. While more research is needed, Ayurvedic principles, herbal remedies, and nasal care practices can complement modern approaches and contribute to better respiratory well-being.

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