Sinusitis is a prevalent and important common cause of ill health in adults. In U.S. alone, an estimated 20 million cases of Acute Sinusitis occur each year. Sinusitis is the third to fifth most common diagnosis for which antibiotic is prescribed within primary care settings in Nordic countries (Andre 2002: Rautakoepi 1999) and the U.S. (SAHP 2004) and accounts for 15% to 21% of all antibiotic prescriptions for adults in outpatient care.

    The prevalence of Sinusitis is rising. Between 1990 and 1992, persons with Sinusitis reported approximately 73 million, restricted activity days—an increase from the 50 million restricted activity days reported between 1986 and 1988.

    A Cochrane Systematic Review of Medical Research found that four out of five patients who are seen in primary care with Simple Sinusitis improved within two weeks even if they had not been given antibiotics. Although statistical significance for antibiotics was found, the clinical significance of the results for antibiotics is questionable because of the considerable improvement rate in the placebo-group and because the benefit of the possible faster cure rate needs to be weighed against the potential for adverse effects at both the individual and population level.

    The economic impact of rhinosinusitis was $5.8 billion. A primary diagnosis of Chronic rhinosinusitis accounted for more than 50% of all expenses. To these costs, indirect cost need to be considered as well, such as days of work lost. In addition, Sinusitis can adversely affect other aspects of quality of life, Mastsui et al. observed an decline of cognitive function in elderly people using the Mini- Mental State examination.

    The various root causes of sinusitis can be broadly divided into three categories: anatomical, genetic and environmental (Table 1), with these factors the sinus gets inflamed and the cycle begins (Figure 1).

Table 1: Root causes of sinusitis

 

Figure 1: The sinusitis cycle

Symptomatologies of sinusitis according to the duration of disease are as follows:
- Acute Sinusitis is defined as symptoms and signs for less than 4 weeks which includes facial pain, headache, purulent nasal discharge, decreased sense of smell, and fever, preceding common cold, purulent rhinorrhoea, pain on bending, unilateral maxillary pain, and pain in the teeth.

- Chronic sinusitis persists 8 weeks or longer labeled with symptom complex of purulent nasal discharge, nasal obstruction, facial pain, headaches, chronic cough, and halitosis

complications of sinusitis are varied and multiple are depicted below

    Many laboratory investigations assist in diagnosing sinusitis. X-ray examination of sinuses, ultrasonography, computed tomography, sinus puncture and culture of aspirate but recent immunological based studies elicit that patients suffering from chronic sinusitis has deficiency in IgG3 subclass interestingly IgG4 was the only immunoglobulin subclass that correlates with extent of disease, while another study finds that the patients deficit of IgG4, alternatively, the level of total IgE could serve as a phenotypic marker for a candidate gene or genes associated with an exaggerated inflammatory response of the sinus mucosa.

    In Homoeopathy several studies were done using complex homoeopathic interventions and the results were encouraging. There are also several individual case records which proves the efficacy of Homoeopathic medicines when prescribed on individual totality
Central Council for research in Homoeopathy has also undertaken a clinical research study entitled, ‘A Disease related open clinical trial to evolve a group of efficacious Homoeopathic medicines in chronic sinusitis’ based on well designed standardized protocol, keeping an eye on the various laboratory parameters and questionnaires.

    From the above review it can be concluded that the burden of Sinusitis is global and Homoeopathy has vast sphere to show its effectiveness. However systemic evidence based research needs to be done. But to do that the various points mentioned below needs to be considered:

a. Homoeopathy is a holistic science. So study should be taken considering health related quality of life questionnaire.

b. The pre and post investigations of all the cases should be maintained and the study to be analyzed statistically.

c. Various immunological biomarkers like IgG3, IgG4 and IgE can be taken into account to further validate the outcome.

d. Crossover study can be taken between Conventional drugs and Homoeopathic medicines to see their comparitive effectiveness.

e. Comparitive study of various types of Homoeopathic prescriptions can be taken to see their effectiveness.

f. Controlled study of Homoeopathic medicines in Sinusitis with conventional medicine as positive control.

g. In vitro studies can be taken up for various microbial causes of Sinusitis with Homoeopathic medicines.