Each year, more than 30 million Americans suffer from sinus issues, including sinusitis and allergic rhinitis, better known as hay fever. That’s a lot of runny noses. Sinusitis, or inflammation of the sinuses, can be the result of acute infection, but in many cases the culprit is chronic, low-grade irritation due to allergens. The end result, according to the American Academy of Allergy, Asthma & Immunology, is 30 million doses of antibiotics and more than 40,000 surgeries a year—yet few mainstream medical options are effective in treating sinusitis, especially the chronic type. That leaves the door open for natural solutions to sinus health.

According to Alonzo Jones, a doctor of osteopathy, a retired physician specializing in family practice medicine and former clinical assistant professor of family medicine at Texas Tech Health Sciences Center, more than 90 percent of all bacteria, funguses and viruses that affect our health enter the body through the nasal passages. “Sinus health is often overlooked, but it can be the root of so many other problems,” adds Brian Craig, vice president of international sales for Xlear, a xylitol nasal–spray manufacturer based in Orem, Utah. Chronic, low-grade infections, for example, can affect the body’s immune response to other pathogens. The good news: Many natural products can help relieve both the immediate symptoms and the underlying causes of sinusitis.

The causes and symptoms of sinusitis
“For people dealing with sinus issues, the mucus membranes, the sinuses, the nasal and even the bronchial passageways are inflamed, and it can take continual effort to keep that inflammation down,” says Keri Marshall, ND, medical director for Gaia Herbs in Brevard, N.C. “Pollen, dust, dander and food sensitivities can all be triggers for inflammation.”

The immediate symptoms of sinusitis include sinus headaches, congestion and runny nose. But the underlying cause is the body’s own immune response to “invaders,” whether they’re bacteria or pollen, which causes an increase in mucus production.

“You need to treat both the symptoms and the underlying problems,” says Diane Heatley, MD, an otolaryngologist at the University of Wisconsin department of surgery.

Sprays and irrigation
Nasal sprays and irrigation methods, like the neti pot (see “To neti or not to neti,” left), are some of the most common treatments for sinusitis, both in the natural channel and in mainstream over-the-counter products. The basic neti pot has been used in Ayurvedic medicine for thousands of years, while modern versions like the SinuCleanse, endorsed by Heatley, can be found in mainstream pharmacies.

Sinus sprays are less thorough than irrigation, but offer similar benefits, often with added ingredients beyond saline. “The term ‘nasal sprays’ can incorporate a lot of different products, from simple purified water to saline sprays or even antihistamine or steroidal drugs,” Craig says. Although some of these ingredients are beneficial, the steroidal prescription drugs can exacerbate the problem by drying the mucus membranes, he says.

Xlear was the first manufacturer to include xylitol in a saline base; its products were developed by Alonzo Jones based on the strong research showing xylitol’s power to prevent tooth decay. New research shows its effectiveness in sinusitis treatment and prevention as well.

“Xylitol is an interesting additive,” says Heatley. “It’s a sugar that bacteria can’t digest. The theory is that bacteria responsible for sinusitis will eat it up, and because it’s non-nutritive they’ll die off.”

Though xylitol doesn’t kill bacteria like antibiotics do, a 2004 study published in the Journal of Antimicrobial Chemotherapy showed that xylitol reduces bacteria by causing them to lose the ability to stick to tissues in the body. The result is a dramatic reduction of bacteria in the upper respiratory system.

Saline sprays and inhalers can be used as a delivery system for almost any ingredient. For example, Redd Remedies, a manufacturer based in Bradley, Ill., offers the Seasonal Sinus Support Aromatherapy Inhaler that includes organic eucalyptus, rosemary, lavender and pine to soothe and relieve symptoms. A 2008 study in the American Journal of Rhinology showed that lavender, eucalyptus and menthol oils increased the movement of cilia that carry mucus out of the sinuses.

Anti-inflammatory flavonoids for fast relief
Flavonoids, the potent antioxidant compounds found in plants, are one of the hottest trends in sinus products. “Herbs rich in flavonoids are highly effective at relieving allergy symptoms. They work in two ways: First, they help stabilize mast cells—the cells that release histamine and cause allergic reactions; second, flavonoids have specific anti-inflammatory properties and so can decrease allergic reactions,” says Roy Upton, a registered homeopath and executive director of the American Herbal Pharmacopoeia, based in Scotts Valley, Calif.

“Nettle leaf is one of the best-studied botanicals for sinusitis because it works as a natural antihistamine,” says Marshall. Other common bioflavonoids found in sinus capsules and sprays include quercetin and bromelain, both research backed. A 2007 study in Inflammation Research showed that quercetin acts on mast cells to reduce inflammation response. And a 2006 study in Otolaryngology—Head and Neck Surgery showed promising results for both bromelain and the European sinus product Sinupret in treating sinusitis and rhinitis.

Sinupret—the subject of an American Botanical Council monograph—contains the herbs European elder, European vervain, gentian, cowslip and sorrel, all high in bioflavonoids. Redd Remedies’ Adult Sinus Support tablets combine quercetin and bromelain with stinging nettle and citrus bioflavonoids, all proven ingredients for reducing inflammation.

A final ingredient to watch in the herbal category: cineole. “This form of eucalyptus oil is clinically proven to support sinus and respiratory health, and can also increase the cilia beat frequencies, which move bacteria and foreign objects out,” says Alyssa Peterson, associate business manager at Green Bay, Wisc.-based Enzymatic Therapy, manufacturer of SinuCheck, which contains a standardized extract of eucalyptus oil. Research supports cineole’s ability to help the body eliminate mucus, and a 2008 study in European Archives of Oto-Rhino-Laryngology showed statistically significant reduction of sinusitis symptoms using cineole.

Long-term strategies
Some products focus on general immune and respiratory support in order to address the underlying causes of acute sinusitis symptoms. These products, such as Enzymatic Therapy’s SinuGuard or Gaia’s Respiratory Defense and Aller-Leaf, tend to combine well-researched herbs with a wide array of properties, including immune supporters such as echinacea and goldenseal, antihistamines, antibacterials and anti-inflammatories like turmeric. They’re designed to support healthy sinus and respiratory function over the long haul, and can be used to help decrease the likelihood of full-blown sinusitis.

Homeopathic options
Many homeopathic remedies are available for sinus issues, in liquid, tablet and spray forms. Generally, homeopathic combination formulas include a variety of ingredients recognized in the homeopathic pharmacopoeia for treating condition-specific issues.

“Our combination [Sinna Nasal Spray] is a really a shotgun approach,” says Eileen Sheets, director of regulatory affairs for Bioforce USA, based in Ghent, N.Y. “It’s a big seller for us, because when people take it they notice a quick onset of symptom improvement, whether they’re stuffed up or have runny noses.”

Other homeopathic products are intended to support respiratory health and prevent sinus problems. “For many people, sinus issues are due to allergic reactions, and when that’s the case, you want to treat the underlying allergy, not just the symptoms,” Sheets says.

Mitchell Clute is a Fort Collins, Colo.-based freelance writer.