What is Sinusitis and What to DO About it?

what is sinusitis? what to do about it?

Image: Sinusitis Can be Miserable (image credit: depositphotos.com)

Hi, and welcome to “ask the boogor doctor,” at boogordoctor.com. Please read my recent note on my gratitude for my readers, and my wish for your Successful and Healthy New Year! The majority of people who visit me here have children who are struggling with sinusitis or asthma. I receive many emails asking for information that is in articles on this site. So to be more helpful to my readers, I thought that it might be time to provide an update, with links to some of those articles. As you know, I focus on children with respiratory ailments, including childhood asthma and pediatric sinusitis. Here is an update to answer these questions:

  • What are the sinuses?
  • What is sinusitis?
  • Who is at risk for sinusitis?
  • What are the complications of sinusitis?
  • How do I “read” a Sinus CT Scan?
  • What are the alternatives to more antibiotics?
  • How can we avoid surgery for our child with chronic sinusitis?
  • How can we detoxify our home?
  • How can we clean the air in our home?
  • If surgery is necessary, what is the best?
  • And much, much more

Sinusitis: Why Do We Care?

Sinusitis is increasingly common. And it’s a huge financial burden: between lost productivity from adults who have sinusitis, to lost hours on the job by parents caring for children with sinusitis, and all of the medications and lab testing, sinusitis costs us about 6 Billion dollars every year in the US!

As parents, we care because some of the complications of sinusitis can be very serious (more below). And we want out kids to be healthy, and safe.

What is Sinusitis?

Technically speaking, Sinusitis is inflammation of the lining of the paranasal sinuses. Practically speaking, sinusitis is infection of these paranasal sinuses. Often a bacterial infection will occur following a viral upper respiratory infection (URI) or “common cold.” The swelling of the lining of the nose, causing the small openings to the sinuses to close off, provides a perfect environment for bacteria to grow and multiply.

Chronic sinusitis is one of the most disabling ailments: some studies suggest that chronic sinusitis has an even more-negative impact on quality of life measurements than other common cronic diseases that we think of as very disabling: like diabetes, rheumatoid arthritis, or heart disease. Here is my article that reviews Sinusitis in Children.

Just exactly what are the “sinuses,” anyway?

You are not born with fully-developed paranasal sinuses. Your sinuses develop over time. And the several pairs of sinuses grow at different rates. Here are the articles that review the anatomy and histology of the nose and sinuses, and development of the sinuses in children. For those of you who don’t want to wade through a long article on anatomy and histology, here are the  ”cliff” notes on sinus anatomy.

Why is Sinusitis Associated with Allergies and Asthma?

Children who are susceptible to getting sinusitis seem to also be those same kids who have asthma, and possibly allergies, and possibly recurrent ear infections, and possibly bronchitis, etc. This is due to something called the Unified Airway. This theory explains why the lining of our respiratory systems shares similar triggers, whether it’s the lining of our sinus or the lining of the middle ear or the bronchi of the lungs. Here is a review that explains the Unified Airway Theory in plain English.

The Truth About Sinus Headaches

In my clinical practice, the majority of children who were sent to me over the years because they had “sinus headaches” did not have sinusitis! Here is an article on the myth of sinus headaches, and what the national studies tell us is the real cause of those “sinus heaches.”

Complications of Sinusitis in Children

There are a variety of potential complications that can develop from sinusitis in children. Fortunately, most of the life-threatening complications are very rare in this day of antibiotics, advanced surgical and intensive hospital care. However, we do still see some of these complications of sinusitis, including some that are potentially lethal.

Again fortunately, the majority of sinusitis can be managed with avoiding surgery. There are several populations of children who are at increased risk for complications. These children must be monitored closely when they “catch a cold” so that early signs of evolving sinusitis can be more aggressively tackled. Here is an article on the risk of sinusitis complications in high risk children, and another article on the “Ciliopathies,” also known as dysmotile cilia syndrome, or primary ciliary dyskinesia (download FREE pdf). Also see the blog post on cilia function.

Amazingly, the way to prevent most of these complications is easy, and nothing to do with antibiotics! Read about the best, simple cure in this article about a 3-year-old boy who was hospitalized for severe sinusitis.

Your eBook provides excellent value for my money! The book provides easy steps to cleanse your LIFE of harmful chemicals that are known culprits to modern diseases. While these chemicals (and persticides) were meant to make our lives “easier” they have done nothing but pollute our bodies and our earth. Our lives will be so much healthier if only every one of us follows these simple steps you have mentioned – instead of buying a plastic bottle of expensive “tap water” I would recommend buying your ebook :)
Saba, Scottsdale, AZ

Why is Sinusitis Increasing?

I can only speculate, but it seems pretty clear to me: there are increasing pollutants in our lives. Pretty simple fact: there are more than 2,000 chemicals that can be measure in your blood today, that did not even exist when your grand-parents were children. They’re all synthesized, “man-made” chemicals. And they don’t belong in your body. None of them are good for you. They are toxic pollutants.

What is the effect of these pollutants on the lining of the nose and sinuses? Here is my article about the human pollution experiment.


What to DO About Sinusitis?

Perhaps your pediatrician has told you that your little boogor-head has sinusitis. Perhaps your child with asthma keeps getting sinusitis that triggers their asthma. Whatever the reason, you’re dealing with sinusitis now.

First order of business: Teach Your Child to Blow Their Nose!! You parents out there recognize that this is not necessarily an easy task. My friend, Dr. Hana, gives us some easy tips in that article. Thanks, Dr. H!

All the information above is just background. Now we’re getting into the useful stuff (like those two eBooks).

The first bits of information that you should be armed with when entering the medical “corporation” with your child with sinusitis are:

  1. How to “Read” a Sinus CT Scan
  2. What to Expect (and how to prepare your child) for Your Child’s CT Sinus Scan

Next, understand that chronic sinusitis is different from acute sinusitis. Once your child experiences several bouts of sinusitis, there is a likelihood that the bacteria that are causing it are never really going completely away. They simply stop growing and dividing, and wait for the course of antibiotics to wash away, and then they start again.

You may be familiar with this phenomenon, whether it’s ear infections, sinus infections, or whatever: your child gets better while they are on the antibiotics, but the problem is back only two weeks after they complete their antibiotics. Sometimes even sooner!

This is most often the result of bacteria that form a biofilm. And it can be very difficult to eliminate. Here is an article on Biofilm and Chronic Sinusitis. Because I personally struggled with my own chronic rhino-sinusitis (CRS) for decades, and because I managed these children in my Rhinitis/Asthma/Sinusitis Center, I am very familiar with how to get rid of chronic sinusitis caused by biofilm.

Know that my approach is to use Integrative Medicine: that is, any remedy that has evidence to back it up; evidence from randomized, controlled clinical trials. There are some good studies in the area of complementary and alternative health for children, now that NIH has been funding better research studies. Let’s start with the 8 Basic Principles to Control Your Child’s Sinusitis (download free pdf). That’s the place to start for managing your child’s sinusitis. Then consider this 5-Step Program to Eliminate Chronic Sinusitis. You may not be able to do every step for your child, but do what you can.

If you are struggling with a child who has asthma or chronic sinusitis – or, commonly, both – you should be aware that reflux (GER) is a common factor in these respiratory ailments. Another common cause of allergies, asthma, and sinusitis in children is dust mites. Dust mites are ubiquitous; they are in every human home! Here are 12 Steps to Reduce Dust Mites in your home.

Control those allergies:

Common Causes of Childhood Allergies

Image: Common Causes of Childhood Allergies – You CAN Control These

Finally, here is the main-stay of “curing” chronic sinusitis – for children and adults: Nasal Saline Rinses.

Here are the links to the 4-Part Series on The Benefits of Nasal Saline Rinses:

  1. Nasal Saline Rinses: What Good Are They? The Concept
  2. Nasal Saline Rinses: What Good Are They? The Medical Evidence
  3. Nasal Saline Rinses: What Good Are They? How to Do It
  4. Nasal Saline Rinses: What Good Are They? How to Make Your Own

Now, you may have heard some scary news articles about a year ago on “Brain-Eating Amoeba” from people doing saline nasal rinses. Because I use saline nasal rinses every day of my life (to prevent my CRS from returning), I was understandably concerned.

So I called up an expert on Amoeba, Dr. Robert Tolan, and asked his expert opinion. It was a pretty interesting conversation, because he told me that his wife struggles with sinusitis, and that she does nasal saline rinses. Here is my report on my Conversation with Dr. Tolan Regarding “Brain-Eating Amoeba.” Bottom line: you must use either boiled water, or distilled water from the store, especially if you live in the Southern United States, where amoeba are endemic in the water supply!!!

More Natural Tools for Combating Chronic Sinusitis

Because I struggled with my own chronic sinusitis for so many years, I diligently read every new research study that was published. And, when the remedies were backed by good, solid evidence (randomized, controlled, double-blind trials), I added those tools to my toolkit to fight sinusitis.

Here are a couple things that you might consider in your own fight against sinusitis:

Honey: Honey has innate antimicrobial properties. Humans have used honey to fight infections for thousands of years. You can download my FREE pdf on the benefits of honey.

Not all honey is created equal with regard to the antimicrobial strength. Here is a recent update on the best: The Benefits of Manuka Honey Keep Growing.

Quercetin:  Quercetin is an anti-inflammatory, anti-histamine compound that occurs naturally in various fruits and vegetables. Just one more reason to eat lots of fruits and vegetables. Consider adding quercetin as a supplement if you struggle with asthma, allergies, or sinusitis. Read this article on Quercetin for Asthma, Rhinitis, and Sinusitis for details. Here is the Amazon affiliate link for the quercetin that I use (it’s the Orthomolecular “D-Hist” product. Note that we use the “Dehist-Jr” for our kids).

Xylitol:  Like honey, Xylitol is powerful antimicrobial that occurs in nature. For treating chronic sinusitis, it often helps to have nasal saline rinse solution that is stronger than physiological concentration – “hyperosmotic.” The problem is that making it stronger concentration by just adding more salt to the solution also makes it burn. Here are a couple Amazon affiliate links for Xylitol products:

The other way to make the saline higher osmolarity is to add something that is not a salt: honey or sugar come to mind. Honey is okay, because it has innate anti-bacterial properties. Normal table sugar, though, invites bacterial growth. That’s where the Xylitol comes in. Read this article on the Benefits of Xylitol. Thanks to my friend, Dr. Lon Jones, Xylitol is easy to get these days. Be sure to check out his company, Xlear, for some of those great products (no financial relationship; just good products).

Two Valuable Resources for Parents: I want to give a shout-out to a couple of awesome resources for parents; a couple of folks who happen to be dear friends (for transparency: I have no financial relationship with them).

When Surgery Becomes Absolutely Necessary

Finally, what to do when you’ve tried EVERYTHING else for your child? What to do then?

  1. When Your Child Absolutely MUST Have Sinus Surgery: Part 1
  2. Part 2: Minimally-Invasive Sinus Surgery (Balloon Sinuplasty)

I hope that answers some questions about sinusitis: I hope it’s enough, and not too much.

Thanks for visiting, and see you here next time. Until then, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)


Hi, I’m Russell Faust, author of this medical education blog. That wonderful photo of me is by Chris Stranad; here is his site: http://www.chrisstranadphotography.com/Index.html

Russell Faust, PhD, MD boogordoctor / healthy children
Image: Dr. Faust and friend

Let me know what topics are important to you and your child’s respiratory health. Join the conversation by leaving a comment / reply below, or email me any time. Thanks for visiting, see you here later. In invite you to subscribe to this blog (it’s FREE). Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email. It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time. Stay informed. Stay healthy.




  1. Lauren Harvey says:

    Hi Dr.Faust,
    Thank you so much for all of this information. I have been following your blog for over a year now and my son’s health has improved over that time using xylitol nasal rinses among other things you’ve mentioned, but unfortunately multiple doctors have recommended surgery. I’ve heard a lot about essential oils lately and just wanted to get your thoughts. (If you’ve already blogged about this, please point me to the article)

    Thank you,

    • Russell A. Faust, PhD, MD says:

      Hi Lauren,
      Thanks so much for your kind comments. Hearing from parents like you, that your children are improving, makes my day!
      I did write a post on essential oils, here is the link: http://wp.me/pR4iB-1l7
      I list the oils that we use in our family on the boogordoctor Amazon Store affiliate link.
      Note that those are the normal, great Amazon prices (but anything you buy through that link brings a small commission back to help support this site).
      How old is your son, and why are they telling you that he needs surgery? What sort of surgery? Sinus surgery? And who is telling you that he needs surgery: pediatricians? pediatric ENT? Has anyone discussed balloon sinuplasty with you? Here is the link to that article: When Your Child Absolutely MUST Have Sinus Surgery.
      Thanks again for visiting, and for sharing. Please keep me updated.

      • Lauren Harvey says:

        Thank you so much for your reply and the link. I will definitely be reading up on essential oils. My son is only 2 but at 3 months landed in the hospital for a week with rsv. Since then he has had an over production of mucus, multiple sinus infections, viruses, pneumonia, etc. He has had tubes put in, a bronchioscopy, a ct scan which revealed that he was very miserable. This led to 2 cf tests(negative) and 1 ciliary dyskenesia tests(inconclusive). In order to more accurately diagnose it was recommended by ent and supported by pulmonologist that a biopsy be done and while he was under anesthesia to take out adenoids and balloon the sinuses. In the meantime his immunities were checked for the prevnar 13 vaccine and they were very low to minimal. He was re vaccinated 2 months ago and we are going back soon for the pneumo vaccine. Since this vaccine we have seen tremendous improvement, which gives us hope that he doesn’t have c.d. and that we won’t have to end up putting him through surgery. I’d LOVE to hear your thoughts on all of this!

        • Russell A. Faust, PhD, MD says:

          Hi Lauren,
          I am going to assume that your son is NEVER exposed to tobacco smoke. I can’t tell you the number of times that parents would bring me their children with chronic rhinosinusitis, bronchitis, chronic otitis media, a history of ear tubes and bronchoscopy; I would ask them if they smoked, and they would either (1) tell me that they did not, even though they smelled like an ashtray from their last cigarette; or (2) admit that they smoked, but insist that their child was NEVER exposed. The reality is: if you smoke, even if you go outside every time, those toxic particles come in with you – on your clothes, in your hair, and your child is exposed.
          Sorry for the rant. Our kids deserve better.
          SO: I am going to assume that you do not smoke, and that your child is never with anyone who does.
          If that is the case, he MAY have CD, but as you have learned, that is a difficult diagnosis to make with certainty. The challenge is that ANY inflammation (recent URI/”cold,” for example) can cause changes in the cilia that are similar to CD. So it can be difficult to tell.
          But whether that is the diagnosis or not, your son will require similar care: his best quality of life will result from you treating him as if he does have CD. That is, maximize everything you can do to keep his respiratory mucosa healthy: daily saline rinses; natural anti-inflammatories (consider things like Quercetin/Bromolain); Pneumovax and HibVax are a good idea, etc.
          Regarding surgery: you may be pleasantly surprised how much benefit he obtains from only an adenoidectomy. The adenoids can retain pathogens and biofilm-forming bacteria that are difficult to eradicate.
          My best advice: find an ENT who you trust and who listens to you, and work together with them for the best healthcare or your son.
          Best success, and please keep me updated.

          • Lauren Harvey says:

            Dr. Faust, we are definitely on the same page regarding cigarette smoke. My son is never exposed to this type of environment, even in public places we immediately leave a location if invaded by a smoker. I have also eliminated all curtains, stuffed animals, bath mats and almost all carpet to reduce dust. We will certainly be trying these anti inflammatories and essential oils. I will also inquire about the HibVax when we take him for the pneumo vaccine. As far as an ENT, this is where we are limited. There is only one practice in my area with outstanding credentials. So we may have to venture to Houston to feel more comfortable with the idea of surgery. Thank you so much for your thoughts and ideas so far and taking time out to talk to me. I hope you know how greatly appreciated you are in my household! I’ll keep you updated!

          • Russell A. Faust, PhD, MD says:

            Lauren: sounds like you’re doing all the right things, good! You might consider tracking down a Naturopath for some suggestions. There are a few in San Antonio. If you do move toward surgery (balloon sinuplasty, for example), Houston is a good bet.
            Again, thank you for your kind words.
            And please keep me updated.

  2. Hello Dr, I am about to start the nasopure sinus rinse, and I would like to know how much honey manuka should I add in the 8 onz bottle for my sinus?

    • Russell A. Faust, PhD, MD says:

      Hi Karin,
      For my own use, I simply add 1-2 heaping tablespoons to the Nasopure squeeze-bottle. It’s not a science. Ideal concentration is about 10%, but it’s unlikely that you will get to that level.

  3. Celia Austin says:

    Dr. Faust,
    I came upon your site, a few weeks ago, as I was again searching for information. I have been sick since 07/2011. It took 6mo. to establish that I have chronic sinusitis. I have had multiple rounds of antibiotics & steroids. I have had multiple xrays & just had my fourth sinus scan. I had balloon surgery in May 2012 & April 2013 & will probably have a 3rd ( scar tissue). Finally getting allergy workup & some immune testing. I have a past history of pollen(hay fever) allergy & recieved “allergy” shots as a kid. Because of the sinus issues I now have asthma issues & use inhalers. I’ ve been doing saline rinses since my first surgery. And since reading your suggestions, l have started using manuka honey, in my rinses. Any thoughts or suggestions? I am happy with my ENT, but we’re both at a loss.
    Thank you for your site, Celia

    • Russell A. Faust, PhD, MD says:

      Hi Celia,
      I feel your pain! Sounds miserable, and familiar (sounds much like my own history with CRS).
      Addition of Manuka honey (with high UMF) is a great idea. I buy my Manuka on Amazon (affiliate link).
      My only other suggestion is to get your hands on two books – the books that helped me the most, and that take the most ‘holistic’ approach to managing CRS. The first is by Dr. Josephson: Sinus Relief Now. The other one is by Dr. Ivker: Sinus Survival. Both books are available on the boogordoctor Amazon Store at Amazon’s best price.
      Please keep me updated,
      and best success!

  4. Marianne Prince says:

    Dr Faust, I am getting good results with the honey, xylitol, and baby shampoo rinses. I have ordered a low intensity, pulse ultrasound. I will let you know the results of that. I was wondering if you would comment on the report in pub med about the use of topical ofloxacin (eye drops) as a nasal rinse 2x/day for 8 mos. which resulted in complete remission of biofilm in 80% of chronic sinusitis sufferers tested and 20% had only patches of biofilm with cilia function returned. It was a small study. Thanks, Marianne

    • Russell A. Faust, PhD, MD says:

      Hi Marianne,
      I LOVE it when readers have done research (I’m a research geek!)!
      That is a very cool study. And yes, small, but very promising. Ofloxacin is one of the Ciprofloxacin derivatives, all very effective against the biofilm-forming bacteria like pseudomonas. You can certainly add Ofloxacin to your nasal rinses, but beware of one requirement, and one risk:
      The requirement is that Ofloxacin requires a prescription, and it may be challenging to find someone to write a prescription for use of Ofloxacin in nasal rinses (it is, as you point out, intended as eye drops). The risk is this: if you do not eradicate all of the offending bacteria, those that survive will have (potentially) developed resistance to Ofloxacin, making it that much harder to get rid of them when they return. On the other hand, if you do knock them down with Ofloxacin, and you do continue daily nasal rinses, even weakening them and reducing the biofilm helps eradicate the biofilm and the bacteria. My? I think it’s a great idea. We do this routinely (using another class of antibiotics) for children with Cystic Fibrosis; nearly all of them have severe biofilm chronic rhinosiusitis.
      Thanks so much for sharing that report, and for reminding me of this approach!!

  5. Hello Dr. Faust,
    I came across your site after a ‘second opinion’ appointment with an ENT for my son…I left feeling like I needed a 3rd opinion. My son is 4, soon to be 5. In the past year he had allergy testing and was diagnosed with asthma. He is not allergic to much at all, however he appears symptomatically to be suffering from them. (Dark under eye circles, tired, constant post nasal, cough, asthma, headaches)
    He just had a ct done, which showed completely full sinuses, all of them. He does not have a history of pneumonia, hospitalization or even been diagnised with a sinus infection. At this point he does not even have a runny nose, so it all must really be packed in his sinuses. It was recommended we get him tested for CF. Now I am wondering if his asthma ever was asthma, maybe it is CF? Have you see pansinusitis in children before who do not have CF? I started saline rinses today (at your advice) and wondered what % you recommend. I purchased two, started with the hypertonic. Should I use it 2x a day. We see the ENT again in a couple days. I just want to get to the bottom of this so he can begin to function as a 4yr old should.

    • Russell A. Faust, PhD, MD says:

      Hi Kelly,
      I have definitely seen children with pansinusitis who do not have CF…and all of them had asthma. Of course, we tested them for cystic fibrosis. Some small percentage of those children have “ciliary dyskinesia,” where the cilia don’t function properly. Most of those, however, have severe ear infections and recurrent pneumonias in addition to sinus troubles.

      For all of those children, nasal saline rinses are a great option.

      Starting with hypertonic saline is a good choice, as long as it’s not so hypertonic that it burns. Please take a look at the videos of children doing nasal rinses on the Nasopure.com website – that website is a valuable resource for parents like you, especially the videos. Watching those videos helped persuade my own children to try saline nasal rinses.

      In Ohio: I’m more familiar with the sinus docs in Columbus than Cleveland, but both cities have excellent sinus specialists. Nationwide Children’s Hospital, in Columbus, has some of the best children’s sinus specialists in the world! If you go there, tell them I sent you.
      Thank you for sharing, and best success! (and please keep me updated)

Speak Your Mind