FAQ for Alt.Support.Sinusitis, Ver. 5.3

  CONTENTS

    * What is Sinusitis?
         + Diagnosis
    * Why Sinusitis Sucks
    * Role of the Immune System
    * Allergies
    * Irrigation
         + Irrigation Techniques
         + Saline Solution
         + Irrigation Additives
         + Risks
    * Hydration
    * Other Home Remedies
    * Drugs
         + Antibiotics
         + Steroid Nose Sprays
         + Decongestants
         + Mucolytics
         + Antihistamines
         + Pain Medications
    * Alternative Medicine
         + Candida
    * Prevention
    * Surgery
         + Choosing a Surgeon
    * Web Sites and Books

  DISCLAIMER

  This FAQ is designed to provide core information about sinusitis.
  It's an attempt at a middle-ground approach, not too far toward the
  "antibiotics and surgery" leanings of traditional medicine, not too
  far toward the "it works for me/anything goes" leanings of alternative
  medicine.  This FAQ isn't designed to cover all issues related to
  sinusitis.  If you have questions not answered here, visit the Web
  sites mentioned at the end of this FAQ or post your questions in the
  newsgroup alt.support.sinusitis.

  This FAQ is informational only and should not be regarded as medical
  advice.  The author has worked as a medical writer but is not a
  medical doctor.  If you have symptoms, or if you plan to initiate
  treatment or undertake a change in treatment as a result of this
  information, you should consult a doctor.  This FAQ is provided as is
  without any express or implied warranties.  While every effort has
  been taken to ensure the accuracy of this information, the author does
  not assume responsibility for errors or omissions or for damages
  resulting from its use.

  WHAT IS SINUSITIS?

  Sinusitis is an inflammation of the sinuses, usually caused by a
  bacterial infection.  It's considered acute if it's short-lived and
  chronic if it's long-lasting -- longer than three months, according to
  most doctors.  Chronic sinusitis is sometimes also defined as four or
  more occurrences of acute sinusitis in a year.  Chronic sinusitis
  presents the same kinds of symptoms as acute sinusitis though they may
  not be as severe.

  Acute sinusitis is often preceded by a cold, flu, or allergy attack,
  which inflames the sinus membranes and blocks the sinuses' drainage
  openings (ostia).  Mucus collects, providing a breeding ground for
  bacteria.

  Chronic sinusitis is often preceded by too many cases of acute
  sinusitis, which cause the ostia to swell shut permanently and
  bacteria to grow continuously.  Chronic sinusitis may also accompany
  other structural changes in the sinuses, including thickened and
  stagnant mucus, a paralysis of the tiny hairs (cilia) that are
  designed to sweep mucus, bacteria, allergens, and other foreign matter
  out of the sinuses, nasal polyps (growths), and swollen nasal
  turbinates (areas inside the nose that warm and moisten inhaled air).
  Sometimes chronic sinusitis may not involve an infection at all but
  chronic inflammation, a blockage of the ostia, a buildup of mucus, and
  sinus pressure and pain.  In a small percentage of chronic sinusitis
  cases, the cause is immunological deficiency, as determined by a blood
  test.

  Sinusitis is more common than many other better-known health problems,
  such as hypertension and arthritis.  It affects 15 percent of people
  each year, according to the American Academy of Otolaryngology.  Some
  experts believe that sinusitis is increasing in frequency as a result
  of air pollution and exposure to colds and flu from daycare centers.
  Other experts feel that sinusitis is only apparently increasing in
  frequency as a result of better diagnostic techniques.  And some
  experts feel that sinusitis is overdiagnosed, that only about half of
  patients who see doctors for symptoms of sinusitis actually have the
  condition.  According to one statistic, more than 85 percent of people
  with colds have inflamed sinuses, though unlike with true sinusitis,
  symptoms are typically brief and mild.  Between 0.5 and 5 percent of
  people with colds develop true sinusitis.

  Diagnosis

  The symptoms of sinusitis are often similar to those of colds or
  allergies, which can make diagnosis tricky.  Sinusitis, however, is
  more often accompanied by facial pressure or pain, particularly when
  bending over, thick yellow or green mucus rather than clear or whitish
  mucus, and post-nasal drip, particularly at night, leading to a sore
  throat.  Also, acute sinusitis typically lasts longer than the 7 to 10
  days of a common cold.

  Yellow mucus is a possible indicator of a bacterial sinus infection
  but not a definitive one.  Mucus can turn yellow as a result of sinus
  inflammation without infection or as a result of mucus drying out.

  Doctors also look for swelling, tenderness, and redness of the skin
  over the cheekbones (these symptoms are usually worse in the
  morning).  They may use transillumination by shining a bright light in
  a darkened room against the cheek or forehead, looking for blockages.
  They may look at the sinuses directly with a flexible tube inserted
  into the nose called an endoscope.

  For chronic sinusitis doctors often order a CT scan (computerized
  tomography, sometimes written as CAT scan and pronounced "cat scan"),
  which is a specialized X-ray technique.  CT scans are more accurate in
  diagnosing sinusitis than conventional X-rays (plain film radiography)
  or MRI (magnetic resonance imaging), but reports indicate that they
  still have a false negative rate of 5 to 10 percent, meaning they
  don't identify sinusitis in a small percentage of cases.

  Some patients have reported that neither an endoscope nor a CT scan
  identified their sinusitis as the infection was in the bone and
  required nuclear bone imaging, also called a bone scan, for a proper
  diagnosis.

  It's important that sinusitis be diagnosed and treated because, if not
  treated, it often just gets worse.  Acute sinusitis should be treated
  no later than two to three weeks after symptoms appear.  If not
  treated acute sinusitis can structurally damage the sinuses and turn
  into chronic sinusitis, which is more difficult to treat and may
  require surgery.

  Sinusitis can clear up on its own (60 to 70 percent of patients
  recover from acute sinusitis without need for an antibiotic, according
  to the American Academy of Allergy, Asthma and Immunology), but in
  rare cases untreated sinusitis can lead to other more serious health
  conditions involving the eyes, the bones of the face, and the brain,
  including osteomyelitis and meningitis.

  WHY SINUSITIS SUCKS

  Sinusitis feels like a cold that never goes away.  It often hurts.  It
  reduces your energy level (and is sometimes misdiagnosed as chronic
  fatigue syndrome).  It can cause mental fog.  It interferes with
  sleep.  It can dull your senses of smell and taste, make you hoarse,
  and give you bad breath.  It costs time and money in trying to manage
  it.

  On the other hand, for most people, sinusitis is manageable.  After
  discovering the techniques that work for them, many people report a
  considerably improved quality of life.

  Treating sinusitis is as much art as science.  While there is common
  ground, each person with sinusitis is different.  What works for me
  may not work for you.  Some ENTs (ear, nose, and throat specialists)
  are better than others in treating patients as individuals, keeping up
  on the latest clinical research, and being receptive to viable
  alternative remedies.  (ENTs are more formally known as
  otolaryngologists, pronounced OH-toe-lair-ing-GOLL-e-gists, or
  otorhinolaryngologists, pronounced
  OH-toe-RIE-no-lair-ing-GOLL-e-gists.) Unfortunately, many ENTs are
  surgery specialists and know little about the other aspects of
  sinusitis care.  Medical school forces students to spend a
  disproportionate amount of time learning about esoteric diseases,
  compromising the ability of general practitioners and even ENTs to
  treat common conditions such as sinusitis.

  Ultimately, you should take control of your own healthcare.

  ROLE OF THE IMMUNE SYSTEM

  The best thing you can do for your sinus health is get your whole self
  healthier.  Gravitate toward a healthier lifestyle and a cleaner
  environment to bolster, or rebalance, your immune system.

  Much of sinusitis has to do with the failure of the immune system to
  deal effectively with stressors that bombard everybody's sinuses every
  day -- air pollutants, smoke, dust and dust mites, molds and mildew,
  pet dander, pollen, viruses, bacteria, and fungi.  One of the
  functions of the sinuses is to help filter out this stuff before it
  reaches the lungs.

  Sinuses, however, can overreact or underreact.  Overreacting creates
  an excessive immune system response, which leads to allergies.
  Underreacting, by failing to sweep invaders out, leads to infections.
  With both allergies and infections, excessive mucus production and
  inflammation results, which can block the ostia, leading to or
  prolonging infection.

  There are no quick fixes in rebalancing the immune system.  Eat a
  variety of veggies and fruit (high in phytonutrients, which you don't
  get from typical multivitamin pills) -- strive for five servings of
  veggies and fruit a day -- ten is even better.  Eat less, or no,
  refined sugar (aside from its immune system effects, sugar can also
  prolong sinusitis if you have the type that's caused by the fungus
  candida).  Cut down on fat, particularly saturated fat and transfat,
  and refined carbohydrates such as white bread.  Try eliminating dairy
  to see if it reduces mucus production (some experts feel dairy has no
  effect on mucus production in the sinuses).  Eat less in general --
  habitual overeating taxes the immune system, while moderation plus an
  occasional feast and occasional fast can help you live longer.  Drink
  a lot of water.  Exercise intelligently -- moderate exercise bolsters
  the immune system, while killer workouts can depress it, bringing on
  allergy attacks or sinus infections (it's best to rest, avoiding
  strenuous exercise, during an acute sinusitis attack).  Stop smoking
  and avoid secondhand smoke (which like smoking can paralyze the
  cilia).  Manage stress with meditation or relaxation exercises.  Get
  enough sleep.  Strive to be happy.

  Some people take megavitamins such as vitamin C, herbs such as
  echinacea and astragalus, and foods such as shiitake mushrooms and raw
  garlic to try to strengthen their immune system.  Most doctors and
  nutritionists say a balanced diet and other measures are more
  effective, though some people report positive experiences with
  supplements, herbs, and specific foods.

  ALLERGIES

  Various medical journals have reported that chronic sinusitis is
  associated with allergies in 40 to 80 percent of adults.  Although
  some doctors feel these figures are too high, if you have chronic
  sinusitis or frequent bouts of acute sinusitis, it makes sense to get
  tested for allergies (allergy skin testing).  Allergists are medical
  doctors, sometimes called immunologists, who often employ
  immunotherapy (allergy shots), which desensitizes you to the offending
  allergen or allergens.  Allergy shots, however, work best in highly
  allergic people, work only on certain allergens, and require a
  considerable time commitment.

  Even if you're not formally allergic, common allergens can be sinus
  irritants.  You can employ environmental control to see if this eases
  your symptoms.  Cut down on dust (and dust mites) in your living
  quarters, particularly your bedroom.  Dust frequently, encase pillows
  and mattresses in dust covers, wash blankets in hot water every week
  or two, keep pets out of the bedroom, and use high-quality furnace
  filters if you have a hot-air furnace (disposable 3M Filtrete filters,
  though more expensive, are considerably more effective than
  washable/reusable filters or cheap fiberglass filters, according to
  Consumer Reports).  You might also consider buying an air cleaner
  (avoid ozone cleaners and negative ion generators) and either
  investing in a HEPA (high-efficiency particulate) vacuum cleaner or
  getting rid of rugs entirely.  Clean well and frequently to help
  prevent cockroaches and mold.  Keep humidity levels below 50 percent
  to discourage mold, mildew, and dust-mite growth -- use a dehumidifier
  if necessary.  When working around dust or fumes, wear an appropriate
  mask.

  Another option, though expensive, is to have an industrial hygiene
  company test your home or office.  Industrial hygiene companies
  typically evaluate the indoor environmental quality in industrial,
  commercial, or office settings but will test homes too.  Among other
  things they check the air for bacteria, fungi, carbon dioxide, carbon
  monoxide, and volatile organic compounds, and they look for evidence
  of mold including checking humidity levels and the moisture content of
  building materials.  After their evaluation they recommend remedial
  procedures, and they can either do the remedial work themselves or
  suggest contractors.

  Doctors don't agree on the role that food allergies play in sinusitis,
  since they typically affect the skin or the gastrointestinal tract.
  You can experiment yourself by eliminating one or more of the most
  common sources of food allergens -- wheat, eggs, nuts, soy, fish,
  shellfish, dairy, and chocolate.  Allergists often recommend an
  elimination diet -- you eliminate many foods and reintroduce one at a
  time, noting if symptoms worsen.  An easier technique is to avoid one
  food for a week, then eat lots of it, noting any increase in symptoms.

  IRRIGATION

  The single most effective self-help measure you can take to prevent or
  treat sinusitis is to wash your sinuses daily with salt water.  Sinus
  washing, commonly called sinus irrigation and medically called sinus
  lavage (and sometimes called nasal washing or nasal douching), is an
  age-old practice.  Historically, it's been used more in the East than
  in Western societies, though this is changing as irrigation is
  increasingly being recognized by doctors and in medical literature for
  its health benefits.  Some general practitioners and even ENTS,
  however, still have little knowledge of sinus irrigation or regard it
  as unproven folk medicine, despite numerous studies of it described in
  medical literature, and they don't mention it to their patients.

  What irrigating with saline (salt) solution does is help your sinuses
  do what they're supposed to do themselves -- flush away cold viruses,
  bacteria, allergens, and fungi.  If you have chronic sinusitis, your
  sinuses have lost some or all of their ability to filter out these
  invaders.  Irrigation is compensation for this.

  Irrigation Techniques

  There are a range of irrigation methods to choose from, some more
  effective than others.  Least effective is splashing water up your
  nose at the sink or in the shower and sniffing it in.  Plain tap water
  stings -- the same feeling as getting water up your nose when
  swimming.

  More effective is a bulb irrigator, also called an ear syringe, used
  with salt water.  Its chief benefits are that it's inexpensive, easily
  available, and easily transportable.  Ear syringes are available in
  most pharmacies.

  Next up the effectiveness ladder is the neti pot, which looks a bit
  like a small watering can.  It's easier to use than an ear syringe --
  you're less likely to splash or leak water over yourself -- and it's
  easier to regulate the flow of saline, but it's harder to find.  One
  source is Sinus Survival Products, at 888-434-0033 or
  http://www.sinussurvival.com/, where it's called the SinuCleanse
  System.

  The most effective technique is pulsatile (pulsating) irrigation.
  When liquid pulsates, it does a better job of cleaning -- it digs out
  the dirt.  In the sinuses, pulsation is also thought to stimulate the
  action of the cilia, part of the sinuses' natural defenses, and to
  remove IgE antibodies, which play a key role in allergic reactions.
  Irrigation also suctions out mucus that the saline doesn't reach
  directly through vacuum action (the Venturi effect).

  There are a number of pulsatile nasal irrigation devices available --
  for a listing, see
  http://www-surgery.ucsd.edu/ent/davidson/NASHAND/nasal.htm#NASAL_IRRIG
  ATION.  The most popular pulsatile irrigation device is the Grossan
  Irrigator, invented by Dr. Murray Grossan, which like similar devices
  is an attachment that's used with a Teledyne Water Pik to slow the
  pulsation to a level appropriate for the sinuses.

  You can obtain the Grossan Irrigator in some pharmacies (Bergen
  Brunswig part number 344-598, McKesson part number 1443217), through
  Hydro Med at http://www.sinus-relief.com/ or 800-560-9007, at Health
  Solutions Medical Products at http://www.pharmacy-solutions.com/, or
  in Europe from Inmunotek at http://www.inmunotek.com/xcitekindex.htm.
  You can save money if you buy a Personal Water Pik (at your local
  pharmacy, for instance) rather than a Professional Water Pik without
  losing much functionality.  The professional version, though, is more
  durable, standing up better to corrosion from salt (washing out the
  personal unit after each irrigation can prevent corrosion as well).
  The professional version is also said to be more versatile when using
  saline additives that don't dissolve fully.

  Many people warm the saline before irrigating, though some people
  prefer cooler temperatures.  Warming it helps it break up mucus,
  encourages blood flow to the area, and usually just feels better.
  Anywhere near body temperature is ideal.  One technique for warming
  saline is to simply place the water or solution in a glass and put it
  in a microwave oven for a minute.

  The most common way to irrigate is to bend over the sink and tilt your
  head to the side to help the irrigation solution drain out.  You place
  the irrigation tip in the upper nostril and let the irrigation
  solution drain out of the lower nostril.  However, if you find this
  clogs up your ears, hold your head straight, without tilting it.  If
  you want to help the irrigation solution reach further into the
  frontal sinuses, bend over further, tilting your head downward.  You
  can also tilt your head further to the side to allow the irrigation
  solution to reach sinus tissue it wouldn't reach otherwise.

  Immediately after irrigating, with the irrigation solution still in
  your sinuses, you can optionally tilt your head back to force it into
  other sinus cavities.  Just clinch your nose shut with your fingers as
  you remove the irrigation tip.

  It's recommended that you irrigate your sinuses two times a day when
  you're experiencing sinus or allergy symptoms or if you have a cold,
  or three times a day if you're producing a lot of mucus.  If you have
  chronic sinusitis with only mild symptoms, you should irrigate once a
  day.  If you're trying to prevent a cold or allergy flare-up during
  cold or allergy season, you can irrigate once a day.  If you have no
  symptoms, you typically don't need to irrigate, though some people
  irrigate anywhere from every other day to once a week as preventive
  medicine.  Over-irrigating can compromise the sinuses'
  disease-fighting capabilities -- it removes from the sinuses the
  enzyme lysozyme, which kills bacteria.

  Keeping the Water Pik and Grossan Irrigator clean helps keep common
  household dirt and other contaminants out of your sinuses, where they
  do no good.  After irrigating, run filtered or tap water through the
  irrigator, and rinse off the Water Pik basin and Grossan tip using
  warm tap.  Place a small sheet of aluminum foil over the basin between
  irrigations.  Some people advocate running a small amount of diluted
  chlorine bleach or hydrogen peroxide solution through the irrigator
  every week or so.  This is especially good practice if you haven't
  used the irrigator in a while and are about to do so.

  Saline Solution

  There are a number of ways of obtaining saline solution for
  irrigation.  First, you can mix it yourself.  The optimal salinity is
  obtained by adding one level teaspoon of salt to a U.S. pint of water
  (a U.S. pint is 16 ounces or 0.47 liter).  Alternately, you can add
  one-quarter teaspoon of salt to 4 ounces (0.12 liter) of water.  This
  creates an isotonic solution -- same salinity as human blood and other
  body fluids.  Some people prefer a saltier (hypertonic) solution, up
  to two teaspoons of salt to a pint of water, which can pull moisture
  out of the sinuses and help shrink swollen mucous membranes.  In some
  people, however, hypertonic saline solution can impair the cilia and
  dry out the sinuses, compromising their disease-fighting ability.

  It's best to use canning, pickling, or kosher salt rather than table
  salt or sea salt, as they contain fewer impurities, and to use
  filtered or distilled water for the same reason.  You can obtain
  canning, pickling, or kosher salt in some supermarkets and health food
  stores.  Some people do fine, though, with tap water and table salt.

  Some people find that saline solution itself burns from its slight
  acidity.  You can neutralize this by adding a pinch of baking soda
  (sodium bicarbonate) to the saline.

  The second way to obtain saline is by buying it prepackaged, which is
  more convenient though slightly more expensive.  Sinus Survival
  Products, at http://www.sinussurvival.com/ or 888-434-0033, sells 80
  packs of saline mixed with baking soda for $5.95, or from about 15
  cents per irrigation.  Canning salt is used, at a ratio of four parts
  salt to one part baking soda, according to a spokesperson at the
  company.  Each packet contains a half teaspoon of salt, so add it to
  eight ounces of water.

  The latest development in saline solution for sinus irrigation is the
  use of Ringer's solution, which has been used intravenously for many
  years.  Along with sodium chloride (salt) and sodium bicarbonate
  (baking soda), Ringer's solution also contains potassium chloride and
  calcium chloride.  One new study (Boek WM.  Laryngoscope, 109(3):396-9
  1999 Mar) has shown that salty (hypertonic) saline solution can
  completely paralyze the cilia and that even isotonic solution can slow
  cilia down, which is the exact opposite of what irrigation is supposed
  to do.  The study also showed, however, that adding potassium chloride
  and calcium chloride can prevent the cilia from slowing.  The theory
  is that the addition of these ingredients allows the irrigation
  solution to approximate not only the salinity of blood and tissue, but
  also their complete electrolyte composition.

  HydroMed, at http://www.sinus-relief.com/ or 800-560-9007, sells a
  product based on Ringer's solution called Breathe Ease.  It's
  convenient but somewhat expensive, costing $14.95 per package, enough
  for about 30 irrigations, which makes the cost per irrigation about 50
  cents.  In Europe you can obtain a similar product called SinuSal from
  Inmunotek at http://www.inmunotek.com/xcitekindex.htm

  You can experiment with making your own Ringer's solution.  You need
  only a tiny amount each of potassium chloride and calcium chloride --
  about 1/30th of a teaspoon per U.S. pint (16 ounces of water), or just
  a pinch (there are different formulations of Ringer's solution, so the
  amount added doesn't have to be exact).  Stores that sell potassium
  chloride and calcium chloride powder can be found by searching the
  web.  Local beer and wine-making shops also sell calcium chloride, the
  purpose of it being to adjust the hardness of water used for brewing
  beer.  Products that are meant for human consumption should be safe
  for use on sinus membranes.

  Some people use saline solution packaged for use with contact lenses,
  though this is expensive, and contact lens solutions made with
  preservatives can potentially damage the sinuses' cilia.

  Irrigation Additives

  Some people are experimenting with, and some ENTs are recommending,
  other additives you can include with the saline solution when
  irrigating.  You need to be careful, though, because small amounts of
  these additives are absorbed into the bloodstream through the sinuses'
  mucous membranes and there's a possibility of swallowing the solution
  when irrigating.

  Two irrigation additives that are commonly used are Alkalol and
  Betadine.  Alkalol is an old-time, traditional remedy that can be
  found or ordered from pharmacies or from Web sites such as
  MediChest.com, at http://www.medichest.com/, for about $3 a bottle.
  It's a solution of eucalyptus oil, pine needle extract, other plant
  oils and extracts, and a tiny amount of alcohol, ingredients that
  together are thought to act as a mucus solvent.  Some people find it
  soothing, others stimulating, others irritating.  It's better to start
  with a small amount rather than the 50/50 ratio of Alkalol to saline
  indicated in the Alkalol directions.

  Betadine (and its generic equivalents) is an iodine-based antiseptic
  used primarily on superficial skin wounds, though some doctors
  recommend it to help kill off the pathogens that cause sinus
  infections.  It's best to use only a small amount -- from a few drops
  to a teaspoon -- to avoid potential harm to the thyroid or the
  kidneys.  One technique is to first irrigate with Betadine and
  immediately afterward to irrigate again without it to wash it away.
  Some people are allergic to iodine and should avoid Betadine
  altogether.

  Some people are experimenting with other irrigation additives,
  including tea tree oil (Melaleuca alternifolia), available at health
  food stores and used for many years in Australia, where it
  originates.  It's described as a germicide, fungicide, and antiseptic,
  and it's usually used for superficial skin wounds, vaginal
  candidiasis, foot fungus, and acne.  It's very strong, so you need to
  dilute it -- one study found a 2 percent solution effective.  Some
  people are allergic to the byproducts created when it breaks down
  (photooxidizes).  Some doctors advise against using it or any
  oil-based product in the sinuses, since any product in the sinuses can
  wind up in the lungs, and oil, Vaseline, etc., in the lungs can cause
  pneumonia.

  Some ENTs are experimenting with antibiotics such as Bactroban
  (mupirocin) and gentamycin as irrigation additives.  Ask your ENT
  about this.

  Risks

  Daily saline irrigation of the sinuses when done correctly is thought
  to be no more risky than daily hand washing.  Problems can arise,
  however, if you do it incorrectly.  Use too much salt and you can dry
  out your sinuses and impair the cilia.  Use too little salt and you
  can increase swelling.  Use too much baking soda and you may be left
  with an ammonia odor.  Use water that's too hot or too cold and you
  can increase swelling.  Use a Water Pik without an attachment, set the
  attachment too high, or use a bulb irrigator and squeeze too hard or
  when your clogged, and you can spread infection to other parts of your
  sinuses or to your ears.  Irrigate too frequently and you may promote
  infection by removing from your sinuses the enzyme lysozyme, which
  acts as a natural defense against bacteria.

  The benefits of irrigation, even frequent irrigation, are thought to
  be far greater than the risks, particularly if you have symptoms.

  You can also damage your sinuses and spread infection by blowing your
  nose too hard.  Some doctors in fact feel this is the most common
  cause of chronic sinusitis.  In response, some people have advocated
  not blowing at all, just swallowing or spitting out mucus, but most
  doctors find this an extreme precaution (and swallowing too much mucus
  can cause nausea and potentially other gastrointestinal problems).
  When blowing, just be gentle.  Many people find that unscented white
  tissues that contain lotion, such as Puffs Plus With Lotion, are best,
  as they prevent the outside of the nose from getting irritated.

  After irrigating, you'll have to blow your nose to rid your sinuses of
  saline (and remaining mucus), preventing the saline from leaking or
  rushing out later, often without warning.  The most effective
  technique has been called the "whale blow." Standing up, bend over
  with your head down for 20 to 30 seconds.  Alternately, you can lie
  down on a bed and hang your head over the side.  Have a paper towel or
  tissue in hand.  Slowly rotate your head, moving one nostril upward
  while keeping the other nostril closed.  When your nostril is as high
  as it will go (like a whale's blow hole breaking through the surface
  of the ocean), blow gently.  Then do the same for the other nostril.

  Optionally, you can then lie on your back, which can force any
  remaining saline and mucus to slide into your throat -- it's always
  best to spit this stuff out rather than swallow it.  Sniff in, though
  not too hard.  This can be a very effective way to complete the
  process of cleaning out your sinuses.

  HYDRATION

  If you have sinus problems, it's important to keep your sinuses well
  hydrated (moisturized), to keep mucus membranes from drying out, which
  prevents them from protecting against bacterial infection.  Saline
  nose spray is helpful in this regard.  You can use it between
  irrigations or on days when you're not experiencing any symptoms and
  are not irrigating.

  Some people, however, are sensitive to the preservatives used in
  over-the-counter saline sprays -- their sinuses become irritated.
  These preservatives can also slow down the functioning of the cilia,
  which also compromises the sinuses' disease-fighting capabilities.  Be
  particularly wary of any product for the sinuses that's preserved with
  benzalkonium chloride.  A number of recent studies have shown that it
  can damage the cilia and lead to mucosal swelling, the exact opposite
  of the effect you want.

  If you frequently use saline nose spray, mixing a batch of home-made
  saline solution is safer than buying a commercial brand nose spray in
  a pharmacy or supermarket.  To prevent infected mucus from being
  sucked into the spray bottle, remove the bottle from your nose before
  releasing the sides of the bottle.  To further reduce the chance of
  contamination, it's good practice to throw the saline out and mix
  another batch once a week.

  You can make an excellent preservative-free isotonic saline solution
  for nose spray with Breathe Ease, which is also used to make
  irrigation solution and is available through HydroMed, at
  http://www.sinus-relief.com/ or 800-560-9007.

  A new saline nose spray on the market is SinusMagic, available at
  http://www.sinusmagic.com/.  It's pricey at $11.99 per one-ounce
  bottle, but it appears to do a better job than saline alone of
  clearing out sticky mucus.

  Along with salt (sodium chloride), SinusMagic contains thymol;
  eucalyptol; menthol; benzoin; potassium alum; potassium chlorate;
  sodium bicarbonate; glycerine; oils of sweet birch, spearment, pine,
  and cinnamon; and alcohol (1/100 of 1 percent).  These ingredients are
  similar to those used in Alkalol, but because of the addition of
  glycerine and because it's pH balanced, it doesn't sting like Alkalol
  can.  SinusMagic like any saline-based nose spray can be a good
  adjunct to irrigation but shouldn't replace it.

  You can make a nose spray similar to SinusMagic and save money, though
  you'll have to experiment with the amounts.  To water add a small
  amount of Alkalol and glycerine as well as sodium bicarbonate (baking
  soda) and salt.  Alternatively, to water you can add Alkalol,
  glycerine, and Breathe Ease.  You can skip the glycerine if Alkalol
  doesn't bother you.

  You can help the saline reach more sinus tissue by tilting your head
  back or lying on your back while you squirt the solution into each
  nostril.

  OTHER HOME REMEDIES

  If you're clogged, it's important to try to clear out your sinuses to
  prevent infection.  Techniques include using Alkalol or Alkalol-like
  ingredients in a nose spray, neti pot, or bulb irrigator; using a
  steam inhaler; taking a hot shower; applying a hot compress to your
  nose and cheeks; dabbing eucalyptus oil on the outside of your nose;
  drinking hot tea and lots of liquids in general; and eating hot
  chicken broth with garlic.

  Some people find that spicy foods (seasoned with garlic, cayenne
  pepper, ginger, wasabi, etc.) help open up their sinuses, while others
  find them sinus irritants.  One trick is to carry wasabi (Japanese
  horseradish mustard) with you.  It's available in small
  toothpaste-type tubes from many Asian grocery stores.  Just place a
  dab on your tongue when you're congested.

  Some people use a vaporizer/humidifier at night to decongest, though
  you need to keep it clean as well as keep the humidity in the room
  from rising above 50 percent to prevent mold and dust-mite growth.

  Another technique is nasal massage, which can sooth your sinuses,
  reduce swelling, and encourage blood flow to the area.  Gently rub the
  sides of your nose and your cheeks with your fingers or knuckles.

  DRUGS

  Both over-the-counter and prescription drugs can be beneficial to
  sinus patients, but they're often relied on too heavily.  Drugs
  invariably have side effects, and which can sometimes cause problems
  as bad as the original sinus infection.

  Antibiotics

  Broad-spectrum antibiotics are the drug of choice of many ENTs, and
  they're usually effective in killing the bacteria that cause acute
  sinusitis, typically Streptococcus pneumoniae, H. influenzae, and
  Moraxella catarrhalis (Staphylococcus aureus, Peptostreptococcus,
  Fusobacterium, and Prevotella may also be found in chronic sinusitis).

  Sinus infections usually require a longer course of treatment with
  antibiotics than other infections, often two weeks and sometimes up to
  eight weeks, as it's difficult for systemic drugs to penetrate into
  the sinuses because of the relatively poor blood flow there.  Some
  doctors even administer intravenous antibiotics in difficult cases.

  Make sure you take all of the antibiotics prescribed to avoid a
  situation where some infection remains without your awareness and
  grows back resistant to the original antibiotic, requiring a new and
  stronger antibiotic, one with a greater risk of side effects.  Some
  doctors recommend continuing antibiotics for one week after symptoms
  disappear and the mucus has turned clear.

  It's best to avoid taking antibiotics for extended periods of time.
  One approach to avoid this is to gauge the effectiveness of whatever
  antibiotic you're taking.  If you don't notice a significant
  improvement after four or five days, the antibiotic you're on may not
  be effective against the bacteria you're infected with.  Ask your
  doctor to switch you to another antibiotic.

  The more sinusitis attacks you have, the less effective antibiotics
  are, and they're often not effective at all for chronic sinusitis.
  Some people wind up taking antibiotics for long periods of time, which
  is risky.  Long-term use promotes the growth of both resistant strains
  of bacteria and the fungus candida (Candida albicans), and it can lead
  to gastrointestinal problems such as cramps, nausea, vomiting, and
  diarrhea.

  The risk of gastrointestinal upset with antibiotics can often be
  reduced by drinking a full glass of water when taking them and by
  ingesting "probiotics" such as acidophilus (Lactobacillus acidophilus)
  and bifidus (Bifidobacterium bifidum) bacteria, found in certain
  yogurts (check the label) or capsules (health food stores).

  Because of their negatives, avoiding antibiotics should be your goal.
  Too many patients, and doctors, make the mistake of relying too
  heavily, even exclusively, on antibiotics in treating sinusitis.
  Unless you also treat the structural defects that typically accompany
  chronic sinusitis, particularly inactive cilia and blocked ostia,
  infection will persist or habitually return.

  Antibiotics used to treat sinusitis include Augmentin
  (amoxicillin/clavulanic acid), Ceclor (cefaclor), Ceftin (cefuroxime
  axetil), LoraBid (loricarbef), Cefzil (cefprozil), Omnicef (cefdinir),
  Biaxin (clarithromycin), and Zithromax (azithromycin).  They're often
  more effective on sinus infections, particularly recurring sinus
  infections that may involve resistant strains of bacteria, than older
  antibiotics such as amoxicillin, ampicillin, tetracycline, and
  erythromycin, though they cost more.  Other antibiotics that are
  sometimes used to treat sinusitis include Cipro (ciprofloxacin),
  Levaquin (levofloxacin), Zagam (sparfloxacin), Avelox (moxifloxacin),
  Tequin (gatifloxacin), Cleocin (clindamycin), Flagyl (metronidazole),
  Vantin (cefpodoxime), Suprax (cefixime), and Cedax (ceftibuten).

  Steroid Nose Sprays

  For many people a prescription steroid nasal spray is the most
  effective medication for managing their sinusitis.  It can shrink
  swollen nasal membranes, reduce mucus secretions, and help prevent or
  alleviate allergic reactions by reducing the number of
  histamine-producing mast cells in your sinuses.  Steroid nasal sprays
  can also prevent the ostia from closing up and shrink or prevent
  polyps, which in some cases eliminates the need for surgery.

  Steroid nose sprays are safer to use than a number of other sinus
  medications.  They don't produce the rebound effect of nasal
  decongestant sprays or the kinds of serious systemic side-effects as
  prednisone and other oral steroids, as only a small amount of the
  steroid (cortisone or a cortisone-like drug) is absorbed into the
  bloodstream.

  However, long-term use of steroid nasal sprays, particularly if you
  use them in quantities greater than recommended, may depress the
  functioning of the cilia, possibly due to the preservatives used
  (avoid products made with the preservative benzalkonium chloride).
  Long-term use may also promote the growth of candida.  Occasionally
  steroid nasal sprays can increase inflammation -- the solution here is
  often to decrease the dosage or experiment with a different brand.
  Some doctors recommend aiming the spray away from the septum inside
  the nose separating the two sides to avoid the potential perforation
  of it.

  For many people the best steroid nasal spray is a new product called
  Rhinocort Aqua.  Older products such as Flonase and Nasonex contain
  alcohol, which may cause sinus irritation, and the preservative
  benzalkonium chloride.  Newer products such as Nasacort AQ are water
  based instead of alcohol based but still contain benzalkonium
  chloride.  Rhinocort Aqua contains neither alcohol nor benzalkonium
  chloride.  Some people, however, do well with older steroid nasal
  sprays and may even prefer them to newer products.

  Decongestants

  Over-the-counter oral decongestants such as Sudafed (pseudoephedrin)
  are also commonly used by sinus patients.  Decongestants can help
  relieve nasal congestion, post-nasal drip, and sinus pressure and
  pain.

  As mild central nervous system stimulants, however, decongestants can
  interfere with sleep and are best taken in the morning.  Decongestants
  may also aggravate high blood pressure, heart and thyroid disease, and
  glaucoma, if you have these conditions.  Also avoid them if you're
  taking diet pills.  In men with enlarged prostates decongestants can
  make urinating difficult.

  Over-the-counter spray decongestants such as Afrin (oxymetazoline) can
  quickly open up clogged nasal membranes, often within ten minutes.
  They're less likely than oral decongestants to aggravate blood
  pressure, overstimulate the nervous system, or cause urinary
  retention.

  Spray decongestants, however, are addicting.  If you use them for more
  than three days or so and then stop, they can leave you more clogged
  than you were initially, so the temptation is to continue using them.
  They can also dry up nasal membranes and depress the action of the
  cilia, which can bring on or aggravate a sinus infection.

  Mucolytics

  Some sinus patients report positive results with guaifenesin, a mucus
  thinner (mucolytic) that's found in small doses in the
  over-the-counter cough medicine Robitussin.  The prescription form may
  be needed for adequately large doses.  You need to drink a lot of
  water when on guaifenesin, as it can cause extreme thirst.  (Some
  doctors feel guaifenesin's mucus-thinning effects are a result of its
  prompting people to drink voluminous amounts of water, rather than the
  effects of the drug itself.)  Side effects may include nausea and
  gastrointestinal upset.

  Antihistamines

  Antihistamines can reduce mucus secretions and sinus swelling.
  Second-generation prescription oral antihistamines such as Claritin,
  Allegra, and Zyrtec are better than first-generation over-the-counter
  antihistamines in that they don't usually lead to drowsiness.  Of the
  over-the-counter antihistamines, most people find that Chlortrimeton
  (chlorpheniramine maleate) is less sedating than Benadryl
  (diphenhydramine hydrochloride).

  Spray antihistamines such as the prescription Astelin or the
  over-the-counter NasalCrom (technically, an "antiallergic" rather than
  an "antihistamine" though it works similarly) are another option.
  Alternatively, you can dissolve one or two 50 mg capsules of Benadryl
  in one ounce of saline solution.

  Antihistamines are best used if it's clear you have allergies and are
  experiencing allergic symptoms, since they can dry out nasal mucous
  membranes, thicken mucus secretions, and compromise the cilia, leading
  to or prolonging infection.  To help prevent nasal dryness, you can
  use saline nose spray throughout the day.

  Pain Medications

  The over-the-counter painkillers ibuprofen (in Advil and generic
  versions) and naproxen sodium (in Aleve and generic versions) can be
  effective in reducing sinus inflammation, swelling, and pain, more so
  than acetaminophen (in Tylenol and generic versions).

  You need to be careful though if you have a tendency to develop
  polyps, as nonsteroidal antiinflammatory drugs (NSAIDS) such as Advil,
  Aleve, and aspirin can worsen them in some people.

  ALTERNATIVE MEDICINE

  Some people advocate alternatives to science-based Western medicine,
  often called alternative medicine, sometimes called holistic,
  integrative, or complementary medicine.  There are different schools
  of alternative medicine, including herbology, naturopathy, homeopathy,
  acupuncture, chiropractic, reflexology, hypnotherapy, aromatherapy,
  Reiki, and Ayurvedic.

  The biggest achievement of alternative medicine has been forcing
  Western medicine, including patients, to view disease not as one or
  more symptoms that need to be treated but as a signal that one or more
  aspects of the body/mind/soul continuum is out of balance and needs to
  be rebalanced.  The biggest failure has been spreading information
  about "cures" without credible evidence about efficacy and with rarely
  any information about safety.

  People with health problems are often desperate, willing to give
  anything a try, and sometimes their desire for a remedy turns into a
  self-fulfilling prophesy, a phenomenon known as the placebo effect.
  You think something is going to work, and your positive thinking
  marshals your body's own natural defenses, independent of any herb or
  pill.  Alternative healers and herb/supplement companies have long
  exploited this, consciously or not.  Problem is, the placebo effect
  works for only a small percentage of people.

  Herb and supplement companies have little incentive to conduct the
  kinds of efficacy and safety studies required of drug companies, since
  under the current (U.S.) law they can make or imply all kinds of
  benefits without having to prove them.  Drug companies don't study the
  efficacy and safety of alternative medicines either, since these
  substances are in the public domain and aren't likely to produce much
  profit.

  Alternative healers and their patients instead rely on anecdotal
  reports, which historically have been unreliable.  Anecdotal evidence
  is what doctors for years used as justification for drilling holes in
  patients' heads to treat headaches and herbalists for years used as
  justification for using plants such as chaparral and comfrey despite
  the fact that, as we now know, these herbs can cause liver damage and
  cancer.

  Some people still promote or use nasal sprays and other products
  containing silver even though it's been shown that silver is toxic.
  Long-term use can cause irreversible bluish or ashen-gray tinting of
  the skin, called argyria.  The U.S. Food and Drug Administration (FDA)
  in September 1999 banned over-the-counter medications containing
  colloidal silver or silver salt, though silver-containing "dietary
  supplements" are still on the market.

  Manufacturers of natural or herbal medications describe their products
  as dietary supplements to avoid having to fulfill FDA safety
  requirements.  Herbal medications, however, are drugs just like
  pharmaceuticals, with side effects and drug interactions.  But while
  the side effects and interactions of pharmaceuticals are usually well
  documented, those of herbs are often unknown.

  The alternative medical community often extols the "natural" qualities
  of its products as benefits.  Just because a substance is found whole
  in nature, however, doesn't make it healthy.  There are plenty of
  deadly poisons in nature.  Some alternative medicine promoters contend
  that their products are better than pharmaceuticals because they don't
  contain chemicals.  The fact is that all substances in nature are made
  of chemicals.  Just because a product is processed and refined in a
  laboratory or factory doesn't make the chemicals it contains
  unhealthy.

  The theory, or "science," behind some alternative medical practices
  strains credibility.  Homeopathy, for instance, contradicts the known
  laws of biology, chemistry, and physics.  Its premise is that the best
  "active" ingredient of a medicine is one that produces the same
  symptoms as the disease.  But because this ingredient typically is
  toxic, it's diluted to such a great extent ("infinitesimally" is the
  word homeopaths use) that there are no molecules left in virtually all
  doses.  What's left, say homeopaths, is the "energy" from this
  ingredient.  Problem is, according to the laws of physics and as
  anybody who's ever built a campfire has observed, energy dissipates
  quickly over time.

  On the other hand, just because an alternative remedy hasn't been
  subjected to multiple double-blind studies doesn't mean it doesn't
  work.  Some people are great enthusiasts of alternative treatments,
  reporting beneficial results.  The best approach may be to combine
  up-to-date science-based medicine with credible alternatives.

  You can also consciously apply the same mind-body mechanism behind the
  placebo effect.  For sinus infections, employ creative visualization
  by picturing your white blood cells gobbling up rampant bacteria.  For
  allergy flare-ups, employ progressive relaxation by telling your
  sinuses, with the same kind of soothing voice you'd use to talk to an
  upset child, to relax, calm down, take it easy, that everything will
  be all right.  These techniques won't hurt, and though they're not
  foolproof of course, they might help.

  Some sinus patients report good experiences thinning mucus and
  reducing inflammation using papaya and pineapple enzyme tablets, found
  in health food stores and as Clear Ease from Hydro Med, at
  http://www.sinus-relief.com/ or 800-560-9007.  Unlike some other
  products, Clear Ease is made without sugar and will thus not promote
  tooth decay.  It costs considerably more than similar products,
  however, at $17.95 per package (60 tablets).  To be effective the
  tablets need to be slowly dissolved between the cheek and gum rather
  than chewed.

  Candida

  Many in the alternative health community have long believed that the
  fungus candida (Candida albicans) causes or contributes to a host of
  health problems, including sinusitis.  The importance of candida,
  however, has been downplayed by most mainstream doctors.  According to
  conventional medical wisdom, candida and other fungi are primarily a
  problem in immunocompromised people such as AIDS patients and organ
  transplantees, those with diabetes or leukemia, or those who've been
  on extended courses of antibiotics or steroids (which can include
  chronic sinusitis patients).

  A recent article in the Mayo Clinic Proceedings, however, has brought
  candida more into the mainstream by reporting that the vast majority
  of sinusitis patients studied by the Mayo Clinic have fungal growth in
  their sinuses.  Some doctors still dispute the importance of candida
  and other fungi for sinus patients because the criteria the Mayo
  researchers used for measuring fungal growth were less stringent than
  is commonly used and because small amounts of fungi are commonly
  present even in people not suffering from sinusitis or any other
  health condition.  The Mayo doctors contend that it's not the fungi
  itself in the sinuses that causes problems but the allergic response
  to it by some individuals.

  Researchers at the Mayo Clinic are further investigating, including
  developing possible new treatments.

  In the meantime, antifungal drugs such as Sporanox and Amphotericin B
  are available, though they don't penetrate the sinuses particularly
  well and frequently have side effects.  Also available are antifungal
  diets, such as the one described in Dr. Ivker's book.  It consists
  primarily of vegetables and non-red-meat sources of protein,
  eliminating refined sugar, bread and other foods made with yeast,
  dairy, mushrooms, fried foods, grapes and some other fruit, alcohol,
  and a number of other foods and drinks.

  Substances that are thought to have antifungal properties include
  garlic, the herbs barberry and oregano, and the bacteria Lactobacillus
  acidophilus, Bifidobacterium bifidum, and Lactobacillus bulgaricus (in
  some yogurts or available in pill form in health food stores).

  You can read more about Candida at
  http://dmoz.org/Health/Conditions_and_Diseases/Infectious_Diseases/Fun
  gal/Candida/.

  PREVENTION

  If you're prone to sinus infections, it's important to try to avoid
  colds and treat them effectively when you do catch them.  Daily hand
  washing (including the use of alcohol-based hand sanitizers) and daily
  sinus washing have been shown to help prevent colds, as does keeping
  your hands away from your nose, eyes, and mouth.  Some people have
  positive experiences avoiding or treating colds with vitamin C,
  echinacea, and zinc lozenges (though zinc in larger doses can weaken
  the immune system).

  If you have a cold, you should control sinus inflammation and
  congestion to try to prevent a sinus infection.  Techniques include
  those described in more detail elsewhere in this document, such as
  sinus irrigation, saline nose spray (with or without Alkalol or
  Alkalol-type ingredients), steam inhalation, using a hot compress on
  the nose and cheeks, nose/cheek massage, drinking lots of liquids,
  eating hot chicken broth with garlic, using a vaporizer at night,
  gentle (as opposed to forceful) nose blowing, using a steroid nasal
  spray, taking an oral decongestant, taking ibuprofen or naproxen
  sodium, and taking papaya enzyme tablets.

  If you have sinus problems, it's best to avoid air travel when you
  have a cold, are experiencing an allergy attack, or are suffering from
  acute sinusitis.  Changes in air pressure can potentially cause a
  vacuum to form in the sinuses, leading to severe pain.  Dry cabin air
  can also dehydrate sinus membranes, leading to or aggravating an
  infection.  Finally, air in airplanes is often high in carbon dioxide
  and bacterial and fungus contaminants.

  If you need to fly, before take-off, you can use a nasal spray
  decongestant or take an oral decongestant.  During the flight you
  should drink plenty of nonalcoholic beverages (alcohol at any time can
  cause dehydration and swelling of sinus membranes, and when flying it
  will just exasperate the effects of dry cabin air).  One trick is to
  bring a water bottle on board with you.  You can also use saline nose
  spray during flight to help keep your sinuses from drying out.

  Along with alcohol, antidepressants and antihistamines can dry out the
  sinuses and exasperate sinusitis symptoms.

  SURGERY

  If your ostia are permanently swollen shut and you've unsuccessfully
  tried other methods, sinus surgery may be your best option.  Surgery
  can help return your sinuses to healthy functioning by returning the
  ostia to their normal size.  Without proper drainage, mucus will build
  and your sinuses will continue to get infected.  Sinus surgery can
  also repair other structural problems with your sinuses, including a
  deviated septum, polyps, cysts, and swollen nasal turbinates.

  Surgery, however, is not a panacea.  Even though 80 to 90 percent of
  patients report improvement after surgery, you still need to deal with
  the underlying factors that caused your ostia to swell shut in the
  first place or they may do so again.  With some people, prolonged
  chronic sinusitis causes damage to the sinuses' mucous membranes
  that's irreversible.  Still, surgery and other treatment can greatly
  ease symptoms and improve the quality of life.

  The most common technique today is endoscopic sinus surgery, also
  called FESS (functional endoscopic sinus surgery).  It's considered
  minor outpatient surgery (you aren't hospitalized overnight) with a
  low rate of complications -- about 3 percent (primarily bleeding).
  Unlike earlier techniques, the surgery is done through the nose
  instead of cutting into the gums or face, so the recovery period
  usually lasts only several days with patients usually returning to
  work from four to seven days after surgery.  Full recovery takes about
  four weeks.

  The operation itself generally takes one to three hours and may be
  done under either local or general anesthesia.  Local anesthesia is
  often the better choice, since general anesthesia is riskier, more
  likely to cause gastrointestinal upset afterward, and typically takes
  longer to recover from.

  Some surgeons routinely pack the sinuses with gauze or other materials
  after surgery to control bleeding, while others do so only if it's
  clear that post-surgical bleeding will be a problem.  Packing, either
  while it's in place or as it's being removed, can be uncomfortable or
  hurt -- it's often the most painful part of sinus surgery.

  Endoscopic sinus surgery has largely replaced turbinate surgery, which
  reduces the size of swollen areas inside the sinuses.  Too many
  patients experienced a worsening of sinus symptoms after
  turbinate-reduction surgery.  Although some ENTs still perform this
  type of surgery, most ENTs today feel that the turbinates should be
  preserved as much as possible.

  Choosing a Surgeon

  If at all possible, choose an experienced surgeon, as the success of
  endoscopic sinus surgery is often directly related to the surgeon's
  experience and skill.  Complication rates are higher with surgeons who
  have completed less than a hundred procedure (Some experts recommend
  that it's best to go with a surgeon who's performed three hundred or
  more procedures).  More severe complications, though rare, include
  meningitis, orbital cellulitis, and blindness.

  The latest advance in sinus surgery is Image-Guided FESS, which is
  performed with a computer-imaging surgical device.  Image-guided
  devices are thought to help prevent complications, particularly among
  patients who previously had sinus surgery or have extreme polypoid
  disease, advanced tumors, or a distorted anatomy.  Among the
  image-guided surgical devices available are the VTI Insta-Trak, the
  ISG Viewing Wand, the ISG Infrared Optotrak, and the IGT Flash Point
  5000.

  Another new technique is Laser FESS, which is promoted as being less
  traumatic than conventional FESS.  Some ENTs feel this is more an
  advertising gimmick than a genuine improvement and that conventional
  FESS is more effective.

  WEB SITES AND BOOKS

  A number of doctors and medical organizations have created useful Web
  sites where you can find more information about managing your
  sinusitis.  The top sinusitis and allergy Web sites include:

  Sinusitis: A Treatment Plan That Works
  http://www.sinuses.com/
  From a New York City allergist named Wellington S. Tichenor who
  occasionally participates in alt.support.sinusitis.  Has helpful
  internal search tool.

  Dr. Grossan
  http://www.ent-consult.com/
  From an ENT from Los Angeles named Dr. Murray Grossan, inventor of the
  Grossan Irrigator and a frequent participant in alt.support.sinusitis.

  Handbook of Nasal Disease
  http://www-surgery.ucsd.edu/ent/davidson/NASHAND/nasal.htm
  From a California M.D. named Terence M. Davidson.

  Rhinology/Allergy Pages
  http://www.geocities.com/shouser144/
  From an ENT trained in rhinology/allergy named Steven M. Houser.

  Sinus Survival
  http://www.sinussurvival.com/
  From Robert Ivker, D.O., author of the book Sinus Survival and
  president of the American Holistic Medical Association.

  American Academy of Otolaryngology
  http://www.entnet.org/index2.cfm
  Patient-education material from an ENT organization.

  American Academy of Allergy, Asthma and Immunology Sinusitis
  http://www.aaaai.org/patients/publicedmat/sinusitis/

  Allergy, Asthma, and Sinusitis Tips
  http://www.aaaai.org/patients/publicedmat/tips/

  Sinusitis Glossary
  http://www.aaaai.org/patients/publicedmat/sinusitis/sinusterminology.s
  tm
  Patient-education material from an allergist organization.

  Indoor Air Pollution
  http://www.epa.gov/iaq/pubs/hpguide.html
  From the U.S. Environmental Protection Agency (EPA)

  Residential Air Cleaning Devices: Types, Effectiveness and Health
  Impact
  http://www.lungusa.org/site/apps/lk/links.asp?c=dvLUK9O0E&b=35700
  From the American Lung Association

  Recommended books about sinusitis include:

  Sinus Survival: The Holistic Medical Treatment for Allergies, Asthma,
  Bronchitis, Colds, and Sinusitus
  By Robert Ivker, D.O.
  This book covers both conventional medical and alternative medical
  approaches and is very accepting of the latter.

  The Sinusitis Help Book: A Comprehensive Guide to a Common Problem
  By M. Lee Williams, M.D.
  This book isn't quite comprehensive, however, not mentioning
  irrigation.

  Sources of products for environmental control of allergies include:

  AllergyBuyersClub.com
  http://www.allergybuyersclub.com/

  Allergy Clean Environments
  http://www.allergyclean.com/

  National Allergy Supply
  http://www.natlallergy.com/

  This FAQ was written by Reid Goldsborough <reidgold@netaxs.com> and
  was last updated on February 3, 2001.

                        http://www.sinusitisfaq.org/