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Best Of Natural Sinus Congestion Relief

November 8, 2010 Written by JP    [Font too small?]

If you’re one of the millions of people who suffer from chronic sinus headaches, today’s column is for you. Several weeks ago my wife was in the throes of a severe sinus headache that had lasted several days. Nothing we tried seemed to help drain her sinuses at all. That is, until she came across a home remedy on the Internet that was attributed to one Dr. Lisa DeStefano. Prior to trying it out we were both highly skeptical. But that soon changed. My Healthy Monday tip of the week is to apply rhythmic pressure to your ethmoid and vomer bone in order to promote sinus drainage. Details to follow.

After witnessing the seemingly miraculous effects of this simple exercise I decided to try to track down Dr. DeStefano. I needed to know if this was a fluke experience or perhaps just a placebo effect. To be honest I still wasn’t convinced that the information we tried out of desperation was legitimate. I was pleasantly surprised to find that Dr. DeStefano was in fact an authority in osteopathic manipulative medicine. In fact, she is the chairperson and assistant professor at the Michigan State University College of Osteopathic Medicine. That initial communication lead to the following interview.

JP – Can you please give us a brief overview of the anatomy of the sinuses and how it relates to sinus headaches?

Dr. DeStefano – There are four pairs of paranasal sinuses each is named for the bone which they are in. The largest is the maxillary sinus located in the maxillary bone or cheekbones under the eyes. This is typically where most people experience pain when they have a sinus headache. The ethmoid sinuses are located between the eyes and nose. The sphenoid sinuses are located further back in the head behind the nose and eyes. The frontal sinuses are located above the eyebrows in the forehead. Each sinus is lined with soft tissue that produces mucous. All the sinuses drain into the back of the nose and into the throat. If the sinus cannot drain properly it becomes congested and signals to the brain that there is pressure within the sinus which can be interpreted as pain.

JP – How does applying rhythmic pressure to the ethmoid and vomer bone affect sinus congestion?

Dr. DeStefano – In the living person all the bones of the face have a varying capability to be deformed under pressure. Much like your rib cage can move if you press on one of its bones. Gently pressing the area between the eyebrows deforms the frontal bone and the ethmoid which sits right behind it. Alternately thrusting the tongue upwards on the hard palate deforms the maxilla and the vomer which sits right above it. This rhythmic volleying of subtle gentle motion allows the other bones that surround the sinuses to begin to billow a bit. It might be a small amount, but this motion is often enough to push fluid out of the sinuses. 20-30 seconds of gentle rhythmic billowing is all that is necessary.

JP – Is this exercise something you feel comfortable recommending in your own practice? If so, what type of success have you found?

Dr. DeStefano – I do suggest this in my practice; from my experience most everyone has some short increase in post nasal drainage as a result of this technique. Not everyone has relief however. Much of the success depends on the overall plasticity of the bones in the face and the degree of mucous membrane inflammation.

JP – Are there other natural techniques that can provide additional support when needed?

Dr. DeStefano – When my patients have chronic sinus problems I begin by treating them using cranial osteopathic techniques thus giving them the capability to naturally drain their sinuses. I often will suggest they stop using drying agents such as Sudafed because of the risk of rebound congestion and because it is very difficult to dry a chamber that is meant to be moist, often times what is left is sludge which will attract more moisture from the mucous membranes. I like salt water sprays and Neti pots as they will gently decongest the nasal membranes allowing the sinuses openings to become wider. These however cannot affect the sinuses themselves.

JP – Do you incorporate dietary or environmental interventions as part of a holistic treating plan?

Dr. DeStefano – Diet plays a huge role in congestion of the body in general. High inflammatory diets can have a detrimental effect on one’s sinuses if they have a predisposition to sinus congestion issues. I suggest my patients eat a low inflammatory diet regardless of their condition. Environmental factors also play a large role in sinus problems, but often are more difficult to control or eliminate. In these situations one must eliminate the global inflammatory influence on the body by eating a low inflammatory diet.

Saline Nasal Irrigation May Reduces Sinusitis Symptoms

Source: Arch Otolaryngol Head Neck Surg. 2007;133(11):1115-1120. (link)

Dr. DeStefano also offered this concise, step-by-step guide to applying her technique: “Forget Sudafed. An easier, quicker, and cheaper way to relieve sinus pressure is by alternately and gently thrusting your tongue against the roof of your mouth, then pressing between your eyebrows with one finger. This rhythmic pressure causes the ethmoid and vomer bone, which runs through the nasal passages to the mouth, to rock back and forth. The motion loosens congestion: after 20 seconds, you will feel your sinuses start to drain.”

Modern science likewise supports incorporating neti pots and/or saline irrigation into natural sinus care regimens. The latest study on the matter was published in December 2009. It found that saline nasal irrigation provided significant improvements in the quality of life of children with acute sinusitis. The authors of the study noted symptomatic amelioration of cough, natural congestion, rhinorrhea (runny nose), sleeplessness and throat itching. (1,2,3)

While researching Dr. DeStefano’s comments about the utility of anti-inflammatory diets I discovered a scientific paper that suggests that alternate day fasting (ADF) may be a good way to promote sinus health. Researchers from Louisiana State University Medical Center report that rapid improvements in chronic sinusitis are often found in patients who adhere to an ADF program. Hopefully, future studies will continue to validate the link between diet and sinusitis scientifically. In the meantime, it’s good to know that there are safe and viable tools available courtesy of fine physicians such as Dr. Lisa DeStefano. (4)

Update: November 2010 – The concept of an anti-inflammatory diet is the focus of an upcoming edition of the Journal of Obesity. An advanced review of the paper points out three dietary changes that have occurred the over the past 30 years: a) increased consumption of refined carbohydrates; b) higher intake of refined vegetable oil (a source of omega-6 fatty acids); c) reduced consumption of long-chain omega-3 fatty acids, such as those found in fish. The authors of the piece, which include the famed integrative physician Dr. Barry Sears, propose that this specific dietary shift has elevated the levels of “silent inflammation” in the population at large. They note that this eating pattern almost certainly results in higher post-meal blood sugar and insulin production, increased cardiovascular risk and obesity. And that’s just the tip of the iceberg. In short, the researchers define this modern diet as “The Perfect Nutritional Storm”. If you want to avoid getting caught in this downpour, consider cutting back on your intake of refined foods and emphasize whole foods that provide a more natural proportion of omega-3 to omega-6 fatty acids instead. (5)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Alternative Therapies, Interviews, Nutrition

8 Comments & Updates to “Best Of Natural Sinus Congestion Relief”

  1. Mark Says:

    Very interesting article. I have saved this one for future use.

    I am wondering if different type of salts are better than others when using a neti pot?

  2. JP Says:

    Thank you, Mark! And sorry for the delay in my response. Your comment got lost in the shuffle!

    I’ve never seen any research comparing different types of salt for use in saline solution. Commercial preparations tend to use isolated sodium chloride to ensure purity. In our home, we’ve used plain ol’ sea salt with success. It’s worked out just fine for gargling and nasal irrigation.

    Be well!


  3. Oliver Says:

    I was told by a naturopathic doctor here in Portland to avoid salt that had iodine added. She didn’t have a clear answer why. I was taught to neti many years ago in India. We learned three different techniques of neti and I’ve only ever seen one used here in the United States. The first was the one everyone here knows. The second involved inhaling deeply into each individual nasal passage and then spitting the water out of the mouth. The third technique was actually filling your mouth with the salty water and blowing it out of your nose. I wouldn’t recommending trying these without some instruction but I have found them to do a better job of cleaning my sinuses then the first techniqoe alone.

  4. JP Says:

    Thank you for sharing your successful experience, Oliver!

    Be well!


  5. JP Says:

    Update: More support for nasal irrigation …


    Laryngoscope. 2014 Apr;124(4):1000-7.

    Long-term outcome of once daily nasal irrigation for the treatment of pediatric chronic rhinosinusitis.

    OBJECTIVES/HYPOTHESIS: Chronic rhinosinusitis(CRS) results in significant morbidity and health care expenditure. Safety and efficacy of nasal irrigation use in the treatment of pediatric CRS have been demonstrated, but long-term outcomes are unknown. We reviewed characteristics and treatment outcomes after 6 weeks of once daily nasal irrigation in pediatric CRS based on computed tomography (CT) scans, and summarized parental reports of subsequent use of nasal irrigation for recurring symptoms

    STUDY DESIGN: Retrospective cohort study and cross-sectional survey.

    METHODS: Review and survey of 144 pediatric CRS patients diagnosed between July 2003 and January 2012.

    RESULTS: One hundred four patients were reviewed. Mean age was 8.0 years, and 65.4% were male. Presenting symptoms included congestion (95.2%), cough (79.8%), rhinorrhea (60.6%), headache (48.1%), and fatigue (40.4%). Comorbidities included positive allergy test (50%), asthma (57.3%), and gastroesophageal reflux disease (28.2%). After 6 weeks, 57.7% of patients reported complete resolution of symptoms. Reductions in Lund-Mackay CT scores were 4.14 and 4.38 on the left and right sides, respectively (P < .001). Of the 54 parents who completed the prospective surveys, 53.7% reported using irrigation again in the past 12 months (median = 1, interquartile range = 3). Only nine patients underwent functional endoscopic sinus surgery (FESS) after the initial 6 weeks. Patients requiring FESS were, on average, 3.6 years older than those who did not receive FESS (P = 0.0005). Median length of follow-up was 48 months (range = 20-113). There were no significant differences in age, Lund-MacKay score changes, and symptom resolution proportions between those who completed the survey and those who did not. CONCLUSIONS: Nasal irrigation is effective as a first-line treatment for pediatric CRS and subsequent nasal symptoms, and reduces the need for FESS and CT imaging. Be well! JP

  6. JP Says:

    Updated 07/31/16:


    CMAJ. 2016 Jul 18.

    Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial.

    BACKGROUND: Systematic reviews support nasal saline irrigation for chronic or recurrent sinus symptoms, but trials have been small and few in primary care settings. Steam inhalation has also been proposed, but supporting evidence is lacking. We investigated whether brief pragmatic interventions to encourage use of nasal irrigation or steam inhalation would be effective in relieving sinus symptoms.

    METHODS: We conducted a pragmatic randomized controlled trial involving adults (age 18-65 yr) from 72 primary care practices in the United Kingdom who had a history of chronic or recurrent sinusitis and reported a “moderate to severe” impact of sinus symptoms on their quality of life. Participants were recruited between Feb. 11, 2009, and June 30, 2014, and randomly assigned to 1 of 4 advice strategies: usual care, daily nasal saline irrigation supported by a demonstration video, daily steam inhalation, or combined treatment with both interventions. The primary outcome measure was the Rhinosinusitis Disability Index (RSDI). Patients were followed up at 3 and 6 months. We imputed missing data using multiple imputation methods.

    RESULTS: Of the 961 patients who consented, 871 returned baseline questionnaires (210 usual care, 219 nasal irrigation, 232 steam inhalation and 210 combined treatment). A total of 671 (77.0%) of the 871 participants reported RSDI scores at 3 months. Patients’ RSDI scores improved more with nasal irrigation than without nasal irrigation by 3 months (crude change -7.42 v. -5.23; estimated adjusted mean difference between groups -2.51, 95% confidence interval -4.65 to -0.37). By 6 months, significantly more patients maintained a 10-point clinically important improvement in the RSDI score with nasal irrigation (44.1% v. 36.6%); fewer used over-the-counter medications (59.4% v. 68.0%) or intended to consult a doctor in future episodes. Steam inhalation reduced headache but had no significant effect on other outcomes. The proportion of participants who had adverse effects was the same in both intervention groups.

    INTERPRETATION: Advice to use steam inhalation for chronic or recurrent sinus symptoms in primary care was not effective. A similar strategy to use nasal irrigation was less effective than prior evidence suggested, but it provided some symptomatic benefit.

    Be well!


  7. jo Says:

    Xlear nasal spray–discovered this a few years ago. Works great! At the first sign of a sinus problem (headache for me), I spray this in my nose. It usually only takes only one or two shots and I’m good. Headache goes away and no more problems.

  8. JP Says:

    Hi Jo,

    Thank you for sharing your successful experience with us! Here’s a recent study that supports the benefits you found:


    Laryngoscope. 2011 Nov;121(11):2468-72.

    OBJECTIVES/HYPOTHESIS: To determine the tolerability of xylitol mixed with water as a nasal irrigant and to evaluate whether xylitol nasal irrigation results in symptomatic improvement of subjects with chronic rhinosinusitis.

    STUDY DESIGN: A prospective, randomized, double-blinded, controlled crossover pilot study.

    METHODS: Twenty subjects were instructed to perform sequential 10-day courses of daily xylitol and saline irrigations in a randomized fashion, with a 3-day washout irrigation rest period at the start of each treatment arm. Collected data included patient characteristics, along with Sino-Nasal Outcome Test 20 (SNOT-20) and Visual Analog Scale (VAS) scores reported at the beginning and end of each irrigation course.

    RESULTS: Fifteen of the 20 subjects (75%) returned their SNOT-20 and VAS data for analysis. There was a significant reduction in SNOT-20 score during the xylitol phase of irrigation (mean drop of 2.43 points) as compared to the saline phase (mean increase of 3.93 points), indicating improved sinonasal symptoms (P = .0437). There was no difference in VAS scores. No patient stopped performing the irrigations owing to intolerance of the xylitol, although its sweet taste was not preferred by three subjects (21%). One patient reported transient stinging with xylitol.

    CONCLUSIONS: Xylitol in water is a well-tolerated agent for sinonasal irrigation. In the short term, xylitol irrigations result in greater improvement of symptoms of chronic rhinosinusitis as compared to saline irrigation.

    Be well!


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