Acupuncture For Sinusitis In Glasgow

Acupuncture For Sinusitis | Glasgow

About Sinusitis

Each year, around 2% of the UK population consults their GP about a suspected sinus infection (Ashworth 2005). Most people with acute sinusitis recover with or without treatment within 10 days of seeing a GP (Williamson 2007), but about 92% are prescribed an antibacterial, even though it makes little difference to outcome. (Ashworth 2005) Acute sinusitis is defined as inflammation of the nose and sinuses characterised by the existence, for 12 weeks or less, of two or more of the following symptoms: blockage/congestion; discharge (anterior or posterior nasal drip); facial pain or pressure; and reduced or loss of smell. (Fokkens 2005) Other symptoms can
include toothache (involving the upper teeth), tenderness, swelling, malaise and fever. (Ah-See 2007) Sinusitis is considered to be chronic if it lasts for more than 12 weeks, and is associated with similar symptoms.

Acute sinusitis can be due to viral or bacterial infections (Fokkens 2005). Predisposing factors include upper respiratory infections, allergic rhinitis, smoking,
diabetes mellitus, dental infections, and mechanical abnormalities such as deviation of the nasal septum. (Ah-See 2007) Potential complications include spreading of the
infection around the eye, which possibly leads to blindness, infection of the frontal bone, and meningitis. (Ah-See 2007) Symptoms and signs of such potentially
serious complications include swelling of the eyes or lids, eye redness, displacement of the eye, double vision, reduced vision, severe frontal headache, and signs of
meningitis. (Scadding 2008) Chronic sinusitis is uncommon, usually develops from acute sinusitis and can be due to poor drainage of the affected sinus, inflammatory
changes to the lining of the sinus that result from infection, and a flare-up of infection from time to time as a result of these changes. Sometimes other factors may cause,
or contribute, to the development of chronic sinusitis. For example, a persisting allergy that causes inflammation in a sinus, and swelling or blockage of the drainage
channel.

Management of sinusitis includes paracetamol or ibuprofen for pain relief, with the addition of codeine if necessary. Steam inhalation and saline nasal solution are also
sometimes used. Antibacterial therapy is appropriate only for patients who are systemically very unwell, and have symptoms and signs of, or are at high risk of,
serious complications.

References

Ashworth MA et al. Variations in antibiotic prescribing and consultation rates for acute respiratory infection in UK
general practices 1995–2000. Br J Gen Pract 2005; 55: 603–8.
Williamson IG et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized
controlled trial. JAMA 2007; 298: 2487–96.
November 2014 page 2
Fokkens W et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy 2005; 60:
583–601.
Scadding GK et al. BSACI guidelines for the management of rhinosinusitis and nasal polyposis. Clin Exp Allergy
2008; 38: 260–75.
Ah-See KW, Evans AS. Sinusitis and its management. BMJ 2007; 334: 358–61.

How acupuncture can help

Evidence from randomised controlled trials suggests that acupuncture may help relieve symptoms of sinusitis such as nasal congestion (Sertel 2009), though it may
not be as effective as conventional medication (Rossberg 2005; Stavem 2008). However, research is very limited and more high-quality randomised controlled trials
are needed to assess the effectiveness of acupuncture for sinusitis (see Table below)
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes
influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to
affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)

Acupuncture may help to relieve pain and congestion in people with sinusitis by:

  • increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states;
  • stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain
  • in the brain and spinal cord (Pomeranz, 1987; Zhao 2008; Cheng 2009);
  • reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
  • enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.


About traditional acupuncture
Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote
and maintain good health. Its benefits are now widely acknowledged all over the world and in the past decade traditional acupuncture has begun to feature more
prominently in mainstream healthcare in the UK. In conjunction with needling, the practitioner may use techniques such as moxibustion, cupping, massage or electroacupuncture. They may also suggest dietary or lifestyle changes.
Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is
unique to each individual. The traditional acupuncturist’s skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective
treatment. The choice of acupuncture points will be specific to each patient’s needs.

Traditional acupuncture can also be used as a preventive measure to strengthen the constitution and promote general well-being.
An increasing weight of evidence from Western scientific research (see overleaf) is demonstrating the effectiveness of acupuncture for treating a wide variety of
conditions. From a biomedical viewpoint, acupuncture is believed to stimulate the nervous system, influencing the production of the body’s communication substances -
hormones and neurotransmitters. The resulting biochemical changes activate the body's self-regulating homeostatic systems, stimulating its natural healing abilities
and promoting physical and emotional well-being.

About the British Acupuncture Council

With over 3000 members, the British Acupuncture Council (BAcC) is the UK’s largest professional body for traditional acupuncturists. Membership of the BAcC guarantees
excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit
www.acupuncture.org.uk

Acupuncture For Sinusitis

The evidence

Research Conclusion
Randomised controlled trials
Sertel S et al. Acupuncture for nasal
congestion: A prospective,
randomized, double-blind, placebocontrolled clinical pilot study.
American Journal of Rhinology and
Allergy 2009; 23: e23-e28.
A randomised controlled trial that compared acupuncture
according to Traditional Chinese Medicine (TCM) with sham
acupuncture in 24 patients with a history of nasal congestion due
to hypertrophic inferior turbinates or chronic sinusitis without
polyposis. They were asked to score the severity of their nasal
congestion on a visual analogue scale (VAS). Nasal airflow
(NAF) was measured by using active anterior rhinomanometry
(ARM). VAS and NAF were scored and measured before and 15
and 30 minutes after acupuncture. Sham acupuncture showed a
significant improvement in VAS and a deterioration of NAF, while
TCM acupuncture showed highly significant improvements in
both VAS and NAF. The researchers found that TCM
acupuncture improved NAF and VAS significantly over time.
Rossberg E et al. Comparison of
traditional Chinese acupuncture,
minimal acupuncture at nonacupoints and conventional treatment
for chronic sinusitis. Complementary
Therapies in Medicine 2005; 13: 4-
10.
Stavem K et al. Health-related quality
of life in a trial of acupuncture, sham
acupuncture and conventional
treatment for chronic sinusitis. BMC
Res Notes 2008;1:37.
A randomised controlled trial that compared TCM acupuncture,
minimal acupuncture at non-acupoints and conventional
treatment (i.e. antibiotics, corticosteroids, 0.9% sodium chloride
solution, and local decongestants) for chronic sinusitis in 65
patients. Only the conventional treatment group showed
significant improvements in sinus soft tissue swelling (CT scan)
or health-related quality of life (HRQoL). Conventional treatment
also produced larger positive trends for sinusitis symptom score
(4.8 v 2.4 for TCM acupuncture and 1.7 for sham). The
researchers concluded that sinus soft tissue swelling was
reduced in the conventional treatment group over 4 weeks, and
HRQoL improved over 12 weeks, and that there was no
significant difference between conventional medication and TCM
acupuncture. They also concluded that there was no clear
evidence of the superiority of one treatment over another on
short-term HRQoL outcomes.
Survey
Pletcher SD et al. Use of
acupuncture in the treatment of sinus
and nasal symptoms: Results of a
practitioner survey. American Journal
of Rhinology 2006; 20: 235-7.
A survey that mailed regional licensed acupuncturists (1,516) in
the USA about the use of acupuncture and chronic sinus and
nasal symptoms. Three hundred thirty-one surveys (22%) were
returned. Ninety-nine percent of those who returned surveys
reported treating patients with chronic sinus and nasal
symptoms. On a five-point scale, the mean perceived efficacy for
the overall treatment of chronic sinus and nasal symptoms was
4.2. The mean cost of an acupuncture treatment course for
chronic sinus and nasal symptoms was calculated to be
$730.00. The researchers concluded that complementary
medicine practitioners frequently use acupuncture in the
treatment of patients with chronic sinus and nasal symptoms and
that, although practitioners report good efficacy using
acupuncture to treat such patients, quantitative data are needed
to substantiate these self-reports.
Research on mechanisms for acupuncture
Hui KK et al. Acupuncture, the limbic
system, and the anticorrelated
networks of the brain. Auton Neurosci
2010; 157: 81-90.
A paper that discusses research showing that acupuncture
mobilises the functionally anti-correlated networks of the brain to
mediate its actions, and that the effect is dependent on the
psychophysical response. The research used functional
magnetic resonance imaging studies of healthy subjects to show
that acupuncture stimulation evokes deactivation of a limbicparalimbic-neocortical network, which encompasses the limbic
system, as well as activation of somatosensory brain regions. It
has also been shown that the effect of acupuncture on the brain
is integrated at multiple levels, down to the brainstem and
cerebellum.
Cheng KJ. Neuroanatomical basis of
acupuncture treatment for some
common illnesses. Acupunct Med
2009;27: 61-4.
A review that looked at acupuncture treatment for some common
conditions. It is found that, in many cases, the acupuncture
points traditionally used have a neuroanatomical significance
from the viewpoint of biomedicine. From this, the reviewers
hypothesize that plausible mechanisms of action include
intramuscular stimulation for treating muscular pain and nerve
stimulation for treating neuropathies.
Lee B et al. Effects of acupuncture on
chronic corticosterone-induced
depression-like behavior and
expression of neuropeptide Y in the
rats. Neuroscience Letters 2009; 453:
151-6.
In animal studies, acupuncture has been found to significantly
reduce anxiety-like behaviour, and increase brain levels of
neuropeptide Y, the brain levels of which appear to correlate with
reported anxiety.
Komori M et al. Microcirculatory
responses to acupuncture
stimulation and phototherapy.
Anesth Analg 2009; 108: 635-40.
Experimental study on rabbits in which acupuncture stimulation
was directly observed to increase diameter and blood flow
velocity of peripheral arterioles, enhancing local
microcirculation.
Kawakita K et al. Do Japanese style
acupuncture and moxibustion reduce
symptoms of the common cold?
eCAM 2008; 5: 481–9.
A review of research into the effects of Japanese style
acupuncture and moxibustion on the symptoms of the common
cold. It reports that research has shown acupuncture to reduce
common cold symptoms, and that acupuncture stimulation
enhances natural killer cell activities and modulates the number
and ratio of immune cell types.
Zhao ZQ. Neural mechanism
underlying acupuncture analgesia.
Prog Neurobiol 2008; 85: 355-75.
Review article that discusses the various peripheral and central
nervous system components of acupuncture anaesthesia in
detail.
Kavoussi B, Ross BE. The
neuroimmune basis of antiinflammatory acupuncture. Integr
Cancer Ther 2007; 6: 251-7.
Review article that suggests the anti-inflammatory actions of
traditional and electro-acupuncture are mediated by efferent
vagus nerve activation and inflammatory macrophage
deactivation.
Han JS. Acupuncture and
endorphins. Neurosci Lett 2004; 361:
258-61.
A literature review of studies relating to the release of
endorphins by acupuncture.
Zijlstra FJ et al. Anti-inflammatory
actions of acupuncture. Mediators
Inflamm 2003; 12: 59-69.
An article that suggests a hypothesis for anti-inflammatory
action of acupuncture: Insertion of acupuncture needles initially
stimulates production of beta-endorphins, CGRP and substance
P, leading to further stimulation of cytokines and NO. While high
levels of CGRP have been shown to be pro-inflammatory,
CGRP in low concentrations exerts potent anti-inflammatory
actions. Therefore, a frequently applied 'low-dose' treatment of
acupuncture could provoke a sustained release of CGRP with
anti-inflammatory activity, without stimulation of proinflammatory cells.
Pomeranz B. Scientific basis of
acupuncture. In: Stux G, Pomeranz
B, eds. Acupuncture Textbook and
Atlas. Heidelberg: Springer-Verlag;
1987: 1-18.
Needle activation of A delta and C afferent nerve fibres in
muscle sends signals to the spinal cord, where dynorphin and
enkephalins are released. Afferent pathways continue to the
midbrain, triggering excitatory and inhibitory mediators in spinal
cord. Ensuing release of serotonin and norepinephrine onto the
spinal cord leads to pain transmission being inhibited both preand postsynaptically in the spinothalamic tract. Finally, these
signals reach the hypothalamus and pituitary, triggering release
of adrenocorticotropic hormones and beta-endorphin.


Terms and conditions
The use of this fact sheet is for the use of British Acupuncture Council members and is subject to the strict conditions imposed by the British Acupuncture Council details of which can be found in the members area of its’ website www.acupuncture.org.uk.

For more information on acupuncture and how acupuncture may help relieve symptoms of sinusitis, contact Elaine Collins at 0141 585 7904 or fill in our Contact form, and we will get back to you.