Video: Sinusitis and the Immune System

One survey of UK residents found an estimated 30% of adults suffer from rhinosinusitis, based on their score on a modified version of the sinonasal outcome test (SNOT-20).1 The CDC estimates that 12.5% of American adults have chronic sinusitis, based on the 2017 National Health Survey data.2 For acute sinusitis, antibiotics are a frontline treatment, while for chronic sinusitis, further interventions are often recommended, including surgery. Tom Sult, MD, IFMCP, shares his approach to chronic sinusitis and how Functional Medicine may help improve outcomes.


Chronic sinusitis is generally thought of as a chronic infection.

But the question becomes, “Why does this individual have the infection, and why does someone else not have it?” That really speaks to the individual’s unique biochemistry, their unique epigenetics.

We’ve known since before we understood what DNA even was that only 30% of the issue is genetic. 70% of the issue is epigenetic—things that happen after translation and transcription.

So, how do I approach chronic sinusitis? Well, we need to treat it locally, so we’re going to do things like rinse the sinuses with a Neti pot or some kind of thing like that. We might put some kind of anti-inflammatory herbal mixture in that.

But then we’re going to look to try to understand what’s making them susceptible.

What’s different and unique about them? We know that 70% of the immune system lines the intestine. If we’re trying to affect the immune system, looking in the intestine is often a good place to start.

For most people who have any kind of chronic infection, we’re going to find out that they also have chronic GI issues. We’re going to treat that and try to normalize the inflammatory milieu inside the gut so that the immune system will work better.

When you reduce allergens in the patient’s environment, you rinse the allergens out of their sinuses, you reduce the inflammatory byproducts in their sinuses, and you improve immune system function, usually their chronic sinusitis starts to improve.


  1. Sami AS, Scadding GK, Howarth P. A UK community-based survey on the prevalence of rhinosinusitis. Clin Otolaryngol. 2018;43(1):76-89. doi:1111/coa.12902
  2. National Center for Health Statistics “Chronic sinusitis.” CDC. Last Reviewed January 20, 2017. Accessed September 3, 2019.

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