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    Sinus Infection (Sinusitis), Symptoms, Causes + Natural Remedies

    The Ayurveda Experience April 20, 2018

    Sinusitis (sinus infection) or rhinosinusitis is inflammation or painful swelling of the sinuses. In this article we’ll cover sinusitis symptoms, sinusitis causes and sinusitis remedies. But first let’s take a look at what sinuses do, where they are located and the different types of sinusitis. Keep reading. Here’s a quick overview of the article for your perusal.

    What Are Sinuses?
    What Sinuses Do
    Types Of Sinusitis
    Sinusitis Causes
    Sinusitis Symptoms
    Sinusitis Complications
    Sinusitis Diagnosis
    Sinusitis And Ayurveda
    Sinusitis Causes, According To Ayurveda (Nidan)
    Management Of Sinusitis According To Ayurveda
    Ayurvedic Home Remedies For Sinusitis
    Clinical Research Related To Peenas Roga (Sinusitis)

    What Are Sinuses?

    The sinuses are the connected systems of hollow cavities around the nasal passages in the skull. These cavities are filled with air and lined with a soft tissue called mucosa. We have four paired cavities in our skull known as sinuses.

    Frontal Sinus are located above the eyes or in the forehead region.
    Sphenoid Sinus are located behind the eyes and in the deeper recesses of the skull.
    Ethmoid Sinus are located between the nasal cavities and the eye sockets.
    Maxillary Sinus are located on either side of the nostrils or in the cheekbone area.

    READ MORE: Herbal Ways Of Fighting That Infuriating Sinusitis

    What Sinuses Do

    Sinuses produce a slimy secretion called mucus which keeps the nasal passages moist. They trap dirt particles, germs and other minor foreign bodies. Sinuses help in filtration of air. They lighten the overall weight of the skull. The cavities allow for resonance of the voice.

    Types Of Sinusitis

    Sinusitis can be classified on the basis of periodicity (the tendency to recur at intervals), on the basis of location (which sinus cavity is infected) and on the basis of the causative agent (viral infection or bacterial infection).

    Acute sinusitis is defined as a new infection of the sinuses which may last up to four weeks. If four or more than four separate full episodes of sinusitis occur within a year, it is called recurrent acute sinusitis. When an infection lasts between four to twelve weeks and shows a transformation between acute and chronic sinusitis, it is called sub acute sinusitis. Chronic sinusitis is when an episode of sinus infection lasts for more than twelve weeks. Acute exacerbation of chronic sinusitis refers to when the signs and symptoms of chronic sinusitis aggravate but return to baseline after treatment.

    Frontal Sinusitis: When the infection occurs in the frontal sinuses.
    Sphenoidal Sinusitis: When the infection occurs in the sphenoidal sinuses.
    Ethmoidal Sinusitis: When the sinusitis occurs in the ethmoidal sinuses.
    Maxillary Sinusitis: When the infection occurs in the sinuses of the cheek bone area.

    Viral Sinusitis

    When sinusitis is caused by a virus it is called viral sinusitis. The main viruses responsible for this problem are rhinoviruses, coronaviruses and influenza viruses. Signs and symptoms usually last for seven to ten days.

    Bacterial Sinusitis

    When sinusitis is caused by bacteria then it is called bacterial sinusitis. The most common responsible bacteria for this problem are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

    READ MORE: 37 Tips To Fight Inflammation Caused By Pitta Dosha

    Sinusitis Causes

    Sinusitis can stem from a variety of factors which cause interference with air flow in the sinus cavity and drainage of mucus out of the sinuses. Let’s look at acute sinusitis causes and chronic sinusitis causes.

    Acute Sinusitis Causes

    1. Upper Respiratory Tract Infection

    Upper respiratory tract infection is one of the main causative factors for acute sinusitis. Upper respiratory tract infection can be due to viral origin, bacterial origin or fungal origin as in diabetic patients or in immunocompromised patients.

    1. Chemical Or Other Irritants In The Air

    Irritants can trigger a buildup of mucus. Excessive mucus will ultimately clog the cavities resulting in sinusitis. Cigarette smoke and chlorine fumes are among the most common irritants.

    3. Tooth Infection

    Tooth infection can be a rare cause of this problem.

    Chronic Sinusitis Causes

    Underlying conditions like nasal polyps can cause chronic sinusitis. Nasal polyps are painless benign growths in the nasal cavity. The main cause behind polyps can be frequent allergies, either seasonal or due to some irritant.

    Besides polyps other underlying conditions like DNS (deviated nasal septum) can also be responsible for chronic sinusitis. In chronic maxillary sinusitis some cases are associated with dental infection. Chronic smokers have higher chances of developing chronic sinusitis. Passive smoking, secondhand smoke or environmental tobacco smoking is also associated with this chronic sinusitis.

    READ MORE: Ayurvedic Herbal Smoking (Dhumpana) And Other Natural Ways To Quit, I Quit Smoking With Ayurveda #MyAyurvedaExperience

    Sinusitis Symptoms

    Here are the common signs and symptoms associated with sinusitis.

    Pain and tenderness around the cheeks, eyes or forehead or in the whole facial region or headache. Sometimes the pain intensifies on lying down or bending. Sometimes the patient suffering from sinusitis feels dull, constant pressure on the head instead of pain.

    Besides the aforesaid symptoms, acute sinusitis may also be associated with the following.

    • Thick nasal discharge, usually green in color. Nasal discharge may contain pus or blood.
    • Fever (constant or on-and-off episodes of fever).
    • Blocked nose.
    • Sometimes toothache may also be associated.

    In chronic sinusitis, along with the common signs and symptoms of sinusitis and the symptoms associated with acute sinusitis, other symptoms associated with chronic sinusitis may include the following.

    • Middle ear problems due to congestion of nasal passages.
    • Dizziness due to pressure in the middle ear.
    • Foul smelling breath (halitosis).
    • Loss of sense of smell.
    • Cough during night time as a consequence of post nasal drip.
    • Tiredness
    • Post nasal drip or upper airway cough syndrome.

    With post nasal drip, excessive mucus has been produced by the nasal mucosa and collects in the back of the nose or throat. It can drop down into the throat from the nose.

    READ MORE: 21 Sleep Inducing Healthy Foods And Beverages For Insomnia, 5 Bedtime Routines For Adults: Inspiration For A Good Night’s Sleep

    Symptoms According To The Sinus Involved

    • Frontal Sinus: Pain or pressure in the head, particularly in the forehead.
    • Sphenoid Sinus: Pain or pressure behind the eyes but often referred as the top of the head or back of the head.
    • Ethmoid Sinus: Pain and pressure between or behind the eyes, or on the sides of the nose.
    • Maxillary Sinus: Pain and pressure in the cheekbone area. Toothache may be present.

    Sinusitis Complications

    One potential complication is infection of the eye socket which may further lead to loss of eyesight. Other orbital complications like orbital cellulitis and orbital abscess may also occur due to proximity of the sinuses to the eye.

    Infection of bones of the forehead or other facial bones can occur. Osteomyelitis of the frontal bone and maxillary bone can also occur.

    As sinuses are located near the brain there are chances of infection of the brain which can be life threatening. Infection of the brain occurs by invasion of anaerobic bacteria by bones or blood vessels.

    Sinusitis may extend to the central nervous system where it may cause retrograde meningitis, brain abscesses and more.

    Sinusitis Diagnosis

    Sinusitis diagnosis is made on the basis of signs and symptoms after clinical examination, which only a physician can do. In some cases investigations like nasal endoscopy, X-Ray, CT scan, MRI, tissue sample for histology and culture are required which is advised by healthcare professionals according to the patient’s condition.

    If you think you have a sinus infection seek the advice of your health care provider immediately.

    Sinusitis And Ayurveda

    In Ayurveda, sinusitis can be correlated with ‘Apeenasa roga’, ‘Peenas rog’ and ‘Dushta pratishyaya’, as described by various masters of Ayurveda, each depicting the various stages of sinusitis from acute to the chronic stage with proneness to complications, respectively.

    Ayurvedic master Sushruta in his treatise ‘Sushruta Samhita, has described ‘Apeenas roga’. 

    Apeenas Roga is due to vitiated Vata and Kapha dosha. The patient feels as if some smoke is coming out of the Nasa or nostril, or is blocked or becomes very dry and doesn’t notice any smells.5,6 This seems to be a transition stage of rhinitis (common cold or running nose) and sinusitis.

    READ MORE: Vata Diet: Everything You Need To Know, Kapha Diet: Everything You Need To Know

    Sushruta devoted a separate chapter named ‘Pratishyaya Pratishedh’ to rhinitis or ‘Pratishaya’ and its chronic stages.

    Peenas’ is a stage which can result from the ‘Pratishyaya’ caused by any of the three dosha and is marked by the disappearance and reappearance of nasal discharge. This stage resembles the stage of chronic sinusitis or acute on chronic sinusitis.

    Dushta Pratishyaya’ is one of the chronic stages which has not been mentioned as a separate disease but considered as a complication of different types of ‘Pratishyaya’ which correlates with present day understanding of pathological events related to rhinitis leading to sinusitis. This stage is also marked by complications as mentioned below and is very much in tune with chronic sinusitis with complications.

    Sushruta states that if the Dosha involved in ‘Pratishaya’ are vitiated more due to the patient’s improper dietary and behavioral habits and if ‘Pratishyaya’ is not managed properly, it leads to a severe and complicated condition called ‘Dushta Pratishyaya’, which is very difficult to treat and causes lot of complications like ‘Badhirya’ (deafness), ‘Andhata’ (blindness), ‘Ghrananasa’ (anosmia).[9]

    Sinusitis Causes, According To Ayurveda (Nidan)

    Vata is the main Dosha involved in sinusitis and Kapha, Pitta and Rakta are associated Dosha. [10]

    Sushruta has described the immediate causes of ‘Pratishaya’ as ‘nari prasanga’ (excessive sexual activity), ‘shirashabhitapam’ (exposure of the head to excessive heat like the summer sun, afflicting the head region), ‘dhum’ (smoke), ‘rajah’ (dust, pollen, environmental pollutants), ’shitamatipratapa’ (exposure to excessive cold or heat),’mutrapurishasandharanam’ (forceful retention of urge of urination and defecation).[11]

    Interestingly, the wearing of headgear in traditional Indian attire is a safeguard from exposure of the head to extreme weather which was practiced with assiduity and is practiced even today in rural India.

    Management Of Sinusitis According To Ayurveda

    The management advised by Ayurvedic master Vagbhatta for ‘dushta pratishyaya’ is similar to that for ‘Rajayakshma’ (a condition involving the respiratory system, marked by emaciation, resembling Tuberculosis)  and ‘Krimi Rog’ (parasitic and microbial infestation).[12]

    The management advised by Sushruta is as follows.

    Samanya Chikitsa Sutra’ or generalized treatment plan involves treating the ‘Pratishyaya’ effectively so that it does not lead to the sinusitis or Peenas or Dushta pratishyaya stages.

    Foremost for ‘Pratishyaya’ (Rhinitis) is to give ‘Ghrit’ (clarified butter) which is for the oleation purpose of patient. After that various types of sweating therapies are done on the patient to control the Vata dosha which is the triggering dosha that gets vitiated first.

    Later to take care of the associated Kapha, the therapist administers ‘Vaman’ or emesis therapy to the patient at an appropriate time (generally decided by the practitioner). Ultimately administration of ‘Avapeeda Nasya’ is given to the patient. This is the juice of an Ayurvedic medicine administered through the nasal passage to take out the accumulated mucus (the pathological form of Kapha) from the sinuses. All of these therapies are advised by the ancient masters in the classical texts.[13]

    If the sinusitis has set in and administering ‘Vaman’ is not possible then Langhan’ (restricted diet) is advised to relieve the heaviness of the head due to Kapha dosha. After that ‘Deepan’ and ‘Pachan herbs’ are given to take care of the remaining Kapha and to make the Pitta stronger. ‘Deepan herbs’ are appetizers. They help in the secretion of digestive juices. ‘Paachan aushadh’ helps in digestion.[14]

    READ MORE: 25 Snack Foods For Pitta Dosha

    In addition to these management tips mentioned by Vagbhatta and Sushruta, here are some other aspects from different text books of Ayurveda related to management of this condition.

    Although every ‘Acharya’ or Ayurvedic master had described ‘dushta pratishyaya’ as a complicated condition and with poor diagnosis[15], still many treatment modalities are proposed by ancient scholars for this condition according to the patient’s condition and progression of disease.[16

    Nasya’, the administration of medicine through the nasal passages, is considered a chief procedure to drain the doshas, the fundamental bio-elements of the body according to Ayurveda, from the ‘Shirah’ (head and skull).

    Dushta pratishyaya’ is a chronic condition of dosha accumulation mainly in ‘Nasa’ (nasal passage) and ‘shira’ (head or skull) which happens due to ‘sroto dushti’ (blockage of channels). For ‘sroto shudhi’ (clearance of channels) and ‘dosha sravana’ (drainage of vitiated doshas) administration of ‘sneha virechana nasya’ (administration of medicated oil in the nasal passage)  with ‘Anu taila’ (medicated herbal oil) or ‘Shad bindu tail’ (medicated herbal oil) can be given.[17]

    Due to decreased immunity, recurrence of this problem is very common. In Ayurveda, ‘rasayana’ or rejuvenation therapy is given to improve immunity. Many ‘rasayana’ preparations are prescribed in different texts as ‘Vyaghri Haritaki Avaleha’ (Ayurvedic medicine in herbal jam form) which is given internally. It is indicated for ‘peenas’. It has ‘rasayana’ as well as anti-inflammatory effects.[18]

    These arduous procedures are best left to the Ayurvedic practitioners. So let us look at some Ayurvedic Home Remedies and measures for managing sinusitis.

    12 Ayurvedic Home Remedies For Sinusitis

    1. Rest

    Take proper rest.

    2. Avoid Cold Weather

    Wear comfortable clothes which cover all body parts to avoid exposure to cold weather.

    READ MORE: Ayurvedic Cold Weather Diet + Lifestyle

    3. Avoid Irritants

    Avoid cold winds, irritants like smoke and dust, because they worsen the problem of sinusitis.

    4. Stay Hydrated

    Drink enough water to keep yourself hydrated but do not drink an excessive amount of water. Warm water is better than cold water.

    READ MORE: Dehydration: 5 Replenishing Beverages Plus Ayurvedic Summer Health Tips

    5. Do Neti

    Saline water helps in thinning of mucus and flushing out the nasal passage. Neti pots can be used for this purpose.

    According to Spencer C. Payne, MD, an associate professor of otolaryngology (head and neck surgery) at the University of Virginia in Charlottesville, NC, “There is a lot of debate about which sinus pain remedies work and what has been proven, but saline spray and washes like neti pot are indisputable.”

    Dr. Payne says, “Saline washes have been studied and proven to be effective and should be the first line of defense against sinusitis.”

    6. Steam Inhalation

    Steam inhalation is helpful in moistening the sinuses.

    Dr. Robert Graham, MD, MPH, an internist at Leno Hill Hospital in New York City and assistant professor at the Hofstra North Shore-LIJ School of Medicine says, “Sprinkle a few drops of eucalyptus or menthol oil in the shower and steam up your bathroom.”

    Sam S. Rizk, MD, a New York City based ear,nose and throat doctor and plastic surgeon says, “A hot, steamy shower or bath can also help to loosen up mucus and debris that is stuck inside your nose.”

    Dr. Rizk says, “Fill a deep bowl or pot with steaming water and place your face over it with a towel around your head to breathe the steam in.”

    7. Eat Warm Foods

    During sinusitis always eat warm food and foods which are easy to digest like porridge, soups, stews and millets.

    8. Ginger, Holy Basil + Black Pepper Tea

    You can take an herbal decoction of ginger, holy basil and black pepper powder two to three times a day. To make this decoction take a cup of water and add the ingredients. Use eight to ten leaves of holy basil, a small crushed piece of ginger and 8 to 10 pieces of black pepper and boil it over a low flame. When half the water remains, remove the pot, let cool and enjoy the decoction.

    You can add some sugar to taste.

    READ MORE: Golden Porridge: A Turmeric Breakfast Bowl Recipe, Basic Kitchari

    9. Nasya

    Take mustard oil and warm it a bit. When it’s lukewarm, pour two drops of this oil in each nostril with the help of a dropper. Take a deep breath and whatever oil comes into the throat, spit it out. Do gargle with saline lukewarm water after spitting out the oil to clear the throat.

    10. Breathing Exercises

    Do breathing exercises like pranayam and kapalbhati as it will help in keeping the nasal passages clean and maintain a good level of oxygen.

    11. Cinnamon Honey Remedy

    One quarter teaspoon of cinnamon powder with one teaspoon of honey one to two times a day will provide some relief.

    12. Turmeric + Garlic

    Add turmeric and garlic to your daily food regimen as both are helpful in relieving inflammation and allergy.

    READ MORE: Will Turmeric Lower Blood Pressure?, 21 Ways To Take Ashwagandha

    Clinical Research Related To Peenas Roga (Sinusitis)

    Some facts about sinusitis…

    • In today’s modern, urbanized living conditions we are in constant touch with different kinds of pollutants. This ultimately leads to allergic conditions, some of which become chronic due to various factors like sinusitis. They interfere with day to day living.
    • According to the American Academy of Otolaryngology and Head and Neck Surgery, more than 37 million Americans suffer from at least one episode of sinusitis each year.[19]
    • In managing chronic diseases, Ayurveda has a noteworthy role. However these days physicians do not rely completely on Ayurvedic texts, so numerous research programs and clinical trials are performed on a large scale.

    Over the past few years many research studies have been done on ‘peenas roga’ (sinusitis) and still much research is going on. Some of them are mentioned below which gives a brief insight into the Ayurvedic management of sinusitis as practiced by Ayurvedic practitioners in India.

    1. Nasya therapy along with herbs provided better and long lasting results in 37 patients. The study examined the role of ‘Pradhamana Nasya’ (Inhalation or administration of  powder of three pungents by nasal passage with the help of a hollow tubal instrument) and ‘Trayodashanga Kwatha’ (a classical herbal decoction) in the management of ‘Dushta Pratishyaya’ with special reference to chronic sinusitis.20

    This study was performed by physicians of Department of ENT, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India and Department of ENT, M. P. Shah Medical College and Guru Govind Singh Hospital, Jamnagar, Gujarat, India.

    This study has also been published by NCBI.[21]

    In this study 37 patients were registered and randomly divided into three groups. Out of 37 patients, 31 patients completed the full course of medicine. In the first group the patients were given Trayodashanga Kwatha ( a classical herbal decoction)  with Madhu (honey) orally. In the second group, Pradhamana Nasya with Trikatu and Triphala Churna (insufflation of powder of three pungents or Trikatu and three fruits Triphala) was administered. In the third  group (combined group), Pradhamana Nasya was administered initially, followed by oralTrayodashanga Kwatha with Madhu (honey).

    After clinical trial it was concluded that the third group showed marked relief. It was concluded that for good and long-lasting results in sinusitis the combination of purification or expulsion of Dosha through nasya therapy and shamana therapy or alleviating therapy (giving herbs orally) will provide better and long lasting effects.

    1. Management of ‘Dushta Pratishyaya’: A Success Story[22]

    This clinical trial was done by physicians of SDM College of Ayurveda and Hospital, Hassan, Karnataka, India on a 32 year old female housewife who came to the physician with complaints of sneezing in the early morning, nasal blockage, headache in the frontal region and heaviness for three years.

    They treated the patient with Shodhana nasya, an oil or ghee (clarified butter) based nasal medication which contains an herbal formulation according to the patient’s condition. In shamana chikitsa they used Vyoshadi vatika, an Ayurvedic formulation, along with Kushmanda rasayana, an Ayurvedic herbal jam.

    Along with this they did Dhumpana (nasal fumigation). After completion of the treatment there was an absence of her ENT related complaints. Along with that digestion and taste perception was normalized. Her sleep was sound. There were no hypersensitivity symptoms on exposure to dust and wind to which the patient was not tolerable.

    1. Nasya proved beneficial for sinusitis in this study, which examined the role of Pradhaman nasya, inhalation or administration of powdered Ayurvedic herbs through the nasal passages, followed by Anu Taila (Ayurvedic herbal oil) Nasya (administration of medicine through nasal route) in the management of Dushta Pratishyaya (chronic sinusitis).23

    This clinical trial has been performed by the E.N.T department at Dr. D. Y. Patil College of Ayurved and Research Institute, Nerul, Navi Mumbai.

    In this clinical study, 34 patients were given pradhaman nasya with Shinkanian Ayurvedic preparation, for three days followed by Anu tail nasya for five days.

    Along with this tablet Laxmi vilas Ras, an herb and mineral combination, with lukewarm water was given for seven days. After completion of the therapy six patients showed complete relief from sign and symptoms, 27 patients were markedly improved (50-100% relief from sign and symptoms), and one patient came under improved category (25-50% relief from signs and symptoms).

    1. Role of Vyaghri Haritaki Avaleha, an Ayurvedic medicine in herbal jam form, and Anu Taila Nasya, administration of an Ayurvedic herbal oil medicine through the nose, in the management of Dushta Pratihsyaya (chronic sinusitis). [24]

    This clinical study has been done in Gujarat and the corresponding author of this article is Parth P Dave who is a PhD scholar in the department of ENT, IPGT & RA. Gujarat Ayurved University, Jamnagar. A total of 30 patients were registered for this study. They were divided into two groups. In the first group patients were administered Vyaghri Haritaki Avaleha orally and Marsha Nasya (self insufflation of oil in the dose of 2-3 drops) with Anu taila (an ayurvedic nasal oil formula). In the second group patients were administered Vyaghri Haritaki Avaleha orally.

    The first group showed statistically significant results while the second group did not show statistically significant improvement. The improvement of the first group is because of nasya karma, as drainage of retained secretions is facilitated by local swedana (sweating therapy) and medicine instillation.

    1. “Sinusitis.” Wikipedia, Wikimedia Foundation, 15 Apr. 2018, en.wikipedia.org/wiki/Sinusitis.
    2. Y.S., Dr. Raghuram. “Sinusitis: Ayurvedic Treatment, Remedies, Preventative Tips.”Easyayurveda.com, easyayurveda.com/2015/12/07/sinusitis-ayurvedic-treatment-home-remedies/.
    3. “Sinusitis Symptoms and Treatments.” Symptoms & Treatment – Illnesses & Conditions, 22 Dec. 2017, www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/sinusitis.
    4. Mann, Denise. “10 Natural Remedies for Sinus Pain.” Everyday Health, Everyday Health, 1 Dec. 2015, www.everydayhealth.com/sinus-health-guide/natural-remedies-for-sinus-pain.aspx.
    5. Sushruta Samhita, Uttar Tantra 22/6.
    6. Sushruta, Sushruta Samhita, Ambika Datta Shastri, Hindi commentary, Chaukhambha Sanskrit Sansthana, Varanasi, 2001.
    7. “What Is Sinusitis?” WebMD, WebMD, www.webmd.com/allergies/sinusitis-and-sinus-infection#1.
    8. Chaudhari, Varsha. “Role of Pradhamana Nasya and Trayodashanga Kwatha in the Management of Dushta Pratishyaya with Special Reference to Chronic Sinusitis.”AyuJournal.org, Wolters Kluwer, 2010, www.ayujournal.org/article.asp?issn=0974-8520;year=2010;volume=31;issue=3;spage=325;epage=331;aulast=Chaudhari+.
    9. Sushruta. Sushruta Samhita with nibandhasangraha commentary of Dalhana and nyayachandrika Panjika on Nidanasthana commentary of Gayadasacharya, Ed. By Vd. Jadavaji Trikamji Acharya & Narayana Ram Acharya. Varanasi; Chaukhamba Surbharati Prakashana; 2010. 652p.
    10. Sushruta. Sushruta Samhita with nibandhasangraha commentary of Dalhana and nyayachandrika Panjika on Nidanasthana commentary of Gayadasacharya, Ed. By Vd. Jadavaji Trikamji Acharya & Narayana Ram Acharya. Varanasi; Chaukhamba Surbharati Prakashana; 2010. 651p.
    11. Sushruta Samhita Uttar tantra 24/3.
    12. Vagbhata. Ashtanga Hridaya. Sarvanga Sundari Comm. Arunadatta & AyurvedaRasayana comm. In: Hemadri D, Sadashiva SP, editors. Varanasi: Chaukhamba Surbharati Prakashana; 2007.
    13. Sushruta Samhita Uttar Tantra 24/18.Edited with Ayurveda Tattva Sandipika Hindi commentary by Kaviraj Ambikadutta Shastri, Chaukhambha Sanskrit Sansthan, Varanasi.
    14. Sushruta Samhita Uttar Tantra 24/23.Edited with Ayurveda Tattva Sandipika Hindi commentary by Kaviraj Ambikadutta Shastri, Chaukhambha Sanskrit Sansthan, Varanasi.
    15. Vagbhata. Ashtanga Hridaya with sarvanga Sundari Arunadatta commentary of Arundatta and ayurvedarasayana commentary of Hemadri, Ed. By Pt. Sadashiva Shastri Paradakara. Varanasi; Chaukhamba Surbharati Prakashana; 2007. 293p.
    16. Sushruta. Sushruta Samhita with nibandhasangraha commentary of Dalhana and nyayachandrika Panjika on Nidanasthana commentary of Gayadasacharya, Ed. By Vd. Jadavaji Trikamji Acharya & Narayana Ram Acharya. Varanasi; Chaukhamba Surbharati Prakashana; 2010. 652p.
    17. Kaviraj Govind Das Sen. Bhaishjya Ratnavali with sidhdhiprada commentary. Varanasi; Chaukhamba Surbharati Prakashana; 2005. 297p.
    18. Vagbhata. Ashtanga Hridaya with sarvanga Sundari Arunadatta commentary of Arundatta and ayurvedarasayana commentary of Hemadri, Ed. By Pt. Sadashiva Shastri Paradakara. Varanasi; Chaukhamba Surbharati Prakashana; 2007. 853p.
    19. Available from: http://www.Entnet.Org [last accessed on 2010 Jul 20].
    20. Chaudhari, Varsha. “Role of Pradhamana Nasya and Trayodashanga Kwatha in the Management of Dushta Pratishyaya with Special Reference to Chronic Sinusitis.”AyuJournal.org, 2010, www.ayujournal.org/article.asp?issn=0974-8520;year=2010;volume=31;issue=3;spage=325;epage=331;aulast=Chaudhari#ref5.
    21. Chaudhari, Varsha, et al. Ayu, Medknow Publications Pvt Ltd, 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3221066/.
    22. Kumari, Nisha. “Management Of Dushta Pratishyaya: A Success Story.” JBSOWeb.com, Moksha Publishing House, 2013, www.jbsoweb.com/admin/php/uploads/21_pdf.pdf.
    23. Patil, Ashwani. “Role Of Pradhaman Nasya Followed By Anu Tail Nasya In The Management Of Dushta Pratishyaya W.S.R. Chronic Sinusitis.” International Ayurvedic Medical Journal, 2014.
    24. Dave, Parth. “Role Of Vyaghri Haritaki Avaleha And Anu Tail Nasya In The Management Of Dushta Pratishyaya.” ResearchGate.net, ResearchGate 2018, Apr. 2016, www.researchgate.net/publication/319643440_Role_of_Vyaghri_Haritaki_Avaleha_and_Anu_Taila_Nasya_in_the_management_of_Dushta_Pratishyaya_Chronic_Sinusitis.


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