Sinus pain isn't the first thing that comes to mind for most people when they think of acid reflux. But in addition to heartburn and other digestive complaints, acid reflux can play a role in a number of respiratory ailments, including asthma, post nasal drip and chronic cough. Whether acid reflux -- also known as gastroesophageal reflux disease, or GERD -- can affect the sinuses is a matter of increasing interest to researchers. While a medical consensus hasn't quite been reached, a number of studies make a very plausible connection between GERD and chronic sinusitis.
Acid Reflux and the Upper Respiratory Tract
Acid reflux occurs when the gastric contents of the stomach leak into the esophagus through the muscular valve that normally closes to form a barrier between the two. Sometimes, however, the gastric acids splash all the way into the throat, mouth and sinus cavities, causing inflammation and damage. When this happens, it's called chronic rhinosinusitis. The underlying condition of reflux projecting beyond the esophagus where it can affect the sinuses and vocal chords is called laryngopharyngeal reflux disease, or LPR, which is related to GERD.
Correlation Between Acid Reflux and Sinusitus
The connection between GERD and rhinosinusitis, or CRS, is better established in children than adults. In a groundbreaking study published in the September 1999 issue of "Otolaryngology -- Head and Neck Surgery," 89 percent of children with chronic sinusitis who were treated for GERD with acid suppressive therapy were able to avoid sinus surgery. In a subsequent study published in July 2000 in the same journal, 79 percent of children with chronic sinusitis showed improvement after reflux treatment. About two-thirds of adults with chronic sinusitis showed improvement in sinus symptoms after acid-blocking therapy. Notably, only patients who tested positive for acid in their nasal passageways experienced dramatic improvements. A study published in the September 2015 edition of "Medicine" of 929 adults in Taiwan with CRS found that people with GERD were almost 2.5 times more likely to suffer from CRS.
How Acid Reflux May Cause Sinusitus
Although the connection between acid reflux and CRS isn't well understood, there are several possible reasons for the increased risk of CRS in acid reflux patients. One is that exposure to acid gastric fluids could injure the lining of the nasal cavities, provoking a series of immune responses such as inflammation and allowing infection. They could also irritate sympathetic nerves in the respiratory system, causing nasal congestion, excessive nasal secretions and continuous post nasal drainage. LRS may also contribute to infection of the upper airways by bacteria from the intestinal tract.
Acid suppression therapy has been shown in some studies to be an effective treatment for CRS. In one study, most adults whose sinusitis persisted even after surgery responded well to PPI therapy. There is, however, some concern that acid suppression therapy can allow intestinal bacteria to colonize the sinuses. Surgical intervention to restore the LES may be recommended for those who suffer from recurrent or chronic sinusitis and have documented GERD or LPR. Of course, anyone suffering from sinus pain or disease should discuss their difficulties with an allergist to determine if any environmental or food allergies might be the cause.
Is This an Emergency?
- Annals of Thoracic Medicine: Pulmonary Manifestations of Gastroesophageal Reflux Disease
- Therapeutic Advances in Chronic Diseases: Optimal Treatment of Laryngopharyngeal Reflux Disease
- Medicine (Baltimore): Increased Risk of Chronic Sinusitis in Adults With Gastroesophgeal Reflux Disease
- Diseases of the Esophagus: Does Gastroesophageal Reflux Contribute to the Development of Chronic Sinusitis? A Review of the Evidence
- Current Allergy and Asthma Reports: Laryngeal Reflux and Chronic Sinusitis
- Ear Nose and Throat Journal: A Study of The Link Between Gastric Reflux And Chronic Sinusitis in Adults