TL;DR  Sinus infections resist antibiotics and your immune system by physically walling themselves off with biofilms.  Destroy this biofilm with any gentle surfactant, such as baby shampoo mixed into ordinary saline sinus rinse, and a normal immune system will quickly take out the undefended infection.  You can accelerate this further by adding topical antibiotic to the saline wash *after* first breaking up the biofilm.  Limit future reinfection by deliberately infecting yourself with lactobacillus, in the form of lacto-fermented foods.

Introduction

Many doctors outside tropical Asia appear to be unaware of certain features of sinus infections, even though the information is widely available from Singapore and elsewhere.

Certain home remedies work well, but are usually so poorly explained or misunderstood, even by their purveyors, that they seem flaky or suspect.

Engineers and scientists don’t want to simply trust.  They want to understand mechanisms.

I suffered, and eventually cured, a ridiculously painful series of sinus infections several years ago — months of incapacitating pain day and night.  This post boils down years of reading and self-experimentation to a single explanation of how sinus infections work, and how to kill them. This is not a how-to-do-it, but just a how-I-did-it.  Your mileage may vary.

Understand these six mechanisms

Biofilms block antibiotics.

• Sinus infections construct biofilms around themselves as a physical barrier that limits contact with your immune system and antibiotics.
• Antibiotics and immune cells don’t pass through the biofilm, so the infection survives.
• Hence oral antibiotics tend to kill every bacteria in your body except the sinus infection.

Surfactants easily defeat biofilms.

• Biofilms are robust against antibiotics, but vulnerable to surfactants.
• Johnson’s Baby Shampoo, for example, easily breaks up biofilms, and is specifically designed to be relatively painless on mucus membranes (“no more tears”).
• Without its biofilm, the infection is defenseless against antibiotics or your immune system.
• The delivery mechanism for the surfactant is saline sinus rinse, aka “neti pot.”

Sinuses are like your belly button.

• Sinuses are an exterior but concave surface of your body, like your belly button.
• Belly buttons get dirty unless you wash them, because of concavity.  Sinuses even more so, because they are more concave.
• Viewed this way, there is nothing odd about washing your sinuses, and in fact it starts to seem weird not to wash there occasionally.
• Hence sinus rinse, aka neti pot, is not weird.

Your body is a bacteria farm.

• Many different strains, some harmful, some benign.
• Benign bacterial strains limit the growth of harmful strains by competing for resources.

Oral antibiotics carpet-bomb the farm.

• Oral and intravenous antibiotics kill all strains in your whole body indiscriminately.
• This eliminates competition for resources, allowing surviving harmful bacteria to come roaring back, this time with little resource competition.
• Topical antibiotics (unlike oral or intravenous) are precision weapons that don’t blow up the whole farm.

You can replant your bacterial farm to limit future infection.

• The strains of lactobacillus bacteria found in everything from yogurt to kimchee are harmless to your body, yet compete for resources with other, more harmful bacteria.
• Eating fermented foods has been shown to spread lactobacillus throughout your body, including your sinuses.
• At least one strain of lactobacillus (lactobacillus sakei, the one in kimchee), when present in the sinuses, has been shown to limit sinusitis, again by competing for resources.

Sinus recovery plan

• Buy equipment.
  • NeilMed sinus rinse squeeze bottle and salt packets.  My experience has been that off-brand and store-brand squeeze bottles don’t work right.  NeilMed works.
  • Johnson’s Baby Shampoo (or the NeilMed equivalent, which I haven’t tried).
  • (Optional but awesome) Find a doctor that will prescribe (and a compounding pharmacy that will mix) a small amount of topical antibiotic into sterile saline solution, to use as a secondary nasal rinse, as described below.  I invented this myself and am proud of it (though undoubtedly others have thought of it too).
• Repeat the following every day, until cured.
  • Fill NeilMed bottle with water, add one drop shampoo and one packet salt.  Shake.
  • Rinse sinuses gently per package instructions.  Don’t squeeze the bottle too hard.
  • Wait 30 minutes for the surfactant to break up biofilm.
  • Repeat the above rinse cycle;  this second round will be much more effective at washing away the infection, because the biofilm is broken up.
  • (Optional) For this second cycle, instead of the normal mix, rinse with topical antibiotic described above.  This will put the antibiotic in direct contact with the infection you just exposed in the first cycle above.  In my experience, this is a neutron bomb, instantly destroying the exposed sinus infection while leaving buildings standing.
  • Recovery takes 3-5 days without the topical antibiotic, or just 1-2 days with it.
• Replant the farm.
  • Buy kimchee, sauerkraut and yogurt.
  • Only works if it is a live culture:  when you first open kimchee or sauerkraut, gas should escape, and the contents should bubble up a little.
  • Eat these daily.
  • Feed the farm by also eating whatever the bacteria likes to eat.  I.e. for kimchee, eat steamed bok choy.  For sauerkraut, eat steamed cabbage.  For yogurt, drink milk (organic to make sure it doesn’t have trace antibiotic).
• Redo the above procedures every time the infection recurs.

Things to worry about (and not to worry about)

• The scare stories about Naegleria fowleri in nasal rinses are wildly overblown.  Yes, there is a nasty waterborne amoeba that kills you if it finds a hole from your sinus into your brain.  However:
  • Naegleria only occurs in warm untreated standing water, above 70 degrees.
  • Only a few hundred reported cases reported worldwide in 50 years.
  • Your odds of getting this from chlorine-treated urban tap water are very low.
  • If you use distilled water, the odds are lower still.
  • You are probably much more likely to die in a car crash driving to the supermarket for distilled water than you are to die from Naegleriasis.
• Squeeze the NeilMed bottle gently.  If your sinus is blocked, water may flow through slowly, so if you squeeze too hard, water will seek other paths out, including your Eustacian tubes.  This can cause an ear infection.  If you are gentle, no ear infection.
• After sinus rinse, wait 30 minutes before lying down, to let any water drain.  If you lie down too soon, water can drain into your Eustacian tubes or middle ear, creating conditions for an ear infection.
• Recurrent sinus infection, as the name suggests, is never fully cured.  When it comes back, you just treat it again, and are fine again for a few months or years.

I do not assert works for anyone else, but it totally, completely works for me.  It seems to have the added benefit of making colds less severe, probably by washing away the nasal component of the infection.

Using my topical antibiotic idea in particular, lasting relief came in 1 to 2 days, after months of chronic sinus pain.