Sinus problems are one of the most common ailments in the United States. Specifically, acute sinusitis affects more than 30 million people yearly, and chronic sinusitis can create long-term symptoms interfering with one’s everyday quality of life.
The sinuses are air-filled cavities in the skull. There are four sets of sinuses. The frontal sinuses lie above the eye and in front of the brain on each side. The ethmoid sinuses are a group of smaller air cells clustered between your eyes. The maxillary sinuses lie underneath each eye, and the sphenoid sinuses lie in the center of your head, underneath the brain. All of the sinuses have openings that communicate with the inside of the nose.
The internal side wall of the nasal cavity has three tissue folds called turbinates. The turbinates are bony outgrowths which are lined by a thick mucous membrane. Their purpose is warming, humidifying and filtering air for the lungs. The turbinates can swell and cause congestion, and even block the sinus drainage pathways. Medications such as steroids, antihistamines, and decongestants can help control the swelling. Sometimes the turbinates are significantly swollen, and a procedure or surgery is required to reduce their size.
The sinuses are lined with a moist mucous membrane similar in appearance to that on the inside of your mouth. It is constantly secreting mucous. During allergy flare-ups, colds, sinus infections, exposure to smoke or air pollution, the mucous becomes thick or overproduced. It can accumulate in the nose and sinuses, causing congestion and pressure, and ultimately, the mucous can become secondarily infected, which is called sinusitis.
Sinusitis means inflammation of the mucous membranes within the sinuses. Acute sinusitis (symptoms less than one month) is usually characterized by intense symptoms such as nasal congestion, facial pressure, nasal discharge, altered smell, fever and dental pain. Sinus inflammation can result from viral or bacterial infection. The latest research suggests that even bacterial sinusitis can resolve with supportive measures such as rest, hydration, nasal and oral decongestants, and nasal saline rinses. Antibiotics, too, are helpful in reducing the severity and duration of acute sinusitis.
Chronic sinusitis (symptoms more than 3 months) can be more difficult to explain. Many patients with chronic sinusitis have an overactive immune response to inhaled foreign particles. This can be in the form of a “true allergy” confirmed by blood or skin allergy testing or an “allergic-like” response (when the problem clinically behaves like an allergy but the allergy tests are negative).
Some researchers believe the chronic inflammation is due to certain bacteria residing in the nose and sinuses that cause a chronic infection that is resistant to standard treatments because they have formed a sticky protective blanket (biofilm) shielding the bacterial cells from antibiotics, nasal rinses and sprays. Others believe that bacteria in the nose and sinuses secrete a toxin ultimately leading to inflammation in the sinuses. A patient’s unique nasal and sinus anatomy (narrow drainage pathways, deviated septum) may also result in inefficient sinus mucous drainage and subsequent inflammation.
An ear, nose and throat doctor (otolaryngologist) is the specialist that deals with sinus problems. The American Academy of Otolaryngology website is http://www.entnet.org.
Jon Zwart is an otolaryngologist for The Vancouver Clinic.
