What is a Sinus?

Sinuses are cavities in your skull bones.  One of their most important functions is to lighten the weight of your skull!  There are four sets of sinus cavities; the frontal sinuses are above your eyes, the sphenoid sinuses are behind and below your eyes, the maxillary sinuses are below your eyes in your cheeks, and the ethmoid sinuses (multiple smaller spaces) run under your nasal bones along the length of your nose.  None of the sinuses are visible as they are only connected to your nose by narrow openings that cannot be seen under normal conditions.  They are best evaluated clinically or radiographically.

Sinus cavities are lined by membranes that secrete an impressive amount of mucous daily, normally more than a liter.  Although people complaining of “post nasal drainage” think that it is not normal, it is not only normal for us to swallow more than a liter of mucous daily but also preferable to that volume running out of your nostrils.  The mucous is formed in response to the air that circulates through the nose and into the sinuses where it is warmed and humidified.  Both the nose and the sinuses function to clear contaminants and dust from the air that we breathe.

More than 37 million Americans suffer from at least one episode of acute sinusitis each year.   Sinusitis is an inflammatory condition where the membrane that lines one or more of the sinuses becomes swollen and/or infected.  This may be due to allergies, viruses (like the common cold), and bacterial infection.  Any of these can cause the sinuses to become closed off to the nose resulting in a sensation of congestion that may be different from stuffiness.  Your sinuses can be effected with or without nasal swelling and stuffiness.

Acute sinusitis is generally limited although it may recur more or less frequently.  Chronic sinusitis is a condition of sinus swelling that persists for 12 or more weeks.  Sinusitis may also be “acute on chronic” or “acute recurrent”.  Each of these have similar but different causes and courses of treatment.  This is a very common problem seen in the ENT office.

Sinusitis symptoms include facial pain/pressure, nasal obstruction, nasal discharge, and diminished sense of smell.   Additionally, sufferers could incur fever, bad breath, fatigue, dental pain, and cough.  Acute sinusitis can last four weeks or more. Acute bacterial infection might be present when symptoms worsen after five days, persist after ten days, or the severity of symptoms is out of proportion to those normally associated with a viral infection such as a cold.

If you are having sinus problems, there are some things you can do to help.  Warm moist air may alleviate sinus congestion.  Even running a hot shower to produce steam can help open clogged sinuses, allowing some drainage.  Similarly, warm compresses are useful in relieving pain in the nose and sinuses.  Saline nasal spray is also helpful in moisturizing nasal passages while saline irrigation can help unblock the narrow openings of the sinuses in addition to drawing free water from the overly wet sinus membranes by the process of osmosis.

While a CT scan is generally the best tool to get a full overview of what is going on in your sinuses, nasal endoscopes can be used in the office to see if there are polyps, pus, or other findings extending from the sinus openings into the nose.  This is performed with some combination of nasal decongestant and topical anesthetic to widen swollen passages and help decrease irritation.

Sinusitis is treated medically as the initial treatment in more than 95% of cases.  Only in the presence of severe complications is surgery an early treatment.  When medical management has failed and the problem has not resolved, surgery may be considered following radiological evaluation.  Sinus surgery opens blocked passages or widens narrowed passages.  Polyps and other accumulations can be removed or suctioned through the newly opened passages.  Depending on the extent of the problem at the time of surgery, it may take weeks to months for the sinus linings to return to normal.  In the presence of certain underlying issues, sinus surgery may serve to reduce symptoms but may be unable to return your sinuses to normal.