JOSEPH R. ANTIAGLIA MD
Medical Advisory Board
“I have a miserable sinus headache, Doc. My sinuses are killing me. My teeth hurt, the left side of my face is tender, I can’t breathe through my nose and awful stuff is coming out of my nose.”
You’re not alone. Millions of adults (18 years and older) suffer from sinusitis at a cost of billions of dollars. Sinusitis affects about one in eight adults and costs over 11 billion dollars a year to treat. (1)
Occasionally it’s difficult to know whether the problem is just a common cold, allergies, or sinusitis. Or could it be a combination of all three or some other problem? What follows are questions that help explain adult sinusitis.
1. WHAT ARE THE SINUSES?
The sinuses, also called paranasal sinuses, are four pairs of air filled cavities located around your nose and eyes that are connected to the nasal cavity. If you blow up a balloon and pinch off the end of it you will have created an air filled cavity.
Each sinus is named for the bone in which the air cavity is located.
- Frontal sinus is located within the forehead bone, above the bridge of the nose, one sinus on each side.
- Maxillary sinus is the cheek bone sinus. One sinus is located in the left cheek bone and the other on the right side.
- Ethmoid sinus is located between the eye and nose, one on each side of the nose. Each sinus is composed of six to ten small honeycomb sinuses
- Sphenoid sinus is in the sphenoid bone which is located behind the upper-posterior part of the nasal cavity. A very thin bony partition often separates one side from the other.
The sinuses vary in size, shape and the age they reach full development. Surgeons take special care to note the anatomic differences between the sinuses of children and adults. In some instances, one or more of the sinuses may fail to develop. For example, the frontal sinus can be absent in 3 to 5% of the population.
2. WHAT IS SINUSITIS?
Sinusitis is the symptomatic inflammation of the lining of the paranasal sinuses caused by viral, bacterial infections or allergic reactions. Less frequently it is due to fungal infections and other causes. There’s a build-up of pressure in the sinuses because the normal openings of the sinuses become blocked preventing the sinuses from draining properly. Patients complain of a sinus headache — facial pressure, pain and discomfort. Sinusitis is almost always associated with inflammation of the nasal cavity and so it is commonly referred to rhinosinusitis.
3. WHAT DO THE SINUSES DO?
The lining of the sinuses has been compared to a blanket with hairs covered by mucus. The tiny hair cells (cilia) continuously move the mucus and unwanted substances out of the sinuses into the nasal cavity. The mucus eventually winds up in the back of the throat and the gastrointestinal intestinal tract.
Clinicians evaluate whether the “mucociliary” actions of the mucus blanket function well; in other words — do the sinus openings remain patent (open) or are the openings blocked? There are uncertainties regarding the significance of some of the other functions attributed ‘solely’ to the sinus.
4. WHAT CAUSES SINUSITIS?
Blockage of the opening of the sinuses and a build-up of pressure within the sinus cavities cause sinusitis. If you put your finger between the inner corner of your eye and nose, that’s the approximate place where normal mucus drainage takes place in the nasal cavity for the maxillary, ethmoid and frontal sinuses. This important intersection of three of the sinuses is pivotal for the normal functioning of the paranasal sinuses.
This “mucus traffic” intersection needs a ‘green light’ (function normally) for the mucus to ‘drive’ unimpeded into the nasal cavity and into the back of the throat. If this intersection (2) is blocked off by mucus plugs or other factors, it’s as if a ‘red light’ stops the normal flow of mucus out of the sinus cavity; sinus pressure builds up and causes a miserable sinus headache. Below are some of the causes that contribute to the blockage of the openings of the sinuses:
Physical
Deviated Septum
Nasal Fractures
Inflammatory
Viral
Bacterial
Fungal
Colds
Tumors
Benign — Nasal Polyps
Malignant — Infrequent
Genetic
Cystic Fibrosis
Immune Deficiencies
Environmental
Allergies
Air Pollution
Cigarette Smoke
There are other causes of sinusitis but normal mucociliary flow of mucous out of the sinus into the nasal cavity and beyond is the key component to healthy sinuses.
5. WHAT ARE THE SYMPTOMS OF ACUTE SINUSITIS?
“I can’t get rid of this cold. I’ve had it for almost three weeks and it’s getting worse.”
It’s not a cold. Acute sinusitis is a short term infection of the paranasal sinuses that lasts less than 4 weeks. It is often preceded by the common cold that doesn’t get better after 7 to 10 days. A bacterial infection can superimpose itself on top of a common cold misleading patients to think it’s a cold that won’t go away. Some of the complaints of common cold patients are nasal congestion, a sore throat, muscle aches and a clear, watery nasal discharge.
Sinusitis patients complain of:
- Thick, discolored nasal discharge
- Facial pain/pressure
- Nasal congestion
- Decrease sense of taste and smell
Symptoms of sinusitis can also include bad breath, headache, cough, upper toothache, sore throat, fatigue, ear pressure and fever.
* * * * * * *
Part B of “Adult Sinusitis” continues with five (“5”) more questions about this problem.