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The sinuses are hollow spaces inside of the bones of the face.
Sinuses are named for the bones in which they are located. Within the
cheekbones are found the maxillary sinuses. The bones of the forehead contain
the frontal sinuses. The bones between the eye sockets house the ethmoid air
cells, a group of small spaces linked by openings similar to a series of
rooms in an apartment. Deep within the skull is a single sinus, the sphenoid
sinus. The sinuses communicate with the nasal passages by narrow passages
called ostia. The sinuses, more properly termed the paranasal sinuses are lined with the same
tissue that lines the nose. This tissue consists of several layers. The
mucosal layer, the layer in contact with the environment, is composed
primarily of two types of cells. Mucous cells produce a thin sticky, yet watery
secretion. The more numerous columnar cells have a surface covered with a
thick lawn of cilia that faces the cavity of the sinus. When functioning
normally the cilia of adjoining cells move or beat synchronously.
Mucous, sitting in a layer on top of the cilia, filters the air trapping
dirt, pollutants, bacteria viruses, and airborne allergens. Ciliary action
sweeps these trapped inorganic and organic materials and microorganisms out
of the sinuses, through the nasal passages, and into the throat where they
are swallowed.
Science has not yet determined an essential role for the
paranasal sinuses. By replacing solid bone with air they make the head
lighter. Dinosaurs had very large sinuses. Some paleontologists theorize that
dinosaurs vocalized by blowing air through the sinuses. Fortunately or
unfortunately for civilized society, we can't do that.
This is an easier question to answer. The sinuses connect to
the nasal passages by narrow channels. When these channels become blocked or
obstructed dysfunction and disease results. Obstruction happens when there is
a deformity of the nasal bones such as in a deviated nasal septum or when
allergy or infection causes tissue swelling or when infection in the nose
causes accumulation of thick, tenacious mucous. When obstruction prevents the
free passage of air between the sinuses and the nose, an air pressure
difference may occur causing sinus pain or sinus headache.
Pain. Maxillary sinus pain is typically felt in the cheeks
and may be mistaken for pain in the upper molar teeth. Frontal sinus pain is
felt above the eyes and is often confused with tension headache. Ethmoid pain
is felt between and behind the eyes and in the temples. Pain originating in
the sphenoid sinus is thought to be experienced as referred pain at the back
of the head.
Although bacterial normally reside in the nasal passage, a
healthy sinus is sterile. Bacteria and viruses gaining access from the nose
are trapped in the mucous coat, inactivated or killed by the concerted action
of resident white blood cells, antibodies, and other microorganism-killing
proteins secreted by sinus lining cells, and then rapidly removed by ciliary
action. When removal of bacteria and viruses by ciliary activity is hindered
by blockage of the sinus ostia, their ability to very rapidly increase in
number overwhelms the other defense mechanisms of the sinus. An infection
ensues.
Sinus infections may be acute, that is, present for less
than a few weeks, or chronic. The primary symptoms
of an acute sinus infection are pain, cough, and the production of thick
green or yellow mucous. The cough is due to postnasal drip often
productive of mucous. The nasal passages are obstructed by mucous. Fever,
fatigue, malaise are commonly present. Facial and head pain may be more
intense when bending over. The upper molars may ache. Mouth breathing leads
to bad breath. In chronic sinus infection, pain is
often absent or minimal and fever
is uncommon. Otherwise, chronic sinus infection resembles acute sinus
infection. The primary symptoms are
cough, postnasal drip, and nasal obstruction and discharge. Because pain is
not prominent, chronic sinus infection may be mistaken for asthma or
bronchitis.
Yes. If sinus obstruction and pain are a result of allergic rhinitis there may also be nasal obstruction and discharge. In this case the discharge will be the clear, watery discharge typical of allergic rhinitis.
For immediately relief, a nonsteroidal anti-inflammatory
drug such as acetaminophen, aspirin, or ibuprofen are employed. For chronic
or recurrent pain or headache associated with sinus blockage, treatment of
the underlying cause is the best course of action. Since the most common
cause of sinus pain is untreated or insufficiently treated allergic rhinitis,
an evaluation by your primary care physician or by an allergist is
appropriate. If allergic rhinitis is found to be present, treatment may
consist of avoidance of allergens, medication such as antihistamines or
topical corticosteroid sprays, or immunotherapy.
No. Nasal septal deformity, nasal polyps, overuse of
over-the-counter decongestant nasal sprays, and sinus infection are other
common causes of such discomfort. Allergic
rhinitis is found to be the underlying cause of seventy to eighty per cent of
all chronic sinusitis.
The cause of an acute sinus infection (or sinusitis) is usually a viral upper
respiratory infection (a "cold") that induces swelling of nasal and
paranasal mucosa, creating obstruction, and resulting in entrapment of
bacteria in one or more sinus spaces. Even though viral colds may precipitate
them, chronic obstruction or a compromised ability of the immune system to
fight infections are the underlying causes when sinusitis is either chronic
or recurs more than twice a year.
Acute sinusitis (literally an inflamed sinus, another name
for a sinus infection) generally responds to a ten-day course of antibiotics
and oral decongestants such as Sudafed?. Chronic or recurrent sinusitis may
require more aggressive therapy including four to six weeks of continuous
antibiotic therapy, decongestants, mucolytics (medications that make thick
mucous more watery), nasal irrigation with salt water drops, and even
intervention by the otolaryngologist.
Frequent or protracted use of antibiotics contributes to
the selection of bacteria resistant to the effects of antibiotics. The
consequence is increasing difficulty in eradicating infection from the
sinuses. Antibiotics may cause other problems such as overgrowth of fungi in
the intestinal tract, skin rashes, and drug allergy. Because of these
concerns, the best way to treat chronic or recurrent sinusitis is to
determine the underlying causes and treat them effectively.
The physician begins by taking a complete medical history
and performing a physical examination. Examination of the nasal passages may
be supplemented by inspection with a flexible fiberoptic rhinoscope, with
radiographs, or with a CT scan
of the sinuses. When allergic
rhinitis is suspected skin testing is generally performed. A microscopic
inspection of sinus mucous may help determine whether allergy or infection is
present. When a defect of the immunes system's ability to fight infection is
suspected because infections of the lungs, skin, or intestinal tract as well
as those in the sinuses have occurred with some frequency, blood tests for
immune function may be obtained.
There are two aspects of effective treatment. First, the
ongoing infection must be eradicated. Simultaneously, the cause of the
chronic condition must be determined and treated as well. Successful
treatment of chronic sinusitis may take time, commitment, and the cooperation
of several physicians including your primary care physician, radiologist,
otolaryngologist, and allergist. It may include administration of antibiotics
for many weeks, efforts to improve sinus drainage with irrigation, decongest,
thin tenacious mucous, and decrease inflammation. Improvement of chronically
poor drainage out of diseased sinus passages may require sinus and nasal
surgery. Control of inflammation may require local or systemic
corticosteroids and immunotherapy.
When allergic rhinitis is determined to be the cause of a major contributor to chronic or recurrent sinus infections, immunotherapy can be of great therapeutic benefit. Immunotherapy reduces mucosal tissue swelling restoring normal drainage of mucous from paranasal sinuses into the nasal passages.
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L CAUTION L |
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The information above represents the writer's opinions and is not meant as a substitute for evaluation by a physician. The reader is advised to seek sound medical evaluation and guidance before undertaking treatment for any medical condition. |
Fellow, American Academy of Allergy, Asthma, & Immunology
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