The sinus cavities are normally
filled with air. The sinuses are lined with a very thin
lining similar to the inside of your mouth, known as mucosa.
This lining secretes mucous which normally is very watery
and is sterile. The mucosa has cilia, fine finger like
projections, which rhythmically beat the mucous ‘blanket’
to the back of the nose. The sinuses and nose help to heat
the air we breathe and most importantly, to humidify the
air so our lungs stay moist. Some filtration of particles
in the air occurs in the nose, as they are trapped in the
mucous. There is a normal slow movement of this mucous
blanket through the nasal cavity to the back of the throat
where it is swallowed. The nose and sinuses secrete approximately
2 liters of mucous every day!
When the normal flow of mucous
is changed, or stops, problems arise. This can be due to
- Anatomic abnormalities
such as: crooked
(deviated) septum, abnormal development of normal sinus
anatomy and drainage system, large adenoids or tonsils,
foreign bodies, hypertrophic or enlarged turbinate bones,
or rarely – tumors or polyps.
- The most likely
cause is a viral infection. The lining of the nose and sinuses becomes
damaged, the mucous is altered or becomes thick, and stops
moving. Once the lining is damaged by a virus it takes
up to 3 weeks and sometimes longer to return to normal!
The lining of the nose, like blood, is red. When the red
heme molecule breaks down it normally turns YELLOW or GREEN.
This does not mean bacterial infection! If the body cannot
clear the secretions (see treatment) it can become secondarily
infected. This usually occurs after about 7-10 days. It
is estimated that 90% of BACTERIAL sinus infections resolve
without antibiotic treatment!
does a patient or Doctor know when it is viral, bacterial, or
This is not always clear cut.
Viruses last 7-14 days. There can be fever. Drainage is
usually clear, then becomes thicker and yellow-green near
the end. The nose is congested, and the person usually
cannot breathe out of the nose. Pain is dull, like a pressure,
and can be in the upper canine teeth. Bacterial infection
can result from this and cause persistence of the dull
pressure, fever, and nasal discharge. The person usually
feels ill; if the symptoms last over 10 days with simple
treatment- you may want to see a doctor.
are usually, not always, seasonal - meaning certain times
of the year. Itchy eyes and palate, thin watery nasal secretion,
and congestion, with sneezing. Rarely is there pain.
As mentioned above, diagnosing a bacterial sinus infection
is sometimes difficult. A proper examination after listening
to the patient’s history, is very important. The examination
consists of looking in the nose with a nasal speculum,
to examine the anatomy. A proper headlight is necessary
for this. The ENT physician will usually also spray topical
decongestant in the nose to see all the normal anatomy.
In chronic conditions, sometimes a magnifying endoscope
is used as well. The Gold standard to make a diagnosis
is History, Physical exam, and a CT Screen (limited 6-8
views of the sinuses). CT, however, can misinterpret a
‘cold’ as an infection, especially if done within 14 days
of onset of symptoms.
Treatment of nasal
congestion starts with trying to re-establish airflow and
normal sinus drainage. Moisture is very important: humidifiers,
vaporizers, nasal saline irrigation, nasal saline gels
(Ayr saline gel, Ocean saline gel, Ponaris ,etc.). Taking
a nice steamy shower or inhaling steam with a towel over
Use a topical nasal spray decongestant
such as Afrin, or Neosynephrine. Read the label: use only
for 3 days. This can be repeated again a week later. ANTIHISTAMINES
are not decongestants!!! Oral decongestants such as Sudafed,
Tylenol-sinus, Robitussin PE. Again avoid antihistamines
as they can dry and thicken secretions.
If symptoms persist:
an antibiotic MAY be necessary. Recent articles have shown
90% of bacterial infection will clear without antibiotic
use. Chronic sinusitis studies have shown little to no
benefit from long term antibiotic treatment.
sprays are effective to help reduce swelling and return
the lining to normal. These are also effective for Allergy.
Allergy treatment also includes antihistamine use.
Treatment of sinus or nasal problems is
dependent on the individual patients problems. Pediatric and young
adult patients may require adenoidectomy and/or tonsillectomy to
relieve the nasal obstruction. This re-establishes normal mucous
The surgical treatment of sinus problems is to promote drainage
and open the nasal airway. This may include straightening the septum,
removing polyps (benign fluid filled sacs which grow out of the
mucosa) , or removing or opening the normal sinus drainage pathways.
Functional endoscopic sinus surgery. Using small telescopes the
ENT surgeon can open and promote drainage of the sinuses.
Balloon Sinuplasty™ (in Office)
New technology allows the placement of a small
balloon in the sinus cavity which opens the normal ostia or opening.
This promotes drainage and decreases time of operation and scarring.
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A microdebrider is sometimes used
to exactly remove diseased tissue in some instances. This decreases
operating time as well as scarring. Rarely is old fashioned gauze
packing used. If bleeding does occur, newer hemostatic gels can
be used. This greatly reduces discomfort post-operatively. Septoplasty
patients (straightening the nasal septum) will require thin plastic
splints which are removed 1 week later. If you are concerned about
sinus problems discuss it with your ENT specialist.