A sinus is generally defined as an empty cavity or hollowed-out space. We humans typically have four sets of these “bony hollows” in our skull; one set is beneath the forehead, one set is within the cheek bones, and the other two sets are centrally located deep within the cranium. The function of these sinuses is still debated. Scientists theorize that because these air-filled spaces makes the head lighter, primates with sinuses had an easier time walking on two feet with an upright posture —and subsequently had superior hunting (and fleeing) abilities. The presence of sinuses also correlates with an improved sense of smell, which is another crucial survival skill. So sinuses are nothing, do nothing, but are deemed important nonetheless.
Paranasal (near the nose) sinuses resembles igloos; each has a large central chamber and single narrow “door” or drainage port. These bony spaces are lined with a thin layer of tissue similar to that which lines the inside of our cheeks. This tissue continuously produces tiny amounts of watery secretions, which is then moved slowly but surely by millions of tiny little hairs called cilia. The small amount of fluid is directed in an organized fashion to the drainage port. This continual one-way, outward flow prevents stagnant pools of fluid from forming, and washes out any random bacteria that may have made its way in.
So healthy sinuses mainly contain air, with a small rim of draining secretions. Anything that disrupts this situation can result in significant sinus pain and infection. Blockage of the drainage port is a frequent first step in sinusitis. Some people are born with, or develop unusually small drainage outlets and are likely to have recurring sinus infections. But more common instigators are allergies and viral infections. These both can have a “double whammy” effect! First, they cause marked tissue swelling, so that the drainage opening, which is lined by mucous tissue, gets much narrower. Secondly, the irritated/swollen tissue puts out dramatically increased amounts of fluid; more than the tiny drainage openings can handle. A “traffic jam,” so to speak, results, and fluid and air are trapped. Exposure to cigarette smoke or other noxious fumes also adversely affects sinus function. They cause paralysis of the cilia, those tiny hairs that keep mucous flowing towards the drainage outlet. Smokers are thus particularly prone to acute and chronic sinus problems.
Whatever the cause or combination of causes, once the drainage outlet is blocked the classic “sinus headache” can develop. Depending on which sinus(es) are involved, the sufferer experiences a marked sense of pressure in the forehead, cheekbones, and/or behind the eyes. The pain commonly increases with bending over, or if pressure is applied to the affected area. Sense of smell usually diminishes, as well.
Sinus blockage caused by allergy or viral infection does not require, or respond to, antibiotic treatment. Many times it will resolve on its own in 5-7 days. Over the counter medications in the antihistamine family, such as diphenhydramine (Benadryl) or loratadine (Claritin) can help by slowing down secretion production. Decongestants such as pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) aid recovery by reducing tissue swelling and improving the drainage capacity of those narrow bony openings. And measures to make the mucous secretions as thin and watery as possible also can improve the reestablishment of effective sinus drainage. Drinking plenty of fluid and using the “mucous loosener” guaifenesin (Mucinex pills) can be curative!
But sometimes sinus problems are more serious and do require medical attention and treatment. Blockage of the drainage port causes stagnation of fluid in the sinus. A single trapped bacterial particle then has the opportunity to divide and multiply many times over, ultimately taking over the entire area. Doctors recognize this “double sick sign”—initial improvement of sinus issues followed by a sudden worsening—as a clue that a secondary bacterial infection may be present. If you experience the “double sick sign,” you may need antibiotic treatment!
There are other symptoms beside the double sick sign that may indicate a bacterial infection is present in the sinuses. Fever, sore throat (from infected sinus secretions draining down the back of the throat), ear pain/altered hearing (due to infected sinus secretions affecting the middle ear), dizziness (caused by sinus pressure interfering with inner ear function) and vision problems (due to pressure on the muscles and nerves directing eye motion) all suggest a bacterial process could be present; medical evaluation would help determine the need for prescription therapy.
Sometimes sinus infections cannot be cured with medications, or initially resolve only to return again and again. This condition is called “chronic sinusitis” and is usually managed by a specialist. People who suffer with chronic sinusitis may require sinus surgery to enlarge chronically narrowed drainage holes, or may benefit from allergy shots to reverse chronic mucous tissue inflammation. Smoking cessation is also critical to reversing chronic sinusitis!
Knowing the structure of the sinuses and understanding why and how problems develop can help you initially manage your own illness. Early use of antibiotics in sinusitis is typically not necessary and only exposes you to their potential side effects. But do be sure to see your doctor if the “double sick sign” occurs, or if worrisome associated symptoms arise. Regardless, adequate rest, abundant hydrations and avoidance of smoke/smoking will improve your chances of having trouble-free sinuses!
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Next month: More on Superbugs