What is Sinusitis? Get the Facts

The sinuses are four interconnected hollow spaces within the cranial bones of the face. These airy cavities exist as mirror opposites on either side of the nose and under the forehead. They are lined with mucus-secreting epithelium and thin hair-like growths called cilia. Acute infection, inflammation, or allergic reactions within the epithelial lining of the cavities spark the symptoms that result in the condition called sinusitis.

Why sinuses exist

There are four distinctly separate sinuses

• The ethmoid group of air-filled cavities are situated between the nasal chamber and the brain.
• The paired frontal sinuses are in the center of the forehead.
• The largest maxillary sinuses are located in the cheekbones on either side of the nasal divide.
• The sphenoid sinuses are located near the pituitary gland under the brain.

The real function of these spaces is largely unknown, but they are widely believed to fulfill certain purposes:

• The intracranial spaces lighten the bones and enhance the mobility of the head.
• The spaces moisten inhaled air, and the hair-like cilia trap debris and particulate matter, using mucus to drain them out through the nasal passage.
• The spaces may act as resonance chambers to add timbre and depth to one's voice.

What happens during sinusitis

Sinusitis is usually triggered by three basic aggravators: bacterial or viral infection, inflammation, or allergic swelling of the epithelial tissues within the air cavities. All the three factors make the epithelial lining secrete excessive mucus that clogs the air cavities, mounting pressure on the surroundings. As the cavities are located in the facial region on either side of the nose, between the eyes, and in the lower forehead above the eyebrows, sinusitis causes recurring headaches.

Factors that trigger sinusitis-like conditions

• Structural abnormalities of the nasal passage and sinuses effectively block the drainage of sinuses.
• Bulbous nasal outgrowths form in response to allergies and inflammation, blocking the free movement of mucus, and creating nasal and sinus congestion.
• Lymphatic adenoid tissue in children swells in size due to infection, triggering inflammation within the sinuses.
• An infection of the upper teeth (back row) travels through the roots all the way into the maxillary sinus, the cavity present inside the cheekbones. As the same nerves service both the teeth and the sinus, the sinus pain resembles a toothache.

Different categories of sinusitis

It is not uncommon to find sinusitis being triggered by infections of the respiratory tract like colds and influenza.

Acute sinusitis

• The cold lasts around three weeks and nasal congestion is heightened.
• Nasal drainage increases and the color of mucus changes from whitish gray to greenish yellow.
• Fever accompanies a lingering headache that worsens when the head is moved.
• As the nasal passages get blocked, mucus drains into the throat, creating a sore throat and smelly breath.
• Pain may radiate through the jawline and back teeth and could be mistaken for a toothache.
• Swallowing mucus may cause stomach upset.

Chronic sinusitis

The infection persists beyond three weeks, and even though the fever subsides with time and medication, other symptoms such as nasal congestion, runny nose, sore throat, bad breath, facial pain, headache, and toothache refuse to let up.

The chronic condition could be due to allergens that provoke the epithelial cells of the sinuses, severe fungal infection in one or more cavities, or the premature termination of an antibiotics or anti-inflammatory medication course, allowing the infection to acquire a stronger foothold.

Recurring sinusitis

In this condition, sinusitis appears and disappears at intervals throughout the year, broken by prolonged periods of respite. It would appear that affected individuals are predisposed to sinusitis triggered by seasonal or other environmental allergens. This could also be a response to the severe weakening of the immune system, as in serious infections such as HIV.

Diagnosis of sinusitis

Superficially, there may be very little to distinguish the common cold from sinusitis because both share identical symptoms, but the suspicion of a sinusitis infection strengthens when a cold refuses to let up and continues to make life intolerable.

Colds and flu that last longer than their normal duration can be said to have transitioned to sinusitis when the infection travels up the airways and penetrates the epithelial lining of the sinus cavities. The epithelial cells secrete more mucus to drain the infection, but the excess mucus clogs the airways leading to nasal congestion, local pain, and headaches.

What doctors look out for in sinusitis patients

• A history of persistent smoking
• Known or unknown allergies such as animal-related, nutritional, or environmental allergens 
• Asthma or chronic obstructive pulmonary disease (COPD), both of which open the airways to germs
• Severe dental problems, especially in the upper back row of teeth
• Anatomical deviations in nasal passages or sinus cavities that may be hindering the normal drainage of mucus

CT scans or X-rays reveal the inner layout of each sinus in great detail and help spot physical abnormalities. The above factors can create a buildup of excess mucus, which prevents normal drainage, trapping the mucus and infection within sinus cavities. Cysts or polyps in the sinus cavities can also do the same.

3D imaging also helps in measuring the progress of medication or corrective surgery.

Treating sinusitis

Broadly speaking, a four-pronged approach can be useful in tackling sinusitis, and all four techniques need not be leveraged together.

1. Identifying and treating the underlying aggravating factor

This would involve treatment of major contributing factors such as asthma, food or environmental allergens, fungal vectors, bacteria, and viruses or dental issues that radiate infection to the sinuses. Once allergy tests confirm the allergen, treatment can focus on neutralizing the aggravator.

2. Eliminating the habits that trigger and worsen sinusitis

These are some proactive approaches you can take: 

• Stopping smoking, to keep the airways free of dirt, tar residue, and irritation
• Eliminating specific foods like yogurt, cold beverages, and ice-cream, which may be triggering allergic reactions
• Practicing proper dental hygiene to keep infections at bay
• Eliminating alcohol, which acts as a trigger, causing sinus cells to swell and become inflamed
• Minimizing plane travel - Any reduction in cabin pressure during flights causes the air trapped within sinuses to expand, thereby increasing pressure on the surrounding tissue and causing pain 
• Working in offices or residential spaces that use humidifiers to pump moisture into the dry air, keeping breathable air moist is one way of helping the sinuses to drain faster
• Removing swimming from your list of outdoor activities helps a great deal, as it minimizes exposure to chlorine which is known to irritate sinus linings

3. Symptomatic relief through medication

• Painkillers: Paracetamol, ibuprofen, and codeine help to ease the pain.
• Fever: Acetaminophen [Tylenol]
• Antibiotics: Penicillin-based drugs like amoxicillin are often administered to treat sinus conditions, but if patients are allergic to penicillin there are other drugs available.
• Steroidal sprays: Nasal sprays using beclometasone help control inflammation
• Nasal decongestants and mucus dissolvers: Guaifenesin
• Surgical solutions for sinusitis: Where medication fails to garner the desired results, a minimally invasive technique called functional endoscopic sinus surgery (FESS) removes bone, creating a bigger passage for draining mucus

If you find that you are a frequent victim of sinusitis, it is highly suggested that you speak with your doctor about the preventative measures you can take. Considering a surgical option is also a possibility.