What Exactly is Sinusitis?
Healthy sinuses are covered with mucous membrane, moist, delicate tissue with microscopic moving hairs called cilia, covered by thin mucous. The nasal and sinus cilia move back and forth like tiny oars, constantly moving the mucous to flush the sinuses and nasal passages. The body is defended against foreign particles and pathogens in the air we breathe by this constant flushing.
When there is a blockage of the sinuses, or when the cilia fail to move the mucus, then an infection can occur. The cilia do not move the bacteria out of your body so they can multiply and make you sick.
In sinusitis, the sinus tissue is infected and inflamed. Bacteria are present. The tissues look swollen in the nose and in the sinuses on examination. The patient will have trouble breathing because of the blockage. Usually there is mild pain, fever and yellow or green discharge. Often the throat and chest are affected — with sore throat and cough.
Essentially in acute sinusitis you get over the attack fully. Might take a month but then you are clear. If we take an X ray at the start of the blockage, fever and pain, we generally see fluid in the sinus cavity, membranes are swollen, and there is severe swelling at the opening of the sinus cavities. If we take a repeat X ray later, the sinuses are now free of fluid, the swollen membranes are back to normal and the openings are no longer swollen and blocked. There is pain, nasal congestion, fever, and patient feels sick. Symptoms may resemble the flu, with weakness and aching. If the correct antibiotic is used, patient may get over this with the antibiotic. At the end of the infection, there is a great deal of yellow / green material that can be blown out or removed by irrigation.
In Chronic Sinusitis, the symptoms have been present for 12 weeks or is the same infection that he had months ago but never fully recovered from. The point is that in chronic sinusitis, there is some problem that prevents effective treatment of the sinusitis. As we will see below, this could be due to antibiotic resistance, failure of the cilia, or any problem that causes blockage and prevents the sinuses from draining properly (sinuses with passages that are too narrow for whatever reason, sinuses that are swollen for reasons such as dental-related swelling, etc.). Even when the patient is feeling well, you can still see some membrane thickening and blockage of the sinuses. He may have symptoms secondary to the bacteria — asthma, cough, fever, fatigue.
The official definition of the Sinus and Allergy Health Partnership states: “Symptoms include nasal obstruction, discolored nasal drainage, loss of smell, or facial pressure or pain should be present for at least 12 weeks. A large number of patients may present with associated diagnoses such as allergy or asthma. Causes include inflammatory conditions of bacteria and fungi. ”
The concerns today about chronic sinusitis are the associated illnesses. There are reports of increased urinary tract infections, elevated blood factors that are associated with circulatory conditions too. Asthmatics are especially at risk.
In my practice, the patient who has had a sinus infection about every 2 — 3 months is a patient who didn’t get return of their cilia function and hence developed a “new” infection in two months.
Recent reports indicate that some persons diagnosed with chronic fatigue syndrome may actually have a chronic sinus condition. I regularly see patients such as these — diagnosed chronic fatigue or fibromyalgia that have chronic sinusitis and clear when their sinuses are cleared.
- Maxillary sinusitis feels like a toothache. The maxillary sinus is located below the eye and above the upper teeth. There is pain below the eye and cheekbone; lower eyelid may be swollen, feels better lying down, larger amount of pus than other sinus infections. Drip causes cough which is worse at night.
- >Ethmoidal sinusitis is infection of the ethmoid sinus, located between your eyes. Symptoms include nasal congestion and discharge, pain between the eyes or at the corner of the eyes at the nose, pressure on lying down, better sitting up with cold compress. Elevated white count and fever. Wearing glasses is uncomfortable.
- Frontal sinusitis is more of a headache above the eye than a pain, with less pain while sitting up. The frontal sinus is located above your eyes.
- Sphenoidal sinusitis is an infection in the area behind and above the nasal cavity. This is accompanied by vague head pains with fever and elevated white count. Feels like a pressure inside the head, bothers the eyes.
In all these conditions you have nasal congestion, colored discharge, and pain.
Normally, sinuses are air filled spaces and are free of infection. They have openings that allow cilia to move mucus that may contain bacteria out of the sinuses. When the openings and the cilia are working you avoid sinusitis. When the openings are closed off, or the cilia – your bodies’ disease fighting system– is overwhelmed, then infection may develop in one of the four pairs of sinuses.
What about a common cold, how do you tell that from a sinus infection? Usually the common cold is milder, the pain is much less. Your doctor can see the white blood cell count reduced during a cold. In sinusitis, a bacterial infection, the white count is elevated. The cold lasts 7 days and is easily transmitted to others. Sinus infection can last weeks.
Sinusitis starts with the cilia. The cilia are your workers that move the toxins and bacteria out of the nose into the throat passage where they are swallowed and disposed of in the stomach.
Normally these cilia move at 14 — 16 pulses / second. It takes about 5 — 8 minutes to move the bacteria from the front of the nose to the back. This system is called The Mucociliary Clearance system and consists of the cells of the surface of the nose, the cilia, and the mucus. The same cilia are in the chest and move infection out of the chest to the stomach.
Things can go wrong:
- Mucosal cells are missing and so there is not enough mucus or cilia
- The mucus may be too thick, like molasses, and this keeps the cilia from moving
- The cilia may be too slow. Diesel and other fumes impair the cilia movement.
In these conditions, bacteria and viral invaders remain in the nose and multiply to enter the body and make you sick. They multiply and give off an unpleasant odor. In addition, the accumulated mucus can block the sinus openings which allows bacteria to multiply inside the sinus cavity.
For example, in Cystic Fibrosis or Aids, the mucus is too thick and the cilia can’t do an effective job. Hence, lots of sinus and chest problems. It is estimated that 25% of asthmatics have sinus problems.
In the Drug Free Approach, efforts are directed to restore cilia movement
What Helps the Cilia?
First rule is adequate hydration. Drink enough to make the urine light. Drinking warm tea is effective because the chemical composition of tea stimulates cilia movement. For example, carry tea bags with you on long flights to overcome the dry cabin air.
Hot compresses to the nose and sinus areas helps blood flow which helps increase cilia movement.
Moisture to the nose in the form of liquids without harsh preservatives are desirable. The closer the liquid is to the natural body the better. For example saline with the body’s electrolytes is reported to stimulate cilia best. *
Irrigation can help by removing thick phlegm that contains bacteria and allergens.
Pulsatile irrigation has been reported in medical journals as being highly effective. This is because the pulse rate “matches” the best rate of the cilia and helps encourage their movement.
Also pulsatile irrigation is more effective in removing thick mucus. It is the choice for removing bacteria from surgical areas.
The pulsation — movement – has a “massage” affect in bringing circulation to the area and moving stale blood products out. A significant advantage to the mechanical pulsatile irrigators is that you can set the pressure at quite low — much lower than nose blowing — so it can be gentle and accepted by kids as well as adults.
Pulsatile irrigation serves another purpose. As a stream flows past a narrow opening like the sinus ones, it creates a vacuum and pulls out the material and the solution replaces the sinus material This is called Bernoulli’s Principle. But with pulsation that “suction / displacement ” is enhanced by the pulsating action which acts like a pumping action so more fluid is displaced from the sinuses.
When the cilia or Mucociliary Clearance system fails, antibiotics help by either killing the bacteria or interfering with their reproduction. The problem comes after the bacteria are killed off. If the cilia continue to non- function or if the sinuses continue to be blocked, eventually a new infection will begin.
Formally, any sinus infection would respond to penicillin or sulfonamides. Due to the abuse of antibiotics, many bacteria are highly resistant to various antibiotics and doctors must study their local bacteria sensitivities which may vary from one city to another.
Relief from symptom of sinusitis can be obtained by vasoconstrictor nose spray, decongestants and just plain bed rest too.
There are several reasons why A Drug-Free Approach to sinusitis is so important:
- It can work
- You avoid side effects of antibiotics
- You train your body to respond to infection like it was born to do
- It works for drug-resistant bacteria as well as drug-sensitive ones.
- You can start treatment anytime including when the doctor’s office is closed.
But it can’t work for all cases. No matter how much you use compresses, take liquids, use pulsatile irrigation, take enzymes that liquefy mucus, medical help may be needed. For example, pulsatile irrigation won’t help if there is a mechanical blockage to the infected sinus. Pulsatile irrigation should be done at low pressure and won’t work if the nose is fully blocked.
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In sinus surgery, there are several goals.
- To increase the size of the sinus openings to improve sinus drainage
- To remove polyps or displaced structures that block sinus drainage
- To remove diseased tissue and clear chronic infection
- To improve airway function — room to breathe — by correcting tissue that blocks the airway. This may be due to a deviated septum or an enlarged turbinate — one of the shelves on the side of the nose.
- To do the procedures so that nasal sinus tissue can return to normal function —not to harm turbinate membranes so that the cilia can continue to function
Good results can follow proper surgery. But the doctor must make a correct diagnosis.
Some common errors:
The patient’s problem is allergy to cat. No matter how skilled the operation, when you are finished, he is still allergic to cat.
The Sinus Pain may be referred from the neck or from the teeth. Obviously you fix these instead of the sinus.
Patient may have one of several kinds of headaches that sinus surgery won’t fix. These include migraine, trigeminal neuralgia and histamine cephalgia.
Complications of sinus surgery do occur. These include an opening to the brain area, injury to eye muscles, loss of sense of smell or empty nose syndrome — where too much tissue is removed. But the worst surgical complication is failure of the patient to improve from the surgery and continuation of the same sinus symptoms. A frequent cause of this is excess removal of cilia containing tissue form the nose. Or, steps have not been adequate to bring cilia back to function. This is why many doctors insist on pulsatile irrigation after sinus surgery — they want happy patients.
The Academy of Otolaryngology (ENT) estimates there are 35 million persons with sinusitis, and 20 million with allergy. I hope some of these suggestions will reduce these numbers.