Part 1 – What’s Making Me Sneeze

The real problem with sinus “problems” is how easily the symptoms they cause are confused with those of the common cold or allergies (seasonal and environmental). Depending on which nasal cavities are involved, you might even be diagnosed with migraines.


Long-term, chronic sinus problems adversely affect the lives of millions of people each year, causing pain, insomnia, fatigue, and an overall diminishment in the sufferer’s ability to enjoy life.

Sinusitis causes people to limit their leisure activities, like playing sports, and it raises the potential for life-long addiction to nose sprays and other “remedies.”

In the United States sinusitis is more common than heart disease. In 2004, the U.S. Centers for Disease Control and Prevention published a report indicating 35 million adults battle some degree of sinusitis every year, missing an aggregate 25 million workdays as a result.

At the same time, however, Americans dole out about $200 million annually on over-the-counter and prescription medications in an effort to get their sinuses back in good working order.

Sinusitis, Hay Fever and Allergic Rhinitis

From the beginning, it’s important to clarify these terms, which are often used interchangeably. They all refer to groups of symptoms affecting the nose and nasal passages. For the most part, we will be using the blanket term “sinusitis,” but let’s look at each one in turn.

What is Sinusitis?

In the simplest terms, sinusitis is an inflammation of the sinuses. There is, however, nothing simple about a condition that, in its short-term, acute phase resolves in a few weeks, but as a chronic problem may exhibit symptoms that fall up and down a broad spectrum of sinus-related secondary illnesses.

Unlike the common cold, which is caused by a virus, the culprit in triggering a bout of sinusitis is a one or more bacterium present in the respiratory system.

Sometimes you will see this same condition referred to as rhinosinusitis since both the nose and sinuses are often affected.

Adults age 20-65 are the most likely population to be confronted with sinus problems. Sinusitis is no respecter of persons, however, occurring equally among men and women.

Hay Fever and Allergic Rhinitis

“Hay fever” is the common term for allergic rhinitis. When a person breathes in dust or pollen to which they are allergic, the mucous membranes in the eyes and nose become inflamed and itchy.

This results in a runny nose and watery eyes, which can occur seasonally when a particular plant is pollinating, or be present year round with the reaction dependent on exposure.

People with hay fever in the spring tend to be sensitive to tree pollens, while summer allergies are generally to grass and weeds. In the fall of the year, weeds and fungus spores are the culprits.

When hay fever seems to be a year-round constant, the allergens are typically things that are present indoors like dust, feather bedding, carpeting, or animal dander. Mold in damp areas like basements and bathrooms can also be to blame.

The Perfect Nasal “Storm”

Because hay fever or allergic rhinitis leads to an inflammation of the mucous membranes, these conditions cause swelling in the nasal cavity and sinuses.

When the openings of the nasal cavities become blocked, a breeding ground for bacteria is created and infection can set in. The reason these conditions are discussed together is because of this intimate – and miserable – relationship.

While allergy treatments won’t cure a sinus infection, controlling allergies can stave off such an episode. Allergies aren’t themselves infections, but they create one of the many doors through which infection can enter.

The Human Nasal System

To understand the nature of the problem, it’s important to get a clear picture of how sinuses actually function in the human body.

We think of our nose as being our most prominent and obvious facial structure. It allows us to draw air into our lungs and to exhale carbon dioxide.

Most of us have some vague sense of where our sinuses are located, but little if any understanding of the intricate system involved in taking a single breath and preparing that air to reach the lungs in optimal condition.


Structure of the Nose

The human nose is comprised of a soft tip made of cartilage, and a hard bridge made of bone. In between is an area called the nasal valve, which collapses inward when we take a deep breath.

The width of the nasal valve varies from person to person, and can itself be the cause of breathing issues.

On the interior of the nose between each nostril there is a thin wall of flexible cartilage called the septum. It progresses 3-4 inches back into the head and becomes solid bone along the way.

Nasal Cavity

The nose leads to a region called the nasal cavity in which a series of openings called ostia adjoining four pairs of sinuses:

– maxillary – in the cheeks

– ethmoid – between the eyes

– frontal – in the forehead

– sphenoid – behind the nose

When the sinuses are healthy, the ostia are open, allowing air to flow freely in and mucus to drain out. If there is a problem, like swelling from an infection, the ostia close off and pressure builds up in the sinus.

The Turbinates

Humans can breathe through both their nose and mouth, but the nose is designed to both filter and warm the air we take in on its way to our lungs.

There are three sets of large bones behind the nose called the turbinates. The largest pair, the inferior turbinates, is at the bottom, roughly in a line with the base of the nostrils. They are approximately three inches in length.

On the next level up we find the slightly smaller middle turbinates (about 1.5 inches), and then the superior turbinates on top (an inch or less), roughly anterior to the bridge of the nose.

The turbinates circulate blood through their spongy, membranous surface to warm the air drawn in through the nostrils. Every six hours the volume of the blood flow in these surfaces switch sides as part of the nasal cycle.

If you have ever been aware of being able to breathe out of only one side of your nose, this is the normal functioning of the nasal cycle.

It switches back and forth throughout the day and night, but for the most part we are not aware of the change unless we consciously stop to check the air flow.

The air that comes into the nose and passes over the turbinates also picks up microscopic drops of moisture to improve its humidity level.

If you stand in front of a mirror and breathe on to the surface, the fog your breath creates illustrates the presence of this moisture in your nose.

Finally, the turbinates act as filters. The structures are covered in mucus that traps particles in the air we inhale and stops them from entering the lungs.

Ostiometal Complex

Before air reaches the sinuses, however, it must pass through the ostiomeatal complex, an area adjacent to the turbinates. Blockage of this structure is one of the most common triggers for an episode of sinusitis.


A Closer Look at the Sinuses

Pain and congestion can be present in each of the four pairs of sinuses or in combinations of these structures. This is why blocked ethmoid sinuses behind the eyes may be mistaken for a migraine, or issues with the maxillary sinuses may be wrongly diagnosed as a toothache.

Ethmoid Sinuses

The ethmoid sinuses are positioned between the eyes behind the bridge of the nose. They play a key role in the overall system of sinuses because the frontal and maxillary sinuses drain through them. If the ethmoids are not clear, the other sinuses will quickly become blocked as well.

The ethmoids are not single chambered, but are made up of 5-10 smaller chambers separated by thin walls covered with mucous membranes. The entire structure, however, is quite small, roughly the size of a matchbox.


Maxillary Sinuses

The maxillary sinuses are located in the cheeks. If they sit low enough, the roots of the upper teeth extend into the cavity’s floor. This is why some people experience upper tooth pain from a sinus infection.

The maxillary sinuses are triangular in configuration. Each one is roughly the size or a walnut.

Frontal Sinuses

If the frontal sinuses are present, they are located in the forehead between the eyes. About 90% of the population develops these sinuses.

The back wall of the frontal sinus is part of the bone that covers the brain. The size of the sinuses varies widely from person to person.

Sphenoid Sinuses

The deeply placed sphenoid sinuses are to the rear of the nose at the point where the eyes connect with the brain. They are about the size and shape of grapes.

The carotid artery runs through the outer walls of the sphenoid sinus and is sometimes visible when a physician is examining the area during surgery.

Internal Structure of the Sinuses

The surface of each of the sinus cavities is covered in small, bumpy glands that secrete mucus as well as a carpet of tiny hairs called cilia.

The sticky mucus serves to trap foreign particles and bacteria, while the cilia sweep the material away through the sinus opening and into the nose. The little hairs beat about six times a second and are very strong in relation to their size.

For instance, in order to push mucus through the ostia of the maxillary sinuses, the cilia actually have to overcome the force of gravity and move the material up to the opening.

This highly efficient process of mucociliary clearance moves approximately eight ounces of mucus a day through healthy sinuses.

Why Do We Have Sinuses?

In truth, there is no definite answer to the question of why human beings have sinuses. Without question, these empty spaces make the human head lighter, and thus may be an evolutionary adaptation to walking upright.

The structures also protect the eyes and brain by lessening the impact of blows to the face and head. They also make the structure of the skull less complicated so the facial bones can mature at an equal rate with the brain inside the cranial cavity.

These are not the only benefits derived from the sinuses, however. They improve our ability to taste and smell and provide resonance to the human voice.

The sinuses help to equalize pressure inside the nasal cavity and help to regulate our body temperature. Their filtering function is important to keep potentially harmful particles out of the lungs, and to ensure that the air we breathe is properly hydrated.

In fact, this whole system is a marvel of engineering efficiency as long as it’s open and functioning. When something goes wrong, however, the consequences for the individual can be absolutely miserable.

In studies conducted at the Harvard Medical School, people with chronic sinusitis reported higher levels of ongoing pain and discomfort than those patients dealing with chronic neck and lower back pain and even heart disease.

What Causes Sinusitis?

There are many potential causes for sinusitis, but one of the most common is an obstruction of the ostiomeatal complex adjacent to the turbinate bones.

This causes mucus to back up into the sinuses, which shuts down the action of the cilia. The mucous glands, however, continue to do their job even though the “drain” is clogged.

Remember that the interior of the sinus is an area that is both moist and warm, making it a natural breeding ground for bacteria. Normally the bacteria that inhabit the area are perfectly safe.

However, when the sinuses back up and the mucus becomes stagnant and foreign debris is not being removed, harmful bacteria begin to rapidly proliferate until infection sets in.

Your Body’s Response to Infection

Once that occurs, your body’s defensive mechanisms are activated. The human immune response, which is attempting to protect you from the infection, is a large part of what makes you so miserable with full-blown sinusitis.


The mucous glands begin to work even harder, churning out vast amounts of mucus and swelling with blood to fight the bacterial invasion.

White blood cells rush to the membranous lining with the intent of destroying the bacteria. Basically your body has gone to war, and the battlegrounds are tiny spaces in your head that rapidly become filled to capacity.

The results are headaches, an awful feeling of pressure, thick mucus that sludges down the back of your throat, irritating the lining and causing even more discomfort.

You can’t sleep at night. You can’t concentrate by day. You feel awful. All because your body is doing exactly what it’s supposed to do!

The longer the war goes on, the worse it tends to get. More of the sinuses become inflamed. There’s more swelling, more blockage, more bacteria — welcome to the “sinusitis cycle.” Now, what do you do about it?

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