Nasal & Sinus Center

Understanding Sinuses

What are Sinuses?

Your sinuses are air-filled chambers inside your skull, behind the forehead, nasal bones, cheeks and eyes.

When filled with air they vibrate, thereby aiding speech. Through small openings, four pair of sinuses connect to your nasal cavity. Mucus produced by the sinuses drains through openings into your nose and down the back of your throat. As the mucus drains, the nose is kept moist and free of dust, bacteria and other germs.

With healthy sinuses, the air circulates freely through the chambers and mucus drains into the nose. Small hairs, called cilia, help move the thin, watery mucus through your sinuses. When the sinuses are free of swelling and thickened mucus and the cilia are working correctly, your sinuses drain freely, which keeps the sinuses clean.

What is Sinusitis?

When the natural drainage of mucus is blocked due to upper respiratory infections (such as colds), allergies or obstructions, stagnant mucus provides the perfect place for bacteria to grow and inflammation may occur. Mucus that is thick, yellow or discolored is typical with this infection.

  • Acute sinusitis is a common problem producing facial pain and pressure. Redness of the skin over the sinus, nasal congestion, postnasal drip, fever and headache may also occur. It is likely to come on suddenly, with symptoms lasting up to four weeks.
  • With chronic sinusitis, ongoing swelling of the sinus lining may last for several months as the result of allergies or chronic infections.

How do allergies affect the sinuses?

When a person sensitive to allergens or irritants breathes these substances, the body releases a chemical known as histamine, which causes the sinus and nasal linings to swell. This can clog the sinuses and prevent the cilia from clearing the mucus. Anatomical obstructions such as polyps can also cause chronic sinusitis. The swelling is likely to keep coming back. The constant irritation can permanently damage the cilia, which makes it more difficult to drain mucus from the sinuses. Symptoms include facial pain and pressure, headache and sinus pain, nasal congestion, postnasal drip, reduced smell and taste, cough and a sore throat. Typically, symptoms will persist longer than a cold, but be less severe.

How do nasal obstructions affect the sinuses?

A sac of swollen tissue, called a polyp, often results from an allergy or infection. The polyp may block the opening where most of your sinuses drain, called the middle meatus, and in some cases grows large enough to block your nose. Another obstruction that can block the middle meatus is a deviated septum. The nasal septum is the wall that divides the nasal cavity into equal halves. When the septum shifts (deviates) and becomes crooked, frequently as a result of injury, difficulty breathing through the nose may result.

How is Acute Sinusitis diagnosed?

To help your doctor diagnose acute sinusitis, a medical history is taken and a physical examination is performed. With an accurate diagnosis, your doctor can determine which treatments may be the most effective. In some cases a culture (mucus sample) is taken to check for a bacterial infection, and in others X-rays are taken to find fluid in the sinuses.

How is Acute Sinusitis treated?

The goal of treatment is to relieve the blockage of the sinuses and help the cilia to work again. Antihistamines and decongestants can help reduce inflammation and decrease the production of fluid. If a bacterial infection is involved, antibiotics may be prescribed.

How is Chronic Sinusitis diagnosed?

Chronic sinusitis is typically diagnosed based on the medical history and a complete examination. Allergy tests may be performed to identify your particular allergen sensitivities. An endoscopy or CT scan may be ordered to detect thickened mucosa, blocked sinus openings and obstructions that interfere with drainage. Nasal endoscopy is performed using an endoscope - a slim, flexible tube with a fiber optic light at the end. The nose and sinuses are first treated with an anesthetic (numbing medication) and decongestant to ease the insertion of the endoscope. When necessary, samples or biopsies are taken through the endoscope for laboratory examination. A CT scan will provide a detailed view of your nose and sinuses from different angles to find the precise location of blockages.

How is Chronic Sinusitis treated?

To reduce fluid secretion and swelling, medications may be prescribed. To clear old mucus, sinus irrigation in which the sinuses are flushed with water or saline may be recommended. Recurrent bacterial infections may require antibiotics. An allergy control program for long-term management may also be recommended by your doctor. For example, allergy injections may help desensitize you to various allergens. In some cases, surgery may be the best option for clearing blockages (to read about common sinus procedures click here). Whichever treatments are recommended, be sure to follow your doctor’s instructions closely.

What methods of self-care are recommended?

Self-care may include drinking extra fluids, using a humidifier and taking over-the-counter decongestants to relieve swelling. Some people use hot or cold packs to relieve pain and discomfort. Saltwater rinses can help keep your sinuses and nose moist. Ready-made saline nasal sprays may be used, or you can make your own rinse. This is done by mixing a teaspoon of salt in eight ounces of fresh, warm water, then using a bulb syringe to gently squirt the water into your nose. You may need to rinse a few times a day.

How can I prevent Sinusitis?

As much as is possible, prevent the underlying problems that lead to sinusitis, such as colds and flu. Wash your hands frequently, and when you can stay away from infected people. Eat balanced meals, exercise regularly and get plenty of sleep. If you feel a cold or flu coming on, take more time to rest.
Also, avoid allergens. You will need to find out what substances you are allergic to, and then take steps to minimize your exposure.

For example:

  • Wear a mask while cleaning or doing yard work
  • Avoid the outdoors during peak pollution times such as rush hour
  • Use an air conditioner during allergy season and clean its filter on a regular basis
  • Keeping your sinuses moist will make the mucus thinner, allowing for better drainage and helping prevent infections. Your doctor may also suggest the following:
    • Use a humidifier and regularly clean out any mold or mildew in its reservoir
    • Drink several glasses of water each day
    • Avoid excessive consumption of caffeine and alcohol
    • Avoid smoke

How do I prepare for Endoscopic or Nasal Surgery?

Your doctor will provide you with specific instructions.

General guidelines include:

  • Do not take medications containing aspirin or ibuprofen for at least seven days prior to surgery.
  • Give your doctors a list of any medications, supplements or herbal remedies you have been taking, and ask if you should stop taking them prior to surgery.
  • Make arrangements for an adult family member to drive you home following surgery.
  • Avoid eating or drinking anything, including water, after midnight on the night before your surgery.
  • Don’t smoke
  • Avoid having a sunburn the day of surgery

What type of Anesthesia might I be given?

Your medical team will determine what is most appropriate to keep you pain-free during the procedure. If local anesthesia is used, you will be awake during surgery. Your nose and the surrounding area will be numbed. You may be given a medication that makes you drowsy. If you have local anesthesia, you may hear tapping, grinding or scraping sounds during the surgery.
Using monitored anesthesia, an anesthesiologist delivers medication through an intravenous (IV) line so that you are drowsy or lightly asleep during your procedure. You may still hear some sounds, but you won’t have any pain.
With general anesthesia, you are given medication throughout surgery that will keep you fully asleep. General anesthesia is administered through an IV in your arm. A tube placed down your throat will help you to breathe during surgery.

What are the risks associated with Sinus Surgery?

Although sinus surgery has an excellent rate of success, it does carry the same risks as any other surgery.

These risks include:

  • Infection
  • Bruising
  • Excessive bleeding
  • An altered send of smell or taste

What is the goal of Endoscopic Surgery?

There are several endoscopic procedures performed to treat sinusitis, depending on the patient’s condition.

For example:

  • Straightening the septum - To repair a deviated septum, the surgeon will reshape or trim the cartilage and bone dividing the nose to create more breathing space.
  • Removing polyps – Techniques to remove polyps vary depending on whether the polyps have grown in the nose and sinus areas, their size and number.
  • Clearing the ethmoid sinuses – Ethmoid sinuses are comprised of numerous small air sacs that drain into the nasal cavity. Your surgeon may need to open the thin walls of bone that separate these air sacs.
  • Opening nasal passages – A think projection of bone and tissue forming the outlet of the maxillary sinus is called the uncinate process. When this tissue is inflamed, the surgeon may remove it so that mucus can drain.

What should I expect after Endoscopic Surgery?

Immediately following your procedure you will be taken to a recovery room. You will probably feel groggy from the anesthesia and may have some discomfort. A dressing under your nose will absorb drainage. An absorbent bandage, or dressing, may also be packed inside your nose. Once you no longer feel groggy you will be able to return home. Except in certain rare cases, you will go home the same day as your surgery.

A few days after your surgery, your doctor will want you to come to his/her office to check on your progress. Dried blood and mucus are removed to promote healing, and any nasal packing will be removed. Feeling stuffiness and having a pink or dark red drainage is normal. Expect to change your nasal dressing as need, take any prescribed medications, and drink plenty of water.

Additional instructions may include:

  • Rinse your nose and sinuses with salt water
  • Sneeze with your mouth open
  • Do not blow your nose
  • Avoid heavy exercise, straining or lifting
  • Use a humidifier to keep nasal passages moist
  • Do not take aspirin or ibuprofen
  • Sleep with your upper body elevated
  • Avoid hot and spicy foods
  • In the ensuing weeks as you are healing, some stuffiness and nasal crusting are normal. You should keep your nasal passages clean and moist to speed healing and prevent scarring. Additionally, be sure to:
  • Take prescribed medication as directed
  • Avoid substances causing irritation, such as dust, chalk and harsh chemicals
  • Use saltwater rinses or a humidifier as directed by your doctor
  • Drink lots of water
  • Avoid exposure to allergens and people with colds
  • Before swimming or traveling, talk to your doctor

What is Turbinate Surgery?

Inside your nose, on each side, are curved, bony ridges called turbinates that are lined with a thin tissue, or mucous membrane. The mucous membrane produces a sticky mucus that helps to clean the air in your nose of dust and other tiny particles. The mucous membrane and turbinates warm and moisten the air you breathe in through your nose. During turbinate surgery, a small incision is made inside the nose and bone or mucous membrane is removed from enlarged turbinates. Some of the bone and mucous membrane is left so that the turbinates can continue to function. Within a week, your doctor will probably remove any packing, splint or dressings. You should be able to breathe better than you did before your surgery.

What can I do to recover from Turbinate Surgery?

You will need to follow up with your doctor within a week after surgery. Follow his advice closely, and be sure to keep follow-up appointments. Here are some additional steps you can take during the first weeks after surgery:

  • Try not to bump your nose or touch the splint or packing. If you find that a scab or crust blocks your breathing, leave it alone. Your doctor can remove it.
  • Do not take any medication containing aspirin or ibuprofen.
  • Try not to bend or lift.
  • To reduce pressure inside your nose, open your mouth when you sneeze or cough .
  • Don’t let eyeglasses rest on your nose. You may need to tape them above your nose.
  • Keep your nose out of the sun.

How will I know if I should call my doctor?

If you notice any of the following, call your doctor:

  • A large amount of bright red blood
  • A fever over 101 degrees F
  • A change in vision or swelling around the eye
  • Signs of infection such as yellow or green drainage
  • A headache that won’t subside, or increasing pain
  • Drainage of large amounts of clear liquid
  • Feeling extremely tired
  • Stiff neck