SIMPLY HEALTH: 'Tis the Sinus Season

posted 12/08/2008
Sinuses are holes in the facial bones that contribute to the shape of the face and resonance of voice. Some of us would give up some timbre in our voices if it meant not having sinus trouble. But it turns out that voice vibration may have an amazing role in sinus health.

We aren't born with sinuses. The sinuses adjacent to the nose (ethmoid) don't show up until about two years of age. Other sinuses begin development after age seven, with most sinus growth occurring in adolescence. Not everyone has frontal sinuses (the ones above the eyebrows), and there is one sinus (sphenoid) located deep in the center of the skull.

A sinus is lined with mucous membrane that secretes thin, clear mucus. Sinuses drain from small holes in the bone into the back of the nose. The roots of the teeth are right next to the maxillary sinuses and an abscessed tooth can inflame the sinus. Likewise, a maxillary sinus infection can create a tooth ache as the nerves are adjacent. These sinuses are the most problematic since the drainage outlet is poorly placed. Lying down on the right side drains the left maxillary sinus and lying on the left side empties the right sinus. That is why post-nasal drainage is worse at night and causes cough as it drips down the back of the throat and into the bronchial tubes of the lungs.

If a person has underlying allergies, the nasal membranes and sinuses tend to be a bit congested all the time and can predispose to infection. Mold, dust mites and pollens are the big three offenders, so if you have never been tested, it might be worthwhile seeing an allergist. Make sure you are not living amid mold or mildew (damp walls or windows, old carpet), get dust mite protectors for bedding and pillows and don't sleep with your window open as pollen counts are highest in early morning hours. Prescriptive nasal sprays are safe and very useful in controlling congestion, runny nose and sneezing.

With onset of a cold, the nasal and sinus membranes swell and secret mucus in response to the viral invader.

Once the tissues are inflamed and boggy, the sinus outlets become obstructed and unable to drain.

Mucus collects in the sinus cavity like a perfect broth for bugs. Bacteria can invade the sinus area and turn that broth into a foul soup.

It is tempting to take antihistamines during a cold to help dry up a runny nose. Unfortunately, these drugs also transform thin mucus that drains easily, into thick, tenacious stuff that sticks to the sinuses like glue. If you smoke, it further aggravates the situation because cigarette smoke paralyzes cilia, tiny hairs that that sweep gunk from the nose and lungs. Smokers make more mucus due to the irritant effect of smoke and retain more mucus and debris in the respiratory passages since the cilia are not working. One more reason in a long list for smokers to quit. The goal for sinuses is to keep them draining and well aerated. If prone to sinus infections, drink lots of water all the time to keep mucus secretions thin and flowing. Herbal teas can also be soothing and promote drainage. Normal saline nasal rinses (a salt water solution the same concentration as the body fluids) can be helpful, but they must be done correctly. Too much salt burns the delicate tissues and too little salt can make them swell more.

Consider trying over-the-counter "Sinu-Rinse" once daily. It uses a special irrigating bottle and contains pre-measured packets to make a proper normal saline. Use only distilled water (it is sterile) and you won't introduce into the nose other contaminants from containers or dirty hands. There are also saline nasal mists that can be used throughout the day to moisten the nasal tissues, thin mucus and promote drainage. Never use Afrin or other nasal decongestants unless specifically instructed by your health care provider.

If sinusitis is persistent or chronic, you may need to have a CT scan of the sinuses. There could be some structural aberration that is setting you up for trouble. Regular x-rays have limited utility in assessing sinus problems. However, think twice about repeat CT scans, as there is a lot of cumulative radiation exposure. Sinus surgery is a last resort as it is not uniformly successful. Sometimes a quick endoscopic look into your sinuses can be done in the office by an ENT (ear-nose-throat) specialist, and a culture obtained during the endoscopy. Recent studies are finding MRSA (methicillin resistant staphylococcus aureus) in sixty percent of chronic sinusitis cases and the implications are serious. (See prior MRSA article)

Antibiotics may help the occasional acute sinus infection but they have limited value in chronic sinus problems. If you have been on several courses of antibiotics, you can also develop a fungal super-infection in the sinuses. This is especially true if using nasal steroids as well. Anti-fungal medication like fluconazole taken while on antibiotics may help prevent this complication.

FOR HEALTHY SINUSES:

Drink lots of water
Try herbal cold care teas
Use saline nasal sprays
Humming helps aerate
Get adequate sleep
Avoid antihistamines
Control environmental allergies
Stop smoking
Limit use of antibiotics
Nasal steroid sprays helpful
Sinus surgery is last resort

Sometimes though, the most simple treatments can be effective. Some fascinating research has been done on the effect of humming in aerating sinuses. Nitric oxide is naturally produced in the mucous membranes and facilitates air exchange in the sinuses. It turns out that humming not only increases the concentration of nitric oxide but also creates vibrations that increase air motion and ventilation of the sinuses. Next time you get congested, serenade your sinuses, or rather, hum to them. Any tune or pitch will do. Zippity-do-dah!

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