The paranasal sinuses are holes in the bones of the skull and face which are lined by mucous membranes containing functioning mucus glands and associated “cilia” or hair cells.  There are four pairs of sinuses: frontal, ethymoid, maxillary and sphenoid.

The functions of the sinuses are based upon their  anatomic structure: 1) the holes in the bones  reduce the weight of the head, act as resonance chambers for the voice, and protect the ears  and nasal cavities  during  air  pressure changes; 2) the mucous  membranes and mucus produced trap air pollution particles, thus cleaning as well as humidifying and warming the air before that air gets into the bronchial tubes;  3) the hair cells are constantly beating in the  same waving direction so as to mobilize and clear the mucus, both sterile and contaminated, from the sinuses and from the nasal passages.

Diseases of the sinuses, called sinusitis, are the most commonly reported the chronic diseases in the United States.  All non-cancerous  disease processes affecting the sinuses have inflammation, most commonly resulting in part from obstruction,  as their common denominator, although their cause and mechanisms of action vary;  1) allergic rhinitis, secondary to the actions of the antibody  Ig E with or without hereditary predisposition, is mediated by chemicals like histamine and probably also including leucotrienes,  and promotes obstruction and consequent infection of the sinuses; 2) acute sinusitis, secondary to infections, with obstruction of drainage of  the sinuses; 3) chronic sinusitis, secondary to the results of multiple interactions of infections with or without underlying allergy and resulting in obstruction of the sinuses, inadequately treated for years; 4) chronic rhinitis and  hyperplastic sinusitis  with or  without  nasal polyps, a separate disease process probably resembling the inflammatory changes of arthritic tissues,  and often complicated by the above processes (1, 2, 3).

These diseases are very symptomatic, leading to substantial medical complaints, episodic disability and - if inadequately treated - leading not only to the miseries of chronic sinus disease, but  often also to the development of persistent bronchial asthma and /or chronic (asthmatic) bronchitis.

Treatment of allergies and acute infection is directed at cure and utilizes medications,  antibiotics and often allergy imunotherapy to treat the underlying cause.

Treatment of the chronic types of sinusitis is directed at management, stabilization, and possibly reversal of some of the disease process-especially any coexisting allergic component.

Proper diagnosis always requires medical and allergy evaluation by competent specialists; namely, certified allergist  for the medical and allergy component, and  ear-nose-throat (ENT) surgeon  if surgical intervention is to be considered.  ENT surgeons are not adequately trained in allergy and immunology to offer scientifically-based, comprehensive allergy diagnosis and treatment; those who  dabble  in the field of “allergy shots” most often use  low, “homeopathic” doses of allergens, long determined by careful scientific studies to be  inneffective.

Therefore,  the approach to “sinus trouble” of any degree beyond “minor”  according to the patient affected by it, is to seek out a proper diagnosis and comprehensive treatment, usually by  a certified allergist, both for relief of symptoms and for avoidance of later complications - most notably bronchial asthma and chronic bronchitis.

GS