What are the sinuses?
Sinuses are tiny air-filled spaces in your face that help you breathe easier, protect your head, and keep your nose healthy. You hardly notice them when they’re working well—but when they get blocked, you definitely feel it.
The paranasal sinuses
The paranasal sinuses or “sinuses” as they are usually referred to, are air-filled cavities in our heads that make our skulls much lighter than they would be otherwise. They also act as “crumple zones” that protect the eyes and the brain in the event of severe facial trauma, as might occur in a car accident. The sinuses are lined with a thin layer of mucosa, which is very much like the lining of the insides of our mouths. The linings are kept moist with constant production of clear mucus from mucus glands in the mucosa. The mucus then is cleared from the sinuses by the motion of microscopic hairs, or cilia, that move the mucus towards the openings, out into the nasal passages, and ultimately down the back of the nose into the throat, where it is swallowed. We all produce and swallow about 1-2 cups of mucus from our sinuses every day! While this might sound gross, this is normal and occurs in all of us.
When things go wrong
The sinuses all have small openings to let the mucus out and let air in. These small openings are the Achilles’ heel, or weak spot. When swelling around the openings occurs, the sinuses become blocked, and problems start. The two most common causes of swelling that closes off the sinuses are viral upper respiratory illness (such as the common cold) and environmental allergies to things like pollen or pets or dust. When the sinus openings swell shut, air cannot get in or out. The oxygen in the sinuses then gets absorbed into the mucosa. This creates a low-oxygen environment in the sinuses. And since the openings are shut, mucus builds up. This low-oxygen, warm, moist environment creates the perfect conditions for bacteria and fungi to grow and reproduce rapidly, and thus a sinus infection starts. The infection then causes the thin mucosa to swell up, sometimes more than 20 times its normal thickness. When this happens, the cilia do not function well, so it makes it even harder for the mucus and infection to exit the sinus openings. As you might imagine, all of this inflammation produces pain and pressure in the foreheads, cheeks, or the area between the eyes. Other symptoms include congestion and difficulty breathing through the nose, large production of yellow, green, and brown mucus, loss of smell and taste, headaches, and sometimes fever.
Types of sinus infections
Acute Sinusitis
Acute Sinusitis is defined as sinusitis symptoms lasting for up to 4 weeks.
Recurrent Acute Sinusitis
If someone gets 4 or more acute sinus infections in a year, but generally feels well in between the infections, this is called Recurrent Acute Sinusitis.
Subacute Sinusitis
Subacute Sinusitis is defined as sinusitis symptoms lasting more than 4 weeks but less than 12 weeks.
Chronic Sinusitis
Chronic Sinusitis is defined as sinusitis symptoms lasting continuously for 12 weeks or more. This category is further broken down into chronic sinusitis without nasal polyps, and chronic sinusitis with nasal polyps.
Chronic Sinusitis
Treatment Options
Medical Therapy
For many patients, a combination of therapies provides improvement.
- Extended courses of antibiotics and steroids
- Prescription nasal sprays and saline rinses
- Oral allergy medications and immunotherapy
Balloon Sinuplasty
Others choose less invasive sinus procedures to open up airways.
- No cutting or removal of tissue
- Local anesthesia, not general
- Fast recovery-most patients return to normal activity in 1-2 days
Sinus Surgery
If symptoms persist, ESS – Endoscopic Sinus Surgery may be the solution.
- No external incisions
- Uses an endoscope with a tiny camera
- Opens blocked sinus and removes polyps
Frequently Asked Questions
What is sinus surgery?
Usually, when a person has undergone all of these medical treatments, but the symptoms have not gone away, it is because there is chronic inflammation in the bone of the sinuses and the mucosa has become so chronically swollen, that the openings to the sinuses remain closed off. So the goal with sinus surgery is to widely open up the sinuses. This allows air in, allows trapped infected mucus out, and allows nasal sprays and rinses to actually enter the sinuses and treat the chronically inflamed mucosa.
What can I do ensure proper healing?
Approximately 85% of patients experience lasting relief after sinus surgery, especially when combined with ongoing medical management.
What is Recovery like?
Most patients feel significantly better within 2–3 weeks. Bleeding and congestion are normal during the first few days, but pain is usually less than expected. With proper rinsing and follow-up care, patients return to normal activity in about 2 weeks