Sinusitis from an ENT’s Perspective – Part 1

Q: Why go to an ear, nose, and throat doctor for sinusitis?  Walk-in clinics and primary care offices give me antibiotics. Do you do something different?

A: When it comes to sinusitis, ENT providers tend to see people that haven’t responded to treatment.

Why would people not respond to treatment?  Sometimes, it is because they don’t actually have sinusitis and got medicine for the wrong thing.  Often it is because of resistant bacteria. Then there are the structural problems that can complicate matters.  Sometimes it is because there are additional factors that keep you from getting well, like an immunity issue, allergies, reflux, nasal polyps, or even a foreign body or growth up in there.

One could make the argument that it is less expensive to see an ENT for your sinusitis.  Nothing is more expensive than the wrong diagnosis or treatment plan. You can see your doctor first, but definitely keep us in mind if you are not getting well, as we are the specialists!

Q: Why do we even have sinuses? The sinuses seem so arbitrary. What purpose could big air pockets in your skull serve, other than to create problems?

A: The sinuses do serve a purpose!

The sinuses are lined by mucous membranes.  Mucous membrane makes thin, watery, and clear mucous.  The body needs a lot of mucous, especially to help us swallow and talk. So we need lots of surface area creating that mucous. Hence the big air pockets above and below the eyes, between and behind the eyes, as well as the honeycombing of the sinuses between the eyes. (Without the sinuses, our heads would be heavier and our voices would not be as resonant, but these are incidental issues.)

The problem with sinuses comes when the small openings into the sinuses are obstructed.  This can happen with inflammation. Inflammatory conditions include allergy, viral or bacterial infection, inflammatory polyps, and aggressive fungal infections.  Structural problems can impact the ability of air to get into the sinus and mucous to get out.  These include a deviated nasal septum, paradoxically curved middle turbinates, concha bullosa of the middle turbinates (where the sinus grows into the turbinate and “expands” it), or congenitally small openings. Often there is a combination of the above that gets you in trouble, such as a narrowed sinus opening that blocks because of a common cold, leading to obstruction and infection.

When the sinus cavity gets blocked, several things happen, none of which are good:

  • The mucous membrane lining thickens.
  • The thousands of rows of cilia, which should work in concert to beat the mucous up and out of the sinuses, die off, with resultant pooling of mucous in dependent areas of the sinuses.
  • The goblet cells that create the thin, watery, and clear mucous cease their normal function and get replaced by glands that make thick, gooey mucous.

Any treatment plan has to include a way to get air in and mucous out of the sinuses.  Period.

Now that we’ve learned about the functions of sinus cavities and why they’re important, check back next week to learn more about sinusitis and the best ways to treat it.