How many times have you said, or heard someone else say, "Oh, it's my sinuses!"  They get blamed for a lot of things!  We hear on TV and from our friends that they are associated with drainage, headaches, allergies, colds and any number of other maladies and that they need relief.  But what is a sinus?  Anyone?  Anyone?  Bueller?  So let's talk about Sinuses for March's Of the Month!

A sinus is actually a space.  According to Taber's Medical Dictionary, a sinus may be a cavity within a bone, a dilated channel for venous blood, a passage leading to an abscess or any cavity with a relatively narrow opening.  They go on to list out 58 different named sinuses in the body from accessory nasal to venous, of sclera.  Not quite A to Z, but pretty darn close!  Of these 58 sinuses, only 5 listings are the ones commonly referred to as "my sinuses."  As a group they are known as the accessory nasal, or paranasal sinuses.  Individually, they are named for the bone in which they reside - the ethmoid, frontal, maxillary or sphenoid. 

Anatomy of a Sinus.  The whole nasal area is actually quite complex.  Briefly, though, there are many similarities between the sinuses and a few unique things.  The maxillary and ethmoid sinuses are both present at birth.  The maxillary sinuses are paired, one in each cheekbone.  Ethmoid sinuses are also present at birth, are found on both sides of the nose, but vary in number and position, usually between the nose and eyes.  The frontal sinuses are usually paired in the forehead bone, which doesn't really turn to "bone" until starting around age 2.  Growth of this sinus really starts around age 5 and continues through the teen years.  The size of this sinus varies greatly and some people never develop frontal sinuses at all.  The sphenoid sinuses also do not begin development until about age 3 and are usually fully formed by the late teen years.  These sinuses are located behind the nose and eyes, more toward the center of the inside of your head.
   There are two other things that all the sinuses have in common.  The first is that they all have an opening somewhere in them that drains into some part of the nasal cavity.  These openings are very small and are covered by one of three turbinate bones. 
   The second is that every sinus cavity is lined with a specialized layer of mucosal tissue that is continuous with the mucosal lining of our nasal cavity.  Some of the cells in this lining are responsible for normal production of mucus.  Another cool cell in this lining is a "ciliated" cell.  Cilia are little hair-like projections on the outside of the cell that beat in a pattern.  The purpose of these cilia is to move mucus and this they do in a very set pattern at the blinding speed of 700-800 beats/minute to move mucus about 9 mm in that minute!  And we all technically have chronic "post nasal drip" because that's where all the mucus is headed - out the sinus passage into the posterior nasal cavity, down the throat and into the stomach. 

Function of a Sinus.  All the functions of the sinuses are actually thought to be as yet unknown, but there are some agreed upon.  They are partially an extension of the nasal cavity's commitment to warming and humidifying air we breathe in.  They also play a role in our immune function, as the mucus and cilia trap, kill and remove potentially harmful things we might breathe in.  Sinuses also play a role in the resonance of our voices.  We can clearly hear the difference when the sinuses are clogged, but some question whether this is a "function" or just a side effect.  Feel free to pick a side if you're looking for an argument today!

Malfunction of a Sinus.  The most common disorder involving the sinuses is called sinusitis, which literally means inflammation of the sinus.  And here we're actually talking about the lining of the sinus, not the sinus itself.  It would be difficult to inflame empty space!  The ethmoid and maxillary sinuses are most often involved with sinusitis.  Inflammation may be caused by an allergy, a virus, bacteria or other irritation to the lining.  Inflammation is a trigger for the immune system, which kicks into higher gear with the increased production of mucus.  If the drainage opening from one of the sinuses becomes blocked from the swelling of inflamed tissue, the mucus and air in the sinus cavity has nowhere to go.  Mucus production does not stop, however, and the increased gunk in the sinus puts pressure on the walls of the sinus, causing pain.  Additionally, any bacteria that are trapped in the sinus may find these ideal conditions to multiply, causing an actual infection.  True sinus infections can be dangerous, potentially moving into the surrounding bone.
   Blockage of the drainage openings may be the result of something other than tissue inflammation.  Nasal polyps, deviated septums, and foreign objects may also be the culprits.  Rarely, other bony malformations or tumors cause a blockage.
   Sinusitis may be acute or chronic.  The differentiation is important as treatment options in the medical community are different for each. 

Care and Feeding of a Sinus.  With the openings of the sinuses being the size of the head of a pin at best, there's no really good way for the layperson to actually get into a sinus cavity to do any direct care and feeding.  But we do have a little bit easier access to the nasal cavity into which they all drain.  Keeping the nasal cavity, and so the actual openings, clear, moist and healthy is the first step.  If there isn't anything to irritate and stimulate the immune system, there won't be any swelling to close the openings in the first place! 
   One of the simplest and best ways to keep the nasal environment moist and clear is nasal irrigation.  Washing our nasal passage helps keep the openings from the sinuses clear.  It rinses away pollen, dust, and germs.  It rinses away excess mucus if you're congested.  The mucus membrane must stay moist in order to function effectively in both trapping unwanted inhalants and using its antibodies to kill germs.  Studies show that simple nasal washing at home is effective in sinus problem relief.  A few studies have shown that it is as effective as drugs for preventing sinus infections, that regular irrigation reduces dependency on medications, and that it is beneficial alone or in conjunction with medication use.  A University of Michigan study with 121 subjects showed it to be more effective than saline sprays for chronic nasal and sinus problems.  Of the handful of devices used for nasal irrigation, the neti pot is probably the most widely known.  For a demonstration on using a neti pot, follow this link:  Neti Pot Demo
   Other ways to help relieve the dryness and irritation of sinus problems include steam inhalations either plain or with essential oils or herbs.  Try a mix of lavender, eucalyptus and thyme.  Sinus oils with respiratory-assisting herbs and/or essential oils may also be used in the nasal passages.  NEVER use essential oils straight from the bottle in the nose.  They MUST be diluted in a carrier oil!  Bitter orange oil is anti-bacterial and can be used in the nasal passages (also diluted in oil).
   Various herbs can help with the immune system response, with inflammation and mucus membrane function.  Euphrasia and urtica (eyebright and nettles) are two commonly used for allergy-type issues with the sinuses.  Vitamin C, bioflavenoids, and quercitin are common nutrients that help in general.  Onions are a great decongestant and anti-histamine together.  Keeping your immune system in good working order will benefit your sinuses, as a part of that system. 
   Massage may also be helpful for sinus trouble.  Massaging along the side of the nose, up to and along the eyebrow and along the cheekbones may provide some relief.  A light to firm pressure held over the ailing sinus may help directly - and the overall relaxation that comes from massage in general helps everything be better anyway!  Some people find warm or cool or alternating compresses to provide symptom relief as well.  Drinking plenty of water helps keep the mucus more fluid and easier to drain. 
   A note about medications...over-the-counter decongestants do, indeed dry you up - often quick, fast and in a hurry.  But overuse of these medications can cause rebound congestion that prolongs the misery and can be worse than the original bout.  Additionally, you may build up a tolerance to them, making them less effective long- term.    And antibiotics...antibiotics are going to be of no use in resolving plain sinusitis - acute or chronic.  Antibiotics are only good for killing bacteria - and your basic sinusitis is simply an inflammation of the sinus tissues, not an infection.  Infection may come later - and then antibiotics may be appropriate.  But at first glance, there are safer, cheaper alternatives to clearing up those little sinus passageways and keep things flowing!   
   So, next time someone complains about their sinuses, I hope you have a better understanding of what that actually is AND maybe will have some tips to share with them to make their sinuses better!