What Is Sinusitis?

Before defining sinusitis, we should first describe the sinuses. The sinuses are cavities in the bones of the skull around the nose, and each opens into the nose in its own way. Humans have 4 pairs of sinuses:

Sinuses in the cheeks (maxillary sinuses)
Sinuses on the forehead (frontal sinuses)
Sinuses between the eyes (anterior and posterior ethmoid sinuses)
Sinuses located behind the nose in the sphenoid bone (sphenoid sinuses)

The situation of the paranasal sinuses is different in infants and children, the growth of them continues until the age of 12-13 years and they reach their adult form at the age of 20-22 years, which is related to the finalization of facial development.

The sinuses are a part of the nasal system that produces normal secretions (mucus). Normally, the nose and sinuses produce about half a liter of mucus daily. The mucus produced acts on the nasal mucosa to collect dust particles, bacteria, viruses, and other particles from the air and moves them into the nasal passages. This mucus is then filtered back into the throat and swallowed. The particles and bacteria it contains are broken down by stomach acid. Many people are not even aware of this, because it is a normal physiological phenomenon.

If I were to define sinusitis, sinusitis is a general definition that refers to the inflammation of the mucous membrane lining the sinuses, whether acute or chronic. Since there is no situation in which only the mucosa of the sinuses is affected and the nasal mucosa is not, rhinitis, the common cold, often accompanies it. The amount of mucus produced increases, but the mucus cannot be cleared from the sinuses into the nose due to mucosal edema in the nose and begins to accumulate. Here, the mucociliary activity, i.e. the deterioration of the function of the hairy cells that provide for the movement of mucus, has an effect due to the infection. As a result, dense mucus accumulates in the sinuses and becomes infected mucus due to the proliferation of bacteria in the mucus. Sinusitis is manifested by symptoms such as nasal congestion, yellow-green discharge, headache, and difficulty in smelling.

The symptoms of sinusitis vary from person to person. Generally, people think it is sinusitis when their head or face hurts, while sinusitis is not usually manifested by pain. Most of the time, the pain and the pressure felt in the face are confused with each other. The rate of pain in sinusitis is about 5%. Complaints that are more common with sinusitis include nasal congestion, worsening of the voice, a feeling of fullness in the face, and a runny nose. In general, the symptoms of sinusitis can be defined as follows;

Persistent cough occurring at night or in the morning – which is due to postnasal drip.
Yellow-green, dark, thickened nasal discharge,
Feeling of pressure around the eyes,
Bad smell in the nose, impaired sense of smell, sometimes nausea
Nasal congestion and snoring,
Sometimes fever
Postnasal drip, sometimes with burning in the throat,
Long lasting headache
Sinusitis can have many different causes, but the most common are the following;

Viral upper respiratory infections (URI):
It is the most common cause of sinusitis. Edema and inflammation in the nasal mucosa due to viral infection obstructs the drainage channels of the sinuses, at the same time the amount of mucus produced and its density increase, and obstructs the ostia, the secretion accumulates in the sinuses and leads to deterioration of the ventilation of the sinuses. Although it starts as a viral infection, bacterial growth occurs in the mucus and sinusitis develops.
Allergy-related mucosal edema and obstruction in the sinus ostia can cause sinusitis.
Displacement of the nasal septum (deviated septum)
Allergic nasal polyps originating from the mucous membrane
Anatomical pathologies such as enlargement of the turbinates (concha hypertrophy), which narrow or obstruct the drainage channels of the paranasal sinuses
Enlarged adenoids in children
Sinusitis causes problems such as nasal congestion, pain in the forehead, weakness and fatigue, opening of the mouth at night, snoring, as well as long-term impairment of quality of life. In fact, the anatomical barriers in the nose itself cause breathing problems in daily life and reduce quality of life by causing difficulty in sleeping.

One of the most asked questions about sinusitis is if going out with wet hair causes sinusitis. People with concha hypertrophy due to allergies, or allergic polyps, or an acute viral upper respiratory infection who go out with wet hair increase the risk of sinusitis because the heat-cold exchange creates edema in the nasal mucosa, which in this case closes the sinuses. However, this cannot be considered a cause of sinusitis.

Although the headache in sinusitis is only 5%, it can cause severe pain that affects the quality of life when it occurs. One of the asked questions is the mechanism by which this pain occurs. The causes of headaches originating from the sinuses, the cavities around the nose, are briefly:

Pain striking with mucosal contact surfaces
Lack of ventilation and negative pressure as a result of it
Pressure from inflamed tissue or non-normal structures such as polyps on surrounding tissue
Usually there is a problem in more than one sinus. Therefore, the resulting symptoms vary depending on the sinuses involved. In addition, there is reflective pain in sinusitis. Again, the range of reflective pain changes depending on the sinuses involved. When there are problems in the maxillary sinuses, pain is felt in the upper teeth and cheekbones, while when there are problems in the ethmoid sinuses, pain is felt in the eyes. Pain in the frontal sinuses is more noticeable in the forehead and around the eyes. Sometimes chronic sinusitis is accompanied by cysts that have formed in the sinus. When the cyst completely covers and obstructs the sinus, pain is felt as intense pressure. The air in the sinuses has the same atmospheric pressure as the air outside in patients with normal anatomical structure. When the entrances to the sinuses are blocked, the air in the sinus is drawn in by the surrounding tissues, creating a negative pressure. This negative pressure leads to a vacuum effect and causes headaches. When the problem blocking the entrance of the sinuses is eliminated, the pain also disappears.

When acute sinusitis is caused by a upper respiratory infection, the cause of the upper respiratory tract infection is corrected with medical treatment. When sinusitis caused by allergic rhinitis is accompanied by bacterial infection in addition to allergy treatment, medical treatment of this infection provides a solution. Thus, acute sinusitis is a condition that can be resolved with medication. Chronic sinusitis can be resolved with surgical treatment. Anatomical obstructions, if present, should be removed and the sinuses should be ventilated. Cystic structures, polyps, and mucosal thickening in the sinuses should be cleared and the sinuses should be opened. There is no solution for chronic sinusitis with medicine treatment, but new formation of polyps and sinusitis can be delayed and even prevented with postoperative preventive medicine treatments, especially in chronic sinusitis caused by allergic rhinitis and allergic polyps.