Dr. Grossan's Ear, Nose and Throat Consultant Pages

Sinus Disease

Sinus problems are most on the minds of my patients these days. No wonder! In Los Angeles we have smog and pollution which adds to symptoms when a person has allergies too!

Today we know that most sinus disease is caused when the cilia - the very tiny "hairs" in the nose and chest stop beating. These wonderful machines act like oars, moving 16 strokes each second to propel bacteria, dirt, and cancer causing poisons out of the nose and chest, before they have a chance to enter the body. Many cancers form where there are few cilia, emphasizing their importance. The treatment of choice for sinus disease is to have the body return the cilia to their normal function, beating 16 times per second. .

Know what the BEST treatment is for early morning sneezing? If you start sneezing on awakening, it is because the nose is trying to get rid of the particles that accumulated there at night. If the nasal cilia are working properly, they beat at 16 beats a second and get rid of these particles and then you don't need the sneezing. The best treatment in breakfast in bed! You see, by drinking hot tea before you get out of bed, the body gets warmed up, the cilia speed up and the sneezing, hacking is avoided.

In the nose and chest are millions of tiny "oars" or cilia. They act in coordination to move out the dust and bacteria from the nose to the back of the throat where it can be swallowed and disposed of in the stomach. In the chest, the cilia beat to move the germs and dust out of the chest, up the windpipe to the throat where it is swallowed. When this system works you don't get sinus disease. When the system fails in the chest you get a cough, the cough takes over to get rid of the dirt and germs in the bronchial passages.

Protection from infection is achieved by the presence of lysozymes, immunoglobulins and phagocytes in the mucus solution. Movement of the bacteria by mucus flow reduces opportunity for penetration of the cell. Dilution of bacterial products makes them less toxic. Mast cells and globulins are carried in the mucous layer. If the cilia don't move the blanket, then the cells and defense can't be delivered where they are needed.

Thus, the mucociliary defense system consists of cells that transport mucous and cells that secrete mucous. Both are essential to health.

Remarkably, the ciliary movement is coordinated so that an effective wave propels the mucus in a specific direction.

Sinus cilia beat toward the natural sinus opening. Nasal cilia beat backward . Nasal mucus propels into the nasopharynx and is swallowed for disposal into the stomach. In the child this course directs the mucus with its bacteria, debris and foreign matter over the adenoids where lymphocytic defenses can act. The deep crypts and rugae of the adenoids create a larger surface area for greater effect in order to defend the body

With a virus infection, the cilia are slowed down by the virus chemicals. This allows bacteria that normally would be swept away by the cilia to enter the body. Therefore, anything you can do to encourage good cilia movement is helpful. Hot chicken soup works! Hot tea is good. Compresses to the sinus/nasal area helps. Enhanced Nasal/Saline Moisturizers, formulas based on the Locke-Ringer's formula, have been shown to aid cilia better than regular saline. (See article by Boek.) It has an advantage over saline in that there are no preservatives such as benzalkonium and the mixture is buffered to avoid any burning sensation. The refillable spray bottle it comes with can be used for spray, drops or to irrigate or wash. Without the burning, this solution can be used regularly by kids.

When you feel a sinus infection coming on, rest, hot soup and tea, hot compresses applied to the sinus area: above the eyes for the frontal sinuses, between the eyes for the ethmoid sinuses, and below the eyes for the maxillary sinuses.

If this is not effective, pulsatile nasa/sinus irrigation can be used to restore nasal cilia, remove nasal pus, and thin the secretions. With a proper pulsatile irrigatin device, the irrigation pressure is adjusted to just the right value of 5 PSI - the water stream is about an inch high. The saline, or better yet, enhanced moisturizing solutinon, goes in one side of the nose and out the other. This is a natural way of healing the sinus condition. Even children as young as 5 years find this a pleasant treatment.

Some people get symptoms after exposure to downtown smog or dust at work. I advise them to use this irrigator much like washing the hands to remove dirt. By irrigating in this manner, the nose doesn't have to do the work. I find it especially useful for Firefighters to use after the smoke of a fire.

Cilia are generally activated by increasing temperature up to 40 C, so hot compresses over the sinus area are beneficial. However above 40 C cilia are inactivated and hence the deleterious effects of hot steam nasal inhalation. Long term dry steam inhalation, (sauna), is suspected of being harmful.

For people with serious sinus disease, pulsatile irigation has proven extremely useful . For example, patients with Cystic Fibrosis have very poor ciliary action and so develop serious sinus disease. The pulsating saline irrigator can remove the pus and act like a normal cilia.

A good medication for nasal congestion is Sudafed Long Acting, 120 milligrams every 12 hours.

The term mucocliliary clearance refers to the system of the cilia and the blanket of mucus. This is a table of medicines and factors that increase clearance which is good, and medicines that slow mucociliary clearance, which is bad.

Mucociliary Clearance

Increase Decrease
Fluids enough to lighten the urine
Hot tea, Hot chicken Soup
Reducing bacterial load
Inhaled coricosteroids
Various enzymes: e.g. Bromelin or Papain taken buccally (proteolytic enzyme lozenges)
Early stages of allergic rhinitis
Breathing and cough excercises
Flutter inhallation device
Antihistamines, dehydration
Inhallation of air or steam above 40 degrees centigrade
Heavy load of iced drinks, chilling, drafts
Sulphur dioxide, ozone, smog
Inhalation of chromium dusts
Cupric (copper) compounds
Nickel dusts; chimney dusts
Late stages of allergy
Nasal polyps
Skydrol (a solvent used in airplane maintenance)
Severe infections such as pseudomonas, bacteria, H. Influenze, and many viral infections
Pseudomonas infection
Hyperbaric oxygen
Reduction of airway diameter

Environmental factors

In World War 1, those who initially survived chlorine gas attacks sustained severely reduced MCC. This led to absence of MCC as a defense mechanism, and these victims died of respiratory infection.

Industrial toxins include chlorine, sulfur dioxide, cupric compounds, and many others.

Pathologic effects of dust exposure may include MCC disorder, and disturbance of regional immunity and the acid-base balance of tissues. These are reported by to be in direct proportion to the length of exposure to excessive dirt and dust.

The Kuwait oil fires released polyelie aromatic hydrocarbons and nickel and vanadium into the atmosphere. Results of this contamination are now being studied with indications of effects on MCC. and an increase in respiratory infections.

Formalin vapor and solutions below 0.25 % will inhibit MCC and cause symptoms. Chromium and chromates are known to be ciliotoxic and harmful to workers in mining and industry. In addition, certain areas of Saudi Arabia have chromium in the sand with an associated high incidence of sinus disease and chest disease. Workers in plating and sanding industries should wear protective inhalers and use pulsating saline irrigation to remove these chemicals and help restore the nasal ciliary action.

Smoking does not give consistent results, even in the laboratory. One interesting phenomenon is the patient who has swollen nasal membranes after he stops smoking. Some patients return to smoking to overcome the congestion and blockage. What may be the mechanism here is that the smoke acted as an irritant to the cilia, inducing movement. With the cessation of smoking, the stimulus is reduced and the cilia stop, leading to the feeling of obstruction.. In these patients I find decreased MCC and they respond to measures to restore normal MCC.

Much has been written about a common industrial complaint which also involves litigation, that of multiple chemical sensitivity syndrome. After a single powerful exposure, the individual in now sensitive to products not previously offensive. After the insecticide was sprayed in her office, now perfume, soap powder and small amounts of dust clog her nose and make her cough. In my experience, some of these cases are characterized by the first offender acting as a strong ciliotoxic substance, now the cilia are no longer defending the body and removing the dust and other particles so that the dust just lays there, multiplies and reaches a symptom producing level. I see this after a Skydrol or a Chlorine Gas inhalation.

Sinus Headaches and Sinus Pain Are Not Always What They Seem

Patients come to me complaining of sinus headaches. They point to the area over the eyes (where the frontal sinuses are) or the area under the eyes (where the maxillary sinuses are located) and ask for sinus relief. Actually, the sinuses are rarely painful due to infection. Even when you are blowing handkerchiefs of yellow pus, there is rarely pain. But, when there is a painful muscle in the back of the neck, the pain is radiated to the sinus area. The treatment is to get the neck well . We do this by checking the posture at work and reading - office typist chairs are good, soft couch chairs are bad, and lighting can be important too. Light from the ceiling or shoulder is good, glare from in front is bad. Then I have the patient do neck stretching; gently turn to see who is behind you. And head leaning onto the shoulder. This is best done in the shower, with the shower stream hard and comfortably hot., for 3 minutes.

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Last Update 2001 January 21

Murray Grossan M.D.