What are the sinuses?
The sinuses are air pockets in the bones of the face and skull. If you touch your cheek or forehead, the bone there feels like hard, solid bone. But these bones are actually hollow and contain the sinuses.
The image on the left shows a CT scan. A CT scan is a special type of x-ray used to look at the sinuses. This scan shows a side view of the face and head. On a CT scan, bone shows up white. Air filled spaces are black. The sinuses are the black spaces inside the bone. You can see the frontal and sphenoid sinuses labeled.
Most people have four sinuses on each side of the face. The names of theses sinuses are:
- Maxillary sinus
- Ethmoid sinus
- Frontal sinus
- Sphenoid sinus
What happens when someone has chronic sinusitis?
Patients with chronic sinusitis can have irritation, swelling, inflammation, and fluid in their sinuses. Healthy sinuses are filled with air and look black on the CT scan. The lining inside the sinuses makes mucus, but that mucus is able to drain continually. The mucus drains through small openings called “ostia.” These ostia are natural openings that allow mucus from the sinuses to drain into the nose. The membrane that lines the sinuses has little hair called “cilia” that are programmed to push the mucus from the sinus to the natural openings.
When the sinuses are unhealthy, the lining can become very swollen or mucus can build up on the inside. In this image, the arrow points to a grey area inside the frontal sinus. This grey is an area where there is swelling and build-up of mucus inside the sinus. This type of swelling and irritation can be seen on a CT scan. The scan shown on the right has an area that looks grey inside the frontal sinus.
Almost everyone gets a cold or a sinus infection once in a while. The sinuses can become irritated and swollen when that happens. Colds and sinus infections typically get better over a few weeks. The sinuses get back to being healthy after the infection gets better.
Some people with chronic sinus problems have frequent infections. Others can have sinus irritation and swelling that never really goes away. When this happens, patients can have symptoms like facial pressure, nasal congestion, nasal drainage, post nasal drip, and a loss of their sense of smell. These types of constant symptoms can have a big impact on quality-of-life. Chronic sinus problems are very common and affect millions of Americans every year.
How is sinusitis diagnosed?
A careful examination of the nose can help diagnose sinusitis. In our office, we will use a small instrument called a nasal endoscope to look inside the nose. The endoscope is like a very small flashlight with a camera on its tip. This allows us to look inside your nose to look for things like swelling, irritation, and drainage of mucus. The picture on the right shows a patient having a nasal endoscopy in Dr. Goyal's office.
A CT scan of the sinuses is also very helpful in helping diagnose sinusitis. In most cases, we have to combine all of the findings from the nasal endoscopy and the CT scan to come up with an accurate diagnosis.
Fortunately, most people with sinus problems can find relief. Sometimes, the best way to get relief is to use the right combination of medications. Things like sinus rinses can also help. In some cases, the sinus issues are severe enough that medications and things like sinus rinses don't offer enough relief. In these cases, treatments like sinus surgery can be helpful.
Dr. Goyal has written several articles and book chapters on sinus problems and sinus surgery. Please see these links for more information:
- Information on our website about sinus surgery.
- Dr. Goyal's published papers related to sinus surgery are listed below:
- Goyal P, Hwang PH. In-Office Surgical Management of Sinus Disease: Office-Based Surgical Procedures in Rhinology. Operative Technique Otolaryngol Head Neck Surg. 17(1):58-65, March 2006.
- Goyal P, Leung M, Hwang PH. Endoscopic approach to the infratemporal fossa for the management of invasive fungal sinusitis. Am J Rhinol. 23(1):100-104, January 2009.
- Isaacs SJ* & Goyal P. The role of three dimensional computed tomography in defining frontal recess and frontal sinus anatomy. Am J Rhinol. 23(5):502-505, September/October 2009.
- Nelson JJ* & Goyal P. Temperature variations of nasal endoscopes. Laryngoscope. 121(2):273-278, February 2011.
- French C* & Goyal P. Submucosal Resection of the Middle Turbinate. Laryngoscope. 123(8):1845-1848, August 2013.
Dr. Goyal has written a book chapter about sinus surgery: