Allergy & Asthma Network Mothers of Asthmatics (AANMA)

It’s Not ALL in Your Head

Published February - 10 - 2009 Print This Post

sinusBy Laurie Ross
What happens in your sinuses doesn’t always stay in your sinuses. In fact, it’s often the fuel that stokes airway inflammation – in other words, asthma. Fix sinus infections and you often fix the asthma.

“The sinuses in your head and lungs in your chest form two ends of the respiratory tree, connected by a network of breathing tubes,” explains Martha White, MD, research director of the Institute for Allergy and Asthma in Wheaton, Maryland, and medical editor for Allergy & Asthma Network Mothers of Asthmatics. “For reasons that we’re only beginning to fully understand, sinus infections tend to ignite asthma symptoms.”

What’s Inside Your Head?
Your nose is the gateway into a miraculous air processing complex. When you breathe in, air swirls through your nostrils into your nasal cavity – an open space lined with folds of tissue that warm and humidify the air before it travels down into your lungs. Next to your nasal cavity, like rooms off a hallway, are your sinuses, with doorways no wider than a pencil lead.

You have four pairs of sinuses, each pair like mirror images on either side of your face.

Ethmoid sinuses: Put your finger alongside your nose, with your fingertip just inside the corner of your eye. That fingertip is pointing to the ethmoid sinuses – a network of 5-10 small chambers that run horizontally front-to-back between the bridge of your nose and your eye sockets. These form the central drainage system for your sinuses – all the others drain through here. Pressure pain in the ethmoids might make you want to pinch the bridge of your nose.

Maxillary sinuses: Leaving your finger next to your nose, feel where your first finger joint hits the top of your cheekbone. That bone protects the largest set of sinuses – the maxillaries. About the size of a walnut, these chambers are connected to the nasal passages by openings at the top, so they must defy gravity to move mucus up and out. They sit so close to your upper teeth that maxillary infections are often mistaken for toothaches.

Frontal sinuses: Sitting behind your forehead, just above your eyebrows, are your frontal sinuses. These sinuses actually determine the shape of your brow – and can cause sinus headaches.

Sphenoid sinuses: You won’t be able to put a finger on these sinuses! About the size of a large grape, the sphenoids sit deep within your head, just below your brain – making an infection there all the more dangerous. Some people feel the pain of sphenoid congestion at the back of their necks.

Housekeeping and Sound Control
A thin layer of sticky mucus coats your nasal and sinus cavities, trapping dust particles, bacteria and other pollutants before they can get into your lungs. When everything is working properly, tiny hairs called cilia sweep mucus into the back of your throat where it can be swallowed and neutralized in your stomach.

Your sinuses also give sound to your voice. “As hollow areas in our facial bones, sinuses operate like the soundboard on a piano or guitar, giving resonance to our voices,” says Dr. White. “If you want to know what your voice would be like without sinuses, think of how you sound when you have a sinus infection or your nose is completely congested.”

The sinuses are formed by facial bones, so they get larger as we grow. That’s one reason sinus congestion and infection in children cause different symptoms than in adults.

Pressure Points
Sinuses become congested just like your nose does when reacting to allergens, irritants or respiratory infections: Tissues become swollen and produce extra mucus. If the cilia can’t move the thick mucus out, it begins to accumulate. Trapped mucus provides a safe haven for germs or fungi to grow. Infection sets in, causing sinus pressure and pain.

Differences in air pressure can also cause sinus pain. When your sinuses are clogged, air can’t pass in and out easily and any atmospheric changes in pressure – whether from driving through the mountains or flying in a plane – can create a painful pressure buildup.

Sinus headache and postnasal drip are the most common complaints from sinus congestion, but other conditions can also point to sinus problems, especially in children:

  • Sleep disorders like snoring, nighttime cough or sleep apnea
  • Sore throat or constant throat clearing
  • Bad breath
  • Ear pain or infection
  • Toothache
  • Fever
  • Exhaustion

Fortunately, maintaining healthy sinuses is as simple as
1  Avoiding illnesses and allergies that cause inflammation
2  Keeping nasal mucus thin and cilia moving
3  Washing nasal passages regularly

Tame Inflammation
Inflammation causes mucous membranes lining your nasal passages and sinuses to swell up, become easily irritated and produce excess mucus – all of which put you at risk for sinus infections. To prevent inflammation,

  • Minimize respiratory infections.
  • Keep your immune system at its peak with a healthy diet and lots of exercise
  • Wash your hands regularly
  • Get your annual flu shot

Minimize allergy symptoms.

  • See a board-certified allergist for accurate diagnosis and an individualized management plan
  • Start allergy medications well before your allergy season and continue as directed to control runny nose or inflammation that can lead to congestion
  • Consider treating hard-to-control allergies with immunotherapy (allergy shots)

Keep Mucus on the Move
If mucus is heavy and thick and cilia cannot move it up and out, mucus will accumulate in your sinuses, setting the stage for infection. To keep mucus on the move,

Stay away from smoke and air pollution.

  • Smoking cigarettes, cigars or pipes – or being around others who are smoking – can damage cilia and make them unable to sweep mucus efficiently. Secondhand smoke is as dangerous as smoking itself.
  • Ozone and other chemicals in the air can also damage cilia, so keep windows closed at home, school, work and in the car on bad air quality days.
  • Use moisture and heat to thin mucus and reduce sinus pressure.

    • Apply a warm, moist washcloth to your face, eyes and nose several times a day to soften mucus and warm the air inside your sinuses, which will relieve pressure.
    • Drink lots of fluids to keep your body (including your sinuses) hydrated; avoid alcohol and caffeine, which can have a drying effect.
    • Inhale steam to moisten and soften mucus. Do this in the shower or create your own mini-nasal-sauna by draping a towel over your head as you lean over a basin full of hot water. (Add a few drops of essential oils for custom-made aromatherapy.)
    • Keep nasal passages moist with saline (saltwater) sprays. The salt helps match the water to your body’s natural pH chemistry, but try to find sprays without BAC (benzalkonium chloride), a common preservative that many people find irritating.
    • Apply moisturizing gel inside your nostrils to relieve dry nasal passages – try ones with eucalyptus, menthol or essential oils like peppermint or clove.

    Shrink swollen membranes.

    • Nonprescription nasal decongestant sprays will reduce swelling in nasal passages, allowing mucus to flow more easily. They should never be used for more than 3-5 days because long-term use can actually increase congestion.
    • Over-the-counter decongestant pills, capsules or liquids relieve nasal swelling and pressure but do not treat the cause of inflammation.
    • Prescription nasal corticosteroid sprays will reduce nasal inflammation and swelling caused by allergies or polyps (tissue growths that can block nasal passages). It will take 4-5 days of use for them to reach full effect; then they should be used daily as directed.

    Wash, Rinse, Repeat
    A saltwater rinse for the inside of your nose will shrink swollen membranes, improve airflow and open sinus passages. Studies show that a mixture of concentrated salt water and baking soda (bicarbonate) helps the nose work better and move mucus out faster. Buy a nasal wash kit or premixed solution at pharmacies and allergy supply stores or make your own. (See recipe below.)

    You will need a bulb syringe or ear syringe (available at most pharmacies), a large medical syringe (30cc) or a Water Pik® with a sinus irrigator tip. Some people use a neti pot, which is like a teapot with a long spout.

    Fill your rinsing device with the saline solution.

    Stand over the sink or in the shower and squirt the mixture into your left nostril, aiming the stream toward the back of your head, not the top. (Don’t inhale!) Tilt your head forward, touching your chin to your chest to allow excess solution to drain out of your nose. If it drains into your mouth instead, simply spit it out. Ideally, the solution squirted into the left nostril will swirl around the back of your nose and come out the right side. Relax – it really won’t make you choke!

    Repeat the process with the right nostril. Continue alternating nostrils several times until you run out of solution.

    If you notice a mild burning sensation in your nose, reduce the amount of salt.

    For children: You can put the solution into a small spray container, like a saline spray bottle. Squirt it several times into each side of the nose. The child should not lie down; it’s easier and more comfortable to do when sitting or standing.

    Nasal Wash Recipe

    • 1 cup distilled water
    • 1 teaspoon “pickling/canning” salt or Kosher salt (avoid using table salt, which has unwanted additives, such as iodine); use ¼ teaspoon for children.
    • 1 pinch baking soda (pure sodium bicarbonate)

    Carefully clean and rinse a glass jar, then fill with 1 cup distilled water. Stir in salt and baking soda. Store at room temperature up to one week.

    A sinus headache does not necessarily mean you have an infection requiring a doctor’s care or prescription medication. Many cases of sinusitis will clear up by themselves within a week, especially if you follow the self-help treatments recommended here. If symptoms continue, however, it’s time to see a physician.

    The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) recommends adults see a doctor if any three of the following symptoms persist for 10 days or longer:

    • Facial pressure or pain
    • Headache pain
    • Congestion or stuffy nose
    • Thick, yellow-green nasal discharge
    • Low fever (99˚-100˚F)
    • Bad breath
    • Pain in the upper teeth

    Your physician will make a treatment decision based on how long you’ve had your symptoms and how often they tend to occur.

    Not all cases of sinusitis require medication. Antibiotics will treat bacterial infections, but many sinus infections are caused by viruses instead. If your healthcare provider prescribes an antibiotic, continue taking it for the full period of time prescribed, even if you feel better within a few days.

    Sinus symptoms that last 12 weeks or longer or recur 4-6 times during the year indicate chronic sinusitis, which often requires more complex treatment than short-term cases. Your doctor may use a CT scan or endoscope to check for a fungal infection or for polyps or structural abnormalities that are blocking your sinuses.

    Young children have immature immune systems and are more prone to infections of the nose, sinus and ears, especially in the first several years of life.

    Symptoms that may indicate your child has a sinus infection include:

    • A “cold” lasting more than 10-14 days, sometimes with a low-grade fever
    • Thick yellow-green nasal drainage
    • Postnasal drip, sometimes leading to or exhibited as sort throat, cough, bad breath, nausea and/or vomiting
    • Headache, usually in children age 6 or older
    • Irritability or fatigue
    • Swelling around the eyes

    Simple Sinus Care

    Taking care of your sinuses will help eliminate sinus infections that can cause asthma flares. You can prevent most sinus problems by avoiding illnesses and allergies that cause sinus inflammation, keeping nasal mucus thin and cilia moving and washing your nasal passages regularly.

    Talk with your medical care team about making these steps part of your asthma and allergy management plans.

    First published:  Allergy & Asthma Today, Volume 6, Issue 2
    Updated:  February 2009