Chicago Nasal & Sinus

What is a "deviated septum"?

The septum is the wall that divides the two nostrils and nasal passages, like a wall that separates two hallways or rooms. The septum is composed of a mucosal envelope, with a thin sheet of cartilage and bone inside. "Deviation" of the septum simply means that this wall is crooked, either due to overgrowth of the cartilage and/or bone within the mucosal envelope or because of some nasal trauma that pushed the cartilage and bone out of position. One out of every 3 or 4 people in the general population has some curvature of their septum, and the degree of curvature determines the extent of any nasal obstruction.

What is "non-allergic rhinitis"?

Rhinitis is defined as an inflammatory condition affecting the membranes which line the nose. This inflammation can lead to nasal congestion, watery discharge with frequent sneezing or nose blowing, decreased sense of smell and taste, pressure in the face, and post-nasal drainage of mucus into the throat. Typically, the turbinates within the nose become engorged with blood and become "leaky," increasing mucus production. Rhinitis can be due to allergies, activated by exposure to specific triggers such as tree or grass pollens, dog or cat dander, or dust and mold; however, rhinitis can also be due to non-allergic triggers such as cigarette smoke exposure, strong fragrances such as perfumes and chemical solvents, temperature and humidity changes, or simply changing position from upright to supine.

What are the differences between allergies and sinusitis?

Allergies represent an inflammatory condition within the nose due to exposure to specific triggers such as tree or grass pollens, dog or cat dander, or dust and mold; these triggers lead to histamine release within the nose and thus a cascade of events that leads to congestion, clear watery mucus, frequent sneezing, itchy eyes, and frequent nose blowing. Allergies can, by themselves, be a source of discomfort; however, allergic inflammation can also cause swelling of the small openings into the sinuses and lead to impaired airflow and mucus drainage. Sinusitis develops when this impaired airflow leads to pressure headaches or impaired mucus drainage leads to bacterial growth within the sinuses and an infection develops. Symptoms of an acute sinus infection can include nasal congestion, facial pain and pressure, pain in the upper teeth, discolored nasal discharge, cough and fever.

What are the differences between a cold and a sinus infection?

The common cold is a viral infection which can trigger symptoms such as nasal congestion, increased nasal mucus production, fever, cough and throat pain. The most common cause of acute bacterial sinusitis is viral cold or URTI. Bacterial growth follows obstruction of the sinus opening, impaired mucus clearance and local mucosal injury. While the symptoms of a sinus infection may initially mimic a viral cold or URTI, their persistence for more than 5-7 days suggests a bacterial infection. While about 40% of acute sinus infections resolve without treatment, antibiotics are recommended to facilitate recovery, prevent complications, and prevent progressive inflammatory changes that lead to chronic sinusitis.

Why do we have sinuses?

The physiology and function of the sinuses has been the subject of much research. Unfortunately, we still are unsure as to all the functions of these air-filled spaces. Proposed functions include:

• Warming and humidification of inspired air
• Lightening the skull, giving resonance to the voice, absorbing shock, and contributing to facial growth
• Contributing to immune defense
• Increasing mucosal surface area
• Assisting in regulation of intranasal pressure and serum gas pressures

Recent studies1-4 have shown that the production of intranasal Nitric Oxide (NO) occurs primarily in the sinuses. NO has been shown to be toxic to bacteria, fungi, and viruses. NO has also been shown to increase ciliary motility. The sinuses may therefore serve as a reservoir for NO, adding small amounts of this gas to the air that we breathe, protecting us from infection and maintaining our overall health.

1.  Lundberg et. al. High nitric oxide production in human paranasal sinuses, Nature Medicine, 1, 1995.
2.  Andersson et. al. The paranasal sinuses as reservoirs for nitric oxide, Acta Otolaryngol 122, 2002.
3.  Sanders et. al. Role of nasal nitric oxide in the resolution of experimental rhinovirus infection. J Allergy Clin Immunol 113, 2004.
4.  Maniscalco et. al. Nitric oxide in upper airways inflammatory diseases, Inflamm Res 56, 2007