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What are sinuses, Why do we have
them, and Why have mine turned
against me?
It has been estimated that one in every
five people suffers from some kind of
sinus disorder. About a third of all Americans
have experienced one or more sinus
infections, and Chronic Sinusitis is the
number one chronic disease in the United
States. You can call it what you want, but
to me that’s an epidemic. Besides, I’m one of
them, and that makes it personal.
My dad used to tell me “knowledge is power”. My mother, on
the other hand, used to say, “everything is connected”.
The first bromide prompted me to research everything I
could find about the war going on inside my head, in order
to take control of my own life and health. This book is the
result of that education. (More on Mom’s wisdom later.)
So, what are sinuses?
C h a p t e r 1
Our sinuses are cavities buried behind and around the nose, eyes
and forehead. The air we breathe moves through these cavities.
Put simply, our sinuses are the filters for our respiratory system.
They are one of our body’s most important protections
against viruses, bacteria, and airborne particles like dust,
pollen and pollution.
They act as a humidifier by moistening dry air before it can
irritate the lungs.
Sinuses also are temperature regulators. They cool hot air
and warm extremely cold air that could damage our lungs.
And, if that weren’t enough, they lighten our heads. Our neck
and spine weren’t designed to carry much weight and our
sinus cavities help to take the load off, so to speak.

T h e S i n u s S o l u t i o n C h a p t e r 1
FRONTAL
eThmOid
mAxiLLARy
Figure 1
As you can see in the illustration (figure 1), there are four
sets of sinus cavities, divided (roughly)in half on each side
of the head. Just like fingerprints, every person has sinuses
that vary in size and shape.
The sinuses are called frontal, maxillary, sphenoid and
ethmoid. Now, I’m not a stickler for overly technical jargon,
but I’ll be using some academic terms in this book.
In my own journey through the sinus labyrinth, sooner or
later I had to discuss my condition with medical professionals.
Nothing impresses and disorients them so much
as a layman who speaks their language. By the end of this
book, you will be able to hold your head (and sinuses) up
in any clinic and take part in your own treatment.
The frontal sinuses are just above the eyes, above the nose
and behind the forehead. The maxillaries are the biggest
sinuses and they are behind each cheekbone. The ethmoids
have multicompartments and are behind the maxillaries and
between the eye sockets. These are very complex mazes of
small air pockets. The sphenoids are buried deep in the skull
behind the nose, a little below the ethmoids (figure 2).
SpheNOid
Our sinuses are interconnected
with each other and
they are connected to the
nasal passage by tiny ducts,
about the size of pencil lead
(figure 3). The openings of
the ducts are called ostia
and are about two millimeters in diameter.
Figure 2
The human body is well designed for the most part but,
personally, I think somebody dropped the ball when they
got to the sinus system. The drainage ducts for the Maxillary
sinuses are located at the top of these large cavities, making
them difficult to drain and easy to block. The ethmoid
sinuses are drained by small ducts in the nasal walls, and can
also be easily blocked. As we will see a little later, this design
is a contributing factor
to chronic sinus problems.
As it turns out,
we have the sinus system
of a creature that
walks on four legs. The
position of the sinus
drainage system actually
works better when
we’re crawling (which
is what I feel like doing
when I have an infection).
We’re sort of set
up for failure.
Figure 3

Figure 4
T h e S i n u s S o l u t i o n C h a p t e r 1
The sinuses, the nose and the lungs are all part of the respiratory
tract, and they are lined with a special tissue called
the respiratory epithelium (figure 4). When we breathe, the
elements of the respiratory tract act together.
On the surface of the respiratory lining are tiny, microscopic
filaments called cilia (figure 5). The cilia maintain
a constant sweeping motion that moves, and removes, the
watery discharge called mucus.
The mucus and the cilia are important parts of the sinus
filtration system. The entire mucus covering of the maxillary
sinus is usually cycled out about every ten minutes. That
means you produce about a quart of mucus a day.
The mucus traps the bad stuff and the cilia sweep the mucus
toward the back of the nose. The mucus is swallowed and
broken down in the stomach, so the bad stuff never reaches
the lungs.
This brings me to my mother’s wisdom.
It really is all connected.
In a way, the sinuses are our body’s first line of
defense. And, boy, do we need a lot of defense.
We are constantly assaulted on all sides by bad
air quality, airborne diseases, pollens, mold, dust,
car exhaust, cigarette smoke and so on. When
our sinuses become unhealthy, our entire system
is at risk. A chronic sinus condition affects our
general health and well being.
How do you get a sinus infection?
I’m not really sure what triggered my first infection
(my awareness level then hovered somewhere
around zero). I’ve always had allergies,
but, before 1991, I had always suffered them
with a shrug, and gone about my busy life. Then,
for whatever reason, for whatever combination
of factors, both internal and external, I found
myself with a sinus infection: ACUTE BACTERIAL RHINOSI-
NUSITIS.
For most people, acute bacterial sinusitis starts with a head
cold, which your doctor will insist on calling viral rhinosinusitis
because doctors love big words. In fact, most cases
of acute rhinosinusitis are viral. Symptoms include: stuffy
head, sneezing, sore throat, cough, fever, and rhinorrhea
(This is another doctor word, which means runny nose. I
was just checking to see if you were awake) - are viral. It’s
important to remember that antibiotics are useless in combating
viral infections. Head colds and other viral respiratory
infections generally clear up on their own within a week.
Bacterial Sinusitis is an entirely different disease. It’s an
infection of the lining of the sinuses. This infection typically
starts with an obstruction of the sinus drainage system. Now
an obstruction could be caused by nasal passages swollen
Figure 5

T h e S i n u s S o l u t i o n C h a p t e r 1
Conditions that Predispose
to Chronic Sinusitis
Common conditions that cause sinusitis
Figure 6
Allergic and nonallergic rhinitis
Anatomic abnormality of the sinuses
Deviated septum
Enlarged turbinates
Aspirin sensitivity
Immunoglobulin deficiency
IgG deficiency
Specific antibody deficiency
IgG subclass deficiency
IgA deficiency
AIDS or other immune deficiencies
Allergy related
from a viral infection or allergies, or by dried mucus, or a
deviated septum or polyps or deformed sinuses. When you
add pathogenic bacteria that are always in your nose, throat
and mouth, you get… nasal nastiness.
Remember, OBSTRUCTION + BACTERIA = SINUSITIS
As discussed earlier, our sinuses are already primed for
obstruction because of the way they are designed. But some
people have deformities of the sinus system that can contribute
to obstruction, like a deviated septum, polyps in the
sinus cavities or deformities of the sinus cavities themselves.
The result is a blockage of the sinus drainage system.
That blockage starts a chain reaction. The body produces
more mucus to deal with the emergency. The main job of the
mucus, to flush out unwanted substances from our body,
like bacteria, is interrupted. Bacteria then does what it does,
it multiplies in a nice, welcoming environment.
Bacteria are all around us and in us. Bacteria like Streptococcus
pneumoniae and Haemophilus influenzae live in most
healthy people’s upper respiratory tracts. That’s generally no
problem because our normal defenses keep these bacteria
in check. Think of it like water in a stream. As long as the
stream flows freely down the mountain, the water stays clear
and clean. But if something stops the flow, the water stagnates
and turns nasty.
When bacteria that colonize the nasopharnx get into the
normally sterile paranasal sinuses, you get a sinus infection.
With no where to go, the mucus becomes a breeding ground
for these bacteria - sort of a petri dish inside your head.
I said that I didn’t really know what kicked-started this battle
for me. But, it had to be one, or a combination of, these
main causes of sinusitis:
Natually occurring deformities (figure 7)
As we mentioned, these could be a deviated septum, deformities
of the sinuses themselves and/or polyps.
The septum is the bone and cartilage that separates the
nostrils. A deviated septum is simply a crooked septum and
this condition can cause or aggravate chronic sinusitis by
causing blockage in the nose and the drainage area from the
sinuses. Just because your septum is deviated doesn’t mean
Figure 7 — Deformed Sinuses

T h e S i n u s S o l u t i o n C h a p t e r 1
it’s causing a problem. However, if you are suffering from
chronic sinus problems, you should let an ENT doctor (otolaryngologist)
make an evaluation.
If the deviated septum is severe enough, you may need to
have surgery. When other surgery for sinusitis is done, such
as removing polyps, the deviated septum is often straightened
at the same time.
NASAL pOLypS
Figure 8
Nasal polyps are not true polyps. They are basically fluid-filled
sacs which look like peeled grapes (figure 8). Experts think
they may be caused by chronic inflammation in the nose. In
fact, if you have had numerous sinus infections (which cause a
great deal of inflammation), you will likely have polyps. If you
live in a city like Houston, as I do, the severe and continuous
pollution can cause chronic inflammation.
Polyps can be found anywhere in the sinuses or nose and are
frequently associated with sinus infections. They can easily
block the ostia (drainage openings) from the sinuses, and as
we have discussed, an infection is sure to follow.
Nasal polyps are often associated with asthma and can be made
worse in some people by ingesting aspirin or related drugs.
Treatment involves steroid sprays, treatment of sinusitis, and
treating any allergies. They may sometimes need to be removed
surgically, but surgical removal doesn’t mean that they won’t
come back. They are not pre-cancerous in most cases.
Viral Rhinitis (Head Cold)
Viral Rhinitis is otherwise known as the common cold. As the
name suggests, a virus, including rhinoviruses and adenoviruses,
causes a cold. In humanity’s long march from the Stone
Age to the twenty-first century, the common cold has dogged
us every step of the way. And the symptoms have always been
about the same:
Fatigue
Headache
Scratchy throat
Sneezing
Watery eyes
Clear runny nose
Nasal congestion
A normal body, with normal defenses, will deal with a cold in
about three to five days, depending, of course, on how good
your mother’s chicken soup recipe is. Viral colds, in and of
themselves, do not cause bacterial sinusitis. But, the body
reacts to an invasion of viruses by producing mucus and
pushing white blood cells to the lining of the nose to fight the
infection. All this activity congests and swells the nasal passages
and ducts.
With all this swelling, the mucus builds up in and around the
mucus membrane that lines the sinuses. Air and mucus get

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T h e S i n u s S o l u t i o n C h a p t e r 1
trapped behind the narrow duct openings, which sets up a
perfect breeding ground for bacteria to thrive. Your body
responds by producing more mucus, overwhelming the
system’s ability to get rid of it. Viruses also inhibit macrophage
and lymphocyte function. These are the parts of
your immune system that fight bacteria, putting you at even
greater risk.
If your “cold” lasts for more than a week or two, you’ve
probably progressed to a sinus infection.
Allergic Rhinitis (Hay Fever)
The sneeze, the drip, the red, watery eyes staring back at
you in the mirror after a fitful sleep. Sound familiar? You’re
in good company – about a fifth of all people suffer from
seasonal allergies. (At least that’s what all the literature says.
In my experience, almost everyone I know has allergies of
some type.) You may know it as hay fever, but your doctor’s
going to insist on calling it allergic rhinitis.
Allergic rhinitis may affect as many as 20% of all Americans.
That translates to almost 10 million lost days of work a year.
Direct and indirect cost of allergic rhinitis has been estimated
at $5.3 billion. It’s difficult to nail down exact statistics
because many sufferers assume they have a common cold.
But, a common cold it’s not. As we’ve discussed, a virus causes
the common cold. Allergic rhinitis occurs when the body’s immune
system attacks a substance called an “allergen”.
I can see your red eyes starting to glaze over, so let’s make
this as simple as possible. When the body detects the
invading allergen, it attacks with a substance called immunoglobulin
E Antibodies or “IgE”. Everybody has some IgE
defenders, but, an allergic person has a large army of IgE,
more than is necessary or, actually, beneficial.
As this battle rages inside your body, there are some casualties.
These victims of “collateral damage” are called
mast cells. When a mast cell is injured it releases a variety
of strong chemicals, such as histamine and certain tissue
destroying enzymes, into the tissue and blood. These
chemicals frequently start reactions that, in
turn, cause the itching, swelling, dripping and
so on.
If you are an allergy sufferer, almost anything
can trigger an allergic reaction, from cat hair
to pollen to perfume, as long as some part of
your body has been sensitized to that allergen.
It’s all in your genetic makeup, although environment
plays a role as well. You may move
to a new location and find that your allergies
have cleared up. The things that bothered you
in, say Louisiana, aren’t around in Denver. But
if you stay in the Rockies long enough, you may develop allergies
to the trees and flowers there. In my case, and people
I know, some allergies come and go. Years ago, I had violent
reactions to cats. These days, they barely affect me.
This all comes back to our story of sinusitis because of the
effect that an allergic reaction has on your body.
When the mast cells release those irritating chemicals, like
histamine, the body automatically does what it’s designed
to do. It rushes help, in the form of white blood cells to the
offended area. This causes swelling of the membranes. In
addition, more mucus is created to try and remove the irritant.
The mucus clogs the swollen sinuses, and you get the
conditions which can lead to infection.
We’ll go into more detail about allergies (and what to do
about them) in the next chapter.

T h e S i n u s S o l u t i o n C h a p t e r 1
Non-Allergic Rhinitis.
Non-allergic rhinitis is not as well understood. It’s not
triggered by an allergy or a virus, but the symptoms are often
the same. We’re entering uncharted waters where the
symptoms might seem to be the same but the causes are
ambiguous, like a particular non-allergic rhinitis, Vasomotor
Rhinitis.
Vasomotor Rhinitis.
Vasomotor Rhinitis, also referred to as Idiopathic Rhinitis,
is a non-allergic rhinitis where something, not an allergen
and not a virus, causes the nose to overreact. Blood
vessels enlarge, or vasodilate, and this results in chronic
swelling and nasal obstruction. Some clinical evidence
suggests that a vasomotor rhinitis sufferer may have an
imbalance in the nerve supply to the nose, which leads to
the dilated blood vessels.
External stimuli, any irritant that you can inhale into the
nose may aggravate vasomotor rhinitis:
• Aerosol products, like hair sprays, deodorants,
insecticides.
• Cigarette smoke.
A brief word about cigarettes. There is a special
place in hell for cigarette manufacturers and if you
suffer from any respiratory problems and haven’t
stopped smoking, WHAT ARE YOU THINKING?
For someone with chronic sinusitis, chronic bronchitis
or asthma, even a few minutes in a smoky
bar can trigger an infection.
Healthy cilia
quickly move
pollutants out of
your respiratory
system.
Pollution such as cigarette smoke can paralyze your cilia..

T h e S i n u s S o l u t i o n C h a p t e r 1
Even healthy cilia are actually paralyzed by second hand
cigarette smoke.
Air Pollution
There is plenty of scientific evidence to link the growing
incidence of chronic respiratory illness around the world
to ever increasing pollution.
· Ozone.
· Formaldehyde.
· Perfumes.
· Chemical odors.
· Changes in temperature and humidity.
Here’s a look at the difference in symptoms between
rhinitis and sinusitis:
SYMPTOM RHINITIS SINUSITIS
Congestion Y e s P a i n f u l l y S o
Sneezing A c h o o ! ! ! N o t M u c h
Itching Y e s N o
Rhinorreah (runny nose)
Clear Y e s N o
Purulent (colored) N o Y e s
Postnasal Drip S o m e L o t s
Headache ? B i g T i m e
Facial pressure N o t R e a l l y S o m e t o A w f u l
Loss of Smell S o m e Y e s
Cough L i t t l e A L o t
Throat clearing N o t M u c h M o r e
Fever N o L o w G r a d e
If all that weren’t enough to take in, there is one more possible
cause for your sinusitis.
Fungal Sinusitis.
The most current research at the Mayo Clinic in Rochester,
Minnesota seems to indicate fungi as a contributing
factor in Chronic Rhinosinusitis. Fungi are all around us
in the environment and most people have them in their
nose and throat along with bacteria. These fungi are usually
harmless to healthy people, as most people have a
natural resistance to them.
But some fungi, such as Aspergillus, can cause serious illness
for people whose immune systems are somehow not
functioning properly.
Fungal sinusitis may be more common than the medical
community previously thought. An article published
in 1999 by the Mayo Clinic contained some interesting
statistics. This type of sinusitis is known as EFRS, eosinophilic
fungal rhinosinusitis or EMRS, eosinophilic mucinous
rhinosinusitis.
Fungal growth was found in washings from the sinuses of
96% of chronic sinusitis patients. Normal subjects, called
controls, had almost as much fungal growth. But, the
difference was that chronic sinusitis patients had a white
blood cell identified with allergic and other reactions,
called eosinophiles.
An independent study by a group from Graz, Austria,
were able to show positive fungal cultures in 92% of their
patients. Again, almost as many controls had fungi. Clusters
of eosinophiles were found around fungi in 94% of
patients. This suggests that the eosinophiles are attacking
and killing the fungi.

T h e S i n u s S o l u t i o n C h a p t e r 1
When the eosinophiles are activated, they release products
called Major Basic Proteins, or MBPs, into the mucus.
These MBP bullets attack and kill the fungus, but have the
counter effect of irritating the lining of the sinuses.
Again, a chain reaction happens. While trying to protect
the body from the invading fungus, they also injure the lining.
The cilia, and the lining itself, are damaged, allowing
our old enemies, bacteria, to proliferate. By now, you know
the rest.
There seems to be a debate within Sinus World about
whether chronic sinusitis does indeed originate from
sensitivity to fungus, and if so, how that affects treatment.
If fungus leads to injury of the sinus lining, then perhaps
treatment of chronic sinusitis should be directed at the
fungus, not bacteria. In this scenario, treatment would
concentrate on the reason the eosinophiles attack the fungus
in the first place. Bacteria would become a secondary
player.
As reported in the January 2005 issue of Journal of Allergy
and Clinical Immunology, the latest findings from the
Mayo Clinic involve the use of an anti-fungal spray, Amphotericin
B, which was given to 30 patients with chronic
sinusitis. This treatment reduced swelling and inflammation,
and lends weight to the theory that fungi are involved
in the development of chronic sinusitis.
Compared with a placebo, six months of treatment with
Amphotericin B nasal spray led to significant reduction in
nasal swelling. It also seemed to reduce the number of immune
cells present in the sinuses. Trials with thousands of
patients are taking place now.
On a personal note, I’ve tried Amphotericin B. It’s pretty
nasty tasting stuff, you have to keep it refrigerated, and it
has known serious side effects, especially in the kidneys.
The doctors at the Mayo Clinic claim that using it as a spray
eliminates the risk of side effects.
Let’s look at some possible reasons people develop sensitivity
to fungus.
Some people believe that the overuse of antibiotics can
cause an overgrowth of fungi, which in turn causes a debilitating
sensitivity. Others believe that extensive exposure to
mold and fungi in our environment has resulted in increased
sensitivity. Water damage from plumbing and roofs as well
as new home construction that has reduced air exchange
may have increased fungi all around us. Remember the
dreaded Black Mold, bane of insurance companies?
Diagnosing Sinusitis.
How do you know when you have a sinus infection? Well,
there could be pain and a feeling of pressure behind your
face. The location of pain depends on which sinuses are affected.
There is a general feeling of stuffiness and difficulty
breathing through your nose. There is also a change in the
color of the mucus, which turns to yellow, brown, gray or
green – eewwwww! I would also suggest that you can tell if
it’s bacterial by the appearance of the mucus, which gets
stringy. This is the way the bacterial colony organizes itself.
There is also often nasal bleeding, as the bacteria actually
start eating the lining of your sinuses.
Here are some general symptoms:
You might have a headache when you wake up. (Assuming
you’re not hung over)
There may be loss of smell and a stuffy nose.

T h e S i n u s S o l u t i o n C h a p t e r 1
When you touch your forehead over the frontal
sinuses, there is pain.
An infection in the maxillary sinuses can
cause your upper jaw and teeth to ache.
Your cheeks can become tender to the
touch.
Sinus infections in the ethmoid sinuses can
cause swelling of the eyelids and tissue around
the eyes and can cause pain between the eyes.
There may be tenderness when the sides of your
nose are touched.
Infections in the deeper sphenoid sinuses can cause earaches,
neck pain and deep aching in the top of your head.
Other, more general symptoms might include:
Low grade fever
Weakness
Lethargy
A cough that seems worse at night and when you get up in
the morning
When the mucus drains from the sphenoid or other sinuses
down the back of the throat, called postnasal drip, you can
get a sore throat.
You can have one or more of these symptoms and not have
sinusitis. Most doctors look at the length of time you have
the infection and the rate of recurrence of infections to
determine if you have sinusitis. Personally, if I see colored
mucus when I irrigate, I know I’m in for another battle.
So, what have you got when you’ve got it?
Acute, Chronic and Recurrent
Acute Sinusitis
Acute sinusitis is the most common form of sinusitis. The
medical community diagnoses it this way. If it lasts less than
eight weeks and occurs less than four times a year, it’s acute.
A typical case lasts from a week to several weeks.
Acute sinusitis can be successfully treated, leaving no residual
damage to the mucous linings in your sinuses, if you
get to it quickly.
Recurrent Acute Sinusitis
Recurrent acute sinusitis is generally defined as four or more
bouts of sinusitis a year for two or more years. This has been
my personal cross to bear. Many people with recurrent
sinusitis feel like they never really get rid of one infection
before another starts up.
Chronic Sinusitis
Usually, you’ve got chronic sinusitis if your sinus infection
lingers into multiple months. You may feel better for a time,
but the infection is fooling you. It actually never goes away.
The mucosa looks different and weeps infected mucus.
In chronic sinusitis, your sinus system has begun to change,
due to the constant attack by the bacteria. The bacteria have
been destroying the cilia. This puts even more pressure on
an already debilitated sinus drainage system.

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T h e S i n u s S o l u t i o n
No matter what stage of
sinus infection you are
experiencing, I would
like to emphasize the
importance of early
treatment. We will discuss in detail
the various treatments that are available
to you in later chapters. Early treatment of
a bout with acute sinusitis may help you avoid
developing a chronic condition. The longer you
wait for treatment, the more difficult it will be to treat.
In my system for achieving respiratory health, maintenance,
self-awareness and immediate response to
the first sign of an infection are the keys to winning the
sinus war.