We can only speculate as to the function of the nasal sinuses, but whatever purpose they serve, they are remarkably conserved throughout evolution. Even dinosaurs, it turns out, had structures equivalent to our nasal sinuses.1 And beyond the mystery of their purpose, the plot thickens. These complex cavities, with miniscule openings into the nasal passages, demonstrate a remarkable propensity for infection and inflammation. If you suffer from sinusitis and feel that your sinuses are “clogged,” you are in fact generally accurate. Obstruction of sinus drainage pathways from infection or allergies, can result in thickening of the sinus lining and a buildup of fluid, causing facial pressure which can be a hallmark of sinusitis. We have only begun to understand the intricate self-cleaning and immune defense mechanisms of the sinuses. Fortunately, we continue to make strides in treatments for sinusitis.
While the field continues to develop, the mainstay of treatment remains the same: support and restore the natural clearance mechanisms of the sinuses. A simple nasal saline rinse, when performed correctly and frequently, will cleanse the sinus drainage pathways and the nose, allowing for improved nasal breathing, more effective sinus clearance, and reduced inflammation.
When discussing sinus rinses, I recommend starting with the NeilMed nasal saline rinse bottle, with distilled water and isotonic saline. The Navage rinse device is a popular and effective alternative. Regardless of the delivery method, rinsing technique really matters. I frequently suggest a YouTube video that you can watch to visualize the correct rinsing method and the relevant anatomy.2
A topical nasal steroid spray, such as Flonase (fluticasone propionate nasal spray) performed after a saline rinse, can further reduce inflammation, restoring nasal and sinus function. These treatments together can speed resolution of a sinus infection. For anyone suffering from chronic sinusitis, they are an effective and safe long-term maintenance therapy.
One of the most intriguing challenges in the management of sinusitis is that two people presenting with exactly the same symptoms may have vastly different causes once an evaluation has been completed. It is, therefore, imperative to have a systematic approach when evaluating patients with sinus complaints. The humble nasal saline rinse, old-fashioned as it is, remains a key component of treatment, as it is a safe and highly effective means of restoring and maintaining natural sinus function.
- Ohio University. “Dinosaurs were Airheads, CT Scans Reveal.” ScienceDaily. ScienceDaily, 9 December 2008. <www.sciencedaily.com/releases/2008/12/081208114300.htm>
- “Dr. Adappa and Dr. Palmer teach you how to do nasal irrigation.” YouTube.com, uploaded by Rhinology at Penn, 2 May 2016, Click here