Sinusitis

The sinuses are air-filled cavities in the bones of the face, all of which drain into the nose through narrow openings. Their lining is covered in microscopic hairs that sweep a thin layer of mucus steadily towards those openings. The system works as long as the openings stay clear and the sweeping continues.

Inflammation swells the lining, and because the openings are narrow to begin with, a small amount of swelling closes them. The trapped mucus stops moving, oxygen in the cavity falls, and the conditions inside change in a way that keeps the inflammation going. That loop is why the chronic form persists long after any original infection is over.

Chronic disease is defined by lasting more than twelve weeks, and it is better understood as inflammation than as an infection sitting there. Allergy, a narrow or bent anatomy, aspirin sensitivity and asthma all feed into it, and treatment aims at the inflammation and the drainage together instead of at bacteria alone.

The nose is examined with an endoscope, which shows the drainage areas high in the nose that cannot be seen with a light from outside. The doctor is looking at the lining, at any discharge and at where it is coming from, and at whether the anatomy narrows the pathways.

A CT of the sinuses is the standard imaging. It shows which cavities are affected, how thick the lining is, and the exact layout of the bony walls, including the position of the eye and the base of the skull. Plain sinus X-rays are no longer used for this because they miss too much.

Where the picture suggests it, allergy testing is added, and a swab taken under endoscopic guidance is more useful than one taken from the nostril. A twelve-week history with confirmed findings on endoscopy or the scan is what separates the chronic form from repeated short attacks.

Medical treatment is slow and its main difficulty is that it is undramatic. Nasal steroid sprays take four to six weeks to show their effect and only work if the technique is right, aiming outwards and not at the septum. Large volume saline rinses are the other half and need doing daily, not when things feel bad.

After surgery the nose is blocked and bloodstained for the first week, and there is a dull ache across the face instead of sharp pain. Rinses start within a day or two and become the most important part of healing, because crusts have to be washed out while the lining regenerates.

Most people are back at desk work in a week, with heavy lifting and gym left for three. The lining takes about three months to settle fully, and reviews with cleaning under endoscopy happen during that time. Sprays and rinses continue afterwards, since the operation restores drainage but does not switch off the underlying inflammation.