Sinus Problems: Rhinitis and Sinusitis

Working Definitions

Rhinitis is the irritation of the nasal cavity, sinusitis = irritation of the sinus cavity. Rhinitis is characterized by dripping, itching, sneezing, and burning of the nasal passages. Sinusitis is characterized by pain in the face, teeth, eyes, and head region. It may be accompanied by green or yellowish discharge from the front or back of the nose. If the discharge continues to travel down the back of the throat, sore throat, hoarseness, throat cleaning, and coughing may ensue. Eventually, fever, weakness, and repeat flare-ups of upper respiratory infections and worsening of pulmonary or allergy attacks occur.

Sinusitis is one of the most common health conditions, affecting over 37 million sufferers in the USA each year and result in over 787 million office-based doctor visits a year. Over $2.5 billion dollars are spent on just the prescription medications. Children miss over 2 million days of school. Sinusitis affects 30% of the population at some time in their life and is more prevalent in the South. (Source: Centers for Disease Control and Prevention)

There are numerous factors that increase the potential incidence of rhinitis and sinusitis in patients:

  • Exposure to germs while in crowds, around children, in airplanes, or packed elevators.
  • poor dietary habits (e.g. RC Cola and a Moon Pie)
  • poor general health (e.g. diabetes, AIDS, depression, chemotherapy)
  • abusive behavior (e.g. smoking, drinking to excess, drug use, over work)
  • geographic factors (e.g. big city, low air flow, lots of plants)
  • allergen exposure (e.g. pets, poor housekeeping, occupational exposure)

The normal physiology of the nose and sinus cavity helps explain what happens when things go wrong. Normally, the lining of the nose has a multitude of glands that create a mucus blanket that provides a protective coating. This coating moisturizes, lubricates, and protects the delicate mucous membranes. It also works like flypaper to trap pollen, dust, bacteria, and viruses for later removal or destruction. The hair like cilia built into the membrane work like a conveyor belt to transport unwanted debris out of the nose and back to the throat. The profuse vascular system (as demonstrated during nosebleeds) warms and humidifies the air entering the nose.

The normal physiology also includes the ability to rapidly air blast the nasal cavities (sneezing). The left and right nostrils take turns breathing by alternating which one is swollen and engorged and which one is shrunken down and wide open. This switching back and forth is frequently unnoticed unless the septum is deviated or the nose is quite narrow.

The sinus cavities are air pockets inside the bones of the skull and face. They were probably created to help lighten the weight of the head while acting as an energy absorbing crash barrier for the brain. In addition, they seem to increase the resonance of the voice. Like the nose, they are lined with mucous membranes, coated with mucus and cilia. They communicate with the nasal passage via small openings that can easily get plugged with mucus, pus, or swollen tissue.


If either the nose or sinus get infected or inflamed, the other will often become symptomatic. Symptoms include:

  • pain of the head, sometimes excruciating
  • significant reduction of airflow through the nose causing change of resonance, mouth breathing, sensation of suffocation, reduction of exercise tolerance
  • spasms of involuntary cough with resultant hoarseness, possible vocal cord damage, and worsening of any pulmonary disease
  • insomnia and fatigue
  • ear infections with reduced hearing and/or impaired balance
  • bouts of repetitive, uncontrollable sneezing

Treatment of Sinusitis

Sinusitis is treated by:

  • identifying and eliminating the causes of rhinitis and sinusitis
  • medications to control rhinitis and treat infections for as long as necessary
  • diagnosis and treatment of significant allergies
  • surgery to eliminate blockage in the nose and sinuses and restore normal airflow

As a rule, if the rhinitis is well controlled, the chances of sinusitis are greatly reduced. If sinusitis is reduced, the need for repeat courses of antibiotics is reduced. If the need for repeat courses of antibiotics is reduced, the chances of needing sinus surgery are reduced. It may sound like the old story about “for want of a nail, a kingdom was lost” but prevention of chronic sinusitis and sinus surgery starts with controlling rhinitis.

An examination by experienced doctors is the first step in treatment. At the St Thomas Sinus & Allergy Clinic, our board certified otolaryngologists, allergists, and pulmonologists work as a team to quickly and accurately determine the cause and start therapy for your sinus problem. The latest in video endoscopic tools are used to painlessly visualize the nasal passages. When indicated, CT scans are obtained and reviewed with you during your appointment. These scans give a clear blueprint of the anatomy and the pathology that could be causing your complaints.

Therapy may consist of modifying your lifestyle, medication, antibiotics, allergy treatment, surgery or any combination of these. Our team works together to find the best treatment for you.

If surgery is necessary, our state of the art outpatient operating rooms allow modern video endoscopic surgical instruments to accurately clear blocked passages and let you recover in your own home. Post operative therapy directed by the St Thomas Sinus & Allergy Clinic will help you and your family doctor to reduce the chances of return of disease.