Holes In Your Head
Don’t leave your job for a sinus cure in Arizona. The trouble may be diet, or your secretary’s face powder
W. W. BAUER, M.D.
HAVE you a sinus? If you have a headache, especially across your eyes, you can find plenty of people to assure you that you have a sinus. In the ready-towear shop the saleslady nods understandingly and agrees that she has the same thing whenever the weather is damp. The seamstress who makes the alterations remarks that it kills her to bend over, and she knows just how you feel. The operator in the beauty shop has her own headaches. Men have it too. The conductor on the train clucks sympathetically as he punches your ticket and admits that he, too, has a sinus headache. The gas station operator, the salesman, the elevator man, and the janitor— they all have “sinus.” Between 90 and 95% of these people are quite wrong.
What is a sinus anyhow? It’s a hollow space or a passage between two hollow spaces. When you say to your friend, “I’ve got a sinus,” what you mean is that you have an inflammation in your upper breathing passages, which may or may not extend to the sinus. The best-known sinus in the human body are the hollows in the substance of the bones in the head. With two exceptions, these are in pairs, and save for one pair they open into the nose.
Directly behind the forehead, above the eyes, is a pair of spaces between two thicknesses of the frontal hone, known as the frontal sinus. These are of varying size in different individuals, and may not be the same size on both sides in one person. They open through a narrow passage into the upper part of the nostril. Within the cheekbone on each side is a hollow cavity known as the maxillary sinus or, after its discoverer, the antrum of Highmore. Antrum is another word for sinus, customarily applied only to this particular cavity. Each maxillary sinus communicates with the corresponding nostril, also through a narrow opening. The mucous membrane which lines the sinus is continuous with the lining of the nasal cavities. There is a fifth sinus, which is not paired but is situated in the mid-line in a cavity of the sphenoid bone, one of the massive bones constituting the base of the skull. The sphenoid sinus is situated above and behind the nose and communicates with it. Although the sphenoid sinus is not paired, it may sometimes be partially divided by a mid-line wall, or septum, of bone. In front of the sphenoid
sinus are numerous small cells, also in communication with the nose, which form a structure resembling a honey comb. This is known as the ethmoid sinus or ethmoid cells. The pair of sinus which do not open into the nose are found in the rounded prominences of bone which you can feel directly behind your ears. These are known as the mastoid sinus or cells. They consist of spongy masses of bone in which the cavities are lined with mucous membrane which communicates with the lining of the middle ear. Although these sinus appear remote from the nose, there is an indirect connection. The mastoid cells open into the middle ear, the middle ear connects with the throat via the Eustachian tube, and the throat communicates directly with the nostrils. Heavy in the Head
THERE has been some argument over the purpose of the sinus. It has been said that if the bones of the head were solid instead of hollow—no wisecracks intended—they would be so heavy that man would need neck muscles like a bull to hold up his head. This idea has recently been denied on the ground that the additional weight of bone required to fill space now devoted to sinus would add very little to the weight of the head. There cannot be the slightest doubt, however, that the sinus make the voice pleasanter by giving it more resonance. A pleasing voice develops from the vibrations of the vocal cords in a column of air which rests upon air in the lungs and in the organpipelike structure, the windpipe; the sounding board action of the air in the sinus gives further aid. Everyone knows the flat, toneless voice which accompanies a cold in the head. This flatness is due in large measure to the absence of sinus reverberation and resonance.
The entire system of spaces and passages has heen compared to a large and rambling house to which the nostrils form a vestibule, the throat cavity constitutes the principal room, and the sinus are additional rooms opening more or less directly off the main room. It has been estimated that at least 14,000 germs per hour are breathed in daily with the air which enters through the nose during quiet breathing. More, when breathing is rapid! Many of these germs are brushed off by the hairs which guard the entrance to the front nostrils—doctors recognize two pairs of nostrils, those in front which open upon the outside and those at the rear of the nose which open upon the throat.
The nose is guarded not only by visible hairs but by tiny, invisible hairlike projections from the mucous membrane cells. These projections, or cilia, have a continuous wavelike motion which causes the mucus to move in a steady stream from the front of the nostrils toward the throat, into which it is eventually expelled and from there swallowed.
It takes about 20 minutes for this flow of mucus to be complete from the front of the nose to the back. By this continuous motion foreign particles which are fine enough to escape the hairs, and germs which have entered the nose, are moved toward the throat. When swallowed they are destroyed by the acid secretions of the stomach unless they are present in overwhelming numbers.
From time to time we run into a germ which is particularly virulent at a time when our general resistance is low, our nutrition poor, or we are greatly fatigued. Such a combination of circumstances results in what is known as a cold, which starts as a virus infection and ends up with the invasion of the local tissues by one or more of the germs. Almost every cold extends to the sinus during its acute stage. Continued on page J2
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Whether there remains a more or less permanent sinus infection depends on a great many factors.
It has been said that the openings to the sinus are small. Therefore it takes very little swelling of the lining membrane to close the entrance and shut the sinus off from communication with the remainder of the “house” cavity. If active germs are shut into a closed sinus, they may create an abscess. The accumulation of infectious material creates pain and tenderness as a result of pressure. Absorption causes fever and general illness. Until the “door” is opened to permit drainage, the individual suffers from acute sinusitis.
If the lining membrane of the sinus is attacked by frequent inflammations, there may develop a chronic condition of sweUing and irritation which keeps the sinus closed most of the time and favors the further development of infection. If the opening of the sinus is located so that secretions cannot escape except by travelling uphill when the head is held erect, drainage is not favored, and chronic inflammation may result. Continuous or frequent swellings due to allergy may contribute to the continuance of chronic sinus inflammation. Sinusitis and allergy will be mentioned more extensively later.
A Cold Can Start It
In the ordinary cold recovery takes place in from three to five days. If the watery secretions characteristic of a cold turn to thick, yellow discharges, it is a reasonable supposition that one or more sinus have become involved. Then it is time for prompt medical attention. Self-medication, especially with oily nose drops, is of Httle or no use, and in the case of oily secretions may predispose to a particularly unpleasant type of pneumonia.
The home use of nose drops is often the surest way to prolong a cold or sinus infection. Few users realize that nose drops depend for their effect primarily on shrinking the membranes. This
provides comfort by making more space available for breathing, and for the flow of nasal secretions. This movement is probably more effective in getting rid of germs than any medication. But drugs like adrenaline, phedrine, and the synthetic shrinking
compounds like metaphedrin and neosynephrin have secondary effects. When the primary shrinkage is over, the membrane not only swells again but often swells much worse than it was before. The patient then proceeds to use nose drops again. And so it goes, round and round, until the poor abused membranes are raw with irritation.
Many preparations for relief of colds contain menthol or camphor. These interesting substances have a peculiar action. They have a pleasant, cooling effect at the very same time that they are increasing the congestion and the temperature of the membrane to which they are applied. This deceptive double action makes them particularly susceptible to abuse by being used too often.
That is not to say that nose drops or other local medication are useless. A physician may prescribe nose drops once, twice or oftener at stated intervals. Or he may order a spray. He may pack the nose with cotton pledgets containing appropriate shrinking or other medications. The point is that the doctor knows what to use and how much, and most important—when to stop. He does not overtreat and thus complicate a situation which is already bad enough. Few nose and throat specialists endeavor to control the flow of secretions during an acute cold. These secretions, annoying as they are, are exceedingly useful in providing an outward current against which germs can make little headway. “Drying up a cold” may be one of the ways to favor a sinus infection.
Sinus trouble may also be related to diet. Overweight people accumulate fat in all their tissues, including the membranes of the. nose and the sinus linings. Swollen membranes filled with fat may obstruct passages which otherwise might be normal. In addition
there is the possibility that the diet may contain substances to which the individual is mildly allergic. These may not create severe symptoms like hay fever, which occurs during the pollen season. Yet they may cause just enough swelling and irritation in the nose and sinus so that when combined with infection they can create painful local irritation.
Blame It on the Weather
AI any a sinus sufferer, sniffling in season and out, blames the weather. Quite likely he is right. In the Chicago area where I live the combination of fog, smoke, dust, and the caustic gases from the chimneys of industrial plants combine to create an atmosphere which is exceedingly irritating to the membranes. In any other locality where similar conditions exist one might suffer from the same kind of local inflammation.
The $64 question asked by all sinus disease victims is: “Will I be cured if I move to a warm climate?” Nobody can tell you. Not long ago I received an angry letter from a man who had written to a government agency, asking this question, and he was irritated because the reply had been “noncommittal.” There can be no other reply. All anyone can say is that some sinus victims are better in warm climates, while others are like the taxi driver who drove me in Phoenix, Ariz., when tfie temperature was 110 degrees. He had left Chicago to get relief, and he did not get it. Dryness and dust, which accompany desert heat, are no better than too much dampness.
Many thousands of people have been relieved in warm, dry climates such as exist in the southwestern United States, particularly along the Mexican border. The dry, clear, unpolluted cold of northern Canada, on the other hand, may be favorable for some persons. In general, a combination of heat and humidity is bad. If there is much smoke and gas, the situation grows worse.
The only way to be sure about what climate will do for your sinus is unfortunately expensive and not available to most people. That is, go to the climate chosen, such as Arizona, New Mexico, southern California or Bermuda, át the season when your sinus disease is worst, and see what the climate does for you. In the meantime, do not quit any job, sell any property, close out any business, or make any other permanent commitments.
You may be disappointed in your “ideal” climate and want to come back where you started from.
If, like most of us, you are tied to your locality, what are you going to do about your sinus? To begin with, you may as well accept the fact that your chronic sinusitis will not be cured once and for all. You will probably have periods in which you feel better and others when you will feel worse. During the latter your doctor can do a great deal to help you. He can look into your diet with respect to overweight, possible allergies, and adequacy of your vitamin intake. Of course, you have to follow his advice about changing your eating habits.
Your doctor may upon occasion use local treatment to shrink the membranes, help to drain the sinus, and give you more comfortable breathing room. He may puncture the sinus and wash them with sterile salt solution. He may recommend surgery to create new openings, larger and more favorably located for drainage. However, surgeons are becoming more and more
! conservative about opening the sinus. It is quite possible that he will use the X-ray for the purpose of shrinking membranes and thus accomplish in a more permanent way the same results derived from packing the nose with shrinking solutions. He may use diathermy or other forms of heat applied locally. It is quite possible that in acute stages he will use sulfa drugs, penicillin or streptomycin (when available). These may be taken by mouth, or given by injection in the nose.
The doctor may prescribe drainage of the sinus by adjusting the position of the head to the best advantage immediately after use of drops or sprays. Liquids run downhill in the body as well as on the landscape. Merely to stand in front of a mirror and put drops or spray liquids into the nose with the head tilted back is not enough. These fluids will run along the floor of the nostril into the throat. Most of the membranes in the nose will not be reached at all. The cavity of the nose extends well up into the roof of the nose. If drops are to reach these upper areas, they must be put in while the patient is lying on his back with his head hanging over the edge of a bed.
It is best to have someone else put the drops into the nostrils. As the liquid runs downward over the membranes, the head, still hanging, should be moved from side to side so that the liquid runs over all of the lining membranes. After a minute or two the patient turns over and lies prone, still with the head hanging over the side of the bed. In this position the liquid has an opportunity to spread over other areas as the head is turned from side to side.
Sprays should be used as a doctor advises. Sometimes he wants a heavy spray, sometimes a lighter one. He will prescribe the frequency, and this I should not be increased or decreased, because undertreatment is a waste of time, and overtreatment may cause irritation, which will make matters worse.
The doctor will also pay attention to the patient’s general health. Fatigue, undernourishment, excessive weight, poorly balanced diet, nervous tension, or any other factor which impairs general health reacts unfavorably in sinus infection.
He may use vaccines, but with more hope than conviction, just to be sure he
hasn’t missed any bets. Don’t be too disappointed if vaccines don’t help you.
Recent studies have emphasized the importance of allergy in relation to sinusitis. The essence of an allergic reaction in any tissue is swelling, and swelling quickly closes sinus openings. There are many possibilities for allergic reactions. Among the most important are diet, breathing, and contact. Diet allergies operate upon the sinus indirectly through the blood. The offending substance is absorbed and carried to all the tissues, including the membranes in the sinus.
Dust Doesn’t Help
Breathing operates more directly in that it carries pollens, dust, animal danders, and the microscopic emanations from furs, textiles, house dust, wheat flour, or cornstarch direct to the membranes. Contact allergies, such as clothing, cosmetics, perfumes, soap and dyes, although their principal reaction would naturally be in the skin and where the contact occurs, may also react secondarily upon the sinus. In many instances, such as cosmetics, the allergy may operate in two ways, by contact and by inhalation.
A patient may even be allergic to the germs of his own sinusitis!
Under unfavorable conditions a sinus condition may become chronic. In that case a cure is unlikely, but the doctor can improve the comfort of the patient by using the treatments mentioned. It does not do to become discouraged over lack of a dramatic cure. Sinus disease controlled by medical treatment is far easier to live with than sinus disease neglected. Going back to the doctor when the condition grows worse or keeping in touch with him from time to time in anticipation of such a relapse can keep the sinus patient in reasonable comfort most of the time.
There are many conditions in and about the head, and elsewhere in the body, which may be mistaken for sinus disease. A headache can indicate almost anything, anywhere in the body. A tight hat, stuffy air in a crowded space, overeating or hunger, allergy, eyestrain, teeth, febrile deseases and many other origins for head pain exist.
Even if a sinus is ultimately found to be at fault, the trouble may not be all in your head. if