Nasal and Sinus Anatomy (and Histology)

ANATOMY:

External Nose:

the external nose – the part of the nose that you see – is there for more than just to make your child beautiful.  Those cartilage and bone structures are there to keep the nasal airway open.  Think of the boxer with the pulverized nose who can no longer breathe through his nose.  Anyone who has ever broken their nose – elbow during basketball, softball to the nose, whatever – knows that having those structures intact helps keep your nose open, helps keep your breathing open and smooth.

Nasal Cavities:

where all the action takes place:

  • air conditioning – humidification, warming or cooling incoming airstream
  • filter the incoming airstream of microorganisms and pollutants
  • immune function – preventing infection by airborne microorganisms
  • olfaction – sense of smell
  • voice quality – affects voice resonance

Nasal Septum:

divides the nose into right and left halves.  If the nasal septum is deviated (born like that or acquired from trauma), obstruction can result.  If severe enough, septal deviation may warrant surgery (septoplasty) to improve nasal airway.

Lateral View, Upper Airway

Lateral Nasal Airway: Turbinates, Adenoids, Eustachian Tube Opening

Turbinates:

3 swellings along the side wall of the nasal cavity.  Their function:

  • create turbulent airflow – this aides in sense of smell, and helps mucus trap microorganisms and pollutants in the airstream (a good thing)
  • cover the openings to the paranasal sinuses (why, we don’t know)
  • alter voice resonance ? (we’re pretty much guessing here)

Adenoids:

The Adenoids lie in the nasopharynx at the very back of the nose.  The adenoid tissue is lymphoid tissue.  It looks well, pretty gross.  It is involved in killing microorganisms that are captured by the nasal secretions. Those secretions are swept to the back of the lose by cilia motion.  This is the area where the nose, sinuses, adenoids and tonsils, and the openings to the Eustachian tubes (to the middle ears), all connect.

Therefore, in a way, the adenoids are sort of a key to keeping everything here (nose, sinuses, eustachian tube and middle ears) healthy.  Unhealthy adenoids – acute or chronic adenoiditis – can be a cause of major nose, sinus, and ear problems.

If you look at the picture below, taken through the mouth using an angled endoscope, looking forward toward the front of the nose, the top of the palate is at the bottom, you can see the nasal septum in the middle, the nasal turbinates attached to either side of the nose, the Eustachian tube opening on the right side is visible (there is one on the left also), and the adenoids at the top of it all.

If the adenoids are too big, they can block the nose – nasal obstruction.  The result is difficulty breathing through the nose, and probable rhinitis and sinusitis.

View of Back of Nose: Adenoids, Turbinates, Back of Septum

Paranasal Sinuses:

pediatric sinusitis pediatric allergies allergic rhinitis children toddlers infants

Frontal, Ethmoid (E), and Maxillary (M) Sinuses

air-filled cavities within the bones of the face, connected to the nasal cavities.   There is great variation in sinus shape and size between people.  Have uncertain role; some speculate that they help lighten the facial skeleton, sort of like hollow bird bones make them lighter.

The sinuses consist of four paired cavities each of which is named after the bone in which it is located.  The four sinus pairs:

  • Maxillary sinuses – in bones of cheeks, one on each side.  May grow to be as large as 15ml (could hold about 3 tablespoons).
  • Ethmoid sinuses – usually 6 – 10 per side, situated between the orbits (eye sockets), up to the skull base.  Responsible for more complications from sinusitis than other sinuses, usually involving the orbits (eye sockets) and tissues around the eyes.  The Ethmoid sinuses are small and irregular, sort of like the “nooks and crannies” that you see when you cut open an English muffin.
  • Sphenoid sinus – 1 or 2 lie in the very middle of the head, surrounded by the pituitary (part of the brain), optic nerves (from the eyes), internal carotid arteries – all important structures.  Rarely a source of sinusitis complications, but due to location, complications can be life-threatening (meningitis, brain abscess).
  • The Frontal sinuses – situated in the eyebrow area of forehead bone of the skull.  Usually one each side, but one or both are absent in about 5% of us.  Due to the fact that the brain is just behind the frontal bones, sinusitis complications in the frontal sinuses can be serious (meningitis, brain abscess); fortunately this is rare.

HISTOLOGY:

The lining of the nose is our first line of defense against airborne microorganisms and pollutants.  This task is handled by the epithelium through mucociliary clearance (more about this in another post).  The nasal epithelium functions to:

  • Acts as a physical barrier to inhaled foreign materials
  • Entraps and clears foreign material by …
  • Mucus secretion and
  • Cilia activity
  • Is an active part of our immune response – contains enzymes and antibodies
  • Helps condition the air we breathe in: warm it, cool it, moisturize it

Respiratory Epithelium: Nasal and Sinus

Nasal (and sinus) epithelium:

is comprised of

  • cells with cilia
  • cells without cilia
  • goblet cells, and
  • basal cells
  • transient immune cells – lymphocytes and mast cells

The ciliated and non-ciliated cells help create most of the physical barrier as they form a tightly-connected sheet that lines the nasal cavity.  This “tight junction” that is formed between these cells, effectively keeps foreign materials – pollutants and microorganisms – from getting into our tissues and bloodstreams.  A breakdown in this barrier can be dangerous.

The goblet cells produce mucus – snot.  Nasal mucus, in the proper viscosity (thickness, stickiness) and amount, is the key to the system of mucociliary clearance working normally.  Mucociliary clearance is the holy grail for healthy sinuses.  Achieve this, you achieve respiratory health.

Cilia:

The most important feature of the respiratory epithelium, shown in the picture above, are the cilia.

Cilia of the ciliated epithelial cells work together to sweep out the mucus that contains any adherent foreign material, including microorganisms and pollutants.  In order to work normally, these cilia need a certain level of humidity.  They are also VERY sensitive to airborne pollutants.  These include toxins that are in cigarette smoke, in common air pollution, and various volatile organic compounds (VOC’s).  VOC’s are all around us in our synthesized, plasticized, man-made world.  They come out of our cleaning agents, out of adhesives, and out of all that plastic.  These toxins prevent the cilia from working properly.

If mucociliary clearance does not function, we can expect chronic respiratory illness, and life-threatening infections can result.  These cilia are on the respiratory epithelial cells that line the upper and lower respiratory tract, including the nose, the sinuses, and the middle ear, as well as the trachea and bronchioles.  The result can be rhinitis, sinusitis, otitis (ear infections), bronchitis, and pneumonia.

The basal cells are progenitor cells – baby cells – that will divide and grow to replace the other cell types when they grow old or are lost due to a toxic environment.  The immune response of the nasal epithelium helps us fight off attacks from various microorganisms (viruses, bacteria, mold), but if it goes haywire, can contribute to allergic rhinitis.

Immune Function:

Finally, the mucus contains special antibodies and enzymes that:

  • prevent viruses and bacteria from sticking to the epithelial lining
  • help our white blood cells to recognize viruses and bacteria as invaders and to kill them

Sorry for the dry, boring anatomy lesson, but it is important to have some idea of how the sinuses relate to the nose and rest of the upper airway.  It is important to have some understanding of how it all fits together and how it works if we are to succeed at keeping it all healthy.  This knowledge will help you as we move forward to control your child’s rhinitis and sinusitis, and improve their asthma or other chronic aero-digestive inflammatory disorders.  See you here again as we move toward that goal.  I will refer to this post often.  There will be a quiz next week ;-)

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Best health and success to you and your families.

It seems that some families of my former patients have found my blog and have left a couple very kind comments.  Thanks you so much! Please post a comment so that we can all learn to achieve sinus health, and healthy airways.  And please, “be excellent to one another.”

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

Comments

  1. Thank you for much for a wonderful, informative site with the added pleasure of a sense of humor!

    • Russell A. Faust, PhD, MD says:

      Hi Letitia,

      Thank you for your kind comments.
      I am grateful for your readership, and that you have taken the time to leave a comment.

      RF

  2. Elizabeth says:

    I am currently on antibiotics for sinusitis. Several days ago when my symptoms were at their worse, I tried sinus irrigation and my sinuses were totally blocked. The fluid, I think, went in my eustachian tubes and ever since, although my sinus symptoms have subsided, I have a totally blocked and a constantly crackling right ear. What do I do? Will it eventually go away? It’s been like it almost a week now.

    • Russell A. Faust, PhD, MD says:

      Hi Elizabeth,
      That is common. In fact, I get rinse up my eutstachian tube with every nasal/sinus rinse (oddly, only the right side). The fluid in the middle ear WILL make odd noises – crackles and pops – but should not cause any further problems. It should also dissipate within a week or so. Since I do nasal saline rinses every day, I commonly have some crackling and popping in my right ear, but it never becomes infected or painful. It is much less annoying than my chronic sinusitis was, so I continue the saline rinses and put up with it. I also find that it helps to use less force when I do the rinses, and mostly rinse the other side. The saline goes through both nasal airways, regardless, so I still get the benefits on both sides.
      Please let me know how this turns out for you.
      RF

  3. Hi Dr. Faust,

    I stumbled onto your website; very informative, thanks.

    Three basic questions: First, are all of the sinuses connected to one another? The reason for asking is that when I do nasal irrigation (after being in dusty/pollen situations) I have wondered if the irrigation flushes ALL of the sinuses or just the maxillary? My second question — some sites caution against using nasal irrigation if you have nasal polyps OR a deviated septum — I probably have a somewhat deviated septum, but nasal polyps? (How would one know, short of being scoped in the nasal area?) Should I still irrigate not knowing if I have nasal polyps?
    Finally, I do get transient dizziness around the same time I go on an irrigation campaign; the dizziness goes away, eventually. But I wonder; was the dizziness related to the allergies (ear involvement) or the use of the irrigation? Note: I use ONLY microwave-warmed distilled water along with the salt packets from Neil Medical under the most sterile conditions, following the neti-pot / irrigation process directions to the letter.

    Any thoughts?

    Frank

    • Russell A. Faust, PhD, MD says:

      Hi Frank,
      The sinuses are all connected, in the sense that they all empty into the nasal cavity. When I think of nasal saline rinses, I think of rinsing the nose, not really rinsing the sinuses, since most of that saline does not actually make it into the sinuses. That’ okay though, because the area that you want to affect – to reduce swelling – is at the opening of the sinuses, not necessarily inside the sinuses. And: you want to rinse away all of the allergens, irritants, and particulate pollutants that collect in the nasal cavity (they stick to the mucus). So, nasal saline rinses help in a couple ways. They rinse away irritants; and they reduce swelling at the opening to the sinuses, allowing the sinuses to normally aerate.
      The dizzy symptom is a new one for me; should ask your ENT doc.
      Thanks for taking the time to share. Please keep me updated.

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  6. Rebecca says:

    Every morning I wake up with you might call a “mucous plug” deep in my nostrils. The only way I can get it out is with my pinkie finger. The size and shape of it, as well as how it feels when I’m getting it out, tell me that the plug extends into both nostrils. It seems to wrap gently behind and on either side of the septum. Is this normal (it’s not painful, and it doesn’t impede my breathing). And does this mean my septum is perforated? Many thanks!

    • Russell A. Faust, PhD, MD says:

      Hi Rebecca,
      You might consider using a humidifier at night in your bedroom; also consider trying nasal saline rinses – I use the Nasopure.com system (no financial relationship). That will provide excellent nasal hygiene by rinsing away things that irritate your nose – pollutants; cigarette smoke particles; allergens; etc. This is assuming that you don’t smoke tobacco; if you do – QUIT!
      Thank you for visiting and taking time to share.

      • Rebecca says:

        Thanks for your reply. I was actually trying to ask a specific question about nasal anatomy. Is it possible to have a single “boogor” stretching behind the nasal septum, with one end stretching into the left nostril and the other end stretching into the right nostril? Or should the nasal septum completely separate the nostrils? Thanks :)

        • Russell A. Faust, PhD, MD says:

          Hi Rebecca,
          What you describe may be a sino-nasal polyp. If you are experiencing what you describe, you should consider visiting with an Ear, Nose & Throat doc (otolaryngologist) for an exam. Best success.

  7. Hi Doctor,

    Thanks for such clear explanation of this stuff! That’s hard to find on the internet, sadly.

    I have kind of a weird issue that I was hoping you might be able to shed some light on. I get this feeling of fullness in my left ear and also sometimes in the right. When I speak, the sound of my voice sort of reverberates through my head from the inside and is very loud and distracting. When I yawn or move my jaw in a certain way I feel and hear this popping and cracking sound in my ears. I saw my family doc and had my ears irrigated and there is no blockage that is causing this from the outside of the ear. She sent me to an ENT who did some looking around and didn’t find anything, but did order a CT (I haven’t done that yet). They did a hearing test and I have no hearing loss.

    So here’s the weird part (please bear with me): I happen to do this exercise where I do a handstand against a wall, and when I do it (i.e., when I’m upside down) the condition goes away instantly and completely! Any ideas what might be causing this issue?

    About three years ago I had surgery for sleep apnea (turbinate reduction, tonsillectomy, he straitened my septum and took out some of my soft palate–with no complications, thank god.). This issue existed prior the surgery and I kind of assumed that it was related to my mild springtime allergies, but why would it go away when I’m upside down? I hope I don’t sound like a crazy person. It’s all true.

    Thanks,
    Joe

    • Russell A. Faust, PhD, MD says:

      Hey Joe,

      You MAY be crazy, but what you describe is common: eustachian-tube-dysfunction.
      Take a look online for more info, but here’s a good description from my friend, Dr. Chang:
      http://www.fauquierent.net/etd.htm

      Let me know if you have questions after looking into this.
      Thanks for visiting, and please keep me updated!

  8. Dr. Faust,
    Since 2012 I started with my nose stopping up & eventually just went from bad to worse. I wake up with my nose stopped up then I start sneezing & then I have to start blowing my nose then the pain comes. Feels like someone has a blow torch up my left nostril. I have pain in my left eye. So much pressure & pain. Went to an ENT almost 2 years ago she did a Cr scan told me I had chronic sinusitis & a severely deviated septum. She said I needed surgery. I came up with the money to pay her but the hospital wanted to charge over 15,000 to do the surgery there. My family doctor gives me hydocodone for pain but it doesn’t help. We also have no insurance. My life is miserable & I’m in pain every day. I mean severe pain!!!!! I have a few side effects. When I blow my nose alot of snot comes out but it’s all clear as can be. I’m not sure when I can have surgery. Can you suggest something that will give me relief 😌??? I have been dealing with this for a long time. Thank you for your time. Sincerely, Carla

    • Russell A. Faust, PhD, MD says:

      Hi Carla,
      I’m so sorry but I have no way to help over the internet :(
      My best recommendation is to find a more holistic practitioner (ND?) and see if they can find underlying issues that can be corrected without surgery. Best success on your path to health and wholeness!

  9. Hello Dr. Faust,
    I’m so glad I came across your website! I have suffered with ear, nose and jaw problems my entire life and I am about to turn 47 in August. I had my tonsils and adenoids removed when I was 14 (due to always having breathing problems, sinus infections and strep throat). I have also suffered with a poor Immune System and enlarged spleen since I was 10 years old (my parents knew and prayed it was something that would just take care of itself). As the years have passed by I have watched my face keep changing (my chin has kept moving to the left of my face). When I was 28 years old I decided to have Rhinoplasty (not to actually straighten my nose, because the Doctor said it was nearly impossible with my facial structure), I had a small plastic square piece put into my chin (to try and at least show a little symmetry with my chin and my nose) and some fat was lipo-suctioned out of my neck. About 2 1/2 years ago I had a 3D scan done of my face through our local Orthodontist and he said I had an unusual cyst in my left sinus cavity and I should watch it. I saw our local ENT and he wasn’t to concerned about it, so neither was I. In the beginning of this year the left side of my face started aggravating me and so did my ear, but I wasn’t able to get into my Doctor @ the Clinic. I just kept messing with my face (rubbing it constantly…even though it hurt), using an ice pack as much as possible (even sleeping with one), different methods for my ear, etc..,
    One evening while watching television with my husband, I was rubbing my face and heard (also felt) something pop (hurt really bad😐). I knew at that moment something terrible had happened and just had no idea what?!?! I was up all night and gradually I watched (looking in the mirror frequently; not something I am very fond of at this stage in my life) and I took selfies of myself at different hours in the morning as my face changed shape. I couldn’t believe the transformation that I was watching. Wow! This was one of the scariest moments of my life (yes, vanity was out of control and all kinds of things were running through my mind…I actually thought I was going to die). My 15 year old son looked at me and said, “Mom, Are you going to look like that for the rest of your life? Could you die?” I truly didn’t know the answer to that question.
    I ended up having a really bad left staph ear infection and left sided facial Cellulitis. Could you possibly tell me how someone gets Cellulitis in the face? Am I doing something to cause it? Also, I live in a very small town in Wyoming and Doctors are limited. When I got out of the Hospital the ENT who saw me twice and I was supposed to see when I got out (actually had a scheduled appointment with him) called me the day of my appointment and had his assistant tell me he couldn’t help me and when I asked her why, she said that he said, “I can’t help that poor woman!”

    I still have sinus, ear, facial, jaw and other facial discomforts. Do you possibly know anyone that could help me? I suffer with a lot of health problems that started in 2007 with West Nile, Encephalitis and Fibromyalgia. The list just goes on…
    I am currently a young woman that is extremely frustrated, misses being a go-getter like she’s always been, misses a lot of family events and is watching the years fly by!!!

    I am Disabled, unable to work, sleep most of the days away, not really able to exercise due to the pain and have gained 30lbs since 2007.

    I’m no working on myself and starting from my head to my toes “literally!”

    Thank you for letting me vent…(even if this isn’t the right forum;)😊

    • Russell A. Faust, PhD, MD says:

      Hi Karla,

      Sounds frustrating! And the fact that you are asking for my opinion only reflects your level of desperation. My best advice: find a physician with a holistic approach – perhaps a Naturopathic Doctor (ND) – even if that means traveling to another state. Of course, there are very well-trained holistic physicians in California, though I know of many in other states. I’m sorry that I don’t have other recommendations beyond that: find a physician who will help educate you and who will listen (not in order), and who will work with you as a team. Thank you for sharing. Best success.

  10. Does many cilated epithelial cells seen in sinus gram stain indicate fungal growth/infection?

    • Russell A. Faust, PhD, MD says:

      No: epithelial cells are normally present in gram stain swabs from sinuses. It’s a positive sign that you have ciliated epithelial cells present.

  11. Hi Doctor,
    5 months ago I felt a fullness in my left ear. I used sinus rinse and after a day my nose was blocked and I wasn’t able to smell.Went to the ENT turned out that the fullness in my ear was fluid built in my ear. My turbinates were so inflammed and the ENT prescribed some antibiotics. A week later the fluid was gone. But It seemed that was having a severe sinus infection. It cleared after after a month. But since then I can’t smell or taste anymore. Is this about the fluid in my ear spreading the virus to my olfactory nerve via sinus rinse ? And if the fluid was viral how could antibiotics clear it out ? Can a sinus rinse spread a virus from ear to olfactory area?

    • Russell A. Faust, PhD, MD says:

      Hi Denise:

      Virus anywhere in the upper respiratory tract can affect you sense of smell: the olfactory sensory nerves are very sensitive. Saline nasal rinses are unlikely the cause of “spreading virus from your ear to your olfactory area,” but I suppose it’s possible. I have occasionally seen patients (or in my own personal experience) where a sinus infection seems to spread to an ear infection. That MAY have been related to saline rinse moving through an infected area (nasal passages) into the throat (where Eustachian tubes travel to the middle ear), but again: that ‘spread’ of infection may have occurred even if saline rinses were not being done.

      It is rare that loss of olfaction does not recover. Sense of smell usually recovers within a few weeks following the injury done by viral infection.

      Hoping that you sense of smell recovers!
      Thanks so much for visiting, and especially for taking time to share.
      Please keep me updated.

  12. Hi Dr. Faust,

    I appreciate your detailed site and blog. Not many doctors would take the time to care so much. My issue is that every time I get a cold, as soon as I start to feel better, no sooner do I start to feel worse. I battle a sinus infection and/or upper respiratory infection. God bless mucinex over the counter. Prior to mucinex, I used to have to use an inhaler when sick and would battle bronchitis every year post cold. It’s a never ending cycle and it’s honestly been this way my entire life. And I know it’s all because of the sinuses and secondary illnesses post cold. Early 2013, for over 4 months I battled first a cold, then sinuses, struggled to keep my chest clear, and ended up with laringitis for over two months. Clearly the upper respiratory crap started the laringitis, but my then undiagnosed reflux made it difficult to heal. After everything finally cleared up, I opted for sinus surgery. In 2013, I had bilateral maxillary ballooning procedure completed, which helped tramendously, except I still noticed when I got sick with a cold, breathing from my right nostril was still difficult (better, but still difficult)–I had wondered if the doctor had did a good enough job opening things up on the right side. When I’m sick or have sinus congestion, I literally have to lay on my left side so that the right side doesn’t get congested. It was like this before the surgery, just worse. Post surgery, I merely treated myself post cold with Claritin D and mucinex as needed which seemed to work great up and kept me out of the doctor’s offices needing antibiotics for sinus infections until this past year. If I sleep on my right side I get congested and can’t breathe from my nose, but if I sleep on the left side, I wake up able to breathe from both nostrils (with still some congestion). Rounds of antibiotics don’t always clear my sinuses fully or perhaps they work for the first week, but then it still lingers for the following 3 weeks post zpak. I asked the doctor to put me on an antibiotic that I take for longer as opposed to the 3 pill zpak, but then I hear the cliche statement that it lasts in my system for two weeks. I currently have been “sick” for over two months since the initial cold that started this sinus crap. I’m headed to the doctor tomorrow for probably a second round of antibiotics for this tenacious sinus crap. I had asked about getting a kenalog shot, but my new doctor says it suppresses the immune system. I’m scared from the last time I tried saline sinus rinses, which was in 2013 when ended up with laringitis for over two months. At the time prior to my allergy testing, I was also trying nasal sprays and I can’t help but feel like I got laringitis either from the nasal rinses or the steroid sinus spray. With all my history of upper respiratory infection, I had never had to worry about laryngitis before. Prior to sinus surgery in 2013, they did a prick allergy tests which concluded I barely had any allergies from their common list. Karagum (which I wonder if it’s the same or similar to xanthan gum which is in EVERYTHING), a couple fungi, and only a slight reaction to pine is all they rated me positive for to clear me for their sinus surgery. I don’t know how accurate these prick tests are compared to testing a persons blood for allergies. I know perfumes bother my sinuses and I can’t burn candles unless I want a stuffy or runny nose. Clearly I have ‘some allergies’ that are more easily irritating during my post cold state where I’m more volatile. Other than that, nothing really bothers me and I’m fine, I’m willing to try the sinus rinse again, but I’ve read some research that there I conflicting opinions on whether or not it does more harm then good. I can’t help but wonder if I need sinus surgery again since that seemed to help so well or am questioning my tonsils or adenoids which no doctor has ever talked to me about. Sometimes I feel like j have no immune system and I often joke about it with friends and loved ones. I get a cold almost every 2 or 3 months (for sure cold symptoms, with sore throat and fever, etc) followed by battling to clear my sinuses and keep my lungs clear (again/ mucinex is a god send) and am usually blowing my nose for a month or two post cold. My husband and I are about to try to start a family, and I’m just scared shitless about the likelyhood of getting a cold while pregnant. I don’t know that my usual regime of mucinex, Claritin D, and nightquil…. And antibiotics when I can’t clear the sinus with the prior drugs. Ugh. Whatever advice you want to give, I’m game to hear it….

    • Russell A. Faust, PhD, MD says:

      Wow, Krista, that all sounds painfully familiar. So similar to my own experience. People who struggle with chronic and recurrent sinusitis, sinusitis that seems to grow out of EVERY viral cold, often have infection with biofilm-forming pathogens. And those are very challenging to get rid of. In my own case, I began adding Xylitol to my nasal rinses, alternating with Manuka honey, with the occasional use of baby shampoo (very cautiously) to help loosen the biofilm. Please search those topics here on this blog and elsewhere. After decades of struggling with sinusitis following every cold, I finally eradicated the sinusitis!! Amen. Please also check out this website: herbcraft.org – Jim is an herbalist who really knows his stuff! And he loves to teach (and is a great teacher), so check out his courses. Let me know what you think. Thanks so much for your kind comments, for visiting and sharing, and best success!

  13. Karen Jones says:

    Hello and thanks for providing this valuable information! I am looking for healthy ways to provide moisture to a chronically dry nose. Can I use coconut oil on a q-tip to moisten safely or is there something else that would resemble more closely the moist environment that seems absent at times in my nose? Thanks for your help!

    • Russell A. Faust, PhD, MD says:

      Hi Karen:
      You’re welcome.
      In general, oils are not optimal for moisturizing in the nose. Water-based gels are best: try “K-Y gel” or other aqueous gel on cotton swab. Sounds gross, but no more so than putting grease in you nose. And your nose will be happier. Really.

  14. Pam Forrester says:

    Dear Dr. Faust,
    Thank you so much for all your dedication to helping people! Ever since I was in my early 20’s I began to have hayfever and allergy to cats. About five years ago I gave up processed food and grains and my allergy symptoms disappeared. But then 2 years ago, after 3 years of being seemingly allergy free, I began to have a chronic cough. My ENT advised trying an antihistamine. That helped so much my fears of TB were allayed. So my allergies still existed. Then, early this month I came down with a sinus infection. I immediately began saline rinses with hypertonic solution. Then I started reading this site and have used xylitol, baby shampoo, and manuka honey b/c I suspected biofilm as a possible cause of the chronic cough. My problem is not as severe as yours was but I am just wondering, if the rinses do not get to sinuses, where do you think the biofilm is forming? In the turbinates or the adenoids, sinuses?

    • Russell A. Faust, PhD, MD says:

      Thank you for your kind comments, Pam.
      Great question, that I hope I can answer:

      Much (most?) of the problems with sinusitis result from congestion of the nasal tissues, causing obstruction of the sinus openings; that can be relieved by rinsing the nose, reducing swelling of those tissues. In fact, as nasal congestion resolves, nasal rinse solutions do reach the sinuses. That’s the first way the rinses can eliminate biofilm.

      The other problem, as you point out, especially in chronic sinusitis, are pathogens that produce biofilm protective coatings. Studies suggest that the adenoid tissue at the very back of the nose can act as a reservoir for these biofilm-producing pathogens. These biofilm bugs can even be resistant to high-dose antibiotics! Nasal rinses should reach the adenoids when done properly. Both of these effects help reduce or eliminate biofilms.

      Your immune system just needs a little help in reducing the bacterial load in order to eliminate these chronic, smoldering infections.

      Thanks for visiting and for sharing. Best success!

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