The nose is intimately related to the paranasal sinuses. The sinuses are air spaces in the bones of and around the face. Most so-called sinus problems as popularized in television commercials are actually allergies (or inhalant sensitivities). However, sinus infection does occur and usually is associated with persistent, infected discharge from the nose, facial pain, and occasional headache over the eyebrows. However, headache is caused by sinus problems much less often than most people think. Acute sinusitis is treated with antibiotics and oral and topical decongestants. Over-the-counter decongestant nasal sprays should never be used for more than three days because of “rebound” swelling and long-term consequences of constriction of nasal blood vessels. When only one of the maxillary sinuses in the front of the face is affected, a dental cause such as tooth abscess should be sought. Chronic sinusitis is treated with longer courses of antibiotics, decongestants, and sometimes steroids. It may ultimately require surgical treatment. Sinus surgery used to require incisions through the face or under the upper lip and extensive, open operations. However, the recent development of functional endoscopic sinus surgery (FESS) has changed all that. In most cases, sinus surgery can be performed through tiny scopes inserted through the nose, often under local anesthesia and sedating medication, so the surgery is much less traumatic. Because of the success rate and minimal trauma associated with endoscopic sinus surgery, safe and effective surgical treatment for chronic sinus problems is now available to people who would not have been surgical candidates before.
Like noses, sinuses can also be fractured. Usually this requires a great deal of force and happens at the same time as other facial fractures. In addition to the maxillary sinuses in the face, there are ethmoid sinuses that run back along the upper inside of the nose, frontal sinuses above the eye, and a sphenoid sinus almost in the center of the head. Any of these can be damaged by trauma or involved in infection. True sinus problems can lead to more serious medical conditions by spreading to adjacent areas. The regions right next to the sinuses include, among other things, the eyes, the brain, and major blood by a physician with experience and specialized training when they do not respond promptly to the initial medical regimen.