Sinus problems begin when the sinus pathways become obstructed as a result of inflammation, which causes the nasal membranes to swell, narrowing the air’s pathway Inflammation in the breathing system occurs when you are exposed to an infection (stemming from bacteria, a virus, or mold), allergens, or other irritants (such as pollution, cigarette smoke, car exhaust, or perfumes).
Many of these substances are in the air all the time, yet some people are more affected by them than others. The inflammatory cycle is triggered by these and other irritants when they are coupled with a genetic predisposition, causing certain people to react. For instance, why are some people sensidve to cigarette smoke while others are not bothered by it? Why are some people sensitive to specific allergens, and others not? Why do some people develop an infection, while others are equally exposed, but not affected?
The answers are still not known. But what we do know is that these phenomena are determined by the genetic makeup of each person. And, although research in human genetics has made great strides, there is still much about individual differences in our immune system that we don’t understand. So currently, we have to treat these phenomena, and the related symptoms and conditions on a case-by-case basis.
Your airway can also be compromised because of your unique anatomical structure. Sinus and nasal narrowing can occur if you were born with a physical defect within the nose. For example, the nasal cavity can be narrowed by a deviated septum or sinuses that never developed properly. Just as some people are short and others tall, some small and others large, the sinus pathways among individuals also vary. The passageways may be intrinsically narrow or small. Often, the turbinates can develop with an air cell within them, or they may be large or positioned in the middle of the airway. In the worst case, rare tumors like papilloma (nasal or sinus warts) or cancer can cause blockage of the nose or sinuses. Any of these anomalies can prevent air from optimally passing through the nose and sinuses.
Trauma, or a blow to the head, can also cause a narrowing of the passageways. A fall taken at a young age could have caused your septum to deviate, growing along a crooked line as you developed. You might have even fractured your nose on your way out of the birth canal, and you may not even know that it was traumatized. On the other hand, you may be acutely aware of a nose injury, such as getting elbowed playing sports. No matter what the initial cause or when the air pathway was altered, the air currently passing through your nose circulates with abnormal motion that can cause erosion of the membranes, leading to drying, crusting, and/or scabbing. It can even lead to bleeding as the erosion becomes more significant. Polyps, which are benign growths or tumors, can form within the nose and sinus cavities from any of the irritants that cause inflammation. Some scientists believe that any inflammation in the nasal passages leads to swelling and then to infection, which ultimately causes polyp formation.
Once the cycle of inflammation begins, it is very difficult to correct it. The initial inflammation leads to obstruction. As this obstruction worsens, it causes more inflammation around the obstructed area. This causes stagnation of the mucus and crusting and/or scabbing, all which create an ideal breeding ground for bacteria and molds to grow. This growth of infection causes more inflammation and swelling and more obstruction. Ultimately, both inflammation and blockage create a cycle that worsens with every breath you take.
Caustic agents like chemicals, pollution and/or smoking can also damage the normal movement of the ciliated hair cells - for example, smoking can cause these hair cells to become singed from the heat of the ingested cigarette. Nicotine also causes the nose’s blood vessels to constrict to the point that the hair cells can become damaged or paralyzed. Metals that are present in air pollution from car exhaust or chemicals in new carpeting can damage the cilia as well. As a result, the sinuses stop draining properly: The mucus backup exacerbates and worsens the inflammation and the obstruction, all making the initial infection worse. This cycle will continue to get worse until it is broken.
Meanwhile, your normal mucus production has also changed. What was once clear running fluid is now thick and static. There is also a change in its acidity (pH). Ironically, the body’s natural reaction to airway
inflammation is to produce more mucus to wash the inflammation and infection away. This mucus continues to pool and starts to thicken as its water content evaporates. This is worsened when your body raises its temperature to fight off the infection. At this point, the body’s defenses start to release white blood cells into the mucus to fight the bacteria, viruses, or molds, all of which can further change the pH and consistency. The white blood cells release toxic substances and enzymes to kill the infection. Some of these cells start “eating” the infection to kill it, a process called phagocytosis. These toxic substances cause damage to the cilia, more inflammation and swelling, and chronically can cause thickening of the membranes. As each sinus cavity closes due to swelling, the oxygen in the cavity itself decreases, making each of these closed cavities more prone to infection. All of this leads to sinus disease, and ultimately to chronic airway-digestive inflammatory disease (CAID) (5).
Chronic problems occur when there are breaks in the nasal membranes that should be keeping infection out of the body. When these membranes are broken, an infection can enter the body. Bacteria pass
into the bloodstream, and when their levels are sufficient, your body reacts again by raising its temperature to kill the infection. This rise in body temperature can occur for short periods of time as a result of spiking bacteria levels in the bloodstream or may occur over longer periods of time when the infection is bad enough to cause a higher, more constant level of bacteria. The fever may be low grade as a result of exposure to constant chronic infection or it may be higher in reaction to an acute infection, or a sudden high exposure to bacteria.