In the past, your sinus condition would be diagnosed depending on where your doctor believed the majority of the inflammation first occurred. For example, I used to consider the nose and the sinuses as separate entities. I spoke about rhinitis when I was dealing with an inflammation of the nose, and sinusitis when I referred to inflammation of the sinuses. While it is possible
to suffer from each of these entities separately, we now realize that inflammation of the sinuses invariably
affects the nose. So we now refer to inflammation of the nose and sinuses together as chronic rhinosinusitis (CRS).
Doctors also believed that sinus problems stopped at the nose. But we now know our individual parts are intricately connected, and what affects the sinuses ultimately affects how the entire body functions. Once sinus problems begin, they spark a chain reaction throughout the body. For example, we know that when the sinuses fail, the air that is breathed into the lungs can become contaminated, which can damage the membranes of the lungs. The lungs can respond by constricting, as is the case with asthma - if you suffer from this, you may feel tight in your chest and hear a wheezing sound as you breath. The oxygen supply to the bloodstream then becomes compromised, and the entire body can experience a loss of oxygen. We now believe that the inflammatory process affecting the nose, the sinuses, and the lungs is one and the same process. This revolutionary thinking now allows us to treat the problems of sinusitis, allergy, and asthma together as one. The result is that my patients are feeling better.
You may have been told that you constantly feel sick because you are suffering from allergies. While your allergies might have been treated, your sinuses were largely ignored; consequently, you continue to feel sick, even though you are taking your allergy medication. Or you may have been told that you had sinus disease, but your asthma was not treated. Or you were treated for asthma but not for your sinus problems. In each of these cases, you were given only part of the diagnosis.
Luckily, those days of misdiagnoses are over. We now believe that while the initial cause of sinus inflammation may vary, inflammation can affect the entire or different select parts of the respiratory tree from the tip of the nose to the smallest end branches of the lung. This thinking intricately connects the conditions of allergies and asthma to the workings, or malfunctions, of the sinuses. Ultimately, inflammation is what causes us to feel sick from any of these disease processes: sinus disease, allergies, or asthma. Therefore, the disease processes that affect the nose, sinuses, and lungs are simply different limbs of the same disease. 1 like to call this inflammation chronic airway inflammation (CAI).
CAI can affect the entire airway as well as the upper and lower gastrointestinal (GI) tract. Just as the nose is anatomically connected to the
gastrointestinal tract through the mucous passageway, infected mucus will drip down the esophagus and into the stomach and enter the GI tract. It upsets the balance of bacteria, which can cause the stomach to react and create acid. The stomach and the esophagus meet at the gastroesophageal junction, which is near the diaphragm, the muscle that controls your breathing. Muscle fibers wrap around this junction and form a closure that is intended to prevent the stomach contents from backing up. If this junction becomes weak, or if the stomach bulges through this junction (called a hiatal hernia) then it becomes easier for the contents of the stomach to back up into the esophagus, causing reflux. The reflux contains acid, and if the acid stays in contact with the membranes of the esophagus long enough it can burn the membranes. This is what gives you a feeling of fullness in your chest, burning, heartburn, or indigestion, and it is called gastroesophageal reflux disease (GERD). If the acids do not stay long enough within the esophagus but instead continue to reflux up to the larynx (voice box), pharynx (throat), and drip into the airway, this is called laryngopharyngeal reflux disease (LPRD). The acids may even reflux into the nasopharynx and/or nose and sinuses.
If the acids reach as high as the larynx (voice box), they can cause swelling, which can result in soreness, hoarseness, or the feeling that something is caught in your throat. The acid can then drop into the trachea and the small airways of the lungs, causing further inflammation, setting off an asthma attack or causing a chemical tracheitis, bronchitis, or even pneumonia. It can cause the larynx to spasm: When this occurs, the larynx closes to prevent further aspiration of stomach contents into the lung, and you feel like you can’t breathe for a few seconds. This is called laryngospasm.
CAI is often connected to various stomach ailments that cause reflux. As well, patients with these disease processes can suffer from snoring and/or sleep apnea. Therefore, I refer to CAI, LPRD/GERD, and snoring/sleep apnea collectively, calling this disease chronic airway - digestive inflammatory disease. Furthermore, some believe that the airway inflammatory processes are connected to all of the inflammatory diseases of the gut, including Crohn’s disease and ulcerative colitis. At this time, there is not enough conclusive evidence; however, it appears that many people with digestive ailments also suffer from sinus disease.