Millions of sinus sufferers share Justine's frank appraisal of her upper airway problems. Even though sinus symptoms are disturbing and steal quality of life, your upper respiratory system is a very complicated and vital structure. Not only is it responsible for your voice production, swallowing, and keeping the back of the throat clear of food and mucus, it helps to prepare the air you breathe to go into your lungs-to keep your body functioning as a fine-tuned machine.
In this chapter, we will introduce you to some breathing basics to help you understand what is happening anatomically when you breathe clearly-and when you don't. We'll explain how the sinuses function correctly and some key factors that cause them to function poorly, such as a viral infection, dry heat, or a refreshing glass of iced tea in the summertime (iced drinks slow the nasal cilia that are crucial to keep mucus flowing; see pages 7-9). After we discuss various types of sinusitis-acute, chronic, and fungal-we'll reveal risk factors that can increase your chance of having sinus problems. Finally, we'll explain the connection between the increasingly common gastroesophageal reflux disease (GERD) and sinusitis and give you some sage advice on how to stop this problem from robbing you of your sleep, your voice, and your ability to breathe clearly and be active.
Within your upper airway there are about twenty muscles that are responsible for carrying out daily functions, as well as for maintaining the opening of the airway, even when external factors tend to make it close or collapse. Specialized muscles in the walls of the upper airway and in the surrounding tissues must keep the airway open as you breathe in and out. These muscles make sure food goes down the right way while you breathe.
Your vocal cords are a stopcock that closes so food doesn't enter your lungs. This system allows you to talk and eat at the same time. To speak, the muscles of the larynx (the voice box) tense, vibrate, open, and close the vocal cords. Fortunately, this is all done automatically without you worrying about it. (A word of caution: never laugh heartily while eating. Your system can't handle eating, breathing, and laughing all at once.)
Your Body's Thermostat
Your nose also acts as an air conditioner for your body and functions to protect your lower airway from cold or contaminated air. That's because the air you breathe varies in temperature, humidity, and purity. The nose adjusts this air temperature so that it becomes close to body temperature during its passage through the nose. Simultaneously, air humidity is modified, and particles in the air are filtered out.
How does it do this? Well, the septum divides the inside of your nose into two parts. There are also three tubular structures called turbinates that project into the nasal chambers and increase the surface areas of the walls of the inside of the nose. A mucous membrane rich in blood vessels covers these turbinates. The turbinates may swell and cause nasal obstruction, which can be caused by a variety of conditions, and usually seems worse when you are lying down. This is because the tissue fluids and blood tend to pool in your head when you recline.
The turbinates serve to warm and filter the air you breathe. They catch bacteria, viruses, toxins, and chemicals before they reach the lungs and also moisten the air. Turbinates also function to aid sleep. Normally during sleep, you turn about fifty times a night. If you didn't, you would develop pressure sores. This turning of your body also helps to distribute the body's lymph fluids.
For example, when you lie on your right side, the turbinates on the right side of your nose fill up simply by gravitational pull. When they fill to the extent that they reach the septum in the midline and apply pressure here, your body responds by turning over to the left side. Eventually the left side fills by the pull of gravity and presses on the septum, forcing you to feel uncomfortable and roll over again.
For those who sleep poorly, your doctor may recommend correcting a deviated septum. It the septum is badly deviated to one side, you will not experience the turbinate pressing on the septum. Instead, you will awaken feeling as if you slept on the wrong side! Just another downside to the related problems of sinusitis ...
The Sinuses Filter Air
The sinuses are hollow cavities within your cheekbones, around and behind your nose and eyes; they are lined with mucous membranes. The tour pairs of sinuses, or cavities in the head (paranasalsinuses), serve an important purpose, helping to lighten the skull and improve the tonality of your voice. They also serve as an air filter for your lungs by warming, moistening, and filtering the air in your nasal cavity. Your eyes and ears have to be positioned right where they are for binocular vision and good hearing. If the sinus cavity were solid, your head would weigh considerably more and require more muscles and bony support.
The sinuses are to blame for your never-ending production of mucus-and for people with sinus problems, this may be a lot!
Cilia Sweep Away Mucus
The entire lining of the nose is covered with a thin coat of mucus. The mucus rests on top of the cilia, tiny hairs on the cells making up the mucous membrane. The cilia beat or wave rhythmically to carry anything on their surface in the direction of their motion out of the respiratory tract. The mucus they carry is sticky and collects tiny airborne particles. This coating also contains enzymes that destroy most bacteria. Nasal cilia beat backward toward the nasopharynx. Once nasal mucus is propelled into the nasopharynx, it is swallowed for disposal into the stomach. The sinuses, Eustachian tubes, bronchi, and bronchioles also have cilia that help propel mucus.
Each of the sinuses has an ostium, a bony opening, through which the mucus drains. The cilia beat or wave in such a manner as to direct mucus and other respiratory tract secretions toward the ostium. For healthy sinuses to function optimally, this natural pattern of mucociliary clearance is essential.
Eighty-five to 90 percent of the particles inhaled nasally are blocked and removed in the nose and nasopharynx. Yet smaller particles may get into the lower respiratory tract. When the action of the mucous coat is altered by trauma, drying, irritating chemicals, or any other factor, the nose, sinuses, and lower respiratory tract become more susceptible to infection.
Cilia are very sensitive to toxins and can be damaged or slowed due to
Using specialized tests, as we describe in chapter 4 (Step 1 of our program), your doctor can find out the condition of your cilia. Studies show that decreased mucociliary flow is a regular precursor to sinusitis and lower respiratory infections. In severe asthma, the cilia of the chest are slowed as well.
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