Sinus Problems

The paranasal sinuses — four pairs of air-filled cavities within the skull bones surrounding the nose and eyes — are among the most common sources of symptoms managed in ENT practice. Problems range from a single acute infection following a cold to severe, chronic, treatment-resistant disease significantly affecting quality of life. This page provides a comprehensive overview of the range of sinus conditions, their mechanisms, and the treatment approaches available. Detailed information on specific conditions is available through the links below.

Anatomy — The Paranasal Sinuses

The four pairs of paranasal sinuses are:

• Maxillary sinuses: In the cheekbones. The largest sinuses and the most commonly involved in acute sinusitis. Drain through a high posteromedial opening that makes gravity-dependent drainage difficult.
• Ethmoid sinuses: A labyrinth of small air cells between the eyes and nose. Critically important in sinus disease — the anterior ethmoids are the “key” to sinus drainage, and ethmoid disease is present in virtually all patients with chronic rhinosinusitis.
• Frontal sinuses: Above the eyes in the frontal bone. Drain through the narrow frontal recess — the most difficult drainage pathway to access and maintain in sinus surgery.
• Sphenoid sinuses: Deep in the skull base, adjacent to the pituitary gland, optic nerves, and carotid arteries. Isolated sphenoid disease is uncommon but can produce deep, poorly localised headache.

All sinuses drain into the nasal cavity through small openings. The ostiomeatal complex (OMC) — a convergence of the drainage pathways of the maxillary, anterior ethmoid, and frontal sinuses in the lateral nasal wall — is the anatomical keystone of sinus disease: obstruction here produces downstream failure of three pairs of sinuses simultaneously. The OMC is the primary target of endoscopic sinus surgery.

How Sinus Problems Develop

Normal sinus health requires two elements: patent drainage pathways and effective mucociliary clearance — the coordinated beating of microscopic cilia on the sinus lining that continuously sweeps the mucus blanket toward the ostia and into the nasal cavity. When either element fails, the consequences are predictable:

1. Mucus accumulates in the sinus, providing a nutrient-rich culture medium for bacteria
2. Reduced oxygen tension in the obstructed sinus favours anaerobic bacterial growth
3. The inflammatory response to infection further swells the mucosal lining, worsening obstruction
4. Repeated cycles of obstruction and infection progressively damage the mucosal lining and impair healing

The triggers for this cascade include viral upper respiratory infections (the most common precipitant of acute sinusitis), allergen exposure causing mucosal oedema and turbinate swelling at the OMC, structural anatomical variants (concha bullosa, Haller cells, deviated septum) that narrow the drainage pathways, and underlying systemic conditions (aspirin sensitivity, primary ciliary dyskinesia, immunodeficiency, cystic fibrosis) that impair mucociliary or immune function.

Range of Sinus Conditions

Symptoms of Sinus Disease

The cardinal symptoms of rhinosinusitis, as defined by EPOS, are:

1. Nasal obstruction or blockage — from mucosal oedema, turbinate hypertrophy, polyps, or anatomical obstruction
2. Nasal discharge or post-nasal drip — anterior discharge (running from the nose) or posterior (draining into the throat)
3. Facial pain or pressure — location reflecting the affected sinus; maxillary (cheeks), ethmoid (between eyes), frontal (forehead), sphenoid (deep/vertex)
4. Reduction or loss of smell (hyposmia/anosmia) — particularly associated with nasal polyps

Additional symptoms frequently reported include headache, chronic cough, fatigue, post-nasal drip, ear fullness (from Eustachian tube effects), and altered taste. The SNOT-22 (Sinonasal Outcome Test) is a validated questionnaire used to quantify sinonasal symptom burden and monitor treatment response.

Investigation

Nasal Endoscopy

The cornerstone of ENT assessment for sinus disease. A rigid telescope passed through each nostril allows direct visualisation of the nasal septum, turbinates, middle meatus, olfactory cleft, and nasopharynx. The presence of nasal polyps, purulent middle meatal discharge, mucosal oedema at the OMC, or anatomical obstruction can all be identified and directly informs the diagnosis and management plan. Endoscopy is essential and significantly superior to simple anterior nasal examination with a speculum.

CT Sinuses

High-resolution CT of the paranasal sinuses provides the anatomical road map for surgical planning. It documents the extent and distribution of mucosal disease, the anatomy of the ostiomeatal complex and frontal recess, the degree of septal deviation, the presence and extent of anatomical variants, and any complications. CT should be performed at a stable baseline rather than during an acute infection, which causes non-specific mucosal thickening. CT is mandatory before any sinus surgery.

Allergy Testing

Skin prick testing or specific serum IgE measurement identifies atopic sensitisation contributing to chronic sinonasal disease. Documentation of specific allergens allows targeted avoidance advice and guides immunotherapy planning.

Olfactory Testing

Objective smell testing (UPSIT 40-item or Sniffin’ Sticks) documents the degree and type of olfactory loss, distinguishing conductive (obstructive) from sensorineural loss. Baseline documentation is important before any surgical or medical intervention that may affect olfaction.

Treatment Approaches

For detailed information on specific conditions:

• Sinusitis (Acute and Chronic Overview)
• Chronic Rhinosinusitis — In Depth
• Sinus Surgery (FESS)
• Nasal Polyps
• Sinus Headaches
• Allergy Treatment
• Blocked Noses
• Post-Nasal Drip

Contact us to arrange a consultation →

Arrange a Consultation

Speak with Dr Jason Roth

Dr Roth consults from Dee Why on Sydney’s Northern Beaches. A GP referral is recommended.

Request an Appointment
(02) 9982 3439

Dr Jason Roth (MED0001185485) — Specialist Otolaryngologist & Head and Neck Surgeon.