Monday, June 16, 2008

Sinusitis - Rhinitis


In the skull there are 4 sinuses – the maxillary, ethmoid, frontal and sphenoid sinus. The sinuses are air-filled cavities which have a number of functions. The sinuses humidify/warm the air before it enters the lungs for gaseous exchange. They also have an immune function – the sinuses are lined with lymphoid tissue that produces large amounts of mucous to filter air by trapping bacteria and other unwanted material. The sinuses which are lined with cilia waft this unwanted material out of the sinuses and towards either the nasopharynx where it is swallowed or towards the nasal cavity where it is blown out.

Sinusitis is the inflammation of the mucous membranes that line the sinuses. In cases where the mucoid material drains poorly then there is a risk that infection will develop. Therefore, in order to reduce the chances of sinusitis the osteopath needs to improve drainage of the sinuses.

The osteopathic perspective is to address the problem mechanically. Osteopaths are interested in the anatomical relationships between the bones that make up the sinuses and the other structures around the face. The osteopath should start by observing facial relationships, looking for signs of squashed eyes, nose, cheeks and mouth. This may be more obvious in infants who may have had pressure through the face on exiting the birth canal. The osteopath should observe the relationship of the skull to the neck, throat, thorax and shoulders where compression and torsion may lead to compromised draining.

In addition to the direct anatomical relationships, the osteopath must address function the autonomic nervous system (parasympathetic and sympathetic nervous system) and its contribution to the function of the sinuses. The autonomic nervous system regulates the activity of the mucosa. The sympathetic nerve supply originates from C8-T2 and travels via the superior ganglion until it reaches the pterygopalatine ganglion which is lodged in the pterygopalatine fossa and which can be irritated following impingement of the palatine bone.

The parasympathetic nervous system has the function of enhancing secretion and has a vasodilatory effect on the mucosa of the sinuses. The parasympathetic nervous system travels via the facial nerve and eventually also arrive at the pterygopalatine ganglion.

It is normally possible for the osteopath to achieve a change in the function of the nasal mucosa within 5-7 treatments.

The osteopath should also explore the possibility that the sinusitis may be affected by diet and exposure to environmental irritants. Once all factors have been addressed the body is normally able to recover.

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