In Partial Fulfillment in the Course
Anne Pauline Ferrolino
A. The Respiratory System
1.Meaning of Sinuses
a. Types of Sinusitis
II. Main Focus: Frontal Sinusitis
A. Meaning of Frontal Sinusitis
B. Causes of Frontal Sinusitis
1.How is Sinusitis Diagnosed?
2.How is Sinusitis Treated
A. The Respiratory System
Respiratory System is the integrated system of organs involved in the intake and exchange of
oxygen and carbon dioxide between an organism and the environment.
What are the parts of the respiratory system?
The respiratory system includes the nose, trachea (“windpipe”), main bronchi, lungs and
some parts of the musculoskeletal system (these are the muscles of the ribcage and the
diaphragm) that are used for breathing.
How does air get into the body?
To deliver oxygen to the body, air is breathed in through the nose, mouth or both. The
nose serves as a filter for unwanted particles in the air like dust and smoke. The nose
also heats and adds moisture into that is breathed in. When large amounts of air are
needed, the nose is not the most efficient way of getting air into the lungs and therefore
mouth breathing may be used. Mouth breathing is commonly needed when exercising.
1. The Nose
What is the nose?
One of the most visible organs on the front of your face is the nose. Anatomically, a nose is a
vertebrate respiratory organ that covers two nostrils in humans. Nostrils are those two holes
visible in the front of the nose, responsible for reception and expulsion of air for respiration
purposes. A septum proceeds from deep within the nose near the skull where it's made of thin
There are also hairs in the nose that function to prevent the airborne particles from proceeding
into the lungs. Within and behind the nose we find para-nasal sinuses and mucus. As soon as
air passes through the pharynx behind the nasal cavity, and proceeds to the entire respiratory
Not only does the nose help us breathe, but identifying which perfume smell better than the
other is also done best by the nose. A nose helps us distinguish scents that are good and
which ones are bad. Although it is not a tasting organ, to a certain extent a nose do contribute
to our sense of taste.
Most of us take our sense of smell for granted, because it is not necessary for our survival the
way our other senses are... However we still rely on it more than you would probably think.
Smell affects many aspects of life such as attraction, memories, and emotions. Our sense of
smell also adds a richness to our lives that we aren't always conscious of, but as soon as it's
taken away it dramatically changes our quality of life ask an anosmic (someone who has lost
some or all of their sense of smell). Anosmics suffer from depression and their quality of life is
Smell is one of the chemical senses and with these sense we sample our environment for
information. We are continuously testing the quality of the air we breathe, like for potential
dangers such as smoke from fires, or food and flowers.
Although it looks little, a nose is a complicated gateway to the respiratory system that most
people find difficult to keep healthy. Colds, hayfever, flu, nasal obstructions, sinusitis and
sinus infections are evident to the complexity of the nose.
About 139 million Americans suffer some form of sinus disorder each year. For the purpose of
this site, the following nasal disorders will be discussed:
Parts of the nose...
The nasal cavity
There is a huge air filled space behind the nose in the middle of the face called nasal cavity
that connects with the back of the throat. The nasal cavity is only separated from the inside of
your mouth by the palate (the roof of the mouth).
The nasal bone just below the eyes, the maxilla and ethmoid bones circle the nasal cavity.
Underneath, the nasal cavity is separated by the palate from the upper mouth. The nose itself
covers the front of the nasal cavity, while its back connects straight to the pharynx.
Right on the nasal cavity, there small openings (ostia) that connects to the para-nasal sinuses.
When these openings become blocked, mucus drainage is delayed leading to the inflammation
of the sinus lining.
On its frontal part, the nasal cavity is divided into two spheres by a septum (a flabby cartilage
wall). A septum proceeds from deep within the nose near the skull where it's made of thin
bone pieces. There is mucus as well as hair-like structures called cilia on the surface of the
nasal cavity that catch and remove germs and dirt from the inhaled air, before it enters the
The most dangerous disease that affects (but rarely does) the nasal cavity is nasal cavity
The skull is one of the heaviest bones in mankind. One may wonder why we are still able to
carry it though. The secret is that on its frontal part it has air-filled pockets (sinuses) that
lighten the weight of the skull and give resonance to the voice. These sinuses also help filter,
moisten and warm the air we inhale before it proceeds to the lungs.
There are four pairs of these air-filled cavities...
What Are The Sinuses?
The sinuses are the spaces between the bones of the face. Air passes in and out of
these spaces, and mucus drains through them and out of the nose. The sinuses also
reduce the weight of the skull and give our voices a nicer sound.
There are four main pairs of sinus openings, sometimes called sinus cavities, in the face:
Maxillary - in the cheekbones
Ethmoid - between the eye sockets
Frontal - in the forehead and above the eyebrows
Sphenoid - deep in the head at the back of the nose
Each of these pairs of sinus openings has a channel that leads to the nose. These
channels are quite narrow and can be easily blocked when the lining of the channels
becomes swollen. This lining is called the mucous membrane. This same mucous
membrane forms the inner lining of the nose.
How Does The Mucous Membrane Work?
The mucous membrane in the nose and sinuses is our personal air filter. It warms,
moistens, and cleans the air. The mucous membrane creates clear, wet, slightly sticky
mucus that gathers any dust, smoke, bacteria, or virus particles that may have been in
Tiny hairs along the membrane called cilia act as miniature oars, moving the mucus
along, much like a conveyor belt, through the sinuses and out the nose. When the
mucus containing the unwanted particles reaches the nose and throat, the body prompts
us to swallow, spit, sneeze, or cough them out of the body. But when the sinus openings
become blocked, cilia can no longer move the mucus through.
The mucous membrane is also one of the body's front-line defense systems. It releases
chemicals that help to destroy bacteria and viruses before they can attack.
2. What Is Sinusitis?
Sinusitis is a swelling of the inner lining of the sinuses. The sinuses are the spaces
between the bones in the face where air passes and where a fluid called mucus drains
into the nose.
In sinusitis, the swelling blocks the openings in the sinuses through which mucus drains
into the nose. When mucus cannot drain properly, the pressure of the blocked fluid
inside the sinuses can be painful.
Sinusitis is quite common. It feels much like a head cold, with a stuffy or runny nose and
a headache. For most people, sinusitis is a temporary condition that goes away with
simple treatment. If the symptoms do not clear up easily, medication can help. In rare
cases, surgery may bring permanent relief.
a. Types of Sinusitis
There are several paired paranasal sinuses, including the frontal, ethmoid, maxillary and
sphenoid sinuses. The ethmoid sinuses can also be further broken down into anterior
and posterior, the division of which is defined as the basal lamella of the middle
turbinate. In addition to the acuity of disease, discussed below, sinusitis can be classified
by the sinus cavity which it affects:
Maxillary sinusitis - can cause pain or pressure in the maxillary (cheek) area
(e.g., toothache, headache) (J01.0/J32.0)
Frontal sinusitis - can cause pain or pressure in the frontal sinus cavity (located
behind/above eyes), headache (J01.1/J32.1)
Ethmoid sinusitis - can cause pain or pressure pain between/behind eyes,
Sphenoid sinusitis - can cause pain or pressure behind the eyes, but often refers
to the vertex of the head (J01.3/J32.3)
Recent theories of sinusitis indicate that it often occurs as part of a spectrum of diseases
that affect the respiratory tract (i.e., the "one airway" theory) and is often linked to
asthma. All forms of sinusitis may either result in, or be a part of, a generalized
inflammation of the airway so other airway symptoms such as cough may be associated
Left-sided maxillar sinusitis (Absence of the air transparency of left maxillar sinus)
Sinusitis can be acute (going on less than four weeks), subacute (4–12 weeks) or
chronic (going on for 12 weeks or more). All three types of sinusitis have similar
symptoms, and are thus often difficult to distinguish. Acute sinusitis is very common.
Roughly ninety percent of adults have had sinusitis at some point in their life.
Acute sinusitis is usually precipitated by an earlier upper respiratory tract infection,
generally of viral origin. If the infection is of bacterial origin, the most common 3 causitive
Haemophilus influenzae -
Acute episodes of sinusitis can also result from fungal invasion. These infections are
most often seen in patients with diabetes or other immune deficiencies (such as AIDS or
transplant patients on anti-rejection medications) and can be life threatening. In type I
diabetes, ketoacidosis causes sinusitis by Mucormycosis.
Chemical irritation can also trigger sinusitis. Commonly from cigarettes and chlorine fu
Rarely, it may be caused by a tooth infection.
Chronic sinusitis is a complicated spectrum of diseases that share chronic inflammation
of the sinuses in common. It is divided into cases with polyps and cases without, and the
former is sometimes called chronic hyperplastic sinusitis.
Causes are poorly understood and may include allergy, environmental factors such as
dust or pollution, bacterial infection, or fungus (either allergic, infective, or reactive). Non
allergic factors such as vasomotor rhinitis can also cause chronic sinus problems.
Abnormally narrow sinus passages, which can impede drainage from the sinus cavities
could also be a factor. A combination of anaerobic and aerobic bacteria is observed,
including Staphylococcus aureus and coagulase-negative Staphylococci. Typically
antibiotics provide only a temporary benefit, although mechanisms involving
hyperresponsiveness to bacteria have been proposed for sinusitis with polyps.
Symptoms include: nasal congestion; facial pain; headache; fever; general malaise; thick
green or yellow discharge; vertigo or lightheadedness; blurred vision, feeling of facial
'fullness' or 'tightness' which worsens on bending over; aching teeth, and halitosis. Very
rarely, chronic sinusitis can lead to Anosmia, the inability to smell or detect odors.[citation
In a small number of cases, chronic maxillary sinusitis can also be brought on by
the spreading of bacteria from a dental infection.
Attempts have been made to provide a more consistent nomenclature 6 for subtypes of
chronic sinusitis. Many patients have demonstrated the presence of eosinophils in the
mucous lining of the nose and paranasal sinuses. As such the name Eosinophilic Mucin
RhinoSinusitis (EMRS) has come into being. Cases of EMRS may be related to an
allergic response, but allergy is often not documentable, resulting in further sub
categorization of allergic and non-allergic EMRS.
A more recent, and still debated, development in chronic sinusitis is the role that fungus
may play. Fungus can be found in the nasal cavities and sinuses of most patients with
sinusitis, but can also be found in healthy people as well. It remains unclear if fungus is a
definite factor in the development of chronic sinusitis and if it is, what the difference may
be between those who develop the disease and those who do not. Trials of antifungal
treatments have had mixed results.
II. Main Focus: Frontal Sinusitis
a. Meaning of Frontal Sinusitis
b.Causes of Frontal Sinusitis
i. How is Sinusitis Diagnosed?
ii. How is Sinusitis Treated