As winter weather spreads and becomes sharper on our gentle senses, hundreds of sinus medications on drugstore shelves disappear as more people seek relief from:

• Sinus infections
• Nose stuffiness
• Sneezing
• A seemingly ever-present post-nasal drip

Actually, it requires an X-ray to diagnose a case of sinusitis. More likely, the problem is in the nose. And, in most cases, problems in the nose start before true sinusitis.

The bugbears in particular are the nasal passages that send oxygen on to the lungs. If you can image those passages as hallways, then sinuses are the attached rooms. Block the hallway and there’s no entry into the rooms.

In most cases of patient-described sinusitis, the gremlin is a crooked or bent septum resulting from one of many causes including blows to the nose.  (The septum is the razor-thin bone and cartilage partition separating the two nasal passages; see a deviated septum sketch.)

          (Learn more about a bent septum)

If crooked or bent, the septum can block airflow to the sinuses, causing some of the above complaints.

Farther up in the nose are three structures known as turbinates; their job is to filter, warm and humidify incoming air. Turbinates are long, thin bone shelves covered with nose lining tissue and can be affected by allergens and swell to block air flow; three turbinates exist on each side of the nose. Actually, all the nasal linings can swell to increase the feeling of nasal stuffiness.

              (Learn what septoplasty and turbinate reduction patients say.)

The remedies? Nasal surgeons can straighten a bent septum in a procedure known as septoplasty. Nose surgery known as a turbinectomy can also be done to trim the turbinates. Frequently, just the lowest turbinate is the problem child.

In many cases, while a nose surgeon operates inside a nose, a cosmetic rhinoplasty can be also done.

            (See some rhinoplasty before & after pictures.)

When doing during a septoplasty along with a nose job, the procedure is known as a septorhinoplasty. (In our practice, rhinoplasty can be done at the same time as turbinate trimming. If the patient has a breathing problem and is in for a nose job, we can perform turbinate resection and straighten the septum if it needs it. Septoplasty and turbinate trimming have a nearly 100 percent success rate in improved breathing.)

Also masquerading as sinus trouble is cigarette smoking – which heats and dries the nasal passages – while thickening the normally thin nasal mucus. Together, those items add to nose blockage.

(Read more about sinus and nose problems)

Yet another goblin often confused with sinus problems: household mold which can set off some of the same conditions as hay fever.