Sinusitis: History and Discovery

Sinusitis — inflammation or infection of the air-filled cavities of the face, today usually called rhinosinusitis because the nose and sinuses behave as one continuous system — has a history that runs from ancient observations of nasal disease to the modern operating room. Along the way the great anatomist Nathaniel Highmore mapped the largest sinus in 1651 (the “antrum of Highmore”), surgeons George Caldwell and Henri Luc devised the radical operation that bore their names in the 1890s, and a quiet Austrian insight about how mucus actually flows inside the nose gave rise, in the 1980s, to functional endoscopic sinus surgery — the technique that transformed sinus care by restoring the body’s own drainage rather than stripping the sinus bare. This page traces that long road of discovery, naming each contributor only where the record is firm.

Ancient Knowledge of the Nose and Sinuses
Highmore, da Vinci, and Mapping the Sinuses
From “Catarrh” to a Concept of Sinusitis
Ostia, Obstruction, and the Drainage Idea
Antral Washout and the Proetz Method
The Caldwell-Luc Operation (1893–1897)
The Endoscopic Revolution: FESS
Acute Versus Chronic Rhinosinusitis
Modern Understanding and Open Questions
Research Papers and References
Connections

Ancient Knowledge of the Nose and Sinuses

Long before anyone spoke of “sinusitis,” physicians of the ancient world recognized that the nose could become blocked, painful, and foul-smelling, and that thick discharge sometimes seemed to flow down from the head. The Edwin Smith and Ebers papyri of ancient Egypt describe nasal disease and treatments for the nose, and Egyptian embalmers were intimately familiar with the cavities behind the face. In the Greek tradition the Hippocratic writers and later Galen of Pergamon (second century CE) described the nasal passages and believed that phlegm could descend from the brain through the nose — the ancient doctrine of catarrh, literally “a flowing down.” These authors are named here as historical sources rather than modern citations.

What the ancients did not have was a clear picture of the paranasal sinuses themselves — the hollow, air-filled spaces in the maxilla (cheek), frontal bone (forehead), ethmoid (between the eyes), and sphenoid (deep behind the nose). Galen and his predecessors knew there were spaces in the skull and understood the nasal cavity, but the precise anatomy of these chambers, and the small openings (ostia) through which they drain into the nose, would not be described in detail for many centuries. For most of recorded history, what we now call sinusitis was simply lumped together with rhinitis, “rheum,” and catarrh as diseases of an over-flowing head.

This matters for the history of the disease because a condition cannot be properly named or treated until the organ it affects is understood. The story of sinusitis is therefore, first and foremost, the story of slowly seeing the sinuses — an anatomical detective story that only really begins in the Renaissance.

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Highmore, da Vinci, and Mapping the Sinuses

The single most famous name in sinus anatomy is Nathaniel Highmore (1613–1685), an English physician and anatomist. In his Corporis Humani Disquisitio Anatomica, published in 1651, Highmore gave a clear and detailed description and illustration of the large air cavity within the cheekbone — the maxillary sinus. So influential was his account that the maxillary sinus has been known ever since as the “antrum of Highmore” (the antrum being simply the cavity), a term still used by clinicians today. Importantly, Highmore also linked the cavity to dental disease, noting how infection from an upper tooth could involve the antrum — an insight that remains clinically true.

Highmore was not, strictly, the first to depict the maxillary sinus. More than a century and a half earlier, around 1489, Leonardo da Vinci had drawn the paranasal sinuses in his anatomical sketches, including the maxillary and frontal cavities, as part of his extraordinary studies of the human skull. Leonardo’s drawings, however, remained private and largely unpublished for centuries and so had little influence on medicine in his own era. Highmore’s published, accessible account is what entered the medical mainstream — a reminder that in the history of science, communication often matters as much as priority. The honest summary is that Leonardo drew the sinuses first but privately, while Highmore described them first in a way that taught the rest of medicine.

Over the following two centuries, anatomists filled in the rest of the map. The frontal, ethmoid, and sphenoid sinuses were described and refined by a succession of European anatomists, and by the nineteenth century the four paired groups of paranasal sinuses, and their drainage pathways into the nose, were well charted. This anatomical foundation was the precondition for everything that followed: only once you can see the sinuses and their openings can you begin to reason about how they become infected, why they fail to drain, and how a surgeon might help.

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From “Catarrh” to a Concept of Sinusitis

For centuries, diseases of the nose and sinuses were described under broad terms — catarrh, coryza, rheum, ozaena (foul-smelling nasal discharge), and “disease of the antrum.” A surgeon as early as the medieval and Renaissance periods might drain a collection of pus from the cheek (an antral empyema) without any modern concept of “sinusitis” as a distinct inflammatory disease of a specific cavity. The clinical reality — facial pain, blocked nose, thick discharge, and sometimes dangerous spread to the eye or brain — was familiar; the unifying name and concept were not.

The modern term sinusitis — built from the Latin sinus (a hollow or bay) plus the medical suffix -itis (inflammation) — came into use as the science of inflammation matured in the eighteenth and nineteenth centuries and as physicians increasingly localized disease to particular organs. As anatomical knowledge of each named sinus became routine, clinicians began to speak specifically of maxillary sinusitis, frontal sinusitis, ethmoiditis, and sphenoiditis, recognizing that each cavity could be inflamed in its own right, often together.

A major turning point in seeing the disease came at the very end of the nineteenth century with the discovery of X-rays by Wilhelm Röntgen in 1895. Within a few years, radiography of the sinuses allowed physicians to detect fluid levels, mucosal thickening, and opacified (clouded) sinuses in living patients — transforming sinusitis from something inferred at the bedside or found at operation into something that could be imaged directly. The later arrival of computed tomography (CT) in the 1970s would, in turn, make the modern endoscopic era possible by revealing the fine anatomy of the drainage pathways.

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Ostia, Obstruction, and the Drainage Idea

The conceptual heart of modern sinus medicine is a simple, powerful idea: the sinuses are healthy only when they can drain and ventilate freely through their natural openings, the ostia. Each paranasal sinus communicates with the nasal cavity through a small ostium, and the sinus lining is carpeted with microscopic hair-like cilia that sweep a thin blanket of mucus steadily toward that opening. When the ostium is blocked — by swelling, infection, polyps, or anatomical narrowing — mucus stagnates, oxygen falls, and bacteria flourish. Obstruction, in other words, is the engine of sinusitis.

This understanding crystallized through the careful anatomical and physiological work of the late nineteenth and twentieth centuries. Anatomists detailed a crucial region on the lateral wall of the nose — later named the ostiomeatal complex — where the maxillary, frontal, and anterior ethmoid sinuses all drain into a common narrow channel beneath the middle turbinate. Because so many sinuses funnel through this small crossroads, a little swelling there can obstruct several sinuses at once. The recognition that disease at this hidden bottleneck drives much of chronic sinusitis became the intellectual key to endoscopic surgery.

The decisive physiological insight came from the Austrian otolaryngologist Walter Messerklinger, who from the 1950s and 1960s painstakingly mapped the routes of mucociliary clearance in the nose and sinuses on cadaver specimens. Messerklinger showed that mucus in the maxillary sinus is always transported toward the natural ostium — not toward a surgically created hole elsewhere — and then funneled through the middle meatus. This finding had a revolutionary practical implication: to cure a sinus, you should relieve obstruction at its natural drainage pathway and let the sinus heal itself, rather than stripping out its lining or making large artificial windows. That principle — restore natural drainage — is the literal meaning of the word functional in functional endoscopic sinus surgery.

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Antral Washout and the Proetz Method

Before endoscopes, much of sinus treatment was aimed at the same goal — getting infected material out and getting air and drainage back in — by simpler mechanical means. The classic procedure for the maxillary sinus was the antral washout (proof puncture and lavage): a needle or trocar was passed through the thin bony wall between the nose and the maxillary sinus (the inferior meatus) or, in earlier practice, through the socket of an extracted upper tooth, and the sinus was flushed with saline to wash out pus. For decades this puncture-and-irrigate approach, sometimes repeated over days, was a mainstay of treatment for acute and subacute maxillary sinusitis.

A gentler, non-puncturing alternative was devised by the American otolaryngologist Arthur W. Proetz of St. Louis, who published his displacement method in the 1920s (his foundational paper on displacement irrigation appeared in 1926). In the Proetz technique the patient lies with the head tipped back so that the sinus ostia point upward; medicated fluid is instilled into the nose, and gentle suction is applied to the nostril while the patient repeats a sound such as “k-k-k” to close off the throat. The alternating suction draws air out of the sinuses and allows fluid to be drawn in through the ostia, irrigating several sinuses at once without any needle. The “Proetz displacement” became a widely taught conservative treatment and was also used to introduce contrast for imaging.

These irrigation methods reflect the pre-antibiotic, pre-endoscopic logic of sinus care: relieve the obstruction, drain the pus, and assist the body’s own clearance. They did not cure the underlying tendency to obstruct, but for many patients they brought real relief, and washout in particular remained common well into the antibiotic era. They also kept the central principle alive — drainage matters most — that the endoscopic pioneers would later honor with far more precision.

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The Caldwell-Luc Operation (1893–1897)

When infection in the maxillary sinus was severe, recurrent, or filled with polyps and irreversibly diseased lining, washout was not enough, and surgeons turned to a more radical operation. The procedure that defined maxillary sinus surgery for most of the twentieth century is the Caldwell-Luc operation, named for two surgeons who independently described very similar approaches a few years apart. The American physician George Walter Caldwell of New York published his account in 1893, and the French laryngologist Henri Luc of Paris published his in 1897; their names were later joined to honor both contributions.

The operation works by entering the maxillary sinus through the mouth: an incision is made in the gum above the upper teeth (the canine fossa) and a window is opened in the front wall of the sinus, allowing the surgeon to clear out diseased mucosa, pus, cysts, and polyps under direct vision. A second opening was traditionally made in the wall between the sinus and the nose (a nasoantral window in the inferior meatus) to provide ongoing drainage and ventilation. Devised in the pre-antibiotic era, when chronic suppurative sinusitis could be disabling or even life-threatening, the Caldwell-Luc procedure gave surgeons a reliable way to deal with maxillary disease that simpler measures could not control.

For roughly a century the Caldwell-Luc operation was the workhorse of maxillary sinus surgery. It was, however, a fairly aggressive procedure: by stripping the sinus lining and creating artificial windows, it sometimes left patients with cheek numbness, dental and facial complications, and scarred sinuses that did not function normally — precisely because it disregarded the natural mucociliary drainage that Messerklinger would later map. As the endoscopic, function-preserving approach took hold in the 1980s, the classic Caldwell-Luc operation became far less common, reserved today mainly for selected problems (such as removing certain tumors, fungal masses, or foreign bodies, or accessing the sinus for specific reconstructions). Its long dominance, and its eventual decline, neatly frame the shift from “remove the diseased sinus” to “restore the sinus’s own drainage.”

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The Endoscopic Revolution: FESS

The most important development in the modern history of sinusitis is functional endoscopic sinus surgery (FESS), which emerged in the 1980s and fundamentally changed how sinus disease is treated. Its intellectual foundation was Walter Messerklinger’s mucociliary-clearance work in Graz, Austria, which established that the cure for a chronically obstructed sinus is to relieve the blockage at its natural drainage pathway — chiefly the ostiomeatal complex in the middle meatus — and let the sinus recover, rather than to strip or bypass it. Combined with the rod-lens nasal endoscope (developed by the British physicist Harold Hopkins and manufactured by Karl Storz) and with the fine anatomical detail provided by CT scanning, this principle made a new kind of surgery possible.

It was Messerklinger’s pupil and colleague, the Austrian surgeon Heinz Stammberger of Graz, who developed, refined, and tirelessly championed the endoscopic technique, and the American surgeon David W. Kennedy, then at Johns Hopkins, who introduced and popularized it in the English-speaking world — teaching the first North American course on the technique at Johns Hopkins in 1985. Working with one another and with the instrument maker Karl Storz, Stammberger and Kennedy are credited with coining and promoting the term Functional Endoscopic Sinus Surgery. Through the endoscope, the surgeon can see deep inside the nose under bright magnified light and, using precise instruments, open the obstructed natural drainage channels — targeting the key bottleneck while preserving as much healthy mucosa as possible.

FESS revolutionized sinus care because it was both more effective and far less destructive than the older radical operations. By restoring natural ventilation and drainage instead of removing the sinus lining, it offered high success rates with less facial scarring, less numbness, and faster recovery, and it transformed the management of chronic rhinosinusitis and nasal polyps. The endoscopic platform pioneered for the sinuses later opened the door to entire fields of minimally invasive nasal and skull-base surgery, including endoscopic approaches to the pituitary gland and the anterior skull base. In barely a decade, the question changed from “how aggressively can we clear the diseased sinus?” to “how precisely can we restore the sinus’s own function?”

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Acute Versus Chronic Rhinosinusitis

A key conceptual advance of the late twentieth century was the clear separation of acute from chronic sinus disease, and the recognition that they are, in important ways, different conditions. Acute rhinosinusitis is typically a short-lived illness, most often triggered by a viral upper respiratory infection (the common cold) that inflames the nasal and sinus lining; in a minority of cases a secondary bacterial infection follows. It is, in essence, an infection-driven event, and most cases resolve on their own as the cold subsides — a fact that underlies modern guidance against reflexively prescribing antibiotics for every sinus infection.

Chronic rhinosinusitis (CRS), defined by symptoms persisting for twelve weeks or more, came to be understood not as a simple long-running infection but as an inflammatory disorder of the lining of the nose and sinuses, in which obstruction, impaired mucociliary clearance, host immune factors, allergy, and sometimes nasal polyps all interact. The very shift in terminology — from “sinusitis” to “rhinosinusitis” — reflects a hard-won insight: because the lining of the nose and the lining of the sinuses are continuous and almost always inflamed together, it makes little sense to speak of sinus inflammation without the nose. The term rhinosinusitis became standard in clinical guidelines around the turn of the twenty-first century.

Researchers further divide chronic rhinosinusitis by the type of underlying inflammation — for example, with or without nasal polyps, and increasingly by the immunological “endotype” (such as type-2 inflammation driven by eosinophils). This more refined picture has direct treatment consequences: it explains why some patients respond to drainage-restoring surgery, others to topical and oral anti-inflammatory medicines, and, most recently, why certain severe polyp-forming cases respond to biologic drugs that target specific inflammatory pathways — a development discussed below.

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Modern Understanding and Open Questions

Today, sinusitis — rhinosinusitis — is understood as a spectrum, from a self-limited viral inflammation that accompanies a cold to a complex, sometimes immune-driven chronic inflammatory disease. Diagnosis combines symptom criteria (facial pressure, nasal obstruction, reduced sense of smell, and nasal discharge), nasal endoscopy, and, when needed, CT imaging of the ostiomeatal complex and sinuses. Management is correspondingly layered: saline irrigation and topical steroids for many; appropriate antibiotics reserved for genuine bacterial acute infections; endoscopic surgery to restore drainage in medically refractory chronic disease; and, for severe type-2 polyp disease, targeted biologic therapies.

The introduction of biologic medications — monoclonal antibodies such as dupilumab (an anti-IL-4/IL-13 receptor antibody approved for chronic rhinosinusitis with nasal polyps in 2019), along with others targeting IgE or IL-5 — marks the newest chapter in this long history. For the first time, the most severe, polyp-forming, inflammation-driven cases can be treated by precisely interrupting the molecular pathways that drive the disease, sometimes shrinking polyps and restoring smell without surgery. This represents the logical endpoint of the centuries-long shift from treating the symptom (drain the pus) to understanding and treating the mechanism (interrupt the inflammation).

Important questions remain genuinely open, and honesty about them matters. Researchers continue to debate the precise role of the sinus and airway microbiome, of biofilms, and of fungi in chronic disease; the best ways to define and classify CRS endotypes; which patients truly benefit from surgery versus medication; and how to prevent recurrence after both. The arc of this history — from Highmore’s 1651 antrum, through Caldwell and Luc’s radical operation, to Messerklinger’s mucus maps, the endoscopic revolution of Stammberger and Kennedy, and today’s biologics — is a story of medicine learning, slowly and then suddenly, to work with the sinus’s own design rather than against it.

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Research Papers and References

The list below combines peer-reviewed historical and clinical reviews of sinus anatomy, surgery, and rhinosinusitis with curated PubMed topic-search links into the relevant literature. Historical primary texts (Highmore’s Corporis Humani Disquisitio Anatomica of 1651, Leonardo da Vinci’s anatomical drawings, and the original Caldwell and Luc operative reports of 1893 and 1897) are named in the article as historical sources. Each external link opens in a new tab.

[Nathanael Highmore (1613–1685) and the maxillary sinus] — biographical/anatomical history (PubMed/National Library of Medicine). — PubMed: Nathanael Highmore and the maxillary sinus
Mehra P, Murad H. Maxillary sinus disease of odontogenic origin. Otolaryngologic Clinics of North America. 2004;37(2):347-364. — doi:10.1016/S0030-6665(03)00171-3
Whyte A, Boeddinghaus R. The maxillary sinus: physiology, development and imaging anatomy. Dentomaxillofacial Radiology. 2019;48(8):20190205. — doi:10.1259/dmfr.20190205
Stammberger H. Endoscopic endonasal surgery — concepts in treatment of recurring rhinosinusitis. Part I: Anatomic and pathophysiologic considerations. Otolaryngology–Head and Neck Surgery. 1986;94(2):143-147. — doi:10.1177/019459988609400202
Kennedy DW, Zinreich SJ, Rosenbaum AE, Johns ME. Functional endoscopic sinus surgery: theory and diagnostic evaluation. Archives of Otolaryngology. 1985;111(9):576-582. — doi:10.1001/archotol.1985.00800110054002
The early history and development of functional endoscopic sinus surgery (historical review). The Journal of Laryngology & Otology. — PubMed: early history and development of FESS
Contemporary indications for the Caldwell-Luc procedure (review). — PubMed: contemporary indications for the Caldwell-Luc procedure
Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). Rhinology. 2020;58(Suppl 29):1-464. — doi:10.4193/Rhin20.600
History and evolution of sinus surgery and antral washout — PubMed: history of sinus surgery and antral washout
Proetz displacement method for sinus irrigation — PubMed: Proetz displacement method sinus irrigation
Ostiomeatal complex anatomy and chronic rhinosinusitis — PubMed: ostiomeatal complex and chronic rhinosinusitis
Chronic rhinosinusitis endotypes and type-2 inflammation — PubMed: chronic rhinosinusitis endotypes
Dupilumab and biologic therapy for chronic rhinosinusitis with nasal polyps — PubMed: biologics for chronic rhinosinusitis with nasal polyps
Acute bacterial versus viral rhinosinusitis — diagnosis and antibiotic use — PubMed: acute bacterial rhinosinusitis and antibiotics

External Authoritative Resources

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Connections

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