Who is Right About Sinuses?

@NLENTS they are coming after you again as well as Dr. Swamidass and all of us. Let’s discuss freely and openly as only Peaceful Science seems able to do. Everyone’s comments are welcomed.


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Yes, Josh had sent that to me as well and they pinged me on Twitter. I am 100% done going back and forth with the DI. As I learned in little league, never swing at a pitch in the dirt.


Good decision. DI is so desperate for anything they can grab on to. They are really becoming quite lame in just about everything that they talk about.

Why couldn’t they come here and discuss it?

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We should respect this decision, even if we don’t agree. So, what I say next does not apply to him.

Everyone else can still discuss the science here. There are important things here. It might be that on something that DI has a point. It is good to recognize those things, even if there is disagreement with their overall point. In this case, it does not appear to be an argument about evolution, per se, but about if the sinuses have bad design or not.

If I were in their shoes, I would be cautious too. Last time, @Patrick was not kind to @Agauger. If we want DI to come here to engage with us, it is going to take time and effort to rebuild trust. It is much more fun if we can treat even people with whom we disagree respectfully. If we can, then they are more likely to come.

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This is also a question about anatomy. Full disclosure, I did go to medical school, but never really liked anatomy. It has been 18 years since my anatomy class. So I do not know the details of this off the top of my head.

Now, at Joshua Swamidass’s discussion forum, Lents claims again that Egnor was wrong to cite this “completely off-topic paper” because it isn’t about the maxillary sinuses:

You will notice that the article is all about the paranasal sinuses not the maxillary sinuses. Totally different structures!

Lents uses Swamidass’s forum to rant at us, saying that we’re “dishonest” and claiming Dr. Egnor was just trying to take advantage of ignorant readers. In Lents’s words, “They made an obvious error, got caught, and then just pretend it didn’t happen.”

No, there was no error to correct. On the contrary, it’s Lents’s description of nasal anatomy that is wrong, at an elementary level. The maxillary sinus and the paranasal sinuses are not “totally different structures.” The maxillary sinus is one of the paranasal sinuses! The paper Egnor cited was discussing the maxillary sinus as well as the other paranasal sinuses.

Lents similarly writes on his blog, “The paranasal and frontal sinuses surround your nose and are in your forehead, respectively. Nothing I write in my book or articles make reference to those sinuses.” Again, that’s not true because, to repeat, the maxillary sinus, which Lents indeeds writes about in his book, is one of the paranasal sinuses, meaning that Lents does write about the paranasal sinuses. He is wrong in his terminology.

In this case, it does appear that the maxillary science is one of the paranasal sinuses. In this case, Egnor does appear to be correct. It does not appear he was caught in a mistake, unless I am missing something here.


i agree with Egnor that its right to have the sinus openings at the top.
The big point for me is speed of drainage. Sometimes i have a unique sinus problem which leads to rapid drainage due to gravity.
By a opening at the top, when infection is on, it slows the drainage , which having congealed,goes out the nose but generally stops going down the throat.
Does one want infected mucus quickly leaving and down the throat??
Egnor says no. I think not and God thinks not too eh.

Well, I went to a different medical school to you, Josh, but I did treat sinus infections throughout my career as a GP. I’m not particularly interested in getting into the debate, but Egnor is quite right - the paranasal sinuses include the maxillary.

If the “bad design” argument is about gravity and drainage, then I think the solution is physiology more than anatomy - the one thing I do remember from work was the increasing realisation by ENT surgeons that “improving the drainage” didn’t improve the problems, which had more to do with cilia motility and mucosal inflammation than anatomical botching.

As for why sinus problems occur (and in my experience they can be traced to the frontals, ethmoidals and sphenoids as much as the maxillary, thus showing the problem to be complex) maybe we need to be asking about causes of increased allergy, atmospheric pollution in towns (where I worked), smoking and the microclimates of modern buildings.

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OK - just read the ENV article for the first time, thus acquainting me for the first time with “the controversy.” Turns out to be just as I thought, and it’s worth adding how I knew it would be.

That’s because I learned about it not from anything to do with ID, but professionally, maybe 15 years ago, in the debate then within otorhinolarynogology (practise that word, guys!) about the poor results from maxillary sinus surgery.

The articles about it, local meetings, correspondence with my ENT colleagues and so on all carried the message that what had once been deemed poor design, to be improved by knocking holes in the bottom of sinuses (thus messing up the ciliary system), turned out to have been poor understanding of the physiology.

In other words, it’s an old, old story lon ago debunked. Frankly I’m not surprised if Egnor reacted robustly to being called out on his own field of expertise.


@Robert_Byers, I’m not sure if out personal opinions matters so much as what the evidence shows. I’m more convinced by @jongarvey and Egnor himself.

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Because they needed material of any kind to create controversy over. They are floundering without purpose, or meaning or reason to exist as a institution. They are not an academic think tank, not a scientific organization, not an organization that is doing something to improve people’s lives. Not much of anything.

Since we can’t redesign our sinuses, I suggest that when one has sinus troubles to see one’s MD or ENT. The discussion of bad or good design of the sinuses is missing something important. We all now live in an place and time where us humans have advanced medical science and technology to the point that Doctors and ENTs know what to do with patient’s sinus sufferings. Through science and technology, an ENT can examine, image, and “fix the problem” of a person’s suffering with his/her’s sinuses. The whole discussion of whether the sinuses were designed right or wrong is moot. We all have had some sort of sinus problem. And we can treat them with modern medicine and technology. That is a testament of thousands of years of human innovation that we should celebrate. And we should thank the doctors, nurses, researchers, and engineers who actually do science to improve people lives.

Would that medical science were as utopian as you say. ENT surgeons may be (no doubt gradually) reducing the rate of BAWO and antrostomy over the last very few years, helped by endoscopic techniques and imaging - but it’s stiill crude stuff. It gets better they closer they can come to restoring original function… which so far isn’t very close.

@NLENTS While we are talking about sinuses, I want to talk about a really bad design that bothers older men. You didn’t talk about this in your book but like the sinuses, the prostate looks like a poor design. Any comments from anyone?

If I spot them my mistake in which labels are associated which sinuses, that’s only one of the errors that I called them on and definitely not the major one. Everything else about my article stands and everything else about their article fails to accurately represent drainage in the maxillary sinuses. They continue to misread their own source and of course fail to respond to my other points including the 5 or 6 studies that I referenced about accessory maxillary ostia, drainage, and chronic inflammation in the maxillary. The question here, if one actually cares about the science and not just scoring cheap shots, is the drainage system of the maxillary sinuses and they continue to reference articles and other sources that describe the other chambers. Yes they are all connected but that doesn’t mean it’s just one big chamber.

The “design” of drainage that they describe in their article is a gigantic Rube Goldberg machine if I ever saw one! Not only does it not work that way, but if it did, you would be really stretching to call it well-designed. I am trying very hard, and failing, not to get drawn into this again. It’s like yelling at a brick wall but even less effectual.

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Yeah, lots of other good examples simply didn’t get included owing to space constraints, which also was why they trimmed so much of my more detailed explanations of various things. The publisher wanted to keep the price point as low as possible and the prose as accessible as possible. You lose something when you do that, but hopefully it reaches more people.

Having the urethra go through the prostate, instead of just having a duct system like the bulbourethral glands have, does indeed seem like a bad arrangement given the prostate’s tendencies later in life. But I can’t say much more than that.


For the record, I agree that poking holes in the bottom of the maxillary sinuses would be a terrible fix because there would be no way route to the mucus to the nasopharynx down there. However, the point I am trying to make still stands: if the drainage could be reworked from the bottom, it would be much preferred. So I do not accept that this “story has been debunked.” Also, another item for the record is that this is not in Egnor’s expertise anymore than it is mine. He’s a neurosurgeon and all of this would be in the purview of an ENT or a plastic surgeon specializing in the facial reconstruction.

If this would get us past the impasse, I’m willing to admit, as I always have been, that there is probably no amount of surgical tinkering we could that would improve on this arrangement. My point is in the evolutionary trajectory that got us here, not in what would be the best design given the other constraints of the face. We can disagree on how our face got this way, while also agreeing that the sinuses do as well as can be expected given the constraints that they have.


I don’t see what science there is behind the argument that a better design would have been ‘X’, therefore evolution, not design. Maybe it’s just me.

How would one go about demonstrating scientifically that ‘X’ is a better design and that absent ‘X’ evolution must be the cause with no design involved?


@mung take note that I agree with you on this one. It is not just you.

Rube Goldberg machines are designed. It’s silly to think that evolution can ‘design’ even a Rube Goldberg machine.