Taming the Stubborn Sinuses
Imagine your last sinus infection. Now, imagine it lasting for months, even years.
That’s a reality faced daily by patients with chronic sinusitis, who may endure years of blocked breathing, congestion, nasal drainage and a myriad of other symptoms that typically accompany sinus infections. For a subset of patients, antibiotics, surgeries, decongestants and steroids provide temporary relief, but ultimately the condition returns full-force.
“We are so successful in treating the majority of patients with sinusitis that it is difficult to understand why some patients don’t respond to therapy,” says Andrew Lane, director of the Johns Hopkins Sinus Center. “Their noses just stay in this chronic inflammatory state at all times. The million-dollar question is, why does that happen?”
It’s a question—along with how to treat and cure patients who suffer from chronic sinusitis—that Lane hopes to answer by drawing on the many resources available in the Sinus Center. “Our clinic tends to draw people who’ve failed medical therapy elsewhere, and so they’re referred here for the specialized care we can provide,” he explains.
While sinusitis is common, unrelenting chronic sinusitis isn’t, Lane says. Most people, in fact, do get better with the right treatment. But the ones who don’t might endure scores of medications and surgeries—and even lose their sense of smell—before anything ever improves, if it ever does.
To best treat these complex patients, Lane believes it’s important to know what causes their condition in the first place. And to that end, Lane studies cells and sinus tissue obtained from patients with chronic sinusitis, and he has also developed mouse models that mimic aspects of the sinus disease human patients suffer.
His goal is to determine what sets patients with chronic sinusitis apart and what remedies prove most valuable. Recent work in his laboratory focused on the inner lining of the nose, called the epithelium, has found that it may be failing to do its job in blocking germs that cause infection.
Lane estimates that three-quarters of his practice is made up of people with chronic sinusitis. Many have a decreased sense of smell, a problem that is challenging to research or treat because the area of the nose responsible for the ability to smell is difficult to access.
What physicians do know is that inflammation of the nasal passages—one of Lane’s primary research targets—is a defining characteristic of chronic sinusitis. In the nose, he explains, the neurons that recognize odors regularly die off and are replaced when exposed to trauma, including inflammation. In most people, those odor-detecting neurons are regenerated as the epithelium works to fight off disease.
But in chronic sinusitis patients, those processes go awry, and the sense of smell remains decreased or absent as the sinus inflammation persists. Lane hopes his mouse models can contribute to a better understanding of why some patients cannot seem to fight off their illness and keep it off.
Until then, chronic sinusitis patients must rely on the right combination of drugs, surgeries and medical management.
“Sometimes we can help people with just the right antibiotic,” Lane says. “Others need more intensive and prolonged medical treatment or revision endoscopic sinus surgery. Even those referred to us for very recalcitrant chronic sinusitis do experience significant improvement in their symptoms and overall quality of life.”