Study Finds Unique Form of Chronic Sinusitis in Older Patients

Justin H. Turner, M.D. (Vanderbilt Image/ Lauren Holland)

Older patients with a medical diagnosis of chronic sinusitis– an illness of the nasal cavity and paranasal sinuses that frequently continues over several years– have a unique inflammatory signature that might render them less responsive to steroid treatment, according to a brand-new study released by Vanderbilt scientists.

The study released in the Journal of Allergic Reaction and Scientific Immunology took a look at tissue and mucous specimens of 147 patients between the ages of 18 to 78 who needed sinus surgical treatment for their chronic sinusitis.

With a preliminary objective of recognizing subgroups of patients based upon their inflammatory signature– the various cytokines and inflammatory proteins discovered in tissue or mucous — Vanderbilt private investigators acknowledged that a person of the recognized subgroups was enriched in patients over age 60.

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Fascinated by the findings, the group compared all patients according to age by analyzing their histopathology, tissue specimens were taken throughout surgical treatment, and the immune markers and inflammatory proteins discovered in their tissue and mucous and observed they were noticeably various.

“Most chronic sinusitis in North America — particularly the kind that requires surgical intervention — has an inflammatory signature characterized by a group of cytokines associated with allergy and asthma called Th2-associated cytokines,” stated Justin Turner, MD, Ph.D., associate teacher of Otolaryngology-Head and Neck Surgical treatment and a lead detective for the study.

“Older patients tend to not have substantial elevations of those specific cytokines. On the other hand, they have an elevation of cytokines that are connected with the body’s natural immune function and both severe and chronic inflammatory reactions, which are extremely based on age.

“You don’t see an elevation in those cytokines until around age 60, and then from that age on, there’s a progressive increase in the levels of those cytokines seen in the mucus and the tissue of those patients.”

Due To The Fact That of this variation, older patients would in theory be less most likely to react to the steroids utilized to deal with chronic sinusitis identified by Th2-associated cytokines.

According to Turner, topical steroids such as nasal sprays and waterings are greatly trusted for long-lasting illness and sign management.

“We’re hoping this data will stimulate some interest in the elderly population with respect to chronic sinusitis management because it suggests we may need patient-specific treatments targeting these older patients. That’s particularly important because steroids can have a number of short- and long-term adverse effects, and those side effects are much more likely in older patients than they are in younger patients,” stated Turner.

To strengthen and build on these findings, Turner’s group is presently utilizing information collected over the last number of years to compare surgical results based upon age.

Initial information recommends that older patients have actually less viewed gain from sinus surgical treatment than more youthful patients, which might be a sign that their illness stands out and their alternatives for post-operative medical management might be less most likely to supply relief.

“Our end goal is that we’re looking for better ways to treat chronic sinus disease and to understand the disease process a little better,” stated Turner.

“We feel we have identified a characteristic of a fairly large population of patients that may ultimately change our treatment of those patients going forward. It at least suggests that we need to be doing more research targeted at that population.”

Extra Vanderbilt private investigators for the study are Rakesh Chandra, MD; Naweed Chowdhury, MD; Suman Das, Ph.D.; Kim Ely, MD; Li-Ching Huang, Ph.D.; Ping Li, MD; Justin Morse, MD; Quanhu Sheng, Ph.D.; and Meghan Shilts, MS.

“This study serves as an example to reinforce the vital rationale for academic medical centers,” stated Roland Eavey, MD, Person M. Maness Teacher and chair of Otolaryngology and director of the Vanderbilt Expense Wilkerson Center. “A curious clinician-scientist, teamed with collaborative clinicians and trainees, in an environment with laboratory and basic researcher resources, sets sail to discover the Far East and on the way encounters the New World. The finding that age serves as a remarkable — yet unexpected — treatment/response insight is highly significant.”

The study was moneyed by the National Institutes of Health/National Institute of Deafness and Interaction Conditions (award number RO3 DC014809) with extra assistance from the National Institutes of Health/National Institute of Allergic Reaction and Contagious Illness (L30 AI113795) and the National Center for Advancing Translational Sciences (UL1TR000445).

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