19 June 2018

How your mucus can be a guide to sinusitis treatment

Suffering from chronic sinusitis? Your mucus might help identify the most effective treatment.

Chronic sinusitis can be extremely painful, and those with the condition may feel sick for weeks and find it difficult to participate in everyday life or complete simple tasks.  

According to a recently published Vanderbilt University study, a person's nasal mucus could provide vital information to predict the type of chronic sinusitis, which could ultimately assist doctors in determining whether surgery or medical treatments will be the most effective. 

What does the research entail and what does this mean for the future treatment of chronic sinusitis? 

What is chronic sinusitis? 

The sinuses are hollow, moist spaces that drain through the nose. When the sinuses are prevented from draining due to either an infection or allergic reaction, fluid and mucus remain trapped. This results in the inflammation and irritation of the sinuses, which is referred to as sinusitis.

Chronic sinusitis is sinusitis that lasts for a long time, usually longer than three months. People with asthma and allergies are usually more vulnerable to chronic sinusitis. There are various types of sinusitis: 

  • Acute sinusitis: typically lasts up to a month
  • Sub-acute sinusitis: longer than one month 
  • Chronic sinusitis: longer than three months

While chronic sinusitis lasts longer than acute sinusitis, the symptoms are the same and include: A cough, thick nasal mucus, post-nasal drip, headaches, fever, congestion, facial pain and swelling. 

However, chronic sinusitis sufferers may also develop nasal polyps, which are growths on the tissue of the nose and sinuses, resulting in difficulty breathing. 

Biological markers

The study, published online in the Journal of Allergy and Clinical Immunologycollected and analysed the mucus of patients by simply putting a small medical grade sponge into the nostrils of the patients. The mucus was then analysed for cytokines, small secreted proteins that allow cells to talk to each other. The cytokine profiles were found to determine six different clusters of chronic sinusitis patients.

Dr Justin Turner, associate professor of Otolaryngology-Head and Neck Surgery and the study's lead author, speaking to Vanderbilt University News, said it is the first study to use biological markers to identify endotypes of chronic sinusitis. “The problem is that those patients tend to have very different responses to surgery,” he said.

What becomes apparent is the reasoning behind the study, to identify which patients will have better outcomes ahead of the time. “Some patients may be better served with surgery, others with medical treatment,” Dr Turner explained. 

“When we look at the postoperative outcomes for those patients, which we assess through a quality of life measure that assesses patient symptom burden, we find that at one year follow up, patients in certain clusters do much better than patients in other clusters,” Dr Turner said.

Future of chronic sinusitis treatment 

According to Dr Turner, the findings should pave the way for more personalised medication and treatment options for chronic sinusitis patients, instead of the one-size-fits-all option that is currently in use.

Presently, chronic sinusitis patients are examined to determine how much previous treatment they have undergone and are then administered courses of anti-inflammatory medications such as antibiotics. Only once this has taken place the surgical options are explained to the patient. 

“In theory, going forward, this is something that could be used in a point-of-care fashion before making a decision to take a patient to surgery. Perhaps some patients may do better with continued medical therapy, or with biologic medications.” Dr Turner emphasised. 

Image credit: iStock


Ask the Expert

Sinusitis Expert

Dr Gary Kroukamp MBCHB, FCORL(SA) is an ENT Specialist, practising from rooms at Kingsbury Hospital in Claremont, Cape Town. He also has a teaching sessional appointment as an ENT Consultant at the Tygerberg Hospital. He is a member of the ENT Society of South Africa and the South African Cochlear Implantation Group. His interests in the ENT field include sinusitis and sinus surgery, nasal allergy and ENT conditions in children.

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