Chronic Sinus Infection Thought to be Tissue Issue, Mayo Clinic Scientists Show

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Mayo Clinic in Rochester

Thursday, July 28, 2005

Chronic Sinus Infection Thought to be Tissue Issue, Mayo Clinic Scientists

Show It's Snot

Findings call for radical change in treatment for the disease, researchers

say Additional Resources _Video on Chronic Sinusitis

Findings_ (http://www.mayoclinic.org/spotlight/chronic-sinus-infection.html)

_Otorhinolaryngology_ (http://www.mayoclinic.org/ent/)

_Sinusitis Treatment at Mayo Clinic_

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ROCHESTER, Minn. -- Mayo Clinic researchers have found that the cause of

chronic sinus infections lies in the nasal mucus -- the snot -- not in the nasal

and sinus tissue targeted by standard treatment. The findings will be

published in the August issue of Journal of Allergy and Clinical Immunology and

are

available _online_ (http://journals.elsevierhealth.com/periodicals/ymai) .

" This strikingly teaches against what has been thought worldwide about the

origin of chronic sinus infection: that inflammatory cells break down,

releasing toxic proteins into the diseased airway tissue, " says lead researcher

and

Mayo Clinic ear, nose and throat specialist Jens Ponikau, M.D. " Instead we

found that these toxic proteins are released into the mucus, and not in the

tissue. Therefore, scientists might need to take not only the tissue but also

the

mucus into account when trying to understand what causes chronic sinus

infections and probably other airway diseases. "

The findings could significantly change the way chronic sinus infection is

treated, according to Dr. Ponikau.

" This has far-reaching implications, " says Dr. Ponikau. " This suggests a

beneficial effect in treatments that target primarily the underlying and

presumably damage-inflicting nasal and sinus membrane inflammation, instead of

the

secondary bacterial infection that has been the primary target of treatments

for the disease. Also, some surgeons have already started to change the way

they do surgery for patients with chronic sinus infections, focusing now on

removing the mucus, which is loaded with toxins from the inflammatory cells,

rather than the tissue during surgery. Leaving the mucus behind might

predispose

patients for early recurrence of the chronic sinus infection. "

Dr. Ponikau conducted this research along with Hirohito Kita, M.D., and Gail

Kephart, Mayo Clinic allergic diseases researchers. Sherris, M.D., and

Eugene Kern, M.D., both former Mayo Clinic ear, nose and throat specialists

who now work at the University at Buffalo, also participated in the project.

The team found that in chronic sinus infection patients, activated white

blood cells (eosinophils) cluster in the nasal and sinus mucus and scatter a

toxic protein (major basic protein) onto the nasal and sinus membrane. While

major basic protein was not distributed in the nasal and sinus tissue, the level

of this protein in the mucus of chronic sinus infection patients far exceeded

that needed to damage the nasal and sinus membranes and make them more

susceptible to infections such as chronic sinus infection.

To conduct this investigation, Dr. Ponikau and fellow researchers collected

specimens from 22 consecutive Mayo Clinic chronic sinus infection patients

undergoing endoscopic sinus surgery. The surgeons extracted the maximum possible

tissue and mucus during the sinus surgery. The surgeons also extracted

tissue and mucus from healthy patients undergoing septoplasty, surgery to fix a

deviated septum, for comparison with the specimens from the chronic sinus

infection patients. Through various forms of laboratory examination of the

tissue

and attached mucus, the investigators observed an abundance of major basic

protein throughout the nasal and sinus mucus in all 22 specimens, but not in

the tissue.

Chronic sinus infection is one of the most common chronic diseases in the

United States, affecting 32 million adults, according to the National Center of

Health Statistics. Chronic sinus infection produces nose and sinus problems

characterized by stuffy nose, loss of sense of smell, postnasal drip, nasal

discharge, and head and face pain lasting three months or longer. It notably

decreases the quality of patients' lives, impairing physical and social

functioning, vitality and general health, according to the Mayo Clinic

researchers.

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