Penn study links underlying bone to spread and chronicity of sinusitis

November 30, 2000

(Philadelphia, PA)- Researchers at the University of Pennsylvania Medical Center have completed an animal model study that strongly confirms, for the first time, that bone is actively involved in the process of sinus disease. The study, entitled Bone Involvement in Sinusitis: An Apparent Pathway for the Spread of the Disease, will be published in this month's issue of Laryngoscope. It is now apparent that risk factors other than fungus or the ability of the sinuses to drain, and areas other than the sinus lining or mucosa, contribute to the frequency, severity, and prolonged nature of sinusitis ("Rhinosinusitis").

Sinusitis, a common and sometimes a chronic and debilitating condition, causes severe inflammation of the membrane in one or more of the sinus cavities. Sinusitis affects approximately 30-35 million people a year, with indirect costs estimated to be approximately $6 billion. Predisposing problems include viral infections, smoking, pollution, allergies and genetic predisposition. When it is severe and chronic it can enormously affect the quality of life, says lead author David W. Kennedy. M.D., Chairman of Penn's Department of Otorhinolaryngology-Head and Neck Surgery. "In fact, sinusitis has previously been demonstrated to have a greater impact on certain aspects of quality of life than such conditions as asthma, angina, chronic pulmonary disease and chronic lower back pain; all of which are problems commonly thought of as more debilitating," explains Kennedy.

The researchers' latest study helps confirm that removal of the bony partitions between the sinuses may be helpful during endoscopic sinus surgery--a technique that Kennedy introduced in the United States a number of years ago. "Opening and draining the sinuses may simply not be enough," said Kennedy. "In addition to surgically resecting some of the involved bone, prolonged courses of antibiotics and medical therapy may also be required." The study further suggests that if these additional measures are not taken, the likelihood that the disease may persist and eventually again become symptomatic is increased with time.

Sinusitis, which is closely allied with asthma, appears to be growing in frequency and severity among the general population. However, despite its prevalence, it is generally misunderstood and may be difficult to diagnose. The symptoms may be considered a minor symptom or side affect of the common cold, resulting in improper or inadequate treatment that can result in long-term suffering and chronic recurrence. "One of the serious problems is that the onset of the infection is often slow and progressive, obscuring the level of seriousness in some patients," cautions Kennedy. These realities, and findings identified with newer diagnostic technologies, prompted a more aggressive and novel approach to the study of the disease and its process.

Recently, there has been publicity with regard to the role of fungus in causing sinusitis. "However, the interest of our group in this study was to focus and explore the role of the underlying bone," said Kennedy. "We had noted that the bone undergoes changes in sinusitis; and that, clinically, the bone appears to be a factor in the chronic nature of the disease. In this study, we were able to show that the inflammation spreads through the bone, and that the inflammation may actually be identified within the bone at a considerable distance from the infected sinus. Indeed, in this study, the inflammation was seen to spread within the bone to the sinuses of the opposite side.

"These findings have significant implications for both our understanding and treatment of this common problem," concludes Kennedy. "This may also explain why the problem can be difficult to treat successfully in some patients."
The study was supported by an educational grant from the Eli Lilly Pharmaceutical Company. Other University of Pennsylvania researchers involved in this study include Joel R. Perloff, MD and William E. Bolger, MD. Also contributing was Richard Orlandi, MD, currently with the University of Utah.

Editor's Note: Dr. David W. Kennedy has no financial interest in Eli Lilly.

University of Pennsylvania School of Medicine

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