In the JournalsPerspective

Unique form of chronic rhinosinusitis identified in older patients

Justin Turner
Justin Turner

A unique inflammatory signature among older patients with chronic rhinosinusitis may make them less responsive to steroid treatment, according to findings recently published in the Journal of Allergy and Clinical Immunology.

“The effect of [chronic rhinosinusitis] in the geriatric population is poorly understood,” Justin C. Morse, MD, of the department of otolaryngology–head and neck surgery at Vanderbilt University Medical Center, and colleagues wrote.

“[Previous] studies suggest that a proinflammatory neutrophilic milieu might be unique to elderly asthmatic patients, with significant implications for disease management and treatment. Similar age-dependent factors might be equally important in patients with chronic rhinosinusitis given the shared immune mechanisms and pathophysiology common to both upper and lower airway inflammatory disease,” they added.

Researchers reviewed histopathology, immune markers and inflammatory proteins found in the tissue and mucus of 147 patients with chronic rhinosinusitis (mean age, 49 years), comparing them to 30 healthy control patients (mean age, 51.6 years).

Morse and colleagues found that the older patients, regardless of cohort they were in, had increased levels of proinflammatory cytokines, neutrophilic tissue inflammation, and increased prevalence of bacterial infection or colonization.

Study co-author Justin Turner, MD, PhD, of the department of otolaryngology–head and neck surgery at Vanderbilt University Medical Center, acknowledged that the research has limitations in the primary care setting.

“While this technology may not be available in the primary care setting, it does help to identify these subgroups. With further research we may ultimately be able to identify these groups with single biomarkers or with clinical and demographic variables like age or sex. A one-size-fits-all approach to management of chronic sinus disease is not appropriate and our studies confirm that,” he said.

Turner also provided insight on how primary care physicians can utilize the findings in clinical practice.

“PCPs should recognize patients who do not respond well to topical or systemic medical therapies. The underlying biology of these patients may make them less responsive and alternative approaches may be needed. Evaluation of immune function and vaccination responses may be helpful and consultation with an allergist/immunologist or otolaryngologist may be of great benefit for many of these patients.” – by Janel Miller

Disclosures: Morse reports receiving grant support from the American Rhinologic Society. Turner reports receiving grant support from NIH’s National Institute of Deafness and Communication Disorders and National Institute of Allergy and Infectious Diseases. Please see the study for all other authors’ relevant financial disclosures.

Justin Turner
Justin Turner

A unique inflammatory signature among older patients with chronic rhinosinusitis may make them less responsive to steroid treatment, according to findings recently published in the Journal of Allergy and Clinical Immunology.

“The effect of [chronic rhinosinusitis] in the geriatric population is poorly understood,” Justin C. Morse, MD, of the department of otolaryngology–head and neck surgery at Vanderbilt University Medical Center, and colleagues wrote.

“[Previous] studies suggest that a proinflammatory neutrophilic milieu might be unique to elderly asthmatic patients, with significant implications for disease management and treatment. Similar age-dependent factors might be equally important in patients with chronic rhinosinusitis given the shared immune mechanisms and pathophysiology common to both upper and lower airway inflammatory disease,” they added.

Researchers reviewed histopathology, immune markers and inflammatory proteins found in the tissue and mucus of 147 patients with chronic rhinosinusitis (mean age, 49 years), comparing them to 30 healthy control patients (mean age, 51.6 years).

Morse and colleagues found that the older patients, regardless of cohort they were in, had increased levels of proinflammatory cytokines, neutrophilic tissue inflammation, and increased prevalence of bacterial infection or colonization.

Study co-author Justin Turner, MD, PhD, of the department of otolaryngology–head and neck surgery at Vanderbilt University Medical Center, acknowledged that the research has limitations in the primary care setting.

“While this technology may not be available in the primary care setting, it does help to identify these subgroups. With further research we may ultimately be able to identify these groups with single biomarkers or with clinical and demographic variables like age or sex. A one-size-fits-all approach to management of chronic sinus disease is not appropriate and our studies confirm that,” he said.

Turner also provided insight on how primary care physicians can utilize the findings in clinical practice.

“PCPs should recognize patients who do not respond well to topical or systemic medical therapies. The underlying biology of these patients may make them less responsive and alternative approaches may be needed. Evaluation of immune function and vaccination responses may be helpful and consultation with an allergist/immunologist or otolaryngologist may be of great benefit for many of these patients.” – by Janel Miller

Disclosures: Morse reports receiving grant support from the American Rhinologic Society. Turner reports receiving grant support from NIH’s National Institute of Deafness and Communication Disorders and National Institute of Allergy and Infectious Diseases. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Christopher C. Randolph

    Christopher C. Randolph

    The elderly are a specific population often with multiple comorbidities and difficulty in communication of medical history and symptoms that often make diagnosis of sinusitis difficult. The results of Morse et al are academically exciting, since chronic rhinosinusitis is not always treatable via systemic steroids. In addition, these findings regarding the patients studied mucus also suggest chronic rhinosinusitis in the elderly may be clinically distinct.

    However, it’s important for primary care physicians to realize that the mechanisms to determine this strain of the condition are not commercially available yet to most PCPs through their hospital or other laboratory service. Thus, real world trials are needed before PCPs can begin implementing this in their practices.

    • Christopher C. Randolph, MD
    • Allergist, immunologist
      Yale New Haven Hospital, Waterbury, Connecticut

    Disclosures: Randolph reports no relevant financial disclosures.