Understanding More About Recurring Sinus Infections

NoseThe following is a press release from Johns Hopkins about research being done to understand why some people have recurrent sinus infections, despite being given all of the current therapies and even undergoing unsuccessful surgeries. The long and short of it is that these people have reduced gene activity in the body’s nasal immune system. Hopefully this study will eventually lead to better treatments for this problem, and less colonization in the nose of the bacteria that makes us sick. Read more:

Researchers at Johns Hopkins have evidence that curbed activity from several key chemicals on the inner lining of the nose are linked to chronic sinusitis that fails to respond to the usual current treatments.

An estimated 32 million Americans know the misery of persistent inflammation of the moist tissue that lines the nose and sinus cavities. The result is clogged passages and recurring infections, according to the U.S. Centers for Disease Control and Prevention.

Because nearly one in 10 of those treated see symptoms return within weeks or months after drugs or surgery fail to keep the sinus passages open, scientists have long suspected that these resistant cases had some underlying problem with the immune system contributing to the ailment.

In a study to be described on Sept. 19 at the annual scientific sessions of the American Academy of Otolaryngology, Head and Neck Surgery, the Hopkins team found that in chronic sufferers who failed to respond to treatment, the activity of at least four genes in the body’s nasal immune defense system were severely decreased, and their production of two proteins critical to this defense was 20 to 200 times less than normal.

Comparing nasal epithelial cell samples from nine patients who benefited from surgery with nine who did not, the Hopkins team discovered suppressed levels of human beta defensin 2 (HBD2) and mannose binding lectin (MBL) in those whose symptoms returned. The proteins are naturally produced in the nose whenever the immune system detects foreign bacteria or fungi, binding to invading pathogens, inactivating them and making them easily disposed of.

An earlier study published by the same team in the March-April issue of the American Journal of Rhinology also showed that sinus tissue from people with chronic sinusitis that resisted treatment had 30 times lower than normal activity of a so-called toll-like receptor gene, TLR9.

Inside the nose, researchers say, toll-like receptor proteins (TLRs) detect invading bacteria and other pathogens in the air by attaching to their trace byproducts. Once a threat is identified, the receptors stimulate the epithelial cells to produce antibiotic proteins, such as HBD2 and MBL, to fight the invading organisms. This innate response helps prevent airborne bacteria or fungi from settling in the nose and sinus cavities, causing infection.

“Colonization with microorganisms is a common problem in patients with chronic sinusitis and polyps, but the reasons for this are incompletely understood,” says Andrew Lane, M.D., an associate professor at The Johns Hopkins University School of Medicine and director of its rhinology and sinus surgery center. “Now we are uncovering new clues as to what might be wrong and perhaps, ultimately, how it might be treated.

“The nose’s first line of defense is the epithelium, and when the local innate immune function is curtailed, infections can get a head start, which might serve to worsen the sinus inflammation.

“The potential is there to manipulate these chemical receptors and proteins to see if this makes patients more responsive to conventional therapy,” says Lane.

The study, led by Lane, was believed to be the first to determine levels of each TLR – there are 10 – by directly measuring messenger RNA expression in sinusitis patients and those more fortunate to not have it. Scientists have known for more than a year that TLRs were present in both the healthy and sinusitis-wracked nose, but not which receptors or proteins were more important than others in the condition’s chronic form. That study involved 30 men and women, mostly from the Baltimore region, who had surgery for chronic sinusitis at Hopkins. (Another 10 had no sinus problem and served as study controls.)

Those who underwent surgery did so after standard therapy using antibiotics, decongestants and steroids had failed to stop their symptoms and keep their infections from coming back. Indeed, 20 participants in the study had developed nasal polyps, which have no known cause and are especially hard to treat, researchers say. They note that polyps must often be surgically removed to allow the sinuses to drain normally.

All patients were monitored for a minimum of six months to see if any symptoms or polyps returned. Thirteen in the surgery group had recurrent inflammation within three months to one year after surgery, while the rest remained symptom free.

The Hopkins team took samples during surgery of the mucous membrane lining the nose, and using real-time polymerase chain reaction, analyzed the samples for any genetic differences between the groups.

“Surgically treating sinusitis is much like plumbing, in the sense that we try to restore normal sinus cavity drainage pathways,” adds study presenter Murugappan Ramanathan Jr., M.D., a resident in otolaryngology – head and neck surgery at Hopkins. “But for the intractable cases, surgery may fail because the problem is not so much about plumbing as it is inflammation, and for this we need research at the molecular level to find a solution.”

Funding for this study was provided in part by the National Institutes of Health, including the National Institute on Deafness and Other Communication Disorders, and the National Institute of Allergy and Infectious Diseases, with additional funding coming from the American Rhinologic Society.

Besides Lane and Ramanathan, other researchers involved in this research, conducted solely at Hopkins, were Quynh Ai Truong-Tran, Ph.D., and Robert Schleimer, Ph.D.

Contact: David March
Johns Hopkins Medical Institutions

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113 Responses to Understanding More About Recurring Sinus Infections

  1. Umzug Berlin says:

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  2. Debbie says:

    This site has really helped me to cope with my sinus problems and realize that I am not alone. I have had several sinus surgeries over many years to remove nasal polyps and open up my constantly congested sinuses. The surgeries have had varying degrees of success, but I have always been very prone to sinus infections. As a result, I have been prescribed antibiotics on countless occasions for those infections. The antibiotics usually helped, but the infections generally came back quickly. About a year ago, I had surgery again, to clear out my frontal sinuses above my eyes. They had gotten so bad I had headaches every day and frequent reoccurring infections. After the surgery, they told me they found I had MRSA in the sinuses which was very upsetting to me. We tried oral antibiotics and topical ointments in the nose, as well as cortisone sprays and saline rinses and I could not get rid of it. I am also very prone to ear infections and the MRSA seemed to make my ear problems worse. I finally asked to be referred to an infectious disease specialist based on all the posts I saw here. Well that turned out to be a total waste of time. He told me my bad sinuses were the root of the problem and there was really nothing he could do for me (although he offered to take yet another CT scan – no thank you!). He gave me some pamphlets and told me to learn how to live with it. Oh yeah, and after I shook his hand after meeting him initially, he immediately looked for some anti bacterial gel to cleanse himself after touching me. What a waste of my time, but he did motivate me to look for alternative remedies. I had seen on several sites that colloidal silver is sometimes a treatment for MRSA so I ordered some online and began using the spray up my nose several times throughout the day. I still use an antibiotic ointment at night and my cortisone spray and the daily saline rinse, but added this spray to the treatment. My sinuses started feeling better, I started feeling less tired and sick and really felt like it was helping. Last week I went back to my ENT and he took a culture and it came back negative for MRSA! I couldn’t believe it. My Dr. and I agree I should keep up with the same treatment regimen since I am doing so well. After a couple months, I may try cutting out the antibiotics. He said I tested positive for yeast but I am not experiencing any problems with that so we will wait on treating that. I wanted to share this with everyone on this site because sometimes I’ve seen recommendations for products and wondered if it was just some marketer trying to sell their product. I really believe the colloidal silver has helped and my Dr. told me he has 3 other patients who are also using it. It may not work for everyone, but it did for me and I think it’s worth a try. It isn’t real expensive and I feel so much better. I don’t know if it will last, but for now I am MRSA free and my sinuses feel better than they have in years! I can truly sympathize with everyone who has posted here because I know how terrible the sinus infections can make you feel and the bottom line is, as great as our modern medicine is, they don’t have all the answers. I have researched MRSA a lot online and am so glad I decided to try something different. Good luck to all of you in your struggles to be MRSA free.

  3. Latisha says:

    WOW I am lost for words. It is tear drenching to see so many others suffering as I. In MAY 2004 I went on vacation, where I first begain having an acute ear infection. After about 9 months of treatment I developed a swollen lympnode. I had it tested and it was cancerous. I was diagnosed with cancer of the nose and throat. I have been cancer free but still suffer from one side effect, chronic sinusitis. In January 2011 I was diagnosed with MRSA. I’ve been prescribed a series of antibiotic; some two at a time, along with two nasoneb antiobiotic and steroid combonation. I still have MRSA and I have taken over 10 different meds. I also have two young children who I am afraid of infecting. What do I DO!

  4. Jen says:

    I recently came down with a boil on my posterior that decided it was lonely, so it was going to make more boils as company. From there, I’ve had a low grade fever that comes and goes, fatigue, and occasional nausea. Few other symptoms, including an instantly congested sinus came into play.

    I am on Biaxin, using mupirocin on my boils, and just began adding it to my nose, too, just in case. I wash with soap and water all over twice a day and wash the boil region with Hibiclens in the shower before my evening gooping and bandaging.

    I am waiting on a culture. It was taken Tuesday and results won’t be available until Friday at earliest. Naturally, I am nervous.

    The more I’ve read, though, both here and on many MRSA/staph support groups online — as well as on science and research sites — the more I am just increasingly angry. You should be too. Because thousands of serious infections could be avoided and the risks of high dose intense antibiotics avoided — not to mention death and amputation — if only the US had access to bacteriophage therapy.

    Phage therapy has a very good track record of beating serious wound and bodily infections such as MRSA as well as other bacterial infections. It has been used for 100 years in Eastern Europe. There have been clinical trials on ear infections in the UK and also at the Wound Center in Lubbock, TX. Those who have had phage — including Michelle Nicholson, who has written about it online on a small blog (and in response to a post on Carl Zimmer’s blog) have said it has saved their lives and done so without side effects.

    I cannot see how we can continue to do what we are doing to our livestock, our food, our children, and ourselves without a dramatic shift in attitude. Antibiotic overuse on the farms has to stop. Phage therapy needs to be adopted. Lives will be saved.

    Please take up the banner and write your Congress person about this. Protest and spread the word. Tell the media. People are going to Tblisi and getting legs and lives saved — in this ex Soviet Union country with a low GDP — and they can’t be saved here, on our own soil?

    This is morally and ethically repugnant to me.

    It has to change.

  5. Maureen says:

    I also have had multiple sinus surgeries, been on excess of 60 courses of antibiotics, had a PICC line for 4.5 months for Invanz, and am currently culturing MRSA + pseudomonas in my maxillary sinuses. Yesterday, I started SMZ/TMP which my culture indicates sensitivity. My cultures are not done by the unreliable nasal swab but by suction of material from my sinus cavity. I, too, am tired of the smell/ taste issue and copious amounts of lime green, creamy nasal discharge which is in my lungs necessitating oxygen. I have had chronic sinus since 2003. This is my first MRSA as I usually grow bacteria from my GI tract. As this is attributed to reflux, I even had a Nissen fundoplication/hiatal hernia repair as a last ditch effort to prevent further sinus infection. That was 8 weeks ago and the IV was discontinued 6 weeks ago. My husband believes I have a nocosomial infection.
    I empathize with the rest of you. The major abdominal procedure was a long shot recommended by my ENT, PCP, GI, ID, and surgeon. I wouldn’t do it again.
    My immune system is now deficient and I will need IVIg to conquer this current problem.
    Happy 2012 free of medical issues.
    Happy new year free of medical issues.

  6. Maureen says:

    PS. My immunologist/pulmonologist at Natioal Jewish in Denver said the sinus nebs are not effective. I also own one of the $300 machines used only once. She called my ENT to have him stop the nebulizer and start oral antibiotics.

  7. Peggy Jones says:

    WOW! Where do I begin with my story?? I am 72 years old and have been battling chronic sinus infections, asthma, bronchitis, pneumonia for most of my life. If my story does nothing more than to assure you that “there is life after sinus disease” then it will be worth the time to write it. I have simply refused to let my sinuses rule or ruin my life. I am amazed at the number of sufferers of chronic sinus disease there are–I thought for years I was the only one. I began having asthma before I started to school, then began having terrible sinus infections while in high school. We were poor and did not consider this to be important enough to go to a doctor, so I just suffered. For the next 20 years, I suffered through many bouts of sinus infections which began to lead to ear infections and bronchitis; which may times led to pneumonia. I can account for between 12 and15 bouts with pneumonia–all stemming from constant sinus drainage and infections. When my fever rose above 102 I would go to a doctor who would prescribe various antibiotics, I would improve, and wait for the next bout. No one ever connected these infections and asthma to my sinus problems. Maybe because my family moved several times and I saw different doctors. Eventually, I had to have a tube placed in my left ear. Then, my sinus problem gradually disappeared. For about 10 years, I had no sinus drainage; however continued to have COPD symptoms, My childhood asthma had returned and I ignored it until I could hardly walk up stairs. Finally, I began having left-side headaches every day. My primary doctor worked and got my asthma under control and began investigating the source of my headaches. I had no signs of sinus drainage, so he concluded that that was not the problem. After two years of various doctors and tests, a MRI revealed a mass in the sinus area. It turned out that years ago, a polyp had completely blocked my left side sinuses and the drainage openings had grown shut and the cavities were filled with hardened mucus– much like old hardened leather–and had eaten into the bone above my left eye. To compact this story, it took 3 major surgeries within 6 months–a total of nearly 10 hours of surgery–to dig out and strip off this hardened material. This was 12 years ago, and I have had sinus infections almost continually since that time, probably due to the pitting and scarring of my sinus linings. I have continued having the COPD with many various antibiotics. After a 10-day hospitalized bout with pneumonia, the pulmonary doctor sent me back to the ENT doctor who did 2 more surgeries–this time on the syphnoid sinus. Sometime along the way I developed MRSA. I probably had it before they put a name to it. No one told me–I just happened to find it out. They “didn’t want to worry me”!!! Currently, I have just finished a 14 day treatment of Zyvox, which didn’t help until the very last day of treament, so don’t know if it truly “cured” it or not. I take many prescriptions, allergy shots, and have either become allergic to or immune to most antibiotics. It has not ever invaded my bloodstream, nor have I had meningitis from it, so I feel fortunate. Don’t give up your fight against this disease and don’t let it rule your life. Despite this chronic condition, I have lived a very productive life–school teacher for 34 years, raised a family and been privilege to visit all 50 states!! God bless all of you and may He help research find a complete cure for all of you!!!

  8. Doug says:

    Interesting article. I had a horrible sinus infection a couple years ago, and the doctor did a deviated septum fix and also the balloon thing. Previous to this I would get a sinus infection about 1x out of 3 colds. Now I get a sinus infection from every cold, despite my nose being much more clear, and in general my sinus health is excellent. For instance, I never blow up discolored stuff, dont have chronic congestion, sleep well through the night. But 4 or 5 days into a cold, I start blowing up egg yolks every 5 minutes, just tons of pus gets produced. How could better drainage cause more frequent sinus infections?

  9. Doug says:

    Oh, my question was – could I have colinization with some MRSA, or something else that causes this?

  10. Jennifer says:

    I was just informed yesterday, by my ENT’s medical assistant, that I have maxillary MRSA that is resistant to EVERYTHING! I was in too much shock to ask if that includes IV antibiotics or not. I got an urgent referral to an ID doc for Monday morning.

    I have a long history of sinus infections and surgeries. I have never had a sinus MRSA infection and this one started about 2 to 3 months ago. The symptoms were drainage of yellow discharge, which has now turned to a thick, and sometimes bloody, green discharge.

    Like many here, I work in a hospital.

    My question is: If I need IV antibiotics, how long will I be in the hospital? Once treatment starts, how long does it take to be clear of MRSA so I can get back to work?

    I don’t have a lot of FMLA time and fear losing my job.

  11. CPR says:

    I am a physician who came across this site while researching my OWN sinus problems. Like many of you, I had endoscopic sinus surgery for chronic sinusitis. Post-operatively, I developed a MRSA infection which ultimately was cleared up with a course of Clindamycin.

    There is a lot of misinformation out there so let me see if I can help you understand what MRSA is, and what it is not. All of our skin is colonized with bacteria, harmless organisms that live on our skin…most of which can be called “staph”. There are different strains of staph, just like there are different “breeds” of dog. All of you can easily describe the difference between a pit bull, and a poodle…right? Most of us are colonized with a harmless form of staph called staph epidermidis…this bacteria behaves much like a poodle in my analogy. Occassionally people get colonized (colonization is NOT infection) with a different type of staph…one that behaves like a pit bull in my analogy. This staph bacteria is called staph aureus. It is differentiated from the other staph, in the laboratory, based on whether it makes an enzyme called coagulase. Coagulase is one of many “virulence factors” that staph aureus possesses. Virulence factors are traits of the bacteria that increase its ability to cause infection. You can read about coagulase here: http://en.wikipedia.org/wiki/Coagulase. Other virulence factors allow the staph to digest through tissue planes, making it invasive.

    MRSA is an abbrievation which stands for Methicillin Resistant Staph Aureus, a substrain of staph that is resistant to the antibiotic methicillin. ALL staph aureus is virulent AND invasive, the only difference between MRSA and MSSA (Methicillin Sensitive Staph Aureus), is which antibiotics can be used to treat it.

    Simply finding MRSA in your nose does NOT mean your sinuses are infected with MRSA. Many people, especially heath care workers, and those who have been hospitalized, will be colonized with MRSA. You truly need a culture of the sinus itself to evaluate whether or not you have a MRSA sinusitis. When a culture and sensitivity of the sinus is taken, the bacteria is grown on a plate and subjected to disk infused antibiotics. This is how the antibiotic choice can be optimized (“sensitivity data”)..it tells the laboratory technician which antibiotics inhibit the growth of the organism being cultured. MRSA can be sensitive to a wide range of antibiotics including doxycycline, Bactrim or Septra, Levaquin, Clindamycin…but only a culture with sensitivity will confirm which antibiotic will be most effective. Zyvox is new, very effective, very expensive and MAY be restricted in some institutions, meaning only a specially trained doctor in infectious disease can prescribe it. This is to prevent it from being over-used and causing antibiotic resistance.

    Anyone who has a history of MRSA in the nose should get a prescription for bactroban to put up in the nose to help de-colonize it. Anyone who has sinusitis and a concern for having MRSA in the sinuses should have a culture and sensitivity done on the sinus drainage performed by a qualified ENT who can then prescribe the appropriate antibiotic. There is no “one size fits all” with regard to antibiotic choice. MRSA in one person can be quite susceptible to several antibiotics and be completely resistant to those same antibiotics in another person.

    Hope that helps.

  12. Peggy Jones says:

    Thanks for the latest info on sinus infection treatment and the explanation of MRSA. Since I wrote my story in January of this year, I was told in February that I had “come to the end of my antibiotic road” and that no more sinus surgery should be performed. My body has become completely antibiotic resistant. My ENT doctor and my allergy doctor have done a complete work-up on my immune system and I am now doing subcontaneous gamma gard weekly infusions to try to keep the sinus infection from invading my pulmonary system. I am trained to do the infusions by myself at home and am doing fairly well. I still have continual infectious post-nasal drip and have been told these antibody infusions will be an on-going treatment. Is there a possibility that new antibiotics will be developed in the future that might clear up this chronic infection so I do not have to do the weekly infusions? I’ve not heard about research for new antibiotics.

  13. Mo says:

    I also was on IVIG for 4 years but monthly for CIDP. It did not help my sinus infections. I’ve just had immolpgical studies at National Jewish Hospital in Denver which were OK except for low memory cells. If I understand this correctly, my body doesn’t recognize the infection and my immune system doesn’t fight it. After two major GI surgeries for the prevention of sinus infections and the consequence of too many antibiotics, I am at a loss. I am now a MRSA carrier. I have grown this on my last three sinus cultures. I have had several courses of Bactrim without much help. I’m better on it, but as soon as I stop, there comes another infection. Any ideas?

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