A nose that completely clogs up. check. But about 16% of adults have chronic sinusitis. Relief is in sight thanks to medical breakthroughs involving antibodies and nasal bacteria.
Sinusitis refers to inflammation of the sinuses (sinuses) in the skull that are filled with air. These sinuses are located at the level of the jaw, around and above the eyes and deeper in the skull. When the sinus mucosa that covers the inside of these sinuses becomes inflamed, this often causes typical complaints such as a stuffy nose, difficult nasal breathing, headache, mucus in the throat or nose and even loss of smell and taste. “Acute sinusitis is almost always a viral infection and often shows up together with a cold. You can feel quite sick because of it, but complications such as a swollen eye or a brain complication are exceptional, unlike in the past. This usually goes away relatively quickly.” , says ENT doctor Prof. Claus Bachert (UZ Gent).
Neuspoliepen
If the complaints persist for more than three months, this is referred to as the chronic variant (CS). “There are two forms: CS without the nasal polyps, which occurs most frequently, and the variant with nasal polyps. In addition to the normal complaints, the latter group also no longer has a sense of smell,” explains Prof. Bachert. “There are quite a few misunderstandings about nasal polyps. This is completely separate from the more well-known throat polyps. Nasal polyps refer to swellings of the sinus mucosa that can completely block the nose. They do not arise during childhood but only after 20 years or later. Moreover, they often do not develop. or only discovered after 4-5 years, because doctors have to look into the nose through a nasal endoscope to detect them.”
Recognize and treat
The diagnosis of CS is based on an examination of the symptoms. “We then start a treatment for 2 to 3 months with a spray with topical steroids and/or antibiotics in the form of a low dose of macrolites. This is followed by a CT scan of the sinuses. Only after you have been treated and then there are still signs If there is an inflammation, you can speak of a CS. In practice, the reverse often happens and a scan is immediately taken.”
In the group without nasal polyps, the standard treatment consists of that spray and medication. Sometimes that is enough, sometimes the disease can disappear on its own, but in quite a few people the complaints do return. “Surgery is usually the next step. The sinuses are opened, the infection is removed from the sinus mucosa, while the nasal mucosa must be spared at the same time. Removing the nasal concha is not recommended. After all, the nasal mucosa is important for your immune system and your sense of smell. .”
Antibodies as game changers
If nasal polyps are also involved, the approach changes. This consists of higher doses of topical steroids via spray or drops in combination with doxycycline (antibiotic). “This often requires lifelong treatment because nasal polyps rarely resolve on their own. In addition, they are often associated with asthma and allergy, which must be treated simultaneously,” emphasizes Prof. Bachert.
If this initial treatment does not provide sufficient results and the polyps continue to grow, a so-called rebooth operation can help. “A fairly new technique that is performed on a very delicate place at the level of the brain and eyes. Nasal polyps are removed and all sinuses are opened while the nasal mucosa is reset, a bit like a faulty computer. People are relieved of complaints for years afterwards.”
As an alternative to such a difficult intervention, another innovation is currently being looked at. International studies by Prof. Bachert’s team have shown that a therapy with monoclonal antibodies (so-called biologicals) can reduce nasal polyps and significantly reduce symptoms. “These innovative agents have been used successfully for some time in asthma and atopic eczema and are now also shown to have an effect in CS with nasal polyps. This is the first time in decades that we can offer people an effective new drug with very few side effects. ” Follow-up studies are currently underway to determine which types of antibodies now give the best results. The other side of the coin is the – for the time being – high cost price.
Snot
This may be an intermediate step towards a second, even tougher, revolution that is on the way in the longer term, assures Prof. Bachert. “There are promising studies in the pipeline for small molecules that are just as effective as the antibodies. In addition, in the future we will have beneficial nasal bacteria that we will be able to introduce into the nasal mucosa and produce a kind of medication there to fight sinusitis.” Immunology is developing rapidly in this area, which will greatly reduce the number of operations.”
What can you do yourself to prevent sinusitis?
– Apply strict hand hygiene
– Avoid frequent hand-nose contact
– Nasal rinses can provide comfort and cleanse the nose. This can be done by pouring physiological water or homemade salt water (9 g salt / 1 liter water) into a nostril with a nasal jug. Meanwhile, say the letter K so that the water can flow from one nostril into the other while preventing the water from flowing down your throat. Disinfect the nasal can after use.
– Smoking cessation, because smoking is one of the known causes of CS.
Sinusitis refers to an inflammation of the sinuses (sinuses) in the skull that are filled with air. These sinuses are located at the level of the jaw, around and above the eyes and deeper in the skull. When the sinus mucosa that covers the inside of these sinuses becomes inflamed, this often causes typical complaints such as a stuffy nose, difficult nasal breathing, headache, mucus in the throat or nose and even loss of smell and taste. “Acute sinusitis is almost always a viral infection and often shows up together with a cold. You can feel quite sick because of it, but complications such as a swollen eye or a brain complication are exceptional, unlike in the past. This usually goes away relatively quickly.” , says ENT doctor Prof. Claus Bachert (UZ Gent). If the complaints persist for more than three months, this is referred to as the chronic variant (CS). “There are two forms: CS without the nasal polyps, which occurs most frequently, and the variant with nasal polyps. In addition to the normal complaints, the latter group also no longer has a sense of smell,” explains Prof. Bachert. “There are quite a few misunderstandings about nasal polyps. This is completely separate from the more well-known throat polyps. Nasal polyps refer to swellings of the sinus mucosa that can completely block the nose. They do not arise during childhood but only after 20 years or later. Moreover, they often do not develop. or only discovered after 4 to 5 years, because doctors have to look into the nose through a nasal endoscope to detect them.” The diagnosis of CS is based on an examination of the symptoms. “We then start a treatment for 2 to 3 months with a spray with topical steroids and/or antibiotics in the form of a low dose of macrolites. This is followed by a CT scan of the sinuses. Only after you have been treated and then there are still signs If you have an inflammation, you can speak of a CS. In practice, the reverse often happens and a scan is immediately taken.”In the group without nasal polyps, the standard treatment consists of that spray and medication. Sometimes that is enough, sometimes the disease can disappear on its own, but in quite a few people the complaints do return. “Surgery is usually the next step. The sinuses are opened, the infection is removed from the sinus mucosa, while the nasal mucosa must be spared at the same time. Removing the nasal concha is not recommended. After all, the nasal mucosa is important for your immune system and your sense of smell. “If nasal polyps are also involved, the approach changes. This then consists of higher doses of topical steroids via spray or drops in combination with doxycycline (antibiotic). “This often requires a lifelong treatment because nasal polyps rarely resolve on their own. Moreover, they often go hand in hand with asthma and allergies, which must be treated simultaneously,” emphasizes Prof. Bachert. If this initial treatment does not provide sufficient results and the polyps continue to grow, a so-called rebooth operation help. “A fairly new technique that is performed on a very delicate place at the level of the brain and eyes. Nasal polyps are removed and all sinuses are opened while the nasal mucosa is reset a bit like a faulty computer. People are relieved of complaints for years afterwards.” As an alternative to such a difficult intervention, another innovation is currently being looked at. International studies by Prof. Bachert’s team have shown that a therapy with monoclonal antibodies (so-called biologicals) can reduce nasal polyps and significantly reduce symptoms. “These innovative agents have been used successfully for some time in asthma and atopic eczema and are now also shown to have an effect in CS with nasal polyps. This is the first time in decades that we can offer people an effective new drug with very few side effects. ” Follow-up studies are currently underway to determine which types of antibodies now give the best results. The other side of the coin is the – for the time being – high cost price. This may be an intermediate step towards a second, even tougher, revolution that is to come in the longer term, assures Prof. Bachert. “There are promising studies in the pipeline for small molecules that are just as effective as the antibodies. In addition, in the future we will have beneficial nasal bacteria that we will be able to introduce into the nasal mucosa and produce a kind of medication there to fight sinusitis.” Immunology is developing rapidly in this area, which will greatly reduce the number of operations.”