08/30/2015 10:28 EDT | Updated 08/30/2016 05:59 EDT

How Microbes Add Misery to Chronic Sinus Issues

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It's a scourge comprised of sniffles, soreness, and snot. Sinusitis affects every one of us at some time during our lives and for the most part, we suffer the symptoms until they eventually subside. But for 5 per cent of Canadians, the troubles seem to go on without end.

Medically speaking, the condition is called chronic rhinosinusitis and for decades, it has been a mystery. What starts off as the signs of a cold or allergy soon becomes a rather complicated problem for which there are few treatments and even less cures. Most of the time, medications are prescribed but some cases become so dire surgery is needed to help a person finally breathe clear.

What makes this ailment so frustrating is the lack of a proper cause. Several possibilities have been considered but there is no one single culprit. The list of suspects includes genetics, cigarette smoke, and allergies. But Sinus Enemy #1 has always been thought to be bacteria.

The allegations are not unfounded as bacteria are known to cause a variety of problems in the head, mouth, and neck area. They find a way into the various areas and colonize, forming communities known as biofilms. When these get into the sinuses, they may trigger the immune system and force it to go into battle much like an infection.

But, unlike the usual colds and coughs, these biofilms are incredibly resistant and prolong the fight from days and weeks to months and years. Our bodies turn to chronic inflammation in order to continue the fight but that comes with consequences, such as symptoms mimicking allergies, the formation of polyps, and the most troublesome of all, deformation of tissue inside our cavities.

Figuring out which bacteria are responsible has been somewhat of a challenge. Many species have been suggested as having a cause but there has been little proof to demonstrate exactly how they are involved. That changed last week when an international team of researchers provided the evidence to show just how bacteria are involved.

The process involved collecting 115 samples of nasal tissue from a collection located in Belgium. Each had come from a person undergoing nasal surgery. Of these, 20 were controls, 15 were from people with cystic fibrosis, and the rest had some form of chronic rhinosinusitis. They divided these samples into those with nasal polyps and those without.

Once the samples were separated, the team looked for the presence of microbial organisms. They focused on some of the usual suspects including Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli and a variety of fungi. They also looked for immune molecules to determine how chronic inflammation was involved. With the markers determined, the team analyzed the data to reveal any possible conclusions.

The results came back with a variety of surprises. The first had to do with the bacteria found. Only P. aeruginosa and S. aureus were higher in number in those with chronic illness than compared to the controls. The number of other bacteria and fungi were the same. This suggested these two species contributed the most to complications.

Looking closer at S. aureus, the team found a linkage to the formation of polyps. This wasn't entirely unexpected as the bacteria can cause cysts and other growths under the skin. To the team, this association seemed to be confirmation of the role of toxins. When these molecules are released they cause breakage of the skin. The body is forced to use fibrous tissue in the healing process. Over time, this new growth accumulates to form the polyp.

As for P. aeruginosa, the team expected to see higher levels in those suffering from cystic fibrosis as it is a major problem in those suffering from condition. But there was no such link. Though there were more bacteria in these patients compared to controls, the numbers were similar to others with sinusitis. This suggested the process of biofilm formation was not linked to the disease. Instead, the bacteria seemingly find their way there and initiate troubles.

As for the mechanism of attack, the immune molecules offered some excellent insight. The group learned S. aureus was mainly responsible for a response mimicking allergies and asthma while P. aeruginosa caused a different type of immune response similar to that of an infection. This suggested people would suffer different symptoms based on the major bacterium causing troubles. This also meant for those with S. aureus, the problems would be far worse than P. aeruginosa.

The authors concluded the relationship between bacteria and chronic sinusitis is far more complex than originally believed. They also realized the nature of the bacteria and the actual form of inflammation occurring was of utmost importance. To better help patients, the best option is to first identify the bacteria then develop treatment based on the type of immune response.

The study also revealed the importance of calming inflammation in order to prevent long term symptoms. While anti-inflammatories have been suggested as treatment in the past, this study suggests it may be the way forward. Medications may offer help as might probiotics. Though this latter suggestion is still in the early stages, studies have shown these good bacteria can reduce inflammation and possibly help to lower the chance for complications.


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