Steroid Treatment Not Effective for Chronic Sinusitis in Elderly: Study

According to a new recent study by Vanderbilt researchers, older patients with chronic sinusitis may develop resistance to steroid treatments. It is a disease in which the nasal cavity is affected; paranasal sinuses last for many years. The study was published in the Journal of Allergy and Clinical Immunology. The researchers selected 147 patients aging from 18 to 78 who were diagnosed with chronic sinusitis and needed an emergency sinus surgery.

Researchers were eager to find out the subgroups behind this inflammatory signature including different types of cytokines and proteins triggering inflammation in the mucus and tissues. The Vanderbilt researchers found a known subgroup in all the patients aging above 60.

This amazed them, thus they continued their research by categorizing the patients on the basis of their age. During their study, the researchers noticed that all the patients had a difference in their tissue specimens which was taken during the surgery, immune markers as well as inflammatory proteins located in the tissues and mucus.

Justin Turner, MD, PhD., and head of the faculty of Otolaryngology-Head and Neck Surgery said: “Most chronic sinusitis in North America—particularly the kind that requires surgical intervention—has an inflammatory signature characterized by a group of cytokines associated with allergy and asthma called Th2-associated cytokines.” Justin is also playing his role as a lead investigator in this research.

“Older patients tend to not have significant elevations of those particular cytokines. In contrast, they have an elevation of cytokines that are associated with the body’s innate immune function and both acute and chronic inflammatory responses, and that is highly dependent on age. You don’t see an elevation in those cytokines until around age 60, and then from that age on, there’s a progressive increase in the levels of those cytokines seen in the mucus and the tissue of those patients.”

Due to this vast difference, the researchers think that the steroid treatments using Th2- associated cytokines would be less effective for the older patients. In order to cure the disease and manage its manifestations, topical steroids like nasal sprays and irrigations are used.

Turner said: “We’re hoping this data will stimulate some interest in the elderly population with respect to chronic sinusitis management because it suggests we may need patient-specific treatments targeting these older patients. That’s particularly important because steroids can have a number of short- and long-term adverse effects and those side effects are much more likely in older patients than they are in younger patients.”

To further strengthen the idea about this variation and his findings, the research team is currently working on the data collected over the past years and analyzing the outcome of the surgeries, especially of the older patients. In a nutshell, the data clearly shows sinus surgery might prove to be less effective for older patients than younger patients. It also means that the postoperative care may not be able to provide such relief to these patients.

Turner said: “Our end goal is that we’re looking for better ways to treat chronic sinus disease and to understand the disease process a little better. We feel we have identified a characteristic of a fairly large population of patients that may ultimately change our treatment of those patients going forward.”

“It at least suggests that we need to be doing more research targeted at that population.” The elderly patients may also develop a link with chronic microbial infection or colonization.

Roland Eavey, MD, Guy M. Maness head of the Department of Otolaryngology and leader of the Vanderbilt Bill Wilkerson Center said: “This study serves as an example to reinforce the vital rationale for academic medical centers.”

“A curious clinician-scientist, teamed with collaborative clinicians and trainees, in an environment with laboratory and basic researcher resources, sets sail to discover the Far East and on the way encounters the New World. The finding that age serves as a remarkable—yet unexpected—treatment/response insight is highly significant.”

Adeena Tariq

Adeena's professional life has been mostly in hospital management, while studying international business in college. Of course, she now covers topics for us in health.

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