A NEW APPROACH TO TREATING COMMON SINUS CONDITIONS

Treatment for many common sinus conditions has changed over the past ten years – with MQ Health otolaryngology researchers and surgeons contributing to a new approach.

Upper airway-related conditions – such as rhinitis, sinusitis and asthma – are common, affecting around nine per cent of the population. Treatment approaches for these conditions have been based on diagnosing them as infections, and treating them with antibiotics.

However, evidence now suggests that many patient’s sinonasal disease is better understood as a condition caused by chronic inflammation rather than infection.

“Our approach to sinus inflammation – the endotyping of the inflammation, the surgery and the treatment afterwards – has all changed in the past decade,” said Professor Harvey, rhinologist and ENT surgeon at Macquarie University Hospital.

“Some of the research that informed this change was performed at Macquarie University by doctoral student Kornkiat Snidvongs in 2013. His work determined chronic inflammation as underlying many common conditions.”

Treatment by the MQ Health ENT team now involves an endoscopic surgical intervention to change the anatomy of the airways. Patients are then given a corticosteroid nasal irrigation and a topical anti-inflammatory treatment, which they  self-administer daily.

“In this treatment paradigm, the purpose of sinus surgery is to create access for topical therapies rather than relieving obstruction,” explained Professor Harvey.

“High-volume and positive pressure irrigations allow pharmaceutical preparations to better contact sinus mucosa and enhance the mechanical removal of mucus and inflammatory products. This is the essential intervention for inflammatory disorders of the sinuses.”

Melbourne-based Rachel Levin experienced first-hand the benefits of the new approach. She had lost her smell and taste for about five years, suffered recurrent sinusitis and chronic congestion, and was unable to find a specialist to treat her case successfully. At one point, she had simple treatment for polyps, and another for allergies. Neither stopped her sinus congestion nor brought back her smell or taste.

Rachel eventually found out about the new approach for her condition after researching the latest in treatment for smell and taste disorders in the UK. This led her to MQ Health, one of the few centres in the country performing the new approach.

“When I met with Professor Harvey, it was a light bulb moment,” said Rachel. “Everything he said made sense. I liked the idea that it wasn’t ‘aggressive’ surgery – as another surgeon had suggested I might need as a ‘last resort’ measure.

“I had the surgery last year. I could fly home within 24 hours later, and you couldn’t outwardly tell that I had had sinus surgery as there was no bruising or swelling. I have my smell and taste and, more importantly, my quality of life back.”

Professor Harvey said that the academic model of medicine practiced at MQ Health allows the translation of research conducted within the precinct to make its way into clinical practice very efficiently.

“Our team had immediate access to the outstanding research performed by past fellow and doctoral student Dr Snidvongs to guide Rachel’s treatment and she has had a fabulous outcome with the resolution of all her symptoms and the return of smell,” he said.

“ENT surgery for sinus inflammation is still transitioning to this new approach, which should become increasingly used as standard treatment in years to come. The research we have undertaken and continue to produce at Macquarie University is part of the evidence that is shifting current clinical practice.”

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