UW ENT Grand Rounds February 18th, 2009

6:30 am – Scott Manning, MD “Allergic Fungal Sinusitis & Update on Pediatric Sinusitis” 

Dr. Manning began with the notion that chronic rhinosinusitis (CRS) is not a disease but “an endpoint of many interacting conditions.” Allergic rhinitis, GERD (acid reflux), eczema, migraine, and otitis (ear infection) are several conditions he mentions that add up to what the everyday patient calls “sinus trouble.” At Nova Sinus Center, we take this idea to its logical conclusion to teach patients that the rhinosinuses are often an “LED indicator” of overall inflammatory burden.

Just think of the game Operation. The playmate patient’s bright red nose lights up as the “surgeon” tries to solve other seemingly unrelated health problems. What does “water on the knee” for example have to do with CRS? Both are evidence of inflammatory processes. No one would argue that edema and effusion point to inflammation – whether in the nose or the knee. In fact, Dr. Manning observes that world is becoming “more allergic and more inflamed.” Urbanization, air pollution, high fat diet, and early introduction of food antigens are just some of the contributing variables he references.

In other words, what Dr. Manning may be saying is “where there’s smoke there’s fire.” That is, if one inflammatory process is being observed and treated, we can assume there are others. I treat the rhinosinuses as if they are the “red light” indicator of overall health. It would seem reasonable then, that treating immediately and routinely with steroids is like pulling the plug on your car’s warning indicators. Just because the light’s not on doesn’t mean your engine won’t be crashing from lack of oil.

One cause of chronic rhinosinusitis that comes up time and again during ENT rounds is primary ciliary dyskinesia (PCD) – a genetic defect causing a reduction of mucus clearance from the respiratory tract. This condition appears so often in clinical conversation that it would seem my ENT colleagues believe it’s prevalent even in the absence of biopsy-demonstrated PCD.

The REST treatment at Nova Sinus Center is designed to amplify and assist ciliatory motility resulting in improved discharge of noxious elements. Dr. Manning confirms a prevailing notion that ciliatory motility is a key factor in rhinosinus health. Clearly, anything that can be done to facilitate ciliatory motility will help reduce rhinosinus distress and inflammation. The REST treatment appears to be a missing link – a first line defense – preferable to covering up sinus trouble with steroids or moving straight away to invasive surgery.

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