AUGUSTA, GA -- It's like having a bad cold that won't go away. Sixteen-million Americans suffer from chronic sinusitis and if they don't get treated quickly it can turn into a dangerous infection. Now a new blood test is making it easier for people to get on a fast track to feeling better.
Artist Cindy Epps believes the beauty of her paintings is in the details. This past year chronic sinusitis turned her world into a blur. Cindy says, “My head hurt. My face hurt. It's hard to be able to focus on something beautiful and creating and doing something like that when you feel miserable like that
On the left is a healthy sinus. On the right is what it looks like when Inflammation causes severe pressure and pain, but diagnosis is difficult because it can have so many causes. Now a new blood test is clearing up the confusion.
Doctor Stilianos Kountakis, an Otolaryngologist with the Medical College of Georgia says, “Using a drop of blood, we are able to tell who are the individuals that have chronic sinus problems."
The test measures specific proteins in the blood linked to chronic sinusitis. In a study of more than 100 people, the blood test was able to identify those
who had the condition even if they had no symptoms.
The doctor says, “It's a more objective test. Also, we can determine the type of sinusitis that the patient has."
The test allows doctors to get patients on the right medications sooner and tailor the treatment to a person's blood profile.
Doctor Kountakis says, “It's like a fingerprint for that individual patient, and that individual disease."
After months of suffering, Cindy found the right treatment routine, allowing her creativity to shine through. She says, “I feel 100 percent better and I feel like I can do the things that I love to do."
The National Institutes of Health says in rare cases, untreated sinus infections can lead to a brain infection. There's no cure for chronic sinusitis, just careful monitoring and management with medication.
See below for Dr. Kountakis's complete interview.
For more information, please contact:
Tony Baker, Public Relations
Medical College of Georgia
(706) 721-4421
Tbaker@mcg.edu
Stilianos Kountakis, M.D., Ph.D., an Otolaryngologist at the Medical College of Georgia in Augusta, Ga., talks about a new blood test to identify sinusitis sufferers.
What is sinusitis?
Dr. Kountakis: Sinusitis is an inflammation of the lining of the sinuses and it can be acute or chronic. We define acute when the patients have symptoms for up to four weeks, but no more than that. The cause of that type of sinusitis is usually an infection -- either a viral infection or bacterial infection. We define chronic sinusitis when the patients have symptoms for at least three months or 12 weeks and longer. That is a complex disease. There is not really one single cause that can lead to chronic sinusitis. Rather, chronic sinusitis is a syndrome of different problems -- a syndrome of diseases. That is the problem we are having when we treat patient with chronic sinusitis. We lump them all together, but initially when they present to us we do not really know what causes the problem to begin with.
Is sinusitis hard to diagnose?
Dr. Kountakis: The diagnosis of chronic sinusitis is based on having certain symptoms, plus objective evidence of having inflammation, either on endoscopy or on a cat scan. We ask the patients what kind of symptoms they have and once we have the symptoms we know whether or not there is a suspicion for chronic sinusitis or sinusitis. Then we do our evaluation with nasal endoscopy or obtain radiographic examination using a cat scan or other films, combine the two and diagnose the patient with sinusitis.
Tell me about this test you developed.
Dr. Kountakis: The reason we developed this test was because we could not really classify patients with chronic sinusitis. We have problems with outcomes and making recommendations because chronic sinusitis is not a single disease. It can be because of an infection, it can be because of an allergy to a fungus, it can be because patients have a genetic predisposition to have inflammation in the lining of the sinuses, like the patients will have asthma or nasal polyps, or patients will have what we call the aspirin or samter's triad. They are sensitive to aspirin, they have aspirin-sensitive asthma, and also they have chronic rhinosinusitis with nasal polyps. The blood test we are working on may help us to determine whether or not a patient has sinusitis and also help us differentiate between all these types of sinusitis.
How does the test work?
Dr. Kountakis: The test identifies the inflammatory protein profiles in the blood of the patients. We thought that every patient that has sinusitis has inflammation and that; the different types of chronic sinusitis may create a different inflammatory profile. We take a sample of blood and separate the serum from the red blood cells. The serum is vaporized using a laser, and then the free molecules are allowed to flow through a special tube. Now all these different proteins being generated have different molecular weights. The proteins that have very light molecular weights travel farther than the bigger sized proteins. The bigger size proteins will not go as far, so we are able to separate them on the side of the tube. The computer picks that up so we get a spectrum of molecular weights. For example, when you look at a light from a star, you have a spectrum of light with different light frequencies. Similarly, the test generates a spectrum of different molecular weights, and it's like a fingerprint for that individual patient and that individual disease. In our first study to evaluate the test, we included 96 patients with chronic sinusitis and 38 controls who did not have sinusitis. Our results showed that we were able to separate the patients who have chronic sinusitis versus the ones who did not. Using a small amount of blood, we were able to tell which individuals have chronic sinus problems compared to the ones who did not.
What does the blood test allow you to do for sinusitis patients?
Dr. Kountakis: The idea is for early intervention or to basically come up with a management plan for each individual patient depending on the subtype of disease that person has. We did a second study that is being now considered for print. It has not been printed yet, but we were able to look at patients with chronic sinusitis and identify the ones that have allergic fungus sinusitis using our test. This is what the patient you interviewed has -- allergic fungal sinusitis, which is different that the patient for example who has samter's triad, which is aspirin-sensitive asthma and chronic sinusitis with nasal polyps. So we can determine if a person has chronic sinusitis or not using a totally objective test -- 100 percent objective test. In addition, we can determine the subtype of sinusitis that the patient has.
In the future, we envision a way to monitor how patients with sinusitis are doing. Sometimes by the time the patients develop symptoms and their inflammation in the sinus lining becomes worse, we have an uphill battle since their inflammation has already progressed. They develop nasal polyps; they develop a bad reaction if they have allergic fungal sinusitis. In the future it would be possible to monitor how the patients are doing by looking in their inflammatory profile in the serum of their blood. So we can actually follow a patient with the blood test and find out that way how their overall inflammation is doing. This part of our research is in progress and we need to do more to understand all of this.
What would this blood test mean for sinusitis patients?
Dr. Kountakis: It would mean, number one, a better understanding of their disease, a more appropriate and targeted medical management and so better outcomes. For example, right now we overuse antibiotics because, especially out there in the community, chronic sinusitis usually means an infection to most physicians and it is really not. It is an inflammation most of the time. It is not really a result of an active infection. We are going to be able to select a more appropriate medication, follow up will be easier, and more importantly, we are going to be able to categorize them, put them in and understand exactly what subtype of sinusitis that they have.
What is the current method for determining if a patient has sinusitis?
Dr. Kountakis: We first take a history and we ask what kind of symptoms the patients have. If the symptoms suggest sinusitis, then we have to do an objective test -- look in the nose, usually using an endoscope, because an endoscope gives you a better view of the area where the sinuses drain instead of looking at the tip of the nose. If there is an x-ray available, we can take a look at it and see if there is any objective evidence of sinusitis. The objective evaluation is needed since there are many other diseases out there that have symptoms similar to sinusitis. For example, migraine headaches; I have a lot of headache patients that come to my office thinking they have sinusitis. What they actually have is a vascular type of headache or primary headache syndrome.
What treatments are available now to patients with sinusitis?
Dr. Kountakis: I will start with the simpler medicines we use to treat sinusitis. We like to use normal saline spray or irrigations to douche the nose, and a lot of patients report improvement with that. Then if there is an active infection, we like to use antibiotics, and the choice of antibiotics depends on whether the patient has acute or chronic sinusitis of if they have had recent antibiotic therapy. If the patients are not complicated and do not have recent antibiotic therapy, we use something simple; such as amoxicillin, that type of antibiotic. If the patient is more complicated, we use a more broad-spectrum antibiotic. We also like to use anti-inflammatory medications, such as intranasal steroid sprays. Those intranasal steroid sprays work like a shotgun. They control the way the nasal lining reacts as to whatever bothers it out there. They reduce inflammation and they improve breathing through the nose. Those are the two mainstay treatments. If they have allergies, we have to manage the allergies very aggressively. Allergy is basically an inflammation and if the patients have an inflammation already because of their sinusitis, having allergies is like fuel on the fire, so we like to control that to improve their symptoms.
End of interview
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If you would like more information, please contact:
Stilianos Kountakis, MD, PhD
Medical College of Georgia
Augusta, Ga
Otolaryngology@mail.mcg.edu
Http://www.mcg.edu/otolaryngology
