Microsoft word - sinusitis press release.clarice-2


Tina M. Foss, Executive Manager
Asthma Allergy Centre
(503) 620-5614
Breakthrough Medical Treatment for Chronic Sinusitis
Relieves Symptoms in 88% of Patients—Without Surgery

Portland, Ore. (March 18, 2008) — Kuo Casey Chang, M.D., announced today the results of
pioneering research that shows chronic rhinosinusitis can be treated successfully without surgery.
Dr. Chang and his colleagues at Portland’s Asthma Allergy Center developed a treatment
protocol using a topical nasal decongestant, nasal steroids, hypertonic saline irrigation, and low-
dose macrolides. Eighty-eight percent of patients using this protocol became asymptomatic or
very mild with treatment, and 75% remained so at long-term follow-up. These results are
particularly remarkable considering that 15% of the patients in the study had already undergone
sinus surgery (the traditional treatment for chronic sinusitis), with no improvement in symptoms.
Although several studies conducted in Japan, England and Australia have indicated that
macrolides, such as erythromycin and Biaxin, are effective in treating sinus inflammation, this
was the first American study to use macrolides in the treatment of chronic sinusitis. The study
consisted of 119 patients divided into two groups. The first group consisted of 72 patients who
were first prescribed a topical nasal decongestant, nasal steroids and hypertonic saline irrigation.
Thirty-seven patients (31% of the total) became either asymptomatic or very mild after this
treatment alone. Thirty-five patients in this group did not show dramatic improvement at 6 weeks,
so a low dose of macrolide (Zithromax, Biaxin, or erythromycin) was added to their treatment.
The second group consisted of 47 patients who had more severe symptoms at presentation. Each
was given a topical nasal decongestant, nasal steroids, hypertonic saline irrigation and a
macrolide from the beginning of treatment. Six of the patients (or 5%) entered the study with
immunity defects. The protocol was so effective that four of them initially healed as a result of
treatment. However, all of them eventually developed chronic sinusitis again.
All patients were treated for a median of 4 months. (Actual length of treatment ranged from 1.5
months to 23 months.) The combined success rate of both groups was 88%. At long-term follow-
up (up to 38 months, with a median of 12 months), 71% of the patients remained symptom-free.
If the six patients with immunity defects are excluded from this analysis, the study’s long-term
success rate was 75%.
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Why the treatment worked

Research indicates that keeping sinuses open plays a critical role in the successful treatment of
chronic sinusitis. The long-term use of a nasal decongestant, such as Afrin nasal spray, helps
diseased sinuses heal by keeping them open for the duration of the treatment (similar to sinus
surgery). The nasal steroid prevents the rebound effect from prolonged use of a nasal
decongestant. Irrigating the nasal passages with a hypertonic saline solution aids the removal of
mucus from the sinuses. The addition of macrolides, which are antibiotics, makes the protocol
even more effective—not because of their anti-bacterial activity, but because of their anti-
inflammatory effects on sinus inflammation.
Potential side effects of the treatment

Three patients in the study experienced elevated eye pressure similar to that experienced in
glaucoma. Because the treatment protocol required that patients lay supine for 5 minutes, it is
possible that the nasal steroids flowed back into their eyes through their tear ducts, resulting in
elevated eye pressure.
Scientists have traditionally believed that tear ducts are one-way ducts with multiple valves that
prevent the backflow of nasal content into the eyes. However, in 2006, Dr. Chang and his
colleagues reported that over 50% of subjects showed backflow of ophthalmic fluorescent
solution into their eyes when the solution was instilled in the nose and the subjects subsequently
blew their noses. In one subject, gravity alone caused the backflow of fluorescent solution into
the eyes.
To ensure patient safety when following this protocol, therefore, it is essential to check eye
pressure during treatment.
Announcement of findings

Dr. Chang announced the results of this research in two papers presented at the 2008 meeting of
the American Academy of Allergy, Asthma and Immunology, which took place in Philadelphia
March 14 to 18. The first paper was titled “Treatment of chronic rhinosinusitis with long-term
topical nasal decongestant, nasal steroids, hypertonic saline irrigation and low-dose macrolide.”
The second paper was titled “The safety and risks of long-term use of topical nasal decongestant
and nasal steroids.”


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