Sinus surgery curbs dangerous bacterial migration

​The sinuses are a bacterial reservoir that can infect the lungs and cause life-threatening pneumonia in patients with chronic lung disease. Groundbreaking keyhole surgery and local treatment with antibiotics spray inhibit bacteria migration.

You may know what it feels like to have a bad cold that turns into a sinus infection, makes it difficult to breathe, makes you tired and makes your head feel heavy. Try to imagine feeling like this every day. Patients with a chronic lung disease like cystic fibrosis, primary ciliary dyskinesia (PCD) and chronic obstructive pulmonary disease (COPD) often have inflamed sinuses which can be difficult to treat. Many of these patients therefore develop chronic sinusitis.

United airways infect

While healthy people have well-functioning airways, in lung patients the cilia in their airways that transport mucus from the lungs to the pharynx do not work properly. They therefore produce sticky mucus that is difficult to cough up. 
Patients often contract lung infections, even if they have received new, healthy lungs from a donor. The 'united airways' theory led physicians to suspect the sinuses as a possible source of infection.
"We suspected that there could be a link between the bacteria in the sinuses, and the bacteria that destroy the lungs in patients with cystic fibrosis. When patients are given antibiotics to treat pneumonia, the bacteria hide in the sinuses. They hide there safe from the antibiotics. So, we decided to examine whether the united airways, i.e. the connection between the upper and lower airways, were the reason that patients can infect themselves with the bacteria hiding in their sinuses. And this turned out to be the case," said Professor Christian von Buchwald, a consultant who was one of the first in the world to put forward this hypothesis almost ten years ago and to introduce this new treatment method.

Trial with coagulated antibiotics formula 

The bacteria that survive antibiotic treatment risk developing resistance, thereby becoming dangerous for patients when they spread to the lungs. Physicians are therefore trying to introduce more effective local treatment with antibiotics in the inflamed sinuses, said Dr Kasper Aanæs who has been involved in the new treatment in connection with his PhD under supervision from Christian von Buchwald. 
"When we've sucked all the infected pus out of the sinuses and the frontal sinus, cleared the airways and treated with antibiotics, the patients feel a difference very quickly. Their airways become better, fatigue disappears and their quality of life improves considerably." 
Kasper Aanæs has been performing this operation for more than six years and has seen the difference it makes for the patients. However, there is still room for improvement.
"We've been challenged because the antibiotics disappear quickly from the sinuses when patients sneeze or blow their noses. This means that the treatment does not stay in the sinuses long enough to have an effect. We're therefore conducting trials in collaboration with a Danish medical firm, in which we're testing a combination of purified fibrin, which is the patients' own coagulation substance in the blood, and antibiotics. By treating sinuses with this combination, we hope that the antibiotics will stay a little longer, for up to 14 days, while the added layer of coagulated fibrin and antibiotics slowly dissolves in the sinuses," said Kasper Aanæs.

More treatment options 

This relatively new knowledge about bacterial migration and the united airways between sinuses and lungs has attracted interest from foreign experts. Many international colleagues are currently introducing this treatment as a standard procedure, after the results were presented at major international congresses in the US. However, the sinuses could conceal possibilities for even more preventive treatments, for asthma and allergies for example.
"We're seeing some of the same tendencies in asthma patients who also have inflamed sinuses and often develop polyps. So, we're hoping that this new knowledge can bring us closer to a preventive treatment and to knowledge about how asthma and allergic reactions in airways occur," said Christian von Buchwald.

Sinuses surgery – in brief

Every year, the Department of Otorhinolaryngology, Head and Neck Surgery & Audiology uses this new method to treat more than 50 patients suffering from a severe lung disease, and demand for the treatment exceeds capacity. The treatment was introduced and developed in collaboration with colleagues from the Danish Pediatric Pulmonary Service outpatient department, the Department of Infectious Diseases and Rheumatology, and the Department of Clinical Microbiology at Rigshospitalet. 

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