The Future of Sinusitis Medications

If in 1975 a person with sinusitis somehow magically fast-forwarded herself to the office of a present-day ENT doctor, she would be in for some pleasant surprises.

Between CT scans, nasal endoscopes, and advances in surgery, the diagnostic and treatment options for sinusitis have improved dramatically. Now, what if today’s patient were thrust thirty years into the future?

I suspect there will be even greater progress. In the next few decades, I see important developments affecting sinus treatment in three areas: gene therapy, computerized surgery, and new classes of sinus medications.

Genomics and Gene Therapy

No doubt you’ve heard about the mapping of the human genome and gene therapy, both of which are aspects of an emerging field known as genomics. Basically, every cell in your body contains strands of DNA, genetic material that carries the code for about thirty thousand genes.

These genes create a detailed and specific pattern of proteins that serve as the body’s building blocks to make you the unique individual that you are.

They are responsible for your eye and hair color, as well as sinus-related issues like allergies and a tendency to grow polyps. Abnormalities in this pattern, such as a missing or extra gene, are associated with inherited diseases.

Sinus infections result from numerous diseases, some of which are genetic in origin. We’ve discussed a few, including cystic fibrosis and primary ciliary dyskinesia, but it’s likely there are dozens of other, more subtle ones that have yet to be identified.

At the moment, we only see the result: inflamed mucous membranes, thick mucus, and nasal polyps. But with the help of genomics, we should be able to gain insight into the specific gene or group of genes responsible for this symptom complex known as sinusitis.

So instead of our current shorthand of three categories of sinusitis patients Locals, Intermediates, and Systemics we might have twenty or thirty different types, identified with a number and letter system.

A patient with a certain genetic pattern of sinusitis genes might be classified as having Type 1A Sinusitis, while another has Type 2C. Diagnosis will be done on the basis of a blood or tissue sample, which is placed on a tiny chip, called a DNA microarray, and analyzed by a computer.

In theory, you would immediately learn which type of sinusitis you have. Armed with this information, your physician would know which medications are most likely to be effective for your condition, and whether you’ll benefit from surgery.

If the computer analysis reveals that your inflammation was triggered by a missing or defective gene, a normal copy of the gene could be incorporated into your cells by means of an injection or a tissue transplant, potentially curing you entirely of sinusitis.

To date, much of the research into gene therapy has focused on life-threatening diseases, such as cancer. Now, researchers are starting to focus more attention on chronic diseases, including diabetes and sinusitis.

Computerized and Robotic Surgery

Here, I’m not talking about a Jetsons-style world in which human-sized robots mingle with people at the supermarket and perform surgery in the operating room. It’s just a matter of computers and high technology playing an even greater role in surgery than they already do.

We now have image-guided surgery that allows the surgeon to navigate through a three-dimensional view of the patient’s sinuses from a computerized CT scan. Although this device can be tremendously helpful, it has limitations.

For example, the CT image is a static snapshot of the patient’s past, which fails to reflect changes that occur as the surgeon operates, removing bone and tissue.

The next step will be a real-time CT or MRI scan that’s instantly updated during surgery. This technology is already being used for certain types of neurosurgery and should be available to sinus surgeons in the not too distant future.

Such a device will help the surgeon remove all diseased tissue and reduce the risk of complications. Somewhat farther down the line, we can expect to see greater use of computer-directed surgical tools (robotics).

Humans have certain physical limitations that robots do not. For instance, our wrists can only rotate so far, and we have slight tremors. By contrast, a robotic arm can rotate 360 degrees without a tremor, allowing for more delicate and precise manipulations than humanly possible.

So in the operating room of the future, the surgeon will be sitting in front of a computer screen showing a three-dimensional view of the patient’s nasal passages. The surgeon will manipulate a control panel with highly calibrated joystick controls not unlike what you see on today’s video games.

This robotic technology has already been introduced for some abdominal, orthopedic, and heart surgical procedures. It’s only a matter of time before it’s applied to sinus surgery, where precise and delicate manipulations are critical.

New Medications

While computers will help make surgery safer and more efficient, I expect that operations for sinusitis will actually become much less common in the future. Surgery will still be needed for those whose sinusitis stems from anatomical abnormalities present at birth or caused by trauma later in life.

But most of the people we currently consider Intermediates and Systemics won’t need surgery, because of the introduction of new medications and techniques that address the root cause of an individual’s sinusitis.

The continued development of longer-acting and more broadspectrum antibiotics is one example where drug development will be helpful in the near future.

But the biggest impact on sinusitis over the next ten years is likely to be the development of whole new classes of medications that reduce inflammation and shrink or prevent polyps.

Trials are currently under way to test the effectiveness of drugs that block the inflammatory response (including one called anti-IL5) and inhibit the immune trigger (including one called anti-IgE) that can lead to sinusitis.

Another trial is planned to study the effectiveness of a drug called imatinib in patients with sinusitis. This medication is known to block the formation of eosinophils, key inflammatory cells found in diseased sinus tissue.

Ultimately, the continued development of improved drug delivery systems such as time-release oral medications and patches worn on the skin that release a continual low dose will free people from having to take these and other new medications every day.