Sinusitis guidelines point the way for further research

Rhinosinusitis -- also known as sinusitis -- is an inflammatory disease rather than an infectious one, although viruses, bacteria and fungi may play a role. The condition may also be caused by allergies or adverse reactions to medications, according to a consensus document issued by an expert panel convened by several specialty societies.

The guidelines were published in supplements with the December issues of the Journal of Allergy & Clinical Immunology and Otolaryngology -- Head and Neck Surgery.

"We do know it's an inflammatory process, but what produces that inflammation, that's what we're trying to define," said James A. Hadley, MD, one of the authors and past president of the American Rhinologic Society and the American Academy of Otolaryngic Allergy.

The hope of those involved is that more precise definitions of the disorder's variants will improve the care of patients and ensure that scientists use the same standards in research.

"We're also trying to define how we can best approach these patients from a research point of view and put them into clinical studies to look at appropriate medications," said Dr. Hadley, who is also associate professor of otolaryngology at the University of Rochester in New York.

Experts praised the consensus paper for providing guidance regarding a condition for which a cause is often elusive and treatment is often chosen by a process of elimination.

"Sinusitis has been just sort of one big blob," said J. David Osguthorpe, MD, president of the Sinus and Allergy Health Partnership and professor of otolaryngology at the Medical University of South Carolina in Charleston. "What this paper is about is tackling acute and chronic [sinusitis] and where we should go in clinical studies to figure this thing out."

The next set of questions

Primary care physicians who deal with many sinusitis cases, however, had reservations. Although they welcomed the concept of establishing definitions that will most likely help researchers, they also had doubts that the 60-pages would directly translate to improvements in patient care -- at least initially.

The paper also focused on defining the condition, but it did not recommend much in the way of treatment once a patient's disease is categorized.

"This gives us a great common language we can use to discuss sinus disease, but it doesn't give us real guidance on diagnosis and treatment in practice," said Robert J. Flaherty, MD, a family physician and staff doctor at the student health service of Montana State University in Bozeman.

Those behind the guidelines acknowledged this point, but hope it will facilitate more such developments. "It's too long, and it's too hard to understand," said Dr. Hadley. "But it establishes for us a place from where we can jump-start a lot of other projects."

Many also hope that defining a condition that is frequently treated with antibiotics, often unnecessarily, would reduce the inappropriate use, thereby reducing the possibility of emerging antibiotic resistance and lead to recommendations for other treatments.

"That's one of the focuses," said Dr. Osguthorpe.

"If it's an allergy-mediated problem, antibiotics are worthless. If it's an infection-related problem, allergy drugs are worthless. You've got to be able to figure out what caused it."

The consensus panel was convened by the American Academy of Allergy, Asthma and Immunology; the American Academy of Otolaryngic Allergy; the American Academy of Otolaryngology -- Head and Neck Surgery; the American College of Allergy, Asthma and Immunology; and the American Rhinologic Society.

The panel will meet again in February to determine methodology for future clinical trials.