Patients who undergo radiotherapy for nasopharyngeal carcinoma tend to suffer from sinusitis because irradiation causes damage to sinonasal tissue. When I had to deal with this problem I realized that there is very little information about the organisms causing sinusitis after radiation therapy. Two recent studies provided important information about the unique microbiology of sinusitis in these patients.
One study evaluated 25 patients with acute sinusitis and the other evaluated 30 with chronic sinusitis. Both studies found higher recovery of Staphylococcus aureus in irradiated individuals. Because of the high prevalence of methicillin resistant S. aureus (MRSA) these individuals may need to be treated with antimicrobials effective against these organisms.
These studies underscore the need to obtain appropriate cultures from patients with chronic sinusitis who were irradiated so that proper antimicrobials can be administered to them.
Itzhak Brook MD

Where (what areas) were these patients radiated?

[quote]One study evaluated 25 patients with acute sinusitis and the other evaluated 30 with chronic sinusitis. Both studies found higher recovery of Staphylococcus aureus in irradiated individuals. Because of the high prevalence of methicillin resistant S. aureus (MRSA) these individuals may need to be treated with antimicrobials effective against these organisms.
These studies underscore the need to obtain appropriate cultures from patients with chronic sinusitis who were irradiated so that proper antimicrobials can be administered to them. [/quote]

What are antimicrobials? Is this antibiotics or decongestants? Dribrook, when you post information about random topics, if possible can you make it easier to understand? Most of us here dont have medical backgrounds, we are mainly patients and caregivers. Unfortunately we have had to learn a great deal of medical information to help us deal with our illnesses.


I have sinusitis caused by radiation. Im not treated with antibiotics. I take singulair and nasonex nasal spray almost daily. My radiation was aimed at the tumor in the middle of my left cheek and the other tumor behind my top, left molar. Its very annoying, its like I always have a cold. I also suffer from problems with thick mucous that clogs my throat. If this is the worst thing I have to complain about then I am a very lucky person. In previous posts several other members mentioned the same problems. But this was never linked to anyone having MRSA. With only 55 people being part of the studies, they are pretty small.

I looked up the info and one of the studies was from Europe. It was mentioned on your website. I wish that there was more info available about this topic since its something that affects quite a few of us after radiation. I dont understand the link between MRSA and sinusitis. When I have more time I will look into this more. Thanks for bringing this topic up.


http://oralcancersupport.org/forums...ords=sinusitis&Search=true#Post79228

Here's more then you'll ever want to know about microbes and antimicrobials:

http://www.answers.com/topic/antimicrobial

It seems like a no brainer that the Dr. is refering to H&N RT since it's a sinus issue. Even RT scatter will affect the sinuses to some degree. But the definition of nasopharyngeal should clarify it.

http://www.cancer.gov/cancertopics/pdq/treatment/nasopharyngeal/Patient

After rads in my nasopharynx area (among others), I had problems with recurrent mild nose-nostril staph infections and nose bleeds for over a year (a few significant nose bleeds during rads).

The staph flare-ups were well controlled with a 'Double Antibiotic Ointment'.

My nose isn't the same, but isn't a big problem. It is often itchy, seems more susceptible to hay-fever irritations and at times can get drippy - ENT calls it old man nose

I would like to respond and explain the meaning of the studies I described.

Sinus irritation and inflammation after radiation treatment does not mean that there is a bacterial infection there. However there can also be a bacterial infection which than may require antibiotic treatment.

The studies I referred to describe the bacteria that caused the sinusitis. This new information offer information that can help in the choice of antibiotics. If anyone has sinus infection and had received radiation treatment in the past they may want to inform their doctors about these studies.

Itzhak Brook MD

Dr. Brook, if you have a link for these studies please pm me. I would like to forward them to my H&N Surgeon

You can get a link to these studies on my Blog at http://sinusitisunderstood.blogspot.com/2010/12/sinusitis-after-radiation-is-caused-by.html

Itzhak Brook MD

The patients received radiation to their head and neck as treatment of their cancer.
I Brook MD

questions have been asked and ignored so I am going to step in here and demystify a few points for non-medics which is most of us.

1 "itis" as in sinusitis or tonsillitis means swelling or inflammation. So Sinusitis is swelling of the sinuses. Most people immediately think of sinusitis as an infection but any asthmatic or person with allergies will tell you, inflamed or swollen sinuses is part of their condition and has nothing to do with infection.

2. An antibiotic is an antimicrobial. Antibiotics, fight microbes or bacteria which cause infection. Generally there are two types of infection - bacterial and viral. Antibiotics only work on bacteria although doctors often prescribe antibiotics for viral infections. The reason for this, is that one can't tell if it is viral or bacterial unless a swab is taken and tested (most don't do this they just guess)so it is treated in case it is bacteria. Sometimes it is worth giving antibiotics prophylactically (as a preventative)to stop the infection progressing to something really nasty.

3. The other kind of sinusitus is when the swelling is not caused by an infection but body itself (immune response). The drugs used by asthmatics and allergy sufferers keep the swelling or inflammation at bay. Basically they are called "anti-inflammatory" drugs and they work to calm down the immune system which is causing the inflammation.

4. Inflammation is a natural (and usually welcome) response to beasties. The immune system literally goes to war with invaders, be that infection or physical injury. Radiation is physical injury and your immune system is in there trying to control the damage. Scarring is the immune system's idea of a bandaid. Unfortunately, your immune system has got a little over excited and doesn't know when to quit. Your meds are taken to calm the immune system down to reduce the inflammation so you don't get so much pain

(There are three main types of infections, and the third is fungal)

Wow!!!! Thank you Karen for putting it in simple terms for me. Sorry but I dont have a medical background so sometimes dont understand technical terms. Thank you so much for taking the time to explain this. I appreciate it very much!!!

you're welcome Christine and thanks to Brian who corrected me and added the fungal infection (sometimes I need to slow my fingers and speed up my brain)

You did a good job. I didn't wish to detract from that.

We have things to deal with bacterial and fungal infections but those viruses..... they are an elegant design, and there is no such thing as a viracide. If we could kill them, we would finally have a cure for the common cold (rhinovirus)!!

And not just the oncogenic viruses that we talk about here are dangerous. The World Health Organization says that about 300,000 to 500,000 people die every year world wide from the common flu virus.

My parents, poor impoverished uni students that they were, could not afford a honeymoon. So they volunteered to be subjects in a British research project on the common cold. They were taken to a holiday camp that had been especially isolated for the project, were given full use of the facilities but were only allowed contact with each other. Then they were injected with rhinovirus followed closely by the potential cure. Perfect honeymoon had the researchers actually managed to find a cure (and probably a nobel prize and knighthood for the researchers).

That was 1958

Interestingly enough, if you Google "sinusitis radiation", Dr. Brook's blog and this thread are the most entries. The last major discussion of this was back in 2008 right when I joined OCF and at the time, sinusitis was the least of my worries

My misadventure with my latest MRI had a silver lining: since the radiologist's computer erroneously told him there were no prior MRI's to compare, he added two sections none of my prior MRI or Petscans did:
[quote]Right Mastoid Sinus: There is some opacification of some of the air cells in the posterior aspect of the right mastoid sinus. This is typically inflammatory in nature
Maxillary Sinuses. there are small air-fluid levels in both maxillary sinuses. This is consistent with acute maxillary sinusitis[/quote]

Of course I did have a wicked cold the week before, but thanks to this post and re reading the 2008 post, I am prepared to discuss this March 1 with my ENT.
Thanks Doc and Brian
Charm

Clicking a few pages more on google brought up another study by Dr. Huang et al on oral cancer patients concluding that [quote]Endoscopic sinus surgery is an effective treatment for irradiation-induced rhinosinusitis in NPC patients, improving ventilation and drainage of the paranasal sinuses, and facilitating regeneration of the sinus mucosa. [/quote]
Mine's not that bad, but here's the link
endoscopic sinus surgery on irradiation-induced rhinosinusitis The technical cite for the study is
Otolaryngology Head Neck Surgery October 1, 2008 vol. 139 no. 4 575-579

Hi Dr. Brook, I have a question. My sinuses seem to be a bit inflamed and sometime I can feel my heartbeat in them? Very weird. My radiation was directly under my chin, could this have affected my sinuses? When I push on them they feel swollen slightly painful? Thanks! Shelly

Shelly,

I�m not Dr. Brook, and I haven�t had cancer or cancer treatments. But when my husband was first being treated, I mentioned to one of his surgeons (ENTs) how I could �hear� my heart beat in my upper cheek and "see" it pulsing in the side of my right eye. I have had chronic enflamed sinuses for years and this was just my taping into my body. I notice my body much more now. It wasn�t anything to worry about. (and they gave me a nose spray that helped a lot)

I have a hard lump inside my jaw on the gums - like Tim�s tumor (except his was two inches long, mine is a pin point). I rushed to the periodontist. Tim had no risk factors; hence, my chances of cancer are greater than average. The lump turned out to be bone. It seems that I grit my teeth and that can make bits of jaw bone grow outward.

Cancer fights dirty, it gets into your mind as well as your body. It makes you think you are sick when you aren't and well when you aren't. Listen to your body and ask your doctor one-on-one to explain why. Don't hold out or be embarrassed. You know your body better than anyone.

Charm, I had the exact same wording on my early post Tx MRI's, they eventually cleared up.

Gary

Thanks. I did meet with my ENT this week and she reviewed the MRI scan images and thought it was very minor and definitely related to that cold I had. On a practical note, I had started using my Netty Pot again after that MRI and asked her about it, she thought it was a very good idea to keep the sinuses healthy.
Charm