About This Project
When we get an upper respiratory infection, our nose and sinuses become swollen which makes us feel congested and heavy headed. For some patients this can last for weeks or months, and becomes chronic sinusitis. We will get nasal sprays, antibiotics, steroids, saline rinses and other medicines, but often the swelling will not go down. We now know the swelling persists because the inflammation in the nose and sinuses will not resolve. But we don't know WHY.
Our project will explore one of the potential causes of this swelling, a breakdown in the lymphatic system. The lymphatic system exists to help remove inflammation and swelling from our body's tissue. We hypothesize that when it stops working, the nose and sinuses can't reverse the swelling.
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What is the context of this research?
The lymphatic system in our body exists to help our tissues heal from injury. Whether it is infection, inflammation, or trauma the body sends many cells and cellular products to fight that injury. As our body heals, those cells and their products need to be removed and the lymphatic system carries them away. This is both active and passive. There is even evidence that the lymphatic cells interact with the immune system.
Dysfunction of the lymphatic system results in tissue edema (swelling) as seen in lymphedema after cancer surgery. So in sinusitis, where tissue edema is the main clinical feature, it seems that the lymphatics are involved. However, no research has been done in this area. This project will explore the lymphatic system in the nose and sinuses.
What is the significance of this project?
Most of us spend a portion of every year sick with a cold. But many patients feel like they have a cold for weeks, months, or years on end. The inflammation in their nose and sinuses grows out of control. Most of the time, doctors can try supportive care, antibiotics, oral steroids, or nasal sprays. Many patients require surgery. But for many patients, these methods are insufficient to relieve their symptoms.
The problem is that sinus medications do not target specific products of inflammation. As a result, we don't know exactly what aspect of the inflammation we are treating. To target the specific cells involved in the swelling of the nasal and sinus lining, we must better understand the components of that inflammation, one of which is the lymphatic system.
What are the goals of the project?
Our specific goals are as follows:
1. Describe the anatomy of the lymphatic system in the nasal and sinus mucosal lining.
2. Discover how specific inflammatory cells and cellular products change the anatomy of the lymphatic system, and how those changes cause swelling of the nose and sinus lining.
NO research has been done on this to date. As viruses continue to evolve and make us sicker, many patients are suffering more severely and longer from upper respiratory illnesses. Out immune system is not evolving as fast as the insults to it. Most of us spend a portion of every year sick with a cold. Many of my patients, however, end up feeling like they have a cold for weeks, months, or years on end. And for many of them the treatments that we have currently don't work.
Our understanding of the biologic reasons for upper respiratory illnesses lags well behind other disciplines like cancer, and we need to improve treatment for these common and disrupting illnesses. While good research has found some hints of why the sinus lining swells, a definitive pathway has not been found. We need to examine the tissue from patients who have sinus surgery to determine whether the lymphatic system plays a role in nasal and sinus disease, as we may develop new treatments from this research.
Meet the Team
I am the Director of Rhinology and Sinus Surgery here at Washington University in St. Louis. I take care of patients who have nasal and sinus problems. I trained in Otolaryngology, or Ear, Nose, and Throat, and became interested in nasal and sinus disorders as I encountered more and more patients who really suffered on a daily basis because the couldn't breathe through their nose, had too much drainage, or had significant facial pressure and pain because of their sinusitis. I was frustrated by the poor understanding of the pathology of these diseases.
I have a BA in economics, and an MA in public policy that I got prior to medical school. Although I spend more time on medicine and science these days, my social science training has made me appreciate the complexity of disease processes and how multiple systems interact to induce effects in the human body. I also do research in medical decision making.
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