Sinusitis after irradiation therapy for head and neck carcinoma

Patients who undergo radiotherapy for nasopharyngeal carcinoma tend to suffer from sinusitis because irradiation causes damage to sinonasal tissue. 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.

X rays film showing right maxillary sinusitis: 

Smoking and sinusitis

Smoking is one of the most important causes of head and neck cancer.
Another important untoward result of active and second hand smoke exposure is the increased risk of respiratory bacterial infection. These include sinusitis, ear infections, bronchitis and pneumonia. Recent studies we and others did show that smokers harbor more pathogenic bacteria that are resistant to antibiotics, can be a source of spread of these bacteria to others (including their household members), and when smokers get respiratory infections treating them may be more difficult than treating non-smokers. These changes are reversible once smokers stop smoking.

A recent study of smokers with sinusitis we have just completed shows that sinusitis in smokers is often caused by antibiotic resistant bacteria including methicillin resistant Staphylococcus aureus (MRSA).

Since many head and neck cancer survivors are engaged in educating young individuals about the risks of smoking this information may be useful to them in encouraging them to stop smoking.