May 12, 2016

Novel sinusitis treatment helps patient breathe easier

For more than five years, Chandler Webb noticed that it was becoming more difficult to breathe through his nose.

For more than five years, Chandler Webb noticed that it was becoming more difficult to breathe through his nose. He compensated by breathing with his mouth, but eating and drinking were still uncomfortable. The pitch and tone of his voice were also changing.

Chandler Webb

“It was basically just a clogging in my sinuses, where I had no airflow,” said Webb, 32, of Nashville.

First, he saw an allergist. But it turned out that Webb had polyps in his sinuses that were obstructing his airflow. That led to him to the Vanderbilt Bill Wilkerson Center and Rick Chandra, M.D., professor of Otolaryngology.

Chandra conceived a treatment for Webb’s chronic sinusitis. He performed surgery to remove the polyps, then implanted a dissolvable Propel sinus implant that delivers steroids to the sinus tissue as it heals. The device acts as a stent, holding the nasal passages open so that they heal in an open configuration. At the same time, the localized application of the steroid prevents the formation of scar tissue, and avoids the side effects that come with oral steroids, an alternative treatment.

“Part of what we are trying to accomplish is not only to keep the sinus cavity open from a mechanical standpoint but also to treat the tissue such that the inflammatory reactions which induced polyp growth in the first place are suppressed,” Chandra said.

He implanted Webb’s device on March 15, and Webb soon was breathing through both nostrils.

Webb said that he experienced very little pain and didn’t even need the pain pills that Chandra prescribed.

“He knew what he was doing,” Webb said. “He was such a good doctor… walked me through everything, explained everything.”

Nasal polyps can be caused by a number of issues, including allergies and hyperimmune factors, Chandra said. Continued irritation in the nose leads to their formation. Chandra works to improve the “plumbing” in the nose, which makes clearance of allergens such as pollen easier. It also makes allergy medications such as nasal sprays more effective and reduces the odds of further polyp formation. That potentially means fewer surgeries.

“He had a very good result from surgery, but it’s also a chronic disease, so it does need ongoing management and there’s a lot of evidence that if you use these stents up front it has a lot of downstream, long-term positive benefits,” Chandra said. “I’m hoping he captures those as well.”

During follow up visits, Chandra will examine Webb’s sinuses to see if scar tissue forms or if polyps recur. He said about one in three patients with Webb’s condition will need a follow-up surgery and maybe one in five will need additional surgeries as a tool to keep the sinuses open.

“If you can get the appearance of the tissue in the sinus tract to normalize, then the odds of him needing further surgery down the line is a lot less,” Chandra said. “One of the things that we think promotes that is to have it heal well during that initial period right after the operation. So for him, from that perspective, the prognosis is very good.”

Webb will continue to use a topical steroid and rinse with saltwater to keep the nostrils clear. So far, so good, he said.

“The results so far have been amazing,” he said. “Vanderbilt did a great job.”