Category: Chronic Sinusitis

Bacterial Biofilms Implicated in Chronic Rhinosinusitis

Blockages can occur in the sinuses due to a number of factors causing trapped mucus to accumulate inside the sinuses and encouraging the growth of microorganisms in sessile layers known as biofilms.   One recent study found that biofilms were present on the mucosa of 75% of patients undergoing surgery for CRS.[i]

Different biofilm species are associated with different disease phenotypes.  H. influenzae biofilms are found in patients with mild disease, whereas S. Aureus is associated with a more severe, surgically recalcitrant pattern.[ii] [iii] Recent studieshave demonstrated that biofilm infections, involving known super-antigen producing bacteria such as S. aureus and P. aeruginosa, are implicated in CRS and reduce the effectiveness of antibiotics.[iv]

Eradication of these biofilm infections and associated virulence factors is important in effectively and successfully dealing with the disease.  Repeated antibiotic exposure and increasing antibiotic resistance is a treatment challenge faced by this patient population.

Photodisinfection has been proven to effectively target and destroy biofilms and associated virulence factors, offering a clear advantage over other therapies.[v]


[i] Ragab A. et al., Evaluation of bacterial adherence and biofilm arrangements as new targets in treatment of chronic rhinosinusitis. Eur Arch Otorhinolaryngol. 2012 Feb; 269(2): 537-44.

[ii] Foreman A., et al. Different biofilms, different disease? A clinical outcomes study. Laryngoscope. 2010 Aug; 120(8): 1701-6.

[iii] Foreman A. et al. Do biofilms contribute to the initiation and recalcitrance of chronic rhinosinusitis? Laryngoscope. 2011 May; 121(5): 1085-91.

[iv] Leid Jeff G. et al., The Importance of Biofilms in Chronic Rhinosinusitis. Biofilm Infections. Chapter 8

[v] Darveau Richard,  DNA and Cell Biology, Volume 28, Number 8, 2009, Pg 1-7.

Sinuwave Photodisinfection: Making a Difference for Refractory Chronic Sinusitis Patients

Carolyn Cross (CEO) with Sinuwave patient

Christina is from Winnipeg, Manitoba. She has been suffering for about ten years from recurring Chronic Rhinosinusitis (CRS). Over time, Christina found that she has become unresponsive to the medical and surgical treatments currently available. She is dealing with tenacious biofilms in her sinuses that have become resistant to antibiotics. She has had 5 or 6 surgeries and countless trips to an array of specialists. Christina lives with debilitating pain from recurring sinus infections and the ongoing concern about her future. Affecting her head and her breathing, this painful condition is hugely disruptive to everyday living. She is frustrated also, that by affecting her, CRS also impacts her entire family.

Otherwise a very healthy person, Christina worries that one day her medical options will run out. New technologies, like Sinuwave™ Photodisinfection, are important to people like Christina as they offer hope for a better quality of life. Christina is one of about 50,000 Canadians suffering from recurring refractory Chronic Rhinosinusitis. In the US, the refractory CRS population exceeds 500,000 and is growing by about 10% (50,000) each year.

Christina came to Vancouver from Winnipeg seeking help with her uncontrollable sinus infections. I had the privilege of spending time this week getting to know Christina and got a better understanding of the nature of the suffering that she gallantly endures. Seen here with me having her second Sinuwave treatment, I was thrilled to learn that her initial Sinuwave treatment the day before had already yielded some positive results for her.  It has taken us about 14 years to develop our innovative non-antibiotic antimicrobial technology to the point where it is now helping refractory CRS patients like Christina. I would like to take this time to thank each member of my very talented team for their personal efforts, sacrifices and dedication that contributed to an important new CRS treatment to help people like Christina.

— Carolyn Cross, CEO

How does Photodisinfection Work?

Photodisinfection is a topical, non-antibiotic antimicrobial therapy that destroys a broad spectrum of pathogens including fungi, bacteria and virus without damaging human tissue. Unlike antibiotics, Photodisinfection selectively kills virulence factors such as the endotoxins and exotoxins produced by pathogens, leading to a clinically observable anti-inflammatory effect. The treatment process takes only minutes, making it over 1,000 times more effective at biofilm killing than antibiotics.

Photodisinfection is a minimally invasive non-thermal therapy involving the light activation of a photosensitizer to eliminate topical infections in a highly targeted approach. Photodisinfection has been proven to be safe and effective in other applications such as for the dental, sinusitis and hospital acquired infection prevention markets. In dentistry, Photodisinfection has been proven to be highly effective for the treatment of caries, endodontics, restorative dentistry, periodontitis, peri-implantitis and halitosis. Many new applications of Photodisinfection are now under development.

The Photodisinfection Process: Instant Antimicrobial Therapy

Apply Photosensitizer to Infection Site & Illuminate with Appropriate Wavelength for Several Minutes

A photosensitizing solution is applied to the treatment site where the photosensitizer molecules preferentially bind to the targeted microbes.  The photosensitizer molecules are inactive at this stage.  A light of a specific wavelength and intensity illuminates the treatment site and a photocatalytic reaction occurs.  The wavelength is carefully chosen to maximize absorption of light energy by the photosensitizer.

This 2 step procedure results in the destruction of the targeted microbes and their virulence factors without damaging host cells.  This reaction involves the formation of short-lived, highly reactive free-radical oxygen species.  These radicals cause a physical disruption of the microbial cell membrane through oxidative reactions, resulting in immediate rupture and destruction of the cell.  This process occurs in seconds with total kills completed in minutes.

The Photodisinfection process has also been shown to eliminate a multitude of virulence factors, unlike antibiotics. When the light isremoved, the photocatalytic reaction ceases along with all antimicrobial action. Photodisinfection does not promote the development of resistance.

The Photodisinfection process is both pain-free and stress-free due to lack of side-effects or damage to human tissue.

Source: Eastman Dental Institute, UK

Take a chill pill: Why antibiotics don’t always help

Listen up, students!

You can finally stick it to all those school nurses/math professors who wouldn’t let you take a make-up exam for lack of a doctor’s note when you had the sniffles.

A number of studies have shown that the antibiotics often used to treat sinusitis make absolutely no difference when it comes to treatment.

In 2008, the BBC reported that 90% of patients with sinusitis in the UK are prescribed antibiotics. The article added that the results of an analysis of nine trials published in the medical journal The Lancet, shows that these antibiotics had no effect, even if the patient had been sick for more than seven days.

The timeline is the important factor here. The consensus used to be that a longer illness was a sign of a bacterial infection that would be susceptible to antibiotics, rather than a viral infection, in which case antibiotics have no effect. If you have a virus, the best thing to do is to don your fanciest flannel pajamas, and curl up in bed with the latest issue of Us Magazine and a steaming cup of tea. In other words: wait it out.

But length, it turns out, may be meaningless. The study looked at 2600 patients who had been suffering from sinusitis before the treatment. The results showed that 15 patients would need to be treated before one would be cured with antibiotics, indicating that time is not an effective gauge of whether or not antibiotics will be effective.

“If a patient comes to the GP and says they have had the complaint for seven to 10 days that’s not a good enough reason for giving them the antibiotic,” study leader Dr Jim Young, from the Basel Institute for Clinical Epidemiology in Switzerland, told the BBC.

To every student/ minimum wage employee: You’re welcome.

More recently, a study published in the Journal of the American Medical Association brought the point home by showing that in many cases, a placebo worked just as well as antibiotics when it comes to sinusitis treatment. The study observed 166 adults meeting the diagnostic criteria for sinusitis, who were given either amoxicillin or a placebo three times a day for 10 days, The New York Times reported in 2011.

The participants recorded their symptoms every other day. In the end, there was no significant difference between those given the placebo and those placed on antibiotics.

These findings come as good news to proponents of antibiotic restraint. The automatic reflex to treat with antibiotics has had serious consequences, namely the development of resistant strains of bacteria that have become more potent and dangerous over time.

Both the studies mentioned in the BBC and The New York Times mentioned that in cases of sinusitis, a patient should refrain from a doctor’s visit unless they’ve been sick for a week.

Still have questions? The CDC lays it all out here in a video slightly reminiscent of Sesame Street… before Cookie Monster got all healthy and ruined everything.

See A Video on: Snort. Sniffle. Sneeze. No Antibiotics Please!




Brush your teeth, save on Kleenex.

Who knew that teeth were such devious little buggers?

Periodontal disease is like the Stewie Griffin of maladies: small, easily overlooked, but man, when he gets mad, watch out.

Gum disease has already been linked to heart disease, impotence, cancer, and even artificial joint infections. But that’s not the end of it.

In 2011, an estimated 29.6 million adults were living with non-diagnosed sinusitis, an estimated 12.8% according to the Centers for Disease Control and Prevention (CDC).

Sinusitis occurs when the air-filled spaces behind your forehead, nasal bones, cheeks and eyes (known as sinuses) become blocked, preventing the mucus from draining and causing bacteria and other germs to build up. Sinusitis can be caused by something as benign as allergies or a common cold, or more serious conditions like a deviated septum or nasal polyps.

As far back as 1996, scientists were already examining the links between periodontal disease and sinus inflammation or infection. A study published in the American Journal of Roentgenology (say that last word 5 times fast) by J.J. Abrahams and R.M. Glassberg of Yale School of Medecine’s Department of Diagnostic Radiology, showed that patients with known periodontal disease were twice as likely to have maxillary sinusitis, and that the two were causally related.

The maxillary sinus is the largest of the paranasal sinuses, and also the closest to the molars of your upper jaw. As mentioned in a previous post, our mouths are teeming with bacteria. When you “forget” to brush your teeth, that bacteria accumulates in the gaps between your gums and your teeth, causing inflammation of the gums (gingivitis). The longer that goes untreated, the more likely you are to develop periodontal disease (periodontitis).
Periodontal disease causes the gums to recede from the teeth, creating little pockets – the bacterial equivalent of a white picket fence in the suburbs.
Because the maxillary sinus is so close to these little bacterial hideaways, infection is more likely.
Another study, conducted by the Oral Health Group and aptly billed as “A Review for the Dental Practitioner,” explained that the physical proximity between the maxillary sinus and the mouth should also be of concern to dentists because sinusitis is often misdiagnosed as dental disease.
As such, the study recommended that dental practitioners study up on the “anatomy, physiology, and pathology of this complex region.”

If undertreated or ignored, regular sinusitis can develop into something chronic, which is definitely not something you want.

The bottom line? Brush your teeth.

And just for kicks, watch Stewie battle a tooth ache on “Family Guy”:

The Advantages of Sinuwave for Refractory Chronic Rhinosinusitis

Sinusitis is a disease in which the sinus cavities around the nasal passages become inflamed and swollen. When symptoms last for longer than12 weeks, the patient is described as suffering from chronic rhinosinusitis (CRS).  Patients typically first seek medical therapy to alleviate their symptoms as well as trying to address the cause. However, 20% of patients are unresponsive to any of the medicines and continue to suffer from the debilitating symptoms associated with CRS.

There are roughly 22 million office visits and 500,000 emergency department visits in the United States alone relating to CRS, indicating that it is a major health concern. The treatment regimen usually consists of the prescription of broad spectrum antibiotics, corticosteroids, and saline nasal irrigation. This disease most commonly affects young and middle aged adults, but may affect other demographics as well. Common symptoms include nasal congestion, throbbing facial pain, fever, headaches, difficulty sleeping and sensations of swelling around the eyes and face.

Sinuwave™ Photodisinfection System offers a unique method of treatment which has several distinct advantages over both medical and surgical CRS treatments. Photodisinfection is a minimally invasive approach to eliminating the pathogens and inflammatory host response involved in the disease process.  Photodisinfection is a 2 step process involving the application of a photosensitizer which is then activated by non-thermal laser light generating singlet oxygen based molecules, or free radicals that are lethal to fungal spores, bacterial biofilms and their virulence factors while not harming human tissue.

The major advantages of Sinuwave™ Photodisinfection for CRS patients are:

* pain-free procedure not requiring anesthesia

* immediate patient relief,

* no antibiotics or developed resistances,

* no removal of tissues are involved,

* no patient compliance requirements

* ease of use

Sniff, slice or swallow? All guesses are good when it comes to chronic sinusitis

We’ve all had colds that seem never-ending, and wondered if maybe, just maybe, we would one day be able to breathe without sounding like a foghorn.

Well for some people, that kind of nasal hell is just another day in the life.

Sinusitis causes swelling in the sinuses and nose, preventing the accumulated mucus from being drained out. The result is pain and pressure around the eyes, sore teeth, and constant headaches. People who suffer from chronic sinusitis go through that for days or even months at a time.

Physicians have recently come around to the idea that chronic sinusitis is an inflammation-related condition, rather than an infection to be treated with antibiotics. Treatment ideology has also shifted. Rather than relying on pills and other external treatments, doctors increasingly believe in getting medicine directly inside the sinuses, up close and personal.

Read More

Let’s Clear Things Up: Chronic Sinusitis

You know that feeling, when your nose is so stuffed that you feel like your head is filled with wet cotton, your thoughts seem foggy and every breath is a burning struggle? Well, multiply that by ten, and you get chronic sinusitis.

What causes this case of the perpetual sniffles? Well that’s the big question.

An article by Inofei Chen, “When Sinus Problems Won’t Go Away,” published in The New York Times in 2011, explored the different theories explaining chronic sinusitis that have emerged over the last couple of years.

Clarification: sinusitis does not equal chronic sinusitis. Sinusitis is a short-term condition that lasts for a couple of weeks, and is usually caused by an infection.

But in millions of cases, boring old sinusitis can become recurrent, and drag on for weeks, months, even years – chronic sinusitis.  For a full list of symptoms, click here.

Read More

How Do I Know I Have Chronic Sinusitis?

As a first year medical student, cancer and HIV/AIDS are two common illnesses that I without a doubt will encounter in my line of work. However, not many people know about chronic rhinosinusitis, or simply known as chronic sinusitis, which also affects many people. Each year, 37 million Americans are faced with combating a case of sinusitis, the fifth most common disease treated with antibiotics [1,2].

What exactly is chronic sinusitis? It is an inflammation of the tissue in our sinuses, the cavities around our eyes, nose, cheeks, and forehead. Usually they are full of air but due to various causes these spaces become filled with viruses, bacteria, and fungi.

Read More

More Than Just A Headache: The Under Recognized Pain and Disability of Chronic Sinusitis

Few words can fully describe the throbbing pain, pressure, and congestion of a chronic sinus infection.  Falling somewhere between a toothache, a migraine headache, and the flu, sinusitis not only impacts quality of life, but also puts sufferers at risk of developing more serious complications including blood clots and aneurysms, due to its close proximity to the brain and major blood vessels.  For the most part though, it’s more synonymous with missed work, painful headaches, and overall misery than with severe illness.

For the majority of sinusitis sufferers, impaired mucous clearance is where the trouble begins.  Anything from a simple cold or allergy to structural defects, such as badly formed nasal cartilage or benign nasal growths have the ability to affect sinus drainage.  Poor drainage, in turn, leads to a secondary bacterial infection—and the associated green, infected nasal discharge noted among sinusitis sufferers. While most people manage to kick sinusitis with a single course of antibiotics and little effort, for others it’s the beginning of a nightmare that lasts for months, if not years.  Read More

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