Do Aging Factors Influence the Clinical Presentation and Management of Chronic Rhinosinusitis?

Abstract

Objective/Hypothesis Chronic rhinosinusitis (CRS) is a complex inflammatory disease of the upper respiratory airways resulting from the dysregulation of immunity and epithelial defenses. More recently, the contribution of an altered nasal microbiome to the development of CRS has also been proposed. However, the impact of aging on the development of CRS has been long overlooked. Here we propose, in a hypothesis piece, that aging can influence the physiopathology of CRS and its subsequent management in an elderly population. Data Sources We summarize the recent literature findings supporting that elderly patients with CRS could be a distinct population from those with adult CRS and might require different or adjunct therapeutic approaches. Methods Review of recent literature of the effect of aging and its possible effects in CRS using 3 different databases. Conclusions Age-dependent decrease in the levels of the S100 family proteins involved in epithelial proliferation, repair, and defenses combined with chronic inflammation might lead to an increased risk of abnormal microbial colonization and loss of microbiota diversity. Ultimately, these changes could have the potential to alter the physiopathology of CRS in the elderly. Implications Unlike in adults, in whom CRS T2-skewed responses with eosinophilia are thought to play a critical role, in aging populations, a microbiome and epithelial barrier dysfunctions may instead be the pivotal agents of disease development and persistence. This supports that therapies for elderly patients may require a different management or additional targeted therapies to control the disease. Prospective studies, however, are necessary to validate this concept.

Gene and protein expression of CXCR4 in adult and elderly patients with chronic rhinitis, pharyngitis or sinusitis undergoing thermal water nasal inhalations

“…In addition to its large sample size, among the pro of the study is the inclusion of a substantial proportion of aged subjects (more than half of the sample), as it has been hypothesized that elderly patients affected by chronic diseases of the upper airways could represent a distinct population from adult patients, showing altered physiopathology and requiring different therapeutic approaches [ 2 ].…”

“…More recently, thermal water inhalation has been shown to modulate Th1 and Th2 cytokine expression and to increase IL-21 and IL-17 levels in blood samples of elderly and young patients with chronic upper respiratory tract infections [ 12 ]. In contrast with previous studies, the present research measured the expression of pro-inflammatory reparative molecules before and after thermal water inhalation directly in nasal cells, which may be subject to age-dependent variations in terms of epithelial proliferation, repair, and defenses [ 2 ].…”

“…Chronic rhinitis, pharyngitis and sinusitis are common health problems with a significant impact on public health in term of costs and quality of life [ 1 ]. Upper airways inflammation is accompanied by a variety of symptoms that can be rather disabling, and ageing factors are suspected to influence both clinical presentation and management of these diseases [ 2 ].…”

“…Among the possible effectors, the gasotransmitter H 2 S has attracted scientific interest recently, as it is contained in several thermal waters and has anti-inflammatory, antibacterial and antifungal properties [ 19 ]. The curative effect of thermal water nasal inhalation could depend on regulation of the expression of different components of the innate immunity system in cells of the nasal epithelia, which can vary with age [ 2 ].…”

Age Features of Bone Tissue Density in the Posterior and Inferior Walls of the Frontal Sinus

“…According to some reports, the incidence of this disease can be equal to diabetes and heart diseases [12] and accounts for 10.9% of the urban population in Europe and 12.5% of the United States population [5]. The course of chronic rhinosinusitis has distinct age-specific features, which also affect the methods of further treatment [7]. Elderly patients occupy a special place among all groups of patients.…”