Sinus Infections & SuperAntigens

The problem with chronic sinus infections is that we don’t seem to have an answer as to “why”.  To be totally accurate we seem to have all kinds of answers, too many answers even.  Readers: be skeptical when doctors have a lot of answers for something, it probably means they really don’t know.  Those who know the least know it the loudest.

The superantigen hypothesis is based on the Staphylococcus bacteria, common to a number of sinus infections, and sometimes present as an abnormal “colonizer” after sinus surgery.  Staph often produces a variety of exotoxins that essentially act to poison the tissue in the area.  These toxins promote an immune system response, sometimes a very vigorous one, leading them to be called “superantigens“.  Your body’s immune system over-activation may then lead to increased sinus swelling or even polyps, further potentiating the sinus infection cycle.
What we are still missing is a “final common pathway” for chronic sinus infection.  We have a number of likely contributors to the disease, but the problem is they aren’t present in everyone.  Superantigens are only present in about half of patients, for instance.  If we could show all these contributors eventually act to throw a single switch then we can develop medicine to regulate that single switch better.  But so far we are left with a host of explanations (some with very uncertain science behind them) and and whole host of treatments.
A sampling of the contributors to chronic sinusitis:
-Anatomic blockage of sinus pathways
  -Nasal septal deviation
Cilia movement problems
-Underactive immune system
-Overactive immune system
  -Elevated eosinophil response
-Allergy to:
  -Pollens, dust, etc
-Untreated fungal infection
-Nasal polyps (a cause or a result?)
-Elevated leukotriene and arachadonic acid pathway
-Environmental irritants & cigarette smoke
-Stomach acid reflux?