The Science Journal of the American Association for Respiratory Care

1999 OPEN FORUM Abstracts

TREATMENT OF FAILURES OF ENDOSCOPIC SINUS SURGERY WITH NEBULIZED TOPICAL ANTIBIOTICS

Martin Y. Desrosiers, M.D., Milagros Salas-Prato, Ph.D. and Dory Durr, M.D., Otolaryngology-Head and Neck Surgery, McGill University Health Centre and Hôtel Dieu Hospital, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada.

Purpose: To study the efficacy of nebulized topical tobramycin in patients with chronic sinusitis persisting despite adequate endoscopic sinus surgery (ESS).

Study Design: 20 patients with failed ESS were entered in a randomized, double-blinded, placebo controlled trial. Tobramycin or saline solution were administered to the nasal passage via a large particle nebulizer apparatus (RhinoFlowTM, Respironics Inc.), for 4 weeks, followed by a 4 week observation period. Symptoms and quality of life (QOL) were assessed by questionnaire. Sinonasal endoscopy assessed mucosal status. Subjects were evaluated at enrollment, initiation of treatment, and 2, 4, and 8 weeks.

Results: Symptoms: In both groups, there was a trend to reduction of pain and post-nasal drip. QOL: In both groups, there was a trend towards improvement in all domains. This was more pronounced at the end of the observation period. Mucosal status: In both groups, edema, secretions, and crusting were significantly reduced following the four week treatment period.

Conclusion: Treatment with four week course of large particle nebulized therapy improves symptomatology and objective parameters of refractory chronic sinusitis. This effect occurs even in the placebo group, suggesting that it is principally due to saline irrigation. Continued improvement beyond the treatment period suggests a lasting effect on the underlying disease process.

Funded by a Grant-in-aid from Respironics/Health Scan Inc.

OF-99-165

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