ABSTRACT

Title: Nebulized Medical Therapy for Chronic Sinusitis

Objective: Nebulized intranasal medical therapy (NIMT) is a novel treatment for chronic rhinosinusitis (CR). To determine the role of NIMT in CR, we compared 50 patients treated with NIMT and oral therapy. We present our findings of pre and post treatment modified SNOT 20 scores and sinus cultures.

Methods: Pretreatment nasal endoscopy with culture was obtained and a modified SNOT 20 questionnaire was completed. Patients were treated with either NIMT or oral antibiotic therapy twice daily for 21 days. Patients were re-evaluated 2 weeks post completion of treatment with repeat SNOT 20 questionnaire and endoscopic culture.

Results: Pre and post sinus cultures were assessed. Both solitary and mixed infections with various degrees of antibiotic resistance were encountered. A preliminary review of outcomes demonstrates a reduction in the pre and post treatment modified SNOT 20 scores in both groups. Final comparison of the 2 study groups and statistical analysis is pending at time of abstract submission.

Conclusion: The use of NIMT in the treatment of CR is an effective alternative. It is particularly valuable in those patients who cannot tolerate traditional oral therapy and/or whose cultures identify an organism to which an oral antibiotic is not available. Patient compliance and treatment morbidity is favorable.

Authors:

  • Aaron Hilton, Florida State University – Fourth Year Medical Student;
  • Dr. John Lanza, South Coast Ear Nose & Throat

BACKGROUND

Nebulized Therapy is a combination antibiotic and/or antifungal and steroid preparation that is delivered at optimal particle sizes (less than 5 microns) into the paranasal sinuses. It was first indicated for post surgical patients with acute bacterial infections not improved with systemic antibiotics. A pilot study (2002) showed longer infection free periods with nebulized therapy (average - 17 wks) when compared to the standard treatment of oral antibiotics (average - 6 weeks).  – Vaughan and Carvalho, 2002

THEORETICAL FRAMEWORK

The theory is that the nebulized delivery of prescribed medication allows for greater permeation into the paranasal sinuses. If valid, this would account for a higher concentration of medication being distributed into the sinuses exceeding the minimum inhibitory concentration for most organisms.

PURPOSE OF THE STUDY

Nebulized intranasal medical therapy (NIMT) is a novel treatment for chronic rhinosinusitis (CRS). To determine the role of NIMT in CRS, this study compared 28 patients treated with NIMT versus oral medical therapy (OMT). The findings of pre and post treatment modified SNOT 20 scores and sinus cultures will be presented.

POPULATION DESCRIPTION

  • Patients in a private community based Otolaryngology practice with CRS documented with CT scan and culture
  • 18 pts on NIMT, 10 pts on OMT
  • Avg age: 60 / Range (31-77)
  • Females: 17 , Males: 11
  • 8 patients with prior FESS greater than 6 mo prior
  • 16 patients with pansinusitis, 7 with ethmoidal, 8 with maxillary, 2 with frontal

METHODS

Pre-treatment nasal endoscopy with culture was obtained and a modified SNOT-20 questionnaire was completed. Patients were offered treatment with either NIMT or OMT for 21 days. Patients were re-evaluated 2 weeks post completion of treatment with repeat modified SNOT-20 questionnaire and endoscopic culture. (see tables: Bacteriology, Nebulized Therapy Used)

OUTCOMES

NIMT: Twenty out of 20 SNOT-20 symptoms improved on average with NIMT, Ear fullness and Ear pain post treatment were statistically significant with p-values of .015 and .045 respectively.

OMT: Seventeen out of 20 symptoms improved on average with the use of OMT; Thick nasal discharge (p .033) and increase in Productivity (p.009) were statistically significant. (see tables: Results One & Two)

RESULTS

  • 18 out of 28 patients chose NIMT over OMT as their treatment of choice
  • 12 out of 18 patients on NIMT had their symptoms at least partially relieved
  • 3 patients, after prior FESS and failing OMT, experienced near total relief from NIMT
  • NIMT was more effective for those with gram positive organisms on pretreatment culture (7 out of 8 patients with near total relief with NIMT

CONCLUSION

The use of NIMT in the treatment of CRS is an effective treatment. It is particularly valuable in those patients who cannot tolerate traditional oral therapy and/or whose cultures identify an organism to which an oral antibiotic is not available. NIMT also appears to provide more favorable outcomes in post FESS patients. Patient compliance and treatment morbidity is favorable.

This study showed a significant decrease in ear fullness and ear pain with NIMT, while also showing comparable outcomes with OMT in the remaining SNOT-20 items. In a previous study, conducted by this research team, results showed that thick nasal discharge and facial pain/pressure were significantly decreased with the use of NIMT. Future studies will strive for a larger sample size in both groups, and improved control of confounding variables such as concurrent nasal steroid use..

REFERENCES

Guevara J, Pascual B, et al.: Ambulatory aerosol therapy in the treatment of chronic pathology in the ORL sphere. An Otorrhinolaringology Iber 1991.

Piccarillo, Jay. Snot-20 Questionnaire. Washington University School of Medicine, St. Louis, Missouri.

Vaughan W, Carvahlo G: Nebulized antibiotics for acute infections in chronic sinusitis. Otolaryngology Head Neck Surgery 2001.

ACKNOWLEDGEMENT

The authors wish to acknowledge Sinus DynamicsTM for providing the NIMT and culture costs for study participants. We would also acknowledge the nurses at South Coast Ear, Nose & Throat for data acquisition

BACTERIOLOGY



 

NEBULIZED THERAPY USED



 

RESULTS (TABLE ONE)



 

RESULTS (TABLE TWO)

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