title: Therapeutic ultrasound as treatment for chronic rhinosinusitis: preliminary observations.
abstract: BACKGROUND
  Bacterial biofilms have been implicated in the pathogenesis of chronic rhinosinusitis. In the laboratory setting, ultrasound is effective in disrupting such biofilms; however, few clinical studies have evaluated the role of therapeutic ultrasound in chronic rhinosinusitis.
  
  
  OBJECTIVE
  This study was performed to investigate the short-term effectiveness of therapeutic ultrasound as a treatment modality for chronic rhinosinusitis.
  
  
  METHODS
  Twenty-two patients with a positive history of chronic rhinosinusitis, according to the criteria set out by the Rhinosinusitis Task Force, together with a previous computed tomography scan compatible with a diagnosis of chronic rhinosinusitis, and who had failed previous, aggressive medical management, were treated with therapeutic pulsed ultrasound at 1 MHz two to three days per week for six sessions. Patients completed an assessment of individual sinus symptom severity and the 20-Item Sino-Nasal Outcome Test questionnaire before treatment, prior to session four and after completion of session six.
  
  
  RESULTS
  Two patients were unable to complete the study protocol. After completion of session six, 18 patients had experienced improvement in symptoms, while two patients noted a worsening of symptoms. Median percentage improvement of the total overall symptom score was 16.7 per cent (Wilcoxon signed rank, p < 0.001). The 20-Item Sino-Nasal Outcome Test score improved by 34.1 per cent (Wilcoxon signed rank, p < 0.0001).
  
  
  CONCLUSIONS
  This study demonstrated a significant improvement in chronic rhinosinusitis symptoms after a six-session course of pulsed ultrasound therapy. Treatment with ultrasound alone or combined with antibiotics may provide a strategy to target biofilms on the sinus mucosa. Therapeutic ultrasound warrants further investigation as a potential treatment modality for chronic rhinosinusitis.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Counties-Manukau District Health Board, Auckland, and the Department of Surgery, South Auckland Clinical School, University of Auckland, New Zealand.
authors.forename: D
authors.initials: D
authors.lastname: Young
authors.forename: R
authors.initials: R
authors.lastname: Morton
authors.forename: J
authors.initials: J
authors.lastname: Bartley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018441:Biofilms; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012220:Rhinitis / Q000000981:diagnostic imaging / Q000628:therapy*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents