title: Rhinotopic therapy for refractory chronic rhinosinusitis: a study of 20 cases.
abstract: The management of refractory chronic rhinosinusitis (CRS) after endoscopic sinus surgery is complex and challenging. We conducted a prospective clinical pilot study to evaluate the effectiveness of a rhinotopic protocol for the treatment of refractory CRS. Our study population was made up of 20 patients--8 men and 12 women, aged 31 to 76 years (mean: 50.1)--who were treated in our tertiary care rhinology fellowship training program. The rhinotopic protocol consisted of twice-daily saline rinses, each of which was followed by the administration of a nebulized corticosteroid and then a nebulized antibiotic. This regimen was administered for 6 weeks. Thereafter, patients underwent a once-weekly endoscopic sinus debridement followed by topical intrasinus installation of a corticosteroid and antibiotic. The duration of follow-up was 24 weeks, and thus the total study duration was 30 weeks. Treatment outcomes were based on Lund-Kennedy symptom scores and Lund-Kennedy endoscopic appearance scores. We found a 56% improvement in the mean symptom score after 3 weeks of therapy and 77% after 6 weeks. Subsequent follow-up revealed 90% improvement 4 weeks following the completion of therapy and 95% at 8 weeks post-therapy. Thereafter, we saw a small decrease in improvement: 73% at 16 weeks of follow-up and 65% at 24 weeks. Analysis of endoscopic appearance scores revealed a 55% improvement at 3 weeks of therapy and 84% at 6 weeks. The same general pattern emerged during follow-up, with 94% improvement 4 weeks after the cessation of therapy, 96% at 8 weeks, 76% at 16 weeks, and 75% at 24 weeks. Sinus cultures performed 4 weeks after the cessation of therapy found no growth in 13 patients (65%), normal respiratory flora in 5 patients (25%), a persistent pathogen in 1 patient (5%), and the emergence of a new pathogen in another (5%). Analysis of symptom scores and endoscopic appearance scores revealed that the rhinotopic protocol resulted in statistically significant improvement (p < 0.001) throughout the treatment period and follow-up period, although the improvement gradually declined over time. We therefore conclude that a rhinotopic protocol can be an effective treatment for refractory CRS.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Union Memorial Hospital, 201 East University Pkwy., Baltimore, MD 21218, USA. ashikani@aol.com.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Shikani
authors.forename: Karim A
authors.initials: KA
authors.lastname: Chahine
authors.forename: Mohannad A
authors.initials: MA
authors.lastname: Alqudah
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068656:Mometasone Furoate; D009330:Nebulizers and Vaporizers; D010865:Pilot Projects; D011244:Pregnadienediols / Q000008:administration & dosage; D011446:Prospective Studies; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*; D012965:Sodium Chloride / Q000008:administration & dosage; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D011244:Pregnadienediols; D000068656:Mometasone Furoate; D012965:Sodium Chloride