Outcome of FESS in Symptomatic CRS Patients with Minimal Change CT

Abstract

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 posttreatment modified SNOT 20 scores and sinus cultures.Method: 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 postcompletion of treatment with repeat SNOT 20 questionnaire and endoscopic culture.Results: Pre-and posttreatment sinus cultures were assessed. Bacteriology cultures and sensitivities demonstrated a wide range of organisms, including Staph aureus, H influenzae, Pseudomonas aeruginosa, Pseudomonas fluorescens, Moraxella catarrhalis, Stenotrophomonas maltophilia, Serratia marcescens, Morganella morganii, and Cornybacterium. Both solitary and mixed infections with various degrees of antibiotic resistance were encountered. Early results indicate a change in bacteriology as a result of treatment. Additionally a preliminary review of outcomes demonstrates a reduction in the pre-and posttreatment modified SNOT 20 scores in both groups. Final comparison of the 2 study groups and statistical analysis is pending. 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 for which an oral antibiotic is not available. Patient compliance and treatment morbidity is favorable.