Treatment of chronic rhinosinusitis using erythromycin phonophoresis

Abstract

Bacterial biofilms have been implicated in many chronic infective diseases, including chronic rhinosinusitis (CRS). Therapeutic ultrasound enhances the breakdown of bacterial biofilms and is clinically effective in CRS treatment, while phonophoresis has also been utilized for antibiotic delivery through the skin. The objective of this case report is to describe the results of a novel treatment, erythromycin phonophoresis, in a woman with CRS. A 31-year-old woman with a 7-month history of CRS refractory to conventional medical management was treated with erythromycin phonophoresis to both maxillary sinuses. Individual sinus symptom severity was assessed and sinus CT scans were obtained both pretreatment and posttreatment. After treatment, the total sinusitis symptom score improved from 12 to 0 and the CT scan showed almost complete disease resolution. At 5-month follow-up, the patient reported sustained improvement. Erythromycin phonophoresis has potential as an effective treatment for CRS.

A randomized clinical trial comparing pulsed ultrasound and erythromycin phonophoresis in the treatment of patients with chronic rhinosinusitis

“…It has previously been reported that therapeutic US in either continuous or pulsed mode is effective in treating symptoms of patients with acute rhinosinusitis (Høsøien, Lund, and Vasseljen, 2010) or CRS (Ansari, Fathali, Naghdi, and Hasson, 2010;Ansari, Naghdi, Farhadi, and Jalaie, 2007;Ansari et al, 2012;Ansari et al, 2013;Naghdi, Ansari, and Farhadi, 2008;Nakhostin Ansari, Naghdi, and Farhadi, 2004;Rocha et al, 2011;Young, Morton, and Bartley, 2010). Overall, the results found in this study agree with prior reports.…”

“…The OMC was scored as 0 or 3 (not occluded or occluded). The individual sinus scores were added to obtain the total CT score for each side (0 ¼ clear to 18 ¼ total opacification) (Ansari, Fathali, Naghdi, and Hasson, 2010;Ansari et al, 2012;Ansari et al, 2013). The total CT score for each patient was obtained by adding the right and left CT scores ranging from 0 ¼ clear to 36 ¼ total opacification.…”

“…The main outcome measure was ''percent improvement'' of the TSS [(pre-treatment total score -post-treatment total score/pretreatment total score) Â 100] classified as follows: No change (0): 0-15%; Poor (1): 16-35%; Fair (2): 36-60%; Good (3): 61-85% and Excellent (4): 86-100% (Ansari, Fathali, Naghdi, and Hasson, 2010;Ansari et al, 2012;Ansari et al, 2013;Naghdi, Ansari, and Farhadi, 2008;.…”

“…The surgical outcome is not always successful (Fokkens et al, 2012). These issues have led investigators to explore alternative strategies for CRS treatment (Albu, 2012;Ansari et al, 2013;Bartley and Young, 2009;Nakhostin Ansari, Naghdi, and Farhadi, 2004).…”

“…Recently, Ansari et al (2013) reported the successful treatment of a woman with CRS using the novel treatment of erythromycin phonophoresis (EP). Theoretically, EP facilitates antibiotic delivery through the skin-enhancing drug delivery to the paranasal sinuses.…”