Treatment of chronic rhinosinusitis refractory to other treatments with topical antibiotic therapy delivered by means of a large-particle nebulizer: results of a controlled trial.

OBJECTIVE To study the efficacy of nebulized topical saline-tobramycin solution in patients with chronic rhinosinusitis refractory to medical and surgical therapy. STUDY DESIGN AND SETTING Twenty patients in whom endoscopic sinus surgery failed to relieve symptoms entered a randomized, double-blind trial of tobramycin-saline solution or saline-only solution administered thrice daily to the nasal passages by means of a large-particle nebulizer apparatus for 4 weeks, followed by a 4-week observation period. Outcome measures of symptoms, quality of life, and endoscopic aspect of sinus mucosa were assessed. RESULTS Both treatments were well tolerated and produced equivalent improvement in symptoms, quality of life, and mucosal aspect. Treatment with the tobramycin-saline solution gave more rapid improvement of pain, but led to the development of nasal congestion. CONCLUSION Therapy with a 4-week course of large-particle nebulized aerosol therapy improves symptomatology and objective parameters of rhinosinusitis in patients refractory to surgical and medical therapies. Addition of tobramycin appears of minimal benefit. The mechanism of this effect is unexplained. SIGNIFICANCE Large-particle nebulized aerosol therapy may offer a safe and effective management alternative for patients with refractory rhinosinusitis.