The role of topical therapies in the treatment of chronic rhinosinusitis.
نویسندگان
چکیده
Brazilian Journal of otorhinolaryngology 77 (6) novemBer/DecemBer 2011 http://www.bjorl.org.br / e-mail: [email protected] Chronic rhinosinusitis (CRS) is a common disease resulting from inflammation of the sinonasal mucosa. The underlying cause of the inflammation is multifactorial, with both genetic and environmental contributions. Guidelines published by the AAOHNS in 2007 and a Cochrane review by Harvey et al. published in 2009 have clearly established the benefits of nasal saline irrigation for patients with CRS. Benefits include improved mucociliary function, decreased nasal mucosal edema, and mechanical removal of infectious debris, allergens, mucus, and bacteria from the sinus and nasal cavities. Irrigation may also reduce reliance on other sinus medications, the number and frequency of acute exacerbations of CRS, and symptoms related to CRS. Side effects of saline irrigation are minimal and selflimiting, mostly related to local irritation or ear symptoms. Nasal Irrigation has also been recognized as a potential route for topical drug administration into paranasal sinuses due to ease of use and direct drug effects on the sinonasal mucosa. Topical drugs being investigated for use in CRS include antimicrobial, anti-inflammatory and immunomodulatory agents. One difficult question for rhinologists to answer is which patients with rhinosinusitis are the best candidates for topical approaches? Desired properties of all topical therapies include complete sinus distribution, high local drug absorption, low systemic absorption, and minimal toxicity to the cilia and sinonasal mucosa. Understandably, the benefits of saline irrigation and topical therapies are greatest in patients who have had prior functional endoscopic sinus surgery (FESS). Clinical studies support this finding, with distribution of topical solutions in the unoperated sinuses on the order of less than 2% of the total irrigation volume, with almost no penetration in the frontal and sphenoid sinuses. For those patients with mucosal edema from infection and chronic inflammation, distribution is probably significantly less. Oral and intravenous antimicrobial therapies have traditionally been prescribed to manage infectious exacerbations of CRS. However, these agents are not without significant side effects, especially for patients requiring prolonged courses. Topically applied antibiotics in irrigation have a theoretical advantage to localize high doses of antibiotics to the sinonasal mucosa while minimizing systemic side effects. The majority of clinical data for topical antibiotics has investigated and provided support for the use of mupirocin sinus irrigation for patients with MRSA infections. Our lab investigated the use of topical tobramycin in a rabbit model of Pseudomonas sinusitis, and found that topical tobramycin resulted in the eradication of viable bacteria within the lumen of the sinus. However, even at high concentrations, topical tobramycin The role of topical therapies in the treatment of Chronic Rhinosinusitis EDITORIAL Braz J Otorhinolaryngol. 2011;77(6):680-1. BJORL.org
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ورودعنوان ژورنال:
- Brazilian journal of otorhinolaryngology
دوره 77 6 شماره
صفحات -
تاریخ انتشار 2011