Effect of medical treatment on eradication of biofilms in chronic rhinosinusitis
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20230100Keywords:
Macrolide, Nasal steroids, Nasal polyp, Biofilm, Chronic rhinosinusitisAbstract
Background: Long-term macrolides and intranasal corticosteroids have evidence-based recommendations. It has been reported that macrolide therapy caused objective and subjective improvements which correlated to the duration of therapy. Topical nasal steroids are the mainstay of treatment in CRS. It is proposed that intranasal steroid may increase the restoration of normal epithelium.
Methods: Sample size of 24 in each group is sufficient to detect the difference between positivity rate with 80% power and 5% level of significance clinically diagnosed cases of CRS with nasal polyps in age group of 18-60 years were taken. Outcome was measured with multiple scoring systems like SNOT-20, CT scoring, endoscopic scoring system.
Results: Significant improvement was seen in the SNOT-20 scores with p value of 0.011 and endoscopic scores with p value of 0.001 in group having macrolides along with steroids pre-operatively however the scores post-surgery didn’t show any significant change in both groups. The efficacy of macrolide with nasal steroidal spray or nasal spray alone showed no further benefit in the subjective outcome measures post operatively. Also, no statistically significant eradication of biofilms or decrease in density could be appreciated in both groups. Furthermore, there was no significant difference in recurrence rate.
Conclusions: Our result demonstrated the subjective improvement in patients of macrolide group post treatment which could be attributed to its anti-inflammatory effect. Even though macrolides in combination with nasal spray reflected some improvement in the secondary outcomes but the primary outcome of eradication of biofilms couldn’t be achieved.
References
Li H, Wang D, Sun X, Hu L, Yu H, Wang J. Relationship between bacterial biofilm and clinical features of patients with chronic rhinosinusitis. Eur Arch Otorhinolaryngol. 2012 Jan;269(1):155-63.
Cryer J, Schipor I, Perloff JR, Palmer JN. Evidence of bacterial biofilms in human chronic sinusitis. Ann Otol Rhinol Laryngol Relat Spec. 2004;66:155-8.
Piccirillo JF, Merritt MG, Richards ML. Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg. 2002;126(1):41-7.
Lund VJ, MacKay IS. Staging in rhinosinusitis. Rhinology. 1993;107:183-4.
Lund VJ, Kennedy DW. Staging of rhinosinusitis. Otolaryngology Head Neck Surg. 1997;7:535-40.
Zhang Z, Kofonow JM, Finkelman BS. Clinical factors associated with bacterial biofilm formation in chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2011; 144(3):457-62.
Korkmaz H, Ocal B, Tatar EC. Biofilms in chronic rhinosinusitis with polyps: is eradication possible?. Eur Arch Otorhinolaryngol. 2014;271:2695-702.
Sachse F, Becker K, Rudack C. Incidence of staphylococcal colonization and of the 753Q Toll-like receptor 2 variants in nasal polyposis. Am J Rhinol. 2010;24:e10-3.
Haxel B, Clemens M, Karaiiskaki N, Dippold U, Kettern L, Mann W. Controlled trial for long-term low dose erythromycin after sinus surgery for chronic rhinosinusitis. Laryngoscope. 2015;125:1048-55.
Tatar EC, Tatar I, Ocal B. Prevalence of biofilms and their response to medical treatment in chronic rhinosinusitis without polyps. Otolaryngol Head Neck Surg. 2012;146(4):669-75.
