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 sol ution in patients with chronic rhinosinusitis refractory to medical and sur gical therapy. STUDY DESIGN AND SETTING: Twenty patients in whom endoscopic sinus surgery failed to relieve symptoms entered a randomized, double-blind trial of tobr amycin-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 symptom s, quality of life, and endoscopic aspect of sinus mucosa were assessed. RESULTS: Both treatments were well tolerated and produced equivalent improv ement 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 aeroso l therapy improves symptomatology and objective parameters of rhinosinusiti s in patients refractory to surgical and medical therapies. Addition of tob ramycin appears of minimal benefit. The mechanism of this effect is unexpla ined. SIGNIFICANCE: Large-particle nebulized aerosol therapy may offer a safe and effective management alternative for patients with refractory rhinosinusit is.