Objectives: To evaluate the therapeutic yield of sinonasal irrigation (SNI) using ceftriaxone solution in
saline and its impact on quality of life (QoL) scores. Patients & Methods: This multicenter study was assigned to
include all patients attending the outpatient clinic with symptoms suggestive of chronic rhinosinusitis (CRS).
Patients were diagnosed according to criteria defined by the Rhinosinusitis Task Force. All patients underwent rigid
endoscopy and endoscopic findings were graded according to Lund-Kennedy scoring. All patients were asked to
complete two quality of life questionnaires: the Rhinosinusitis Disability Index (RSDI) and the chronic sinusitis
score (CSS). All patients received bilateral nasal and sinus irrigation using ceftriaxone sodium 1 gm/200 ml normal
saline. Then, all patients were allowed to use the same fluid for twice daily nasal irrigation for 6 weeks and
reevaluated. Study outcome included clinical evaluation of presenting symptoms, evaluation of QoL questionnaires
and endoscopic scoring at the end of 6 weeks of domiciliary irrigation. Results: The study included 700 CRS
patients; 450 in Emirate and 250 Egyptian patients. After 6-weeks of irrigation; 220 patients had only minor
symptoms (Responders) and 480 patients had varied distribution among other symptoms severity grades (Nonresponders).
There was significant difference of the frequency of patients among symptom severity grades between
both evaluation sessions. After 6-weeks follow-up, mean Lund-Kennedy scores, total and subscales of RSDI were
significantly lower with significantly higher CSS compared to baseline scores of responders. Moreover, responders
showed significantly lower Lund-Kennedy scores and RSDI with significantly higher CSS at the end of follow-up
compared to non-responders. Conclusion: SNI has a significant role as a therapeutic modality for CRS patients
which could be implemented wherein bacterial resistance to systemic antibiotics was encountered or to postpone
surgery or in patients who are unfit or refusing surgery. SNI with ceftriaxone-saline solution allowed minimization
of clinical manifestations with improvement of QoL scores. |
