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| Antifungal Therapy to Prevent Recurrent Allergic Fungal Rhinosinusitis After Surgery
Allergic fungal rhinosinusitis (AFRS) is the most common form of fungal sinus disease. Its recurrence rate is high despite numerous strategies to prevent it. A study assessed the effect of systemic and topical antifungal agents-both separately and in combination- in preventing recurrence of AFRS following functional endoscopic sinus surgery (FESS). It was concluded that treatment with topical fluconazole as either a nasal spray (0.5mg in each nostril twice daily for 3 months) or an irrigation solution (once a week for 6 consecutive weeks) can significantly reduce the rate of recurrence of AFRS after FESS. Ear Nose Throat J. 2011 Aug;90(8):E1-7.
Bleeding is the most frequent complication of nasal surgery. A prospective study evaluated the effectiveness of tranexamic acid (TA), an antifibrinolytic agent, in reducing bleeding during and after nasal surgery. The study concluded tranexamic acid “is a safe and effective drug for the reduction of bleeding in nasal surgery. It may be recommended for routine use.” Am J Rhinol. 2006 Mar-Apr;20(2):227-9.
Capsaicin Nasal Spray for Idiopathic/Perennial Rhinitis Capsaicin nasal spray has been shown to reduce nasal complaints in patients with non-allergic non-infectious perennial rhinitis. Blom et al. hypothesized that the beneficial effect of capsaicin might be the result of a down-regulation of inflammation, and showed that intranasal capsaicin spray gives a significant and long-term reduction of symptoms. In a double-blind parallel groups trial, 30 patients were randomized into two different treatment regimens: group A received capsaicin five times on the first day at one-hour intervals. This was followed by a placebo once every second or third day for a total of five treatments within 2 weeks after the initial capsaicin application. Group B received the placebo five times on the first day followed by capsaicin once every second or third day for a total of five treatments 2 weeks after the placebo application. The visual analogue scale scores for overall nasal symptoms, rhinorrhea and nasal blockage showed significant decrease after the start of treatment in both groups, with a significantly steeper decrease in group A. A significant reduction in cold dry air dose responsiveness was also found up to 9 months after therapy in both groups, reflecting a decrease in nasal hyperreactivity. No significant changes in smell, blood pressure, or heart rate were found. They concluded that intranasal capsaicin seems safe to use and that five treatments of capsaicin on a single day is at least as effective as five treatments of capsaicin in 2 weeks. In a separate trial, a total of 208 patients affected by idiopathic rhinitis (IR) were enrolled in a randomized placebo-controlled trial. Diagnosis of IR was made on the basis of history of nasal obstruction, sneezing and/or rhinorrhoea and after exclusion of other nasal/paranasal anatomic disorders. IR patients were randomized into four groups receiving increasing doses of capsaicin (Capsicum) or placebo. A significant reduction in the frequency of IR symptom was noticed in the group that received capsaicin 4 micrograms/puff, three times a day for 3 consecutive days. No significant difference in side effects was recorded in patients receiving capsaicin therapy when compared to controls. Acta Otolaryngol. 2009 Apr;129(4):367-71. Otitis Media Clin Otolaryngol Allied Sci. 2004 Aug;29(4):321-3. David S. Haynes, MD, director of otology and neurotology at the Vanderbilt University Medical Center and the St. Thomas Hospital Neuroscience Institute in Nashville, and associate professor in the Department of Otolaryngology and the Department of Hearing and Speech Sciences, notes that at Vanderbilt, physicians use a powder made up of amphotericin B, sulfanilamide, chloramphenicol, hydrocortisone, and corn starch to successfully treat refractory draining mastoid cavities and external ear infections. Powders have a mechanical drying effect and can be used to deliver antibiotics and other agents (i.e., antifungals) that are not commercially available as ototopical agents. Ear Nose Throat J. 2002 Aug;81(8 Suppl 1):13-5. Xylitol for Otitis Media In two clinical trials (of three months duration), oral xylitol in a daily dose of 8.4-10 g given in five divided doses was found to reduce the incidence of acute otitis media (AOM) by 35-40% in young children. The need for antimicrobials decreased markedly when using xylitol. Xylitol appears to be an attractive alternative to prevent AOM. However, in a high-risk group of children with tympanostomy tubes, xylitol was ineffective in preventing otitis.
This study found that “Oral xylitol solution at dosages of 5g TID and 7.5g QD is well-tolerated by young children.” Int J Pediatr Otorhinolaryngol. 2007 Jan;71(1):89-94. Epub 2006 Nov 9. Xylitol inhibits the growth of Streptococcus pneumoniae and inhibits the attachment of both pneumococci and Haemophilus influenzae to the nasopharyngeal cells. Vaccine. 2000 Dec 8;19 Suppl 1:S144-7. Laryngoscope. 2008 Sep;118(9):1677-80. Click here to access the PubMed abstract of this article.
Results of this study indicate that topical fluconazole application may help patients with allergic fungal sinusitis. Ear Nose Throat J. 2004 Oct;83(10):692, 694-5. Click here to access the PubMed abstract of this article. Acta Otolaryngol. 2008 Jul 10:1-6. Acta Otorhinolaryngol Ital. 2001 Jun;21(3 Suppl 66):1-7 Eur Arch Otorhinolaryngol. 2003 Feb;260(2):73-7. Epub 2002 Sep 11 Acta Otolaryngol Suppl. 2000;544:34-9 Betahistine increases vestibular blood flow. Acta Otolaryngol Suppl 1991;479, pp. 44-47 |
