Victoria King, M.D., Otolaryngologist in private practice in Canon City, CO
Fall 1997
As an otolaryngologist with a previous affiliation at Stanford, Dr. King
treated over 50 patients with cystic fibrosis. Based on her experience with these
patients, Dr. King and her colleagues developed the protocol for Endoscopic Sinus Surgery
and Serial Antimicrobial Lavage (ESSAL). ESSAL, like standard endoscopic sinus surgery,
removes inspissated mucus and polyps. But in the late 1980's, a treatment program using
topical antibiotic lavage of the sinuses was added to the procedure in an effort to reduce
the incidence of reinfection and repeat surgeries.
The surgery is intended to be as non-invasive as possible. Dr. King warned potential
patients not to have surgeons remove their turbinates. Following surgery, topical
treatment of the sinuses with Tobramycin (an antibiotic used to treat Pseudomonas) is
instituted and continued on a monthly basis. Dr. King demonstrated how the antibiotic
flush is administered. 84 percent of the patients had high compliance rates with the
monthly antibiotic sinus lavage process and 67 percent of these patients had complete
relief of their symptoms for the follow-up period of 3.5 years following surgery. This
compares remarkably well with reports of patients having standard surgery alone, which
typically has produced only a one year hiatus from symptoms.
The video of this talk might be particularly helpful for any CF patient who suffers from
chronic sinus infections and pain and is being urged to undergo the sinus surgery year
after year. It is straightforward enough for the lay person to understand, yet provides
enough information for an ENT who might be willing to consider employing this
infection-control strategy. It is important to note, however, that many doctors (and
insurance companies) outside of the Bay Area may consider this procedure experimental. If
you show them the tapes and other available literature on the subject, they may be
persuaded to investigate it further themselves. For more information, Dr. King's phone
number is (719) 275-0008.