An Update on the Use of Topical Antibiotics to Treat Sinusitis in Patients with Cystic Fibrosis

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.

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