Use of low-level laser therapy for patients with chronic rhinosinusitis: a single-blind, sham-controlled clinical trial.

Chronic rhinosinusitis (CRS) is one of the most common conditions all over the world. The purpose of this study was to investigate the effects of low-level laser therapy (LLLT) in patients with CRS. Fourteen adult patients with CRS participated in this single-blind, sham-controlled clinical trial (12 male, mean age 40 years). Patients received five successive sessions of sham laser followed by five successive sessions of real laser after 2 days. Ga-Al-As laser of 830 nm in a continuous mode at a power output of 30 mW and energy dose of 1 J was applied on the cheeks and the forehead for the maxillary and frontal sinuses, respectively. Laser was delivered on six points over each sinus, each point for 33 s. Four measurements were taken. The total symptom score (TSS) was calculated as the primary outcome measure. The effects of LLLT on TSS were evaluated by using repeated measure ANOVA. The percentage improvement of real laser and sham laser was compared by Wilcoxon signed ranked test. Cohen's d was used to calculate the effect size. Total symptom score significantly improved after real laser (p = 0.015, Cohen's d = 0.69). The percentage improvement for real laser (34.12 ± 46.43) was significantly better than the sham laser (5.02 ± 37.34, Z = - 2.23, p = 0.026). No significant improvements were observed after sham laser. This study indicates that five-session active LLLT when compared with sham is effective in the treatment of CRS symptoms.

Bacterial community of chronic rhinosinusitis patients and therapeutic ultrasound efficacy: clinical trial study.

Background and Objectives: Bacterial involvement in chronic rhinosinusitis (CRS) condition made it difficult to treat using available antibiotic therapy. Therapeutic ultrasound was investigated here to evaluate bacterial diversity and quantity before and after continuous/pulsed ultrasound strategy compared to control patients. Materials and Methods: Totally, 34 CRS patients were studied in three groups, including continuous ultrasound, pulsed ultrasound and control. Bacterial culture and identification were done before and after treatment. Computed tomography scan (CT scan) and questionnaire scores were recorded two times before and after intervention. Results: The most prevalent bacterial isolates were non-hemolytic Streptococci (34 patients), coagulase-negative Staphylococcus (33 patients), Gram-negative cocci (26 patients), Staphylococcus aureus (19 patients), Streptococcus pneumoniae (five patients) and Streptococcus pyogenes (five patients). Both continuous and pulsed ultrasound could significantly reduce the quantity of bacterial isolates after treatment. CT scan and questionnaire results support the effectiveness of therapeutic ultrasound. Conclusion: The quantity of clinically important bacteria was significantly reduced using ultrasound treatment and recovery of patients was supported by CT scan and questionnaire scores. Alternative therapeutic ultrasound could be an effective procedure in CRS patients.

Effects of pulsed ultrasound on olfactory dysfunction in patients with chronic rhinosinusitis: A pilot study.

BACKGROUND: and purpose. Olfactory dysfunction is a common symptom of chronic rhinosinusitis (CRS). This study aimed to evaluate the effects of therapeutic pulsed ultrasound (PUS) on olfactory dysfunction in patients with CRS. MATERIALS AND METHODS: Patients with CRS underwent treatment with PUS for 10 sessions, three days a week. The outcome measures were the Smell Identification Test (SIT) and 20-item Sino-Nasal Outcome Test (SNOT-20). RESULTS: Fifteen patients (9 male, mean age 48.9 ± 9.7 years) with disease duration of 55.13 ± 65.4 months participated. Analyses showed olfactory dysfunction was completely resolved (Cohen's d = 5.62). The SNOT-20 scores showed significant improvement of CRS symptoms after treatment (Cohen's d = 1.55). Effects remained at one-month follow-up. CONCLUSION: Therapeutic PUS improved the olfactory dysfunction and sino-nasal symptoms in patients with CRS. The PUS can be considered as a promising strategy to target chronic rhinosinusitis.

The pulsed ultrasound strategy effectively decreases the S. aureus population of chronic rhinosinusitis patients.

OBJECTIVE: Staphylococcus aureus with the ability of biofilm formation and the drug resistance acquisition is one of the most frequently isolated pathogens from chronic rhinosinusitis patients. Ultrasound as an alternative therapy is effectively able to kill the bacteria by cavitation in or on the bacterial cells and peroxide generation and hence improving antibiotic treatment efficacy. RESULTS: Staphylococcus aureus was detected in 4 and 6 out of 14 patients by phenotypic and qPCR assays, respectively. Four patients were completely resolved after pulsed ultrasound treatment. However, presence of the S. aureus was confirmed in three healthy controls by bacterial cultivation. Pulsed ultrasound have been quantitatively decreased the S. aureus population in chronic rhinosinusitis patients (p < 0.05). Further studies need to be investigated the effectiveness of pulsed ultrasound as an alternative course of CRS patient's treatment.

Quantitative analysis of Staphylococcus aureus in patients with chronic rhinosinusitis under continuous ultrasound treatment.

BACKGROUND AND OBJECTIVES: Bacterial pathogens, in particular drug resistant strains, involved in chronic rhinosinusitis may result in treatment failure. Ultrasound waves are able to destroy bacterial population in sinus cavities and can recover patients. MATERIALS AND METHODS: Twelve patients with chronic sinusitis and 10 healthy controls were treated by continuous ultrasound waves. Clinical specimens were collected before and after treatment. Serial diluted specimens were cultured on blood agar, chocolate and MacConkey agar plates for bacterial isolation. Bacterial DNA was extracted and used for Staphylococcus aureus detection using quantitative PCR. RESULTS: S. aureus was the most isolated bacterium (10 patients), which was eradicated from 8 patients after treatment. Using phenotypic methods at the beginning, 3 out of 10 healthy individuals were found to be positive. From 11 positive patients for S. aureus identified by real time qPCR, 9 showed significant reduction after treatment. In the healthy group, S. aureus was detected in 4 samples using qPCR, but they were clean at the second sampling. CONCLUSION: According to our phenotypic and molecular experiments, continuous ultrasound treatment effectively reduced the bacterial population in studied patients (p < 0.01). This was a hopeful basis for doing more studies with ultrasound therapy as a treatment option.

Validation of the Persian version of the dysphagia handicap index in patients with neurological disorders.

BACKGROUND: Dysphagia as a common condition affecting many aspects of the patient's life. The Dysphagia Handicap Index (DHI) is a reliable self-reported questionnaire developed specifically to measure the impact of dysphagia on the patient's quality of life. The aim of this study was to translate the questionnaire to Persian and to measure its validity and reliability in patients with neurogenic oropharyngeal dysphagia. METHODS: A formal forward-backward translation of DHI was performed based on the guidelines for the cross-cultural adaptation of self-report measures. A total of 57 patients with neurogenic dysphagia who were referred to the neurology clinics of Tehran University of Medical Sciences, Iran, participated in this study. Internal consistency reliability of the DHI was examined using Cronbach's alpha, and test-retest reliability of the scale was evaluated using intraclass correlation coefficient (ICC). RESULTS: The internal consistency of the Persian DHI (P-DHI) was considered to be good; Cronbach's alpha coefficient for the total P-DHI was 0.88. The test-retest reliability for the total and three subscales of the P-DHI ranged from 0.95 to 0.98 using ICC. CONCLUSION: The P-DHI demonstrated a good reliability, and it can be a valid instrument for evaluating the dysphagia effects on quality of life among Persian language population.

A randomized clinical trial comparing pulsed ultrasound and erythromycin phonophoresis in the treatment of patients with chronic rhinosinusitis.

Therapeutic ultrasound, an important physiotherapy modality, has been used successfully in the treatment of patients with chronic rhinosinusitis (CRS). No study has compared pulsed ultrasound (PUS) with erythromycin phonophoresis (EP). The aim of this randomized, double-blind, parallel group study with concealed allocation was to compare PUS with EP. Sixty CRS patients were randomly allocated into two groups. Group 1 had PUS and Group 2 had EP. Patients were treated 3 days a week for 10 sessions over 4 weeks. The severity of nine CRS symptoms was self-rated by patients on an ordinal scale of 0-3 (absent, mild, moderate or severe) at baseline and after the 10th treatment session. Individual symptom scores were summed to obtain a "Total Symptom Score" (TSS). The outcome measure included percentage improvement in the TSS. A statistically significant improvement in TSS occurred with both PUS and EP therapy groups (p < 0.05). The percentage improvement in the EP group was statistically greater than in the PUS group (67.2 versus 49.3%) (p = 0.03). The effect sizes in both therapy groups were large; PUS: d = 1.36 and EP: d = 2.15. EP was found to be superior over PUS therapy.

A pilot study into the effect of low-level laser therapy in patients with chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nose and paranasal sinuses that has a significant impact on patients' quality of life. No study has examined the effectiveness of applying low-level laser therapy (LLLT) locally over the sinuses in patients with CRS. The aim of this study was to evaluate the effect of LLLT in patients with CRS. Fifteen adult patients with CRS participated in this pilot pretest-posttest clinical study. Patients were treated with a 830-nm Ga-Al-As laser in continuous-wave mode at a power output of 30 mW and energy dose of 1 J. Laser irradiation was delivered on six points over each maxillary or frontal sinus with 33 sec irradiation for each point and a total treatment duration of 198 sec for each sinus. Patients were given LLLT three times per week for ten treatment sessions. Patients were asked to score their symptoms in accordance with a four-point scale (0-3), and a total symptom score (TSS) for each patient was calculated. Percentage improvement of TSS was considered as the primary outcome measure. TSS was calculated at baseline (T0), at 2 weeks (T1) and at 4 weeks (T2). The TSS was improved significantly at T1 (39%) and at T2 (46.34%). A large effect size for LLLT was found (ηp(2) ηp(2) = 0.63). The therapeutic effect was sustained for a mean of 5 months. This pilot study indicates that LLLT applied for 4 weeks improves symptoms in patients with CRS.

Treatment of chronic rhinosinusitis using erythromycin phonophoresis.

Bacterial biofilms have been implicated in many chronic infective diseases, including chronic rhinosinusitis (CRS). Therapeutic ultrasound enhances the breakdown of bacterial biofilms and is clinically effective in CRS treatment, while phonophoresis has also been utilized for antibiotic delivery through the skin. The objective of this case report is to describe the results of a novel treatment, erythromycin phonophoresis, in a woman with CRS. A 31-year-old woman with a 7-month history of CRS refractory to conventional medical management was treated with erythromycin phonophoresis to both maxillary sinuses. Individual sinus symptom severity was assessed and sinus CT scans were obtained both pretreatment and posttreatment. After treatment, the total sinusitis symptom score improved from 12 to 0 and the CT scan showed almost complete disease resolution. At 5-month follow-up, the patient reported sustained improvement. Erythromycin phonophoresis has potential as an effective treatment for CRS.

A randomized, double-blind clinical trial comparing the effects of continuous and pulsed ultrasound in patients with chronic rhinosinusitis.

The objective of the present study was to compare the effects of continuous ultrasound (CUS) with pulsed ultrasound (PUS) in patients with chronic rhinosinusitis (CRS). In this prospective, randomized, double-blind, parallel group study, 40 patients (10 losses) with CRS participated. Patients received either continuous or pulsed (1:9) 1 MHz ultrasound (US) using a US head of 1 cm2 at 1 W/cm2 and 0.5 W/cm2 for the maxillary and frontal sinuses, respectively. Treatment was performed in 10 sessions, 3 days per week, with US given every other day. The primary outcome measure was percent improvement in the Sinusitis Symptom Score. Measurements were taken before and after 10 treatment sessions. The patients were followed up monthly for 2 months. After treatment, both groups improved significantly on the Sinusitis Symptoms Score. Patients who received PUS had significantly decreased total symptom scores compared with patients receiving CUS (mean change 9.8 vs. 5.6, p = 0.049). The percent improvement in the Sinusitis Symptom Score between the PUS group (65.2 SD 23.1) and the CUS group (43.9 SD 40.7) was not statistically significant (p = 0.09). The effect size for each treatment was large; PUS: d = 3.92 and CUS: d = 1.93. Symptom improvement in both groups was similar at the 2-month follow-up. These results support the use of therapeutic US for CRS. This pilot study gives only marginal evidence to favor PUS over CUS.

Effect of pulsed ultrasound on chronic rhinosinusitis: a case report.

This case report demonstrates that pulsed ultrasound (US), when used for a total of 20 treatment sessions, provided symptom relief to a patient with chronic rhinosinusitis (CRS). A 16-year-old boy with a 12-month history of rhinosinusitis and candidate for sinus surgery was referred for ultrasound therapy. He presented with facial pain/pressure, nasal obstruction, and postnasal drip (total sinusitis score=7). On computed tomographic (CT) scanning, the total opacification of the right maxillary sinus was observed. The ostiomeatal complex was occluded (total CT score=6). Pulsed ultrasound was administered three times a week, every other day. After 10 treatment sessions, his symptoms were resolved with exception of nasal obstruction being mild (total sinusitis score=2). On CT scan, right maxillary sinus showed partial improvement (total CT score=2). After additional 10 treatments, the nasal obstruction was resolved, and follow-up CT scan of his sinuses showed that right maxillary sinus was clear and normal. At 6-month follow-up, the positive effects were maintained and the patient reported no recurrence of symptoms. Twenty sessions of pulsed ultrasound therapy eradicated the CRS and resolved the symptoms.