Randomized, double-blind study on role of low level nitrogen laser therapy in treatment failure tubercular lymphadenopathy, sinuses and cold abscess.

ABSTRACT

Background: Effectiveness of low level nitrogen laser therapy along with antitubercular treatment (ATT) in cases of treatment failure and drug resistant tubercular lymphadenopathy, sinuses and cold abscess. Methods: In a double-blind randomized controlled trial of LLLT ,104 patients assigned to either the low level nitrogen laser therapy along with ATT ( LLLT group) (n =54) or ATT only(Chemotherapy group)(n=50). Both groups were treated two times per week for five weeks. Those in the treatment group received pulse nitrogen laser with a pulse duration of seven nanosecond, wave length 337 nanometer and average power output of 5 mW whereas those in the control group were treated with sham laser. The primary outcome measure was bacteriological conversion and the secondary outcome measures were decrease in size of lesion and the clinical improvement. Results: Acid Fast Bacilli (AFB) smear, AFB culture and Polymerase Chain Reaction(PCR) conversion rate at five weeks (after 10 sittings of laser) were 49.15%( Fishers P exact test-p= 0.015), 60%, 44.44% (Fishers P exact test-p= 0.048 ) in LLLT group as compared to 11.86%,20%,17.77% in chemotherapy group. Average percentage reduction in the size of gland at 5 weeks was 70.67% (p value 0.01) as compared to 54.81 in chemotherapy group. Average time taken for closure of sinuses was 11.03 weeks in LLLT group as compared to 26 weeks in chemotherapy group. The follow up was conducted for two years. Conclusion: Low level nitrogen laser therapy can be used as an adjunctive therapy along with antitubercular drugs in cases not responding and drug resistant tubercular lymphadenopathy, sinuses and cold abscess.