Efficacy of nasal irrigations and nebulizations for nasal symptom relief.

PURPOSE OF REVIEW: To review current literature regarding the use and utility of nasal saline irrigation in nasal and sinus diseases. RECENT FINDINGS: Nasal irrigations, in various forms, are a widely used and accepted means of treatment of the symptoms of chronic rhinosinusitis and other sinonasal disease processes. Over the past two decades, significant research has been done to evaluate the role of nasal irrigations in the treatment of sinonasal disease. The use of a high-volume, low-pressure system like a squeeze bottle remains the optimal delivery device. Although additional research is required for many of the additives discussed, the use of xylitol in chronic rhinosinusitis and topical fluconazole in allergic fungal sinusitis appear promising. SUMMARY: Use of nasal saline irrigations can improve symptoms of sinonasal disease and may improve outcomes in certain settings. Ongoing research will continue to shape and optimize understanding of maximally effective nasal irrigations.

Bacteriology of the paranasal sinuses in pediatric cystic fibrosis patients.

OBJECTIVES: To review the characteristic microbiology of the paranasal sinuses in patients with cystic fibrosis who undergo endoscopic sinus surgery. To examine the subtypes of organisms cultured from the maxillary sinuses and determine their sensitivity to antibiotic therapy. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care children's hospital. METHODS: Sinus cultures were obtained from 51 patients with cystic fibrosis during endoscopic sinus procedures between 2000 and 2004 at a tertiary care children's hospital. A retrospective chart review was undertaken to obtain culture and sensitivity data of the sinus contents. RESULTS: The most common bacteria isolated was Staphylococcus aureus (71%), followed by Pseudomonas aeruginosa (PSA) (27%), Haemophilus influenzae (21%), Staphylococcus non-aureus (16%) and Streptococcus viridans (12%). Streptococcus pneumoniae and Moraxella catarrhalis were rarely isolated (2% and 0% respectively). Twenty-nine percent of the patients with cultures positive for PSA were of the mucoid variant. Only one patient had culture positive Escherichia coli. Antibiotic resistance among the more common organisms cultured from the sinus samples is also listed. CONCLUSION: Staph. aureus is the most common isolate in the sinuses of this pediatric CF population followed by P. aeruginosa and H. influenzae. Although many isolates are pansensitive, some isolates are panresistant.