Comparative study of the efficacy of topical steroid and antibiotic combination therapy versus oral antibiotic alone when treating acute rhinosinusitis.

BACKGROUND: Acute rhinosinusitis arises as a consequence of viral rhinitis, and bacterial infection can subsequently occur. Intranasal antibiotics as an adjunct to corticosteroids usually demonstrate the greatest symptom relief. AIM: We wanted to clinically evaluate the effects of a topical antibiotic and steroid combination administered intranasally, versus an oral antibiotic alone when treating acute rhinosinusitis. METHOD: Forty patients with acute bacterial rhinosinusitis were divided into two groups. Group A received an antibiotic and steroid combination (ofloxacin 0.26 per cent and dexamethasone 0.053 per cent nasal drops) for 10 days, administered intranasally (5 drops in each nostril/8 hours). Group B, the control group, received an oral antibiotic alone (amoxicillin 90 mg/kg). RESULTS: Eight hours after commencing treatment, facial pain was more severe in group B and nasal obstruction was reduced in both groups. Ten days after commencing treatment, anterior nasal discharge was 0.15 per cent in group A and absent in group B. CONCLUSION: The application of a topical antibiotic and steroid combination into the nasal cavity is an effective way of treating uncomplicated, acute bacterial rhinosinusitis with the theoretical advantages of easy administration, high local drug concentration and minimal systemic adverse effects.

Management of clinically diagnosed subacute rhinosinusitis in children under the age of two years: a randomized, controlled study.

BACKGROUND: In children, a diagnosis of rhinosinusitis is usually made on clinical grounds. Subacute rhinosinusitis (SRS) may be the cause of persistent cough, low-grade fever, snoring, ear problems and difficult feeding in children under the age of two years. OBJECTIVE: To compare the efficacy of culture-based antibiotics and empiric amoxicillin-clavulanate (40 mg/kg/day) in treating SRS in children under the age of two years. STUDY DESIGN: Randomized, controlled study. POPULATION: Sixty children with persistent nasal discharge and nasal obstruction (and other related symptoms) for 30-90 days. METHODS: Group one (n = 30) received culture-based antibiotics and group two (n = 30) were treated empirically with 40 mg/kg/day of amoxicillin-clavulanate. Treatment was continued for two weeks. RESULTS: At the end of the three-week follow-up period, statistically significant greater improvements in nasal obstruction (p = 0.037) and nasal discharge (p = 0.003) were seen in group one compared with group two. CONCLUSION: culture-based antibiotics were more efficacious than empiric amoxicillin-clavulanate (40 mg/kg/day) in treating SRS in children under the age of two years.

Cartilage perichondrium composite graft (CPCG) in pediatric tympanoplasty.

Different policies on the treatment of tympanic membrane perforation in the pediatric age group continue to exist. Thirty patients were included in this study over a period of 2 years, where cartilage perichondrium composite graft (CPCG) was used to close the tympanic membrane perforation. Successful drum closure was achieved in 86.6% of cases, regardless of the site of perforation or the status of the operated ear. The graft was taken from the tragus and was placed in an underlay fashion with cartilage towards the promontory and the perichondrium immediately to the tympanic membrane remnants. The postoperative hearing gain although delayed up to 6 months was excellent either subjective or objective. So, CPCG has proved advantageous as a graft material to close perforation in the tympanic membrane in pediatric age group.

Combined functional endoscopic sinus surgery (FESS): a revisited approach.

A technique of combined functional endoscopic sinus surgery (FESS) was carried out through the nose to clear up the ostiomeatal complex. A small window was then created in the canine fossa to remove the maxillary sinus pathology under endoscopic control. It aims at the complete removal of maxillary sinus pathology, which cannot be safely removed via the middle meatus while preserving the rest of the mucosa to ensure sinus rehabilitation. It also helps the surgeon in case of difficulty in locating the ostium during FESS. A series of 36 patients was studied over a period of two years, with a follow up, up to two years, post operatively. The present technique proved to be complementary to FESS with no serious complications. It is recommended for cases of recurrent antrochoanal polyps, oroantral fistula, sinusitis of dental origin or fungal infection of the nose and sinuses.