Aerosols and polypi
Reviewed by Badr Eldin Mostafa

Infection in the operative cavities after endoscopic sinus surgery for sinonasal polyposis leads to recurrence of symptoms and mucopurulent discharge. The usual therapies include systemic antibiotics sometimes with steroids. The authors hypothesised that the use of a topical antimicrobial (tobramycin 150mg/3mL) as an aerosol could be more effective than isotonic saline administered by the same aerosol apparatus in eradicating infection and relief of symptoms. It was a prospective multicentric randomised study. It included 72 patients who were previously operated on at least three months prior to inclusion and having bacterial superinfection of the cavities. The commonest organism was Staph aureus. The patients received two daily treatments for seven days. At the end of the trial 46.88% of bacteria were eradicated in the trial group versus 17.39% in the saline group (p = 0.02). The authors conclude that this form of therapy is well tolerated and quite effective in such a group of patients. However the main flaw is that they did not compare with a third group receiving systemic antibiotics as routinely used in most cases. This would have shown whether this novel therapy is really effective or not.

Efficacy of tobramycin aerosol in nasal polyposis.
Bonfils P, Escabasse V, Coste A, et al.
EUROPEAN ANNALS OF OTORHINOLARYNGOLOGY, HEAD AND NECK DISEASES
2015;132(3):119–23.