W. S. Tichenor, M. D.
New York, New York
Rationale: Patients with chronic rhinosinusitis have persistent symptoms despite medical and surgical treatment. Current theories regarding causation include immunological reactions to fungi and bacteria, but there is no consensus regarding the cause. Since mycological causes have been investigated previously, NTM could also be a cause.
Methods: Endoscopically directed cultures of all patients with chronic resistant rhinosinusitis were reviewed. Most patients have cultures done for mycobacteria. Those with positive cultures for NTM were selected. Treatment records were then reviewed.
Results: Twenty-one patients grew out NTM from either the ostiomeatal unit or paranasal sinuses. Nineteen grew out Mycobacterium chelonae and 1 each of M. majoritense and M. immunogenum. Eighteen of 21 patients had previous sinus surgery and 19/21 used nasal irrigation. Based on sensitivities, patients were typically treated with a combination of 3 antibiotics: amikacin irrigation, an oral quinolone, and clarithromycin. Treatment time ranged from 6 weeks to 13 months. Eleven patients responded to treatment, 2 were not treated, 1 received inadequate treatment, 2 remained culture positive, 2 did not respond, 2 were lost to follow-up, and 1 responded but was treated at the same time for MRSA. There were negative follow up cultures on 14/19 patients.
Conclusion: Patients with chronic rhinosinusitis resistant to treatment should have endoscopically directed cultures performed for NTM. Treatment is often successful with an extended course of multiple antibiotics.
Watch for another abstract which will be presented at the September, 2008 meeting of the American Rhinologic Society
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