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Safety and efficacy of Anti-Microbial Photodynamic Therapy (aPDT) in patients with recalcitrant chronic rhinosinusitis : a pilot study

University of British Columbia

Introduction: This pilot study intended to test the feasibility of addressing problems of recalcitrance with management of patients with Chronic Rhinosinusitis (CRS). The study explored the level of response and determined the safety of a novel treatment option for recalcitrant CRS patients. Methods: The primary outcome was to assess the efficacy of antimicrobial photodynamic therapy (aPDT). Improvements with Alsaleh-Javer Endoscopic Symptom score (AJESS) by 1-point; Sinonasal Outcome Test 22 (SNOT-22) by 9-points and culture swab results over a 45-day period. The Secondary outcome was to evaluate the safety of the aPDT. Presence of adverse events, increase in pain and discomfort scores, smell test (UPSIT) and Nasal Mucociliary test (Saccharin test), were determined over the same period. Results: A total of 7 participants completed the pilot study. There was a slight male preponderance (1.3:1, M: F) and age ranged from 47 to 78 years with mean age ± SD, 60.3 years ± 10.1. Two (2) out of the 7 participants (28.6%) had co-morbid conditions (Asthma), while all of the 7 participants were non-smokers. Patients with a clinical diagnosis of Chronic sinusitis without polyps (CRSsNP) accounted for more than half of the participants (57.2%). Mean AJESS reduction was maximal between completion of the aPDT treatment (day 7) and one-week post-treatment (day 14), 3.00 to 1.50 points. While mean SNOT-22 scores reduction was maximal between day-0 (44.53) and day-7 (35.57), about 9 points. A marked reduction in laboratory cultures within a week of treatment completion (days 7 and 14) noted but not sustained. No adverse events recorded, with mild-moderate discomfort noted with treatment. The NMCT results showed significant improvement in 2/7 participants (28.6%), while smell test did not record appreciable improvement. Conclusion: This study showed that aPDT was able to improve the endoscopic scores (AJESS) and sinus-specific questionnaire (SNOT-22) by at least 1 point and 9 points or 1 MCID, respectively. No adverse events noted identified during the study period. Olfaction (using UPSIT), showed dysfunction not worsened with the procedure. Future research may involve sinonasal microbiota transplants use via nasal lavage post aPDT to treat refractory CRS patients from suitably healthy donors.

Text

2019-12-06

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/72579

Surgery

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/