Case Series with Endoscopic Findings of a Novel Nasal Irrigation Protocol for Refractory Chronic Rhinosinusitis

Abstract

Objective: Present an innovative treatment protocol for refractory chronic rhinosinusitis (CRS) in order for practitioners to 1) learn of a new topical treatment regimen, 2) be able to apply this protocol to their own patients, and 3) understand the proposed mechanism of its action. Method: Case series of 20 patients with refractory CRS treated with a novel topical sinus regimen that included diluted baby shampoo between June 2009 and June 2010 with analysis of patient, disease, and treatment characteristics. Treatment endpoints include subjective improvement of nasal symptoms and objective improvements on nasal endoscopy. Results: Our novel treatment protocol involves gentamicin 20 mg per 240 mL (8 ounces), Johnson’s Baby Shampoo 1 drop per 240 mL, and pulmicort respules 1 mg per 240 mL. Patients are advised to use 120 mL via a 240 mL squeeze bottle. We then remove the gentamicin, pulmicort, or both, and track patient progress based on symptomatic improvement and improvements seen on nasal endoscopy. All patients had positive response using this treatment protocol after failed medical and surgical management with a variety of other topical and systemic therapies. Two notable cases are presented with endonasal photos to illustrate the positive response achieved using this treatment protocol. Conclusion: This novel sinus irrigation treatment protocol is effective in the treatment of CRS as documented by subjective improvements in nasal symptoms as well as significant improvement in nasal endoscopic findings. This protocol is well tolerated by patients and should be considered by otolaryngologists and allergists treating refractory CRS.