Our team at AOO have pioneered the development, use, and research into nebulized medications for the management of difficult chronic sinus cases since 2000. (See links below.) This work has led to an entirely new treatment option being available nationwide for these patients via compounding pharmacies based in California. Dr. Vaughan serves as the director of the scientific advisory board of Sinus Pharmacy, which compounds these medications. He also consults for a separate research company, Sinus Pharma Inc. AOO has been designated as one of the national research centers into this newer therapy.

Topical Furosemide For The Treatment Of Nasal Polyps

One of the main causes of recurrent disease after sinus surgery is the regrowth of nasal polyps with subsequent obstruction and infections. Lasix TM (furosemide) has been shown to decrease the fluid volume of nasal polyps in studies from Italy. Studies are being started to investigate the potential role of topical furosemide for the treatment of nasal polyps.

Effect Of Carbon Dioxide Levels On Blood Loss During Endoscopic Sinus Surgery

The level of carbon dioxide in blood can be regulated during anesthesia. Regulation of this level may decrease blood loss. Joint studies with the Stanford Anesthesia Department have been ongoing for the last three years. Sinus surgical patients are offered enrollment in this study, which should be completed in the next year. Co-investigator: Vladimir Nekhendzy, MD, Department of Anesthesia.

Use Of Alternative Therapies In Sinus Management

There are publications which suggest that a significant number of chronic sinus patients use alternative therapies to treat their sinuses. These include herbs, acupuncture, biofeedback etc. Studies have been completed, and papers are in the reviewer process for publication. Preliminary data has been presented. This reveals that standard therapies (both medical and surgical) continue to ‘out-perform’ against alternative therapies, but patients have a very high acceptance rate for alternative treatments.

Emergence Of Increasing Drug Resistance In Chronic Sinusitis

Chronic sinusitis patients have frequent infections. There are several studies that demonstrate increased antibiotic resistance, and the emergence of gram negative and fungal species. We are studying whether there are approaches that can decrease the use of empiric antibiotics in chronic sinus patients. Several studies continue at AOO in this area. These include:

• Use of culture-directed therapy for acute infections in chronic sinus patients.
• Randomized study of post-operative antibiotics after sinus surgery.
• Microbiology of acute infections in chronic sinus patients.

Use Of Anti-Fungals In The Management Of Allergic Fungal Sinusitis

Allergic fungal sinusitis can lead to extensive and recurrent sinus disease. The use of nebulized antifungals, antifungal nasal rinses, and oral antifungals are recommended. Side effects, failure rate, and outcome data of these different approaches are being studied.

Psychological Impact Of Chronic Sinusitis On Patients

All chronic diseases can lead to significant impact on the quality of life and psychological functioning of patients. Quality of life outcomes are conducted on all sinus patients at AOO. Retrospective studies (via outcome surveys) on the impact of several therapies include:

• Impact of longer endoscopic and culture-directed therapy,
• Impact of revision endoscopic sinus surgery with surgical navigation,
• Impact of nebulized therapies on psychological outcome measures.