Recently, I treated a patient with recurrent Pseudomonas aeruginosa sinusitis with intravenous (IV) meropenem after he had failed oral Levaquin. The patient had underlying reflux, GERD, which was being exacerbated by mild to moderate obstructive sleep apnea (OSA). An oral appliance had been suggested for the patient’s OSA, but it was contraindicated because of his use of a retainer at night. In addition, the patient did have sinus polyposis which was responding well to Dupixent.
For several months, the patient remained symptom-free, but in January of this year his symptoms had returned. His ENT wanted me to consider restarting IV antibiotics. In a discussion with the patient, he was reluctant to restart IV antibiotics because he had a physically demanding lifestyle that had been interrupted initially with the PICC line that had been placed several months earlier.
A Less Invasive Path to Chronic Sinusitis Relief
Thankfully, based on how well the patient had done initially, I did have an alternative that I believed, in this particular case, would be a less invasive option for this patient. Initially, the patient had extensive mucosal thickening, and topical medications would not work. This time around, there was no mucosal thickening, and I felt that a topical medicated sinus protocol would be more appropriate. Additionally, his underlying sinus polyposis was being well-managed with Dupixent.
The patient started on a sinus rinse containing tobramycin and budesonide twice a day. After a month of therapy, the patient was re-examined by his ENT, who was extremely pleased with the outcome. In the meantime, he continues on Dupixent and will be starting on a CPAP to address his sleep apnea which is a major contributing factor to his nocturnal reflux which, in addition to his chronic sinusitis, presents as a chronic cough.
Sinus Rinse for Mild Chronic Sinusitis Symptoms
For patients with mild chronic sinusitis symptoms, a medicated sinus rinse may be a great alternative to systemic medication because there are fewer side effects and it is less invasive than having a PICC line.
