There are different methods for applying antibiotics topically to the nose and sinuses:
■ Nebulizer therapy
■ Irrigation therapy
Patients who have already undergone FESS may continue to suffer from chronic or recurrent sinusitis. For these patients, it is often more effective to get the antibiotic directly on the inflamed area, instead of ingesting the medication. Most important, topical antibiotics offer the opportunity to use medications that are well tolerated topically, yet would have significant risks if ingested.
A nasal nebulizer delivers compounded medications that are aerosolized to a particle size small enough to disperse within the sinus
cavities yet large enough to be deposited in the sinuses. Nasal nebulizers can be used to deliver antibiotics, antifungals, and steroids to the sinus mucus membrane. A popular nasal nebulizer is the SinuNEB
Side effects of medications in nebulized forms of antibiotics appear to be milder in some patients than those experienced from oral and intravenous forms. In some patients, sore throat may develop, which can be improved by gargling after each treatment. Cough may occur in patients who have asthma, which should improve with a temporary increase in the use of pulmonary inhalers. Joint pain may be observed in patients undergoing fluoroquinolone therapy. Tinnitus and hearing loss could occur with gentamicin therapy. With topical administration of antibiotics, the risk of these side effects is significantly decreased compared with oral or intravenous administration.