Ultrasound as a treatment for chronic rhinosinusitis
Ultrasound as a treatment for chronic rhinosinusitis
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DOI：
10.1016/j.mehy.2008.12.049
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发表时间：
2009-07-01
影响因子：
4.7
通讯作者：
Young, Danuta
中科院分区：
文献类型：
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作者：
Bartley, Jim;Young, Danuta
细菌现在被认为以两种形式存在-自由漂浮（浮游）或称为生物膜的复杂社区。生物膜内的细菌难以培养，并且对抗生素治疗非常难治。生物膜可以解释一些与慢性鼻窦炎相关的矛盾。许多患者对抗生素治疗无效，细菌学培养拭子通常不生长细菌，细菌学拭子阳性通常与临床结果无关。由于抗生素在细菌生物膜的治疗中基本上无效，因此正在探索替代治疗策略，包括阻断细菌之间的分子通讯（群体感应），抑制生物膜基质的产生和破坏细菌膜的干预措施。到目前为止，这些方法在很大程度上都是徒劳的。虽然物理疗法，如短波透热疗法和治疗性超声波已被提倡作为鼻窦炎的治疗多年，这些治疗干预的关键评价几乎是不存在的。直到最近，任何好处都难以用传统的微生物范式来解释。然而，在实验室环境中，超声波增强了体外和动物模型中生物膜中细菌的杀灭。超声在鼻窦疾病中的成功应用可能意味着我们治疗慢性鼻窦炎的新模式的发展，抗生素耐药性的减少和医疗管理的改善以及随后手术干预的减少。(C)2009爱思唯尔有限公司保留所有权利。
Bacteria are now recognised as existing in two forms - free floating (planktonic) or in sophisticated communities called biofilms. Bacteria within biofilms are difficult to culture and highly refractory to antibiotic treatment. Biofilms could explain some of the paradoxes associated with chronic rhinosinusitis. Many patients are refractory to antibiotic therapy, bacteriology culture swabs frequently do not grow bacteria and positive bacteriology swabs often do not correlate with clinical findings. As antibiotics are largely ineffective in the treatment of bacterial biofilms, alternative therapeutic strategies including blocking molecular communication (quorum sensing) between bacteria, inhibiting biofilm matrix production and interventions that damage bacterial membranes are being explored as treatment options. So far these approaches have been largely unproductive. While physical therapies such as short wave diathermy and therapeutic ultrasound have been advocated as treatments for rhinosinusitis for many years, critical evaluation of these therapeutic interventions is virtually non-existent. Until recently any benefit has been difficult to explain using conventional microbiological paradigms. However, in the laboratory setting ultrasound enhances the killing of bacteria in biofilms both in vitro and in animal models. The successful application of ultrasound to sinus disease could mean the development of a new paradigm in our treatment of chronic rhinosinusits, a reduction in antibiotic resistance and improved medical management with a subsequent reduction in surgical intervention. (C) 2009 Elsevier Ltd. All rights reserved.