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Therapeutic ultrasound as treatment for chronic rhinosinusitis: preliminary observations

  • D Young (a1), R Morton (a1) and J Bartley (a1)

Bacterial biofilms have been implicated in the pathogenesis of chronic rhinosinusitis. In the laboratory setting, ultrasound is effective in disrupting such biofilms; however, few clinical studies have evaluated the role of therapeutic ultrasound in chronic rhinosinusitis.


This study was performed to investigate the short-term effectiveness of therapeutic ultrasound as a treatment modality for chronic rhinosinusitis.


Twenty-two patients with a positive history of chronic rhinosinusitis, according to the criteria set out by the Rhinosinusitis Task Force, together with a previous computed tomography scan compatible with a diagnosis of chronic rhinosinusitis, and who had failed previous, aggressive medical management, were treated with therapeutic pulsed ultrasound at 1 MHz two to three days per week for six sessions. Patients completed an assessment of individual sinus symptom severity and the 20-Item Sino-Nasal Outcome Test questionnaire before treatment, prior to session four and after completion of session six.


Two patients were unable to complete the study protocol. After completion of session six, 18 patients had experienced improvement in symptoms, while two patients noted a worsening of symptoms. Median percentage improvement of the total overall symptom score was 16.7 per cent (Wilcoxon signed rank, p < 0.001). The 20-Item Sino-Nasal Outcome Test score improved by 34.1 per cent (Wilcoxon signed rank, p < 0.0001).


This study demonstrated a significant improvement in chronic rhinosinusitis symptoms after a six-session course of pulsed ultrasound therapy. Treatment with ultrasound alone or combined with antibiotics may provide a strategy to target biofilms on the sinus mucosa. Therapeutic ultrasound warrants further investigation as a potential treatment modality for chronic rhinosinusitis.

Corresponding author
Address for correspondence: Mr Jim Bartley, Otolaryngologist, 10 Owens Rd, Epsom, Auckland 1023, New Zealand. Fax: +649 631 0478 E-mail:
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1Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg 2003;129(Suppl. 3):S132
2Kilty SJ, Desrosiers MY. The role of bacterial biofilms and the pathophysiology of chronic rhinosinusitis. Curr Allergy Asthma Rep 2008;8:227–33
3Hunsaker DH, Leid JG. The relationship of biofilms to chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2008;16:237–41
4Post JC, Hiller NL, Nistico L, Stoodley P, Ehrlich GD. The role of biofilms in otolaryngologic infections: update 2007. Curr Opin Otolaryngol Head Neck Surg 2007;15:347–51
5Psaltis AJ, Wietzel EK, Ha KR, Wormald P-J. The effect of bacterial biofilms on post-sinus surgical outcomes. Am J Rhinol 2008;22:16
6Bartley J, Young D. Ultrasound as a treatment for chronic rhinosinusitis. Med Hypotheses 2009;73:1517
7Le T, Psaltis A, Tan LW, Wormald PJ. The efficacy of topical antibiofilm agents in a sheep model of rhinosinusitis. Am J Rhinol 2008;22:560–7
8Chiu AG, Palmer JN, Woodworth BA, Doghramji L, Cohen MB, Prince A et al. Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient. Am J Rhinol 2008;22:34–7
9Kahn J. Principles and Practice of Electrotherapy. New York: Churchill Livingstone, 2000
10Ansari NN, Naghdi S, Farhadi M, Jalaie S. A preliminary study into the effect of low-intensity pulsed ultrasound on chronic maxillary and frontal sinusitis. Physiother Theory Pract 2007;23:211–18
11Ansari NN, Naghdi S, Farhadi M. Physiotherapy for chronic rhinosinusitis: the use of continuous ultrasound. Int J Ther Rehabil 2007;14:306–10
12Naghdi S, Ansari NN, Farhadi M. A clinical trial on the treatment of chronic rhinosinusitis with continuous ultrasound. J Phys Ther Sci 2008;20:233–8
13Piccirillo JF, Merritt MG Jr, Richards ML. Psychometric and clinimetric validity of the 20-Item Sino-Nasal Outcome Test (SNOT-20). Otolaryngol Head Neck Surg 2002;126:41–7
14Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngol Head Neck Surg 1997;117:S3540
15Jonsson P, Sahlstrand-Johnson P, Holmer NG, Persson HW, Jannert M, Jansson T et al. Feasibility of measuring acoustic streaming for improved diagnosis of rhinosinusitis. Ultrasound Med 2008;34:228–38
16Heges MM, Lewis J, Lunec J, Cramp WA. The effect of ultrasound at 1.5 MHz on Escherichia coli. Int J Radiat Biol 1980;37:103–8
17Scherba G, Weigel RM, O'Brien WD. Quantitative assessment of the germicidal efficacy of ultrasonic energy. Appl Environ Microbiol 1991;57:2079–84
18Quian Z, Sagers RD, Pitt WG. The effect of ultrasonic frequency upon enhanced killing of P. aeruginosa biofilms. Ann Biomed Eng 1997;25:6976
19Geerlings SE, Hoelepman AI. Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999;26:259–65
20Pitt WG, Ross SA. Ultrasound increases the rate of bacterial cell growth. Biotechnol Prog 2003;19:1038–44
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
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