EFFECT OF NADIFLOXACIN PHONOPHORESIS AND PULSED ULTRASOUND IN SUBJECTS WITH ACUTE SINUSITIS- A RANDOMIZED CLINICAL TRIAL

Aim : To find effectiveness of nadifloxacin phonophoresis over pulsed ultrasound in acute sinusitis subjects. Methods: Study was approved by Institutional Ethical Committee of KAHER Institute of Physiotherapy, Belagavi.40subjects with acute sinusitis were divided randomly into group A, treated with nadifloxacin and group B, treated with pulsed ultrasound. were using Sinusitis Symptom Score, Numerical Rating scale and outcome test-22 before and after 4 days of intervention. pain in a better way and found relief post-treatment. Previous study conducted used numerical rating scale to rate pain and congestion due to rhinosinusitis and it was observed that there was reduction in pain around the nose by 1.5 points out of 10 post-intervention. 9 The outcome measure SNOT-22 was effective in the current study as it showed marked reduction in all the domains of the test after the treatment sessions. A study conducted in patients having facial pain and sleep disturbances due to chronic sinusitis suggests that SNOT-22 was the only outcome measure that assesses interference in the sleep patterns and reports about the improvement in sleep patterns and other symptoms of sinusitis post-intervention. 10


ISSN: 2320-5407
Int. J. Adv. Res. 8(09), 1179-1182 1180 Acute sinusitis can be defined by certain major and minor criteria that exists for longer than typical viral upper respiratory tract infections, greater than 7 days. Major criteria includes purulent nasal discharge, purulent pharyngeal drainage,cough and minor criteria includes peri-orbital oedema , headache ,facial pain, tooth pain, ear pain , sore throat, foul breath, increased wheeze and fever.
The presence of two major or one minor and two or more minor criteria for more than 7 days signifies acute sinusitis. 4 The medical management includes the use of oral or topical decongestants, mucolytics, pain and fever management with NSAIDs and saline rinses provides maximum relief of symptoms. 2 Surgical management is advised if the conditionis severe or if they have severe intracranial complications. 2

Demographic Data Distribution In Group A And Group B:
The p-value of gender, age and BMI suggest that both the groups are homogeneous.
Physiotherapy management includes use of therapeutic ultrasound. The principle on which ultrasound works is piezoelectric effect. 5 The ultrasonic waves cause mechanical vibration within the affected sinuses and helps in mobilization of secretions. 5 Phonophoresis is used as an alternative for transdermal drug delivery.It is advantageous because the rate and concentration of transport of drugs to the affected paranasal sinuses is enhanced. 6 Need for the study: The use of pulsed ultrasound is proven to be effective for acute sinusitis whereas there is paucity in the literature to support use of phonophoresis in acute sinusitis subjects, thus the need arise to compare the effectiveness of phonophoresis over ultrasound.

Methodology:-
Methods: Forty subjects with acute sinusitis were recruited from tertiary health care centre, out of which 4 subjects were unable to follow up.

Inclusion criteria:
Subjects clinically diagnosed with acute sinusitis, Age group between 18-50 years,Both male and female subjects willing to participate in the study.

Exclusion criteria:
Prostheses or metal implant in the brain, face, or orbit , dental implants, Other infection on the face, Obstruction for the free drainage of the sinuses , Pregnant women , Malignancy of head and neck

Procedure:
The study was approved by Institutional Ethical Committee of KAHER Institute of Physiotherapy, Belagavi.

Intervention:
The subjects diagnosed with acute sinusitis were recruited in the study after screening for the inclusion and exclusion criteria. They were randomly divided into group A, who received nadifloxacin phonophoresis and group B, who received pulsed ultrasound. In group A, the position of the subject is supine lying and therapist is standing on the side to be treated. The treatment is begun with applying nadifloxacin ointment with aqueous gel on the treatment area. Pulsed mode of ultrasound was chosen where the intensity was 0.5W/cm 2 with ratio of 1:4 and frequency of 1MHz and 20% duty cycle. 7 Duration of treatment was 5minutes for maxillary sinus and 4 minutes for frontal sinus for 4 days a week. 7 Group B received PUS with aqueous gel and Dosage was the same as described

Comparison of Group A And Group B Within And Between The Groups With Respect To Sinusitis Symptom Score
In the present study the p-value for both the groups was 0.001 which suggests that it is significant whereas the pvalue of difference between the groups was 0.700 which was not significant but both groups were equally effective. In the present study the p-value for both the groups was 0.001 which suggests that it is significant whereas the pvalue of difference between the groups was 0.014 which is significant and suggests that group A is better than group B

Comparison of Group A And Group B Within And Between The Groups With Respect To Snot-22
In the present study the p-value for both the groups was 0.001 and the p-value of difference between the groups was also 0.001which suggests that it is significant and suggests that group A is better than group B

Discussion:-
Sinusitis symptom score was used as one of the outcome measure in our study and it was observed that this outcome measure did not prove to be effective. The reason being that the patients scored zero for few symptoms and according to a study conducted it is proven that the scores should not be zero or near zero following treatment but rather it should be closer to the values scored by healthy individuals. 8 Numerical rating scale was another outcome measure used in our study to rate the facial pain and it was observed that subjects rated facial pain in a better way and found relief post-treatment. Previous study conducted used numerical rating scale to rate pain and congestion due to rhinosinusitis and it was observed that there was reduction in pain around the nose by 1.5 points out of 10 post-intervention. 9 The outcome measure SNOT-22 was effective in the current study as it showed marked reduction in all the domains of the test after the treatment sessions. A study conducted in patients having facial pain and sleep disturbances due to chronic sinusitis suggests that SNOT-22 was the only outcome measure that assesses interference in the sleep patterns and reports about the improvement in sleep patterns and other symptoms of sinusitis post-intervention. 10 In the present study the limitations were: Inability to treat ethmoid and sphenoid sinuses, Long term follow up could not be achieved and recurrence of symptoms could not be noted, Subjects with other co-existing infections in the head and neck region could not be treated.

Groups
Future scope of this study is: Exploration of more drugs for phonophoresis in sinusitis, studying the effects of phonophoresis in recurrent cases of sinusitis.

Conclusion:-
The present study concluded that both, nadifloxacin phonophoresis and pulsed ultrasound are effective in the treatment of acute sinusitis but comparatively, nadifloxacin phonophoresis is more effective than pulsed in acute sinusitis.