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Varvyanskaya and Lopatin
2
=
thick, purulent discharge. The mucosal edema was
scored as follows: 0
=
absent; 1
=
mild; 2
=
severe. Crust-
ing and scarring in the postoperative cavity was scored as
follows: 0
=
absent; 1
=
mild; and 2
=
severe; these findings
were evaluated for the right and left nasal cavity separately.
Active anterior rhinomanometry and acoustic
rhinometry
The active anterior rhinomanometry (AAR) and acoustic
rhinometry (AR) studies were carried out with the SRE
2000
R
device (Rhinometrics, Lynge, Denmark), which al-
lowed performing both tests: AAR objectively assessed both
nasal resistance and nasal airflow whereas AR reflected the
geometry and the volume of the entire nasal cavity.
Multislice computed tomography
Multislice computed tomography (CT) of the nose and
paranasal sinuses was performed prior to and 6 months af-
ter FESS on all patients. One-half-centimeter (5 mm) slices
in both the axial and coronal planes were obtained. The
degree of opacification of a particular sinus (0-2) and the
ostiomeatal complex (0
=
intact, 2
=
occluded) were cal-
culated using the Lund-Mackay scoring system.
4,13
Eosinophil cationic protein
Eosinophil cationic protein (ECP) contents in the nasal
discharge was measured using a collection kit with data
generated by the automatic chemiluminescent analyzer
IMMULITE
R
1000 (Siemens Healthcare Diagnostics Inc,
NY, USA). To collect the mucus, a piece of sterile foam-
rubber sponge measuring 20
×
20
×
5 mm was introduced
into the middle meatus for 20 minutes. After removal, the
sponge was placed in a 10-mL test tube and centrifuged for
3 minutes at a velocity of 4000 rpm allowing for collection
of 0.2 to 1.0 mL of mucus for further analysis. The test
sensitivity was 0.2 ng/mL.
Microbiological testing
Nasal swab for microbiological testing was collected from
the middle nasal meatus prior to FESS and at all postoper-
ative visits. Culture and sensitivity (resistance) testing was
performed using bacteriological analyzer Walk Away-40
(Dade Behring, Marburg, Germany) and the disk diffusion
method (Becton Dickinson discs with clarithromycin, USA).
Results were estimated according to the CLSI (clinical and
laboratory standards institute) recommendations.
Skin prick tests
Skin prick tests for indoor and outdoor allergens were per-
formed in all patients using standard methods.
Final assessment of treatment results
Final assessment of treatment results was carried out us-
ing the changes of EAS and Lund-Mackay CT scores at
24 weeks after FESS.
Statistical analysis
After consulting a medical statistician, the results obtained
were entered into a computerized database and processed
using the statistical software package SPSS version 17.0 for
Windows. Wilcoxon signed rank tests were performed to
evaluate treatment effects at various time points. Values
were presented as means
±
standard deviations. Changes
within and between groups were considered statistically
significant when
p
values were
<
0.05.
Results
Eleven patients were dropped from the study for various
reasons: 8 patients in group 2 (antibiotics for 12 weeks)
were withdrawn. One patient developed abdominal pain
after starting clarithromycin therapy; a second patient was
withdrawn because of nightmares beginning 3 days af-
ter starting clarithromycin treatment. One female in the
same group developed an exacerbation of erosive duodeni-
tis 2 months after enrollment and was withdrawn whereas
5 others were withdrawn because of noncompliance. One
female patient in group 3 (control no antibiotics) was ex-
cluded because of pregnancy and 2 others in this group
were withdrawn because of noncompliance. Therefore,
55 patients completed the study and at the last visit all
22 patients in group 1 (antibiotics for 24 weeks) completed
the study, 14 patients remained in group 2 (antibiotics for
12 weeks), and 19 patients remained in group 3 (control
no antibiotics).
Thirty-five patients had BA, and 27 of these 35 patients
presented with AERD. Atopy was confirmed by skin prick
tests in 19 of the 66 initial patients. There were no signif-
icant differences between the 3 groups regarding age, sex,
presence of atopy, severity of the disease, and number of
previous surgeries, as well as all the other initial parame-
ters that we examined. Baseline characteristics of each of
the 3 treatment arms: group 1 (antibiotics for 24 weeks),
group 2 (antibiotics for 12 weeks), and group 3 (control no
antibiotics) are presented in Table 1.
Treatment results were better for patients completing the
course of long-term clarithromycin treatment in group 1
(antibiotics for 24 weeks) and group 2 (antibiotics for
12 weeks) compared to patients in group 3 (control no
antibiotics).
Statistically significant differences (
p
<
0.05) were ob-
tained for all parameters (but not at every visit) between the
study medication groups 1 and 2 and group 3 (control no
antibiotics) with the only exception being for VAS and AR
where statistically significant evidence was not achieved.
SNOT-20
The initial SNOT-20 scores were 2.20
±
0.54 in group 1
(antibiotics for 24 weeks), 2.64
±
0.49 in group 2 (antibi-
otics for 12 weeks), and 2.44
±
0.18 in group 3 (control no
antibiotics). After the FESS, QoL improved and the sever-
ity of the rhinosinusitis symptoms was relieved in all study
International Forum of Allergy & Rhinology, Vol. 4, No. 7, July 2014
146