Q:

6/25/2013
I have a hypothetical question if biofilm and mucouuuuuuus is big part of chronic sinusitis now that nasal nebuliser is available can we use acetyl cysteine in these patients or they are already doing it.

A:

Thank you for your inquiry.

N-acetylcysteine has been used in the treatment of chronic sinusitis for many years, as you can see from the earlier abstracts copied below. A more recent review (Pintucci, et al.), abstract copied below, discusses the use of N-acetylcysteine in this condition in more detail.

Thank you again for your inquiry and we hope this response is helpful to you.

Natural Treatment of Chronic Rhinosinusitis

Chronic sinusitis refractory to standard management in patients with humoral immunodeficiencie
Clinical & Experimental Immunology
Volume 109, Issue 3, pages 468-472, September 1997
Chronic refractory sinusitis is a common feature in patients with primary immunodeficiencies. The efficacy of standard therapeutic strategies is questionable. In an open trial we evaluated the efficacy of azithromycin, N-acetylcysteine and topical intranasal beclomethasone (100 ìg twice daily for 6 weeks) in 16 patients with primary immunodeficiencies (median age 13.5 years, range 5-32 years). All patients suffered from chronic sinusitis despite regular immunoglobulin replacement therapy every 3 weeks. Magnetic resonance imaging (MRI) scans were performed before and after 6 weeks of treatment to evaluate morphological changes in the paranasal sinuses. Nasal swabs and washings were taken for microbial analysis and measurement of inflammatory mediators (IL-8, tumour necrosis factor-alpha (TNF-á), eosinophilic cationic protein (ECP)) before and post therapy. Inflammatory mediators in nasal secretions were significantly elevated in patients: IL-8 median 2436 pg/ml (range 441-5435 pg/ml), TNF-á 37.3 pg/ml (3.75-524 pg/ml) and ECP 33 ng/ml (1.5-250 ng/ml) versus age-matched healthy controls: IL-8 median 212 pg/ml (99-825 pg/ml), TNF-á 3.77 pg/ml (2.8-10.2 pg/ml) and ECP 1.5 ng/ml (1.5-14.8 ng/ml) (P < 0.0001). Inflammation of the maxillary sinuses was confirmed by MRI scans in all patients, additionally infection of the ethmoidal and frontal sinuses was recorded in five patients. Bacterial growth appeared in 11 out of 16 cultures. In spite of therapy, no improvement in sinal inflammation visualized by MRI was achieved. Moreover, no significant decrease in pathogens and levels of inflammatory mediators could be detected (IL-8 1141 pg/ml, 426-4556 pg/ml; TNF-á 13.9 pg/ml, 4.1-291.6 pg/ml; ECP 32.3 ng/ml, 3.7-58.4 ng/ml). Our results demonstrate that conventional management of sinusitis is of little benefit in patients with chronic refractory sinusitis with an underlying immunodeficiency. More studies are needed to test antibiotic regimens, probably combined with surgical drainage and anti-inflammatory agents.

Eur Rev Med Pharmacol Sci. 2010 Aug;14(8):683-90.
Biofilms and infections of the upper respiratory tract.
Pintucci JP, Corno S, Garotta M.
Source
U.O.C. Otorhinolaryngology, City Hospital, Vimercate, Italy.
Abstract
Biofilms are microbial communities consisting of bacteria that either are self-reproducing on biological surfaces or are present in the lifeless environment. Biofilms are quite diffuse entities frequently found in human pathological conditions. The formation of bacterial biofilms involves mainly the contamination of artificial medical devices, such as valves and catheters, and their direct implant on mucous membranes, with subsequent development of chronic or recurrent infections. Bacterial biofilms show a complex organization consisting of bacterial cells adherent to a surface and surrounded by a large extracellular matrix mostly made up of polysaccharides and proteins. The resistance observed in biofilms does not appear to be genotypic; instead, it is due to multicellular strategies and/or to the ability of each cell, contained inside the biofilm, to differentiate into a protected phenotypic state which tolerates the antibiotic action. In fact, biofilms are subject to changes following their recurrent exposure to antimicrobial agents, thus incrementing their resistance. Biofilms play an important role in otitis media, sinusitis, chronic cholesteatomatous otitis media, tonsillitis and adenoiditis, thus demonstrating that adenoidectomy may be helpful to children suffering from such a morbid conditions. It is presently estimated that biofilm formation is involved in at least 60% of all chronic and/or recurrent infections. In addition, 30% of the exudates developing in the course of otitis media has shown to be positive for the presence of biofilms; likewise biofilms have been found in tonsillar crypts and in odontostomatologic infections as well. Studies have been carried out on both the use and the efficacy of N-acetylcysteine (NAC) in biofilm breakdown. It has been shown that NAC, used at different concentrations, is able to reduce bacterial adhesion in several anatomical districts.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology