Physiotherapy Protocol in Treating Chronic Rhinosinusitis
Condition: Rhinosinusitis
MeSH terms: Sinusitis
Study type: Interventional

Summary: 
      This study aims to investigate the effect of adding of integrated physiotherapy program to
      the conservative medical therapy on quality of life and pressure pain threshold (PPT) in
      chronic rhinosinusitis patients. Patients in this study will be randomly assigned into 2
      groups. Group A (control group) will receive conservative medical treatment only which
      prescribed by Ear, Nose and Throat (ENT) specialist, while group B (experimental group) will
      receive the conservative medical treatment prescribed by ENT specialist in addition to
      physiotherapy program. Quality of Life (QoL) will be evaluated by Rhinosinusitis Disability
      Index (RSDI) and PPT will be evaluated by digital algometer at the baseline and immediately
      after the end of tenth session of treatment for both groups.
    

Detailed description: 
      Sixty-eight patients will be recruited for this study from Al-Qurayyat General Hospital in
      Al-Jouf Region, Saudi Arabia, with the following inclusion criteria: patients of both sexes,
      aged from 30 to 50 years, diagnosed by ENT specialist, with chronic rhinosinusitis with a
      history of 3 months or longer. The patients will be allocated into two equal groups at random
      (n = 34). Group A (control group) will receive medication only which prescribed by ENT
      specialist. Group B (experimental group) will receive prescribed medication by ENT specialist
      in addition to physiotherapy program which consists of: Ultrasound Therapy: The patients will
      receive pulsed (duty cycle 50%) US therapy with an intensity of 1 and 0.5 W/cm2 for maxillary
      and frontal sinus, respectively, with a frequency of 1MHz collimating beam. The small probe
      US applicator (0.8 cm2) with effective radiating area (ERA) equal 0.6 cm2 and beam
      non-uniformity ratio (BNR) equal 6:1 will be used to deliver US to the treatment area. The
      area of US application will be the skin over the cheeks for maxillary sinus and forehead for
      the frontal sinus. Ultrasound transmission gel will be used between the applicator and the
      skin, full contact technique in slow circular motion will be used for the duration of 5
      minutes over the maxillary sinuses and 4 minutes over the frontal sinuses on each pair of
      sinuses. Manual Drainage Techniques: for the frontal and maxillary sinuses. Self Massaging
      Technique: The patients will also advised to perform self-massaging for the frontal and
      maxillary sinuses from the supine lying position. A demonstration session will be used to
      provide patients in the experimental group with a full description of the manual therapy
      procedure before the beginning of the study. The physiotherapy program will be applied 3
      times a week (day after day) for 12 treatment sessions.
    

Intervention name(s): Ultrasound Therapy; Manual Drainage Techniques; Self Sinus Massage Technique
Intervention type(s): Other; Other; Other
Intervention description(s): Using an Enraf Nonius Sonoplus 490 from the Netherlands, the patients were asked to lie supine while the therapist stood at the level of the patient's head. The patients received pulsed (duty cycle 50%) US therapy with intensities of 1 and 0.5 W/cm2 for maxillary and frontal sinus, respectively, and a collimating beam frequency of 1MHz. To deliver US to the treatment area, a small probe US applicator (0.8 cm2) with an effective radiating area (ERA) of 0.6 cm2 and a beam non-uniformity ratio (BNR) of 6:1 was used. The skin around the cheeks was used for the maxillary sinus and the forehead for the frontal sinus. Between the applicator and the skin, ultrasound transmission gel was employed, and a full contact technique in slow circular motion was used for 5 minutes over the maxillary sinuses and 4 minutes over the frontal sinuses on each pair of sinuses; Manual Drainage Techniques for the frontal and maxillary sinuses; Patients will also encouraged to self-massage their frontal and maxillary sinuses while resting supine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Rhinosinusitis; ultrasound therapy; quality of life; pain threshold; manual therapy