A pilot study into the effect of low-level laser therapy in patients with chronic rhinosinusitis

Effect of photobiomodulation therapy on headache, and fatigue in patients with chronic rhinosinusitis: a randomized controlled study

Chronic rhinosinusitis (CRS) is a debilitating disease that resists medical treatment. Photobiomodulation therapy is one of the promising treatment modalities for CRS. The purpose is to investigate the effect of photobiomodulation therapy on headache, fatigue, sinus opacification, and ostiomeatal complex obstruction in patients with CRS. Thirty-one patients with CRS were randomly divided into photobiomodulation therapy and control groups. The photobiomodulation therapy group received photobiomodulation therapy (2.5 J, frequency 9.12 Hz, and 904 nm for 10 min for 12 sessions) on eight rhinosinusitis sites, and the control group received a sham laser. Headache, fatigue, and sinus opacification outcomes were measured before and after treatment. There was a significant improvement in headache, fatigue, and sinus opacification in the photobiomodulation therapy group in comparison with the control group (p < 0.05). Photobiomodulation therapy is an effective physical therapy treatment modality for the management of CRS.Clinical trial registry: NCT05861817.

Effect of Adding Physiotherapy Program to the Conservative Medical Therapy on Quality of Life and Pain in Chronic Rhinosinusitis Patients

OBJECTIVE

: To assess the effectiveness of combining physiotherapy techniques with conservative medical treatment in chronic rhinosinusitis (CRS) patients.

METHODS

: Sixty-eight volunteers with CRS were randomly assigned. Group A received only traditional medical treatment, whereas group B received a physiotherapy program that included pulsed ultrasound therapy, sinus manual drainage techniques, and self-sinus massage technique in addition to traditional medical treatment. Interventions were applied 3 sessions a week for 4 weeks. The rhinosinusitis disability index (RSDI) served as the main outcome indicator for assessing the quality of life, and the secondary outcome measure was the pressure pain threshold (PPT) using a pressure algometer.

RESULTS

: Wilcoxon signed rank test revealed a significant reduction (p<0.001) in total RSDI values from 71.08±1.13 pretest to 47.14±1.15 posttest for group A, while it decreased from 70.64±1.20 pretreatment to 31.76±1.04 posttreatment for group B; furthermore, Mann-Whitney U-test revealed a significant difference (p<0.001) in total RSDI values between both groups when comparing the change of the pre-post data values, it was 23.94±0.95 for group A and 38.88±0.67 for group B. The independent t-test revealed a highly statistically significant increase (p<0.001) in the PPT values in the experimental group compared to the control group.

CONCLUSION

: The physiotherapy program which included pulsed ultrasound therapy, sinus manual drainage technique, and self-sinus massage technique in conjunction with conventional medical treatment was more beneficial for enhancing the quality of life and PPT than traditional medical treatment alone in CRS patients.

Efficacy of Low-Level Laser Therapy in a Rabbit Model of Rhinosinusitis

Little is known about alternative treatment options for rhinosinusitis (RS). We aimed to evaluate the efficacy of low-level laser therapy (LLLT) for RS in experimentally induced rabbit models of RS. A total of 18 rabbits were divided into four groups: a negative control group (n = 3), an RS group without treatment (n = 5, positive control group), an RS group with natural recovery (n = 5, natural recovery group), and an RS group with laser irradiation (n = 5, laser-treated group). Computed tomography and histopathological staining were performed for each group. mRNA and protein expression levels of local cytokines (IFN-γ, IL-17, and IL-5) were also measured. Tissue inflammation revealed a significant improvement in the laser-treated group compared with the RS and natural recovery groups (p < 0.01). In addition, sinus opacification in the CT scans and cytokine expression was reduced in the laser-treated group, though without statistical significance. LLLT could be an effective option for the management of RS concerning radiological, histological, and molecular parameters.

Use of low-level laser therapy for patients with chronic rhinosinusitis: a single-blind, sham-controlled clinical trial

Chronic rhinosinusitis (CRS) is one of the most common conditions all over the world. The purpose of this study was to investigate the effects of low-level laser therapy (LLLT) in patients with CRS. Fourteen adult patients with CRS participated in this single-blind, sham-controlled clinical trial (12 male, mean age 40 years). Patients received five successive sessions of sham laser followed by five successive sessions of real laser after 2 days. Ga-Al-As laser of 830 nm in a continuous mode at a power output of 30 mW and energy dose of 1 J was applied on the cheeks and the forehead for the maxillary and frontal sinuses, respectively. Laser was delivered on six points over each sinus, each point for 33 s. Four measurements were taken. The total symptom score (TSS) was calculated as the primary outcome measure. The effects of LLLT on TSS were evaluated by using repeated measure ANOVA. The percentage improvement of real laser and sham laser was compared by Wilcoxon signed ranked test. Cohen's d was used to calculate the effect size. Total symptom score significantly improved after real laser (p = 0.015, Cohen's d = 0.69). The percentage improvement for real laser (34.12 ± 46.43) was significantly better than the sham laser (5.02 ± 37.34, Z =  - 2.23, p = 0.026). No significant improvements were observed after sham laser. This study indicates that five-session active LLLT when compared with sham is effective in the treatment of CRS symptoms.

Alternative therapies for chronic rhinosinusitis: A review

The use of alternative medicine in chronic rhinosinus-itis (CRS) continues to increase in popularity, for the most part without meeting the burden of being based on sound clinical evidence. New and emerging treat-ments, both natural and developed, are numerous, and it remains a challenge for otolaryngologists as well as general practitioners to keep up to date with these therapies and their efficacy. In this systematic review, we discuss a number of alternative therapies for CRS, their proposed physiologic mechanisms, and evidence supporting their use. This analysis is based on our re-view of the English-language literature on alternative therapies for CRS (we did not include any therapies that are already recommended by accepted profession-al bodies). Data collection was performed using the PubMed database (not restricted to MEDLINE due to the nature of the subject matter), the Cochrane data-bases, and bibliography searches. We found that while many of the alternative therapies we reviewed might have a firm basis in science, they lack any clinical ev-idence to support their use specifically for CRS. Some emerging therapies, such as therapeutic ultrasonog-raphy and phonophoresis, show some promise, based on a growing body of positive evidence. In addition, the use of baby shampoo, thyme honey, and bromelain additives to saline lavage in CRS are all supported by clinical evidence, as is Sinupret, an oral preparation that contains echinacea. However, higher levels of ev-idence gleaned from large, well-designed, prospective, randomized, controlled trials are needed before any of these therapies can be recommended.

The Effectiveness of the Polarized Low-Level Laser in the Treatment of Patients With Myofascial Trigger Points in the Trapezius Muscles

Introduction: This study assessed the effect of polarized low-level laser therapy (PLLLT) on the treatment of myofascial trigger points (MTrPs) in the trapezius muscles. Its effectiveness in pain reduction was compared to low-level laser therapy (LLLT). Methods: Sixty-four patients with MTrPs were randomly divided into 2 groups, namely PLLLT and LLLT. Each patient received treatment for a period of 2 weeks, 5 sessions a week. The intensity of laser irradiation to the skin surface was 6 J/cm² . The system exit power was 160 mw at a 755 nm wavelength. The visual analog scale (VAS) for the 1st, 5th and 10th sessions was analyzed through two-way repeated measures ANOVA. Results: Increasing the number of treatment sessions was effective in reducing pain intensity (P>0.05). The effect of LLLT on pain reduction was significantly greater than that of PLLLT (P>0.05). Referred pain (RP), the limitation of neck movement (LNM), the presence of muscular taut band (PMTB) and the sensitivity of muscular taut band (SMTB) were reduced significantly by the end of the 10th session, compared with participants' condition at the beginning of the 1st session in both groups. Conclusion: PLLLT and LLLT can effectively treat MTrPs in the trapezius muscles and they reduce RP, LNM, PMTB, and SMTB in particular. However, the effect of the LLLT was significantly greater than that of PLLLT. In accordance with the observed results, LLLT is recommended as an effective method for treating MTrPs.

Intraoral Dual Wavelength Laser Diode Therapy for Chronic Maxillary Sinusitis

Background

Chronic sinusitis is one of the most common chronic diseases involving different age groups. The different etiological factors and difficult diagnostic procedures contribute to misdiagnosis and chronicity of sinusitis. There is no standard treatment for sinusitis. Long term use of corticosteroids and antibiotics may lead to numerous adverse side effects. Laser therapy has been suggested as a non-invasive treatment for sinusitis. It has anti-inflammatory and antibacterial effects. When considering maxillary sinusitis, discharge tends to collect in the sinus base due to its anatomy and altered physiology. To improve penetration of laser into the maxillary sinus, intraoral laser at the vestibule depth of the maxilla may be more effective.

Material and Subject

Thirty-four patients with chronic maxillary sinusitis were assigned into two groups. All were assessed before and after treatment. Group A received laser radiation plus standard medical treatment and group B received medical treatment only. The treatment plan was performed in 12 sessions using a Diode laser with a wavelength of 810 nm and 980nm. The SNOT-22 questionnaire and Computed Tomography were used to evaluate patients. A p-value < 0.05 was considered statistically significant.

Results

Both groups showed a significant improvement in symptoms following treatment (p < .001), however, the laser therapy group demonstrated greater improvements for all variables in response to treatment as compared to the traditional treatment group (p < .001).

Conclusions

Using high intensity intra-oral laser therapy with medical treatment is more effective than using medical treatment only for treatment of chronic maxillary sinusitis.

Laser Light Therapy in Inflammatory, Musculoskeletal, and Autoimmune Disease

PURPOSE OF REVIEW

The goal of this review is to summarize the field to date and to discuss strengths and limitations of low-level laser (light) therapy (LLLT) for the future investigation as a treatment of inflammatory disease.

RECENT FINDINGS

LLLT is a promising therapeutic, particularly for those diseases of skin and joints because they are most accessible to treatment. Indeed, the known mechanisms of LLLT support its use for anti-inflammatory purposes, as well as stimulation of tissue growth and repair. Although the standard of care for the majority of inflammatory diseases is immunosuppressive agents such as corticosteroids with undesirable toxicities, LLLT offers a unique approach by being non-invasive and incurring minimal side effects. It is also relatively inexpensive and accessible and even has the possibility to be patient directed at home. There is evidence that LLLT is able to modulate the immune system at the skin and joint, and it has been shown to be efficacious in humans by affecting bacterial colonization as it may pertain to chronic rhinosinusitis. However, there is variability in the methods of laser application as well as a lack of evidence for laser type, dose-ranging studies, and wavelength selection that create barriers to the implementation of LLLT without further more rigorous and standardized study. The heterogeneity makes it difficult to draw strong conclusions about the efficacy of LLLT and its mechanisms.

Painless injections-a possibility with low level laser therapy

Background

Dental procedures commonly involve the injection of local anesthetic agents, which causes apprehension in patients. The objective of dental practice is to provide painless treatment to the patient. The purpose of this study was to evaluate the effect of Low Level Laser Therapy (LLLT) in reducing the pain due to local anesthetic injection.

Materials and Methods

A prospective, split-mouth study was conducted on 25 patients. In Condition A, LLLT was administered followed by the administration of a standard local anesthetic agent. Patients' perception of pain with use of LLLT was assessed based on a Visual Analogue Scale (VAS). In Condition B, LLLT was directed to the mucosa but not activated, followed by the administration of local anesthesia. VAS was used to assess the pain level without the use of LLLT.

Results

Comparison between Condition A and Condition B was done. A P value < 0.001 was considered significant, indicating a definite statistical difference between the two conditions.

Conclusion

In our study, we observed that LLLT reduced pain during injection of local anesthesia. Further multi-centric studies with a larger sample size and various modifications in the study design are required.

Is there a measure for low power laser dose?

Low power lasers have been used successfully for treatment of many diseases in soft and bone tissues. Basic and clinical researches have developed quickly being the scientific basis to therapeutic protocols based on these lasers. However, there are difficulties to compare experimental and clinical results obtained from different researchers because a complicated and intricate list of physical and biological parameters should be checked before the irradiation procedures as well as part of these parameters are omitted or inaccurately reported. This review focuses on the physical and biological parameters proposed to make experimental and clinical protocols accurate and reproducible as well as suggests dose parameters based on biological effects induced by low power lasers. A variety of parameters are reported by different authors and the number of parameter suggested could overcome three dozens. Thus, laser dose and laser dose equivalent are defined based on laser-induced biological effects and suggested as simplified dose parameters for low power lasers. These parameters could simplify and be useful to researchers and clinicians, permitting comparisons and decreasing mistakes and inaccuracies when laser-induced effects are evaluated and compared with those obtained in previous studies. The laser dose and laser dose equivalent could contribute significantly to improve accuracy, effectiveness, and safety of clinical protocols based on low power lasers.

Intra-oral low level laser therapy in chronic maxillary sinusitis: A new and effective recommended technique

Background

Chronic sinusitis is one of the most common chronic diseases involving different age groups. Because the nature and etiology of chronic sinusitis are not completely known, there is not any standard treatment for this disease. It has been suggested that low-level laser can be used in treating chronic sinusitis but there are limited studies about its usage. In this research, intra-oral radiation of low-level laser has been described and implemented for the first time. Suggested hypotheses about the efficacy of this type of radiation (intra-oral) in treating chronic maxillary sinusitis includes this fact that the depth of maxilla’s vestibule is also the floor of maxillary sinus and sinus discharges collect in this area because of gravity effect. Therefore, with considering suitable radiation angle, this area gets the most benefits of laser’s anti-inflammatory effects.

Material and Methods

In this study, 20 patients with chronic maxillary sinusitis were included. They were assessed before and after treatment. Treatment plan was performed in 8 sessions every other days using low-level diode laser with 810 nm. Snot-22 questionnaire and rhinomanometry were used for evaluating patients. Changes of signs and symptoms were recorded in questionnaire every session and 6 months after treatment. Friedman and Wilcoxon tests were used for data analyses. In this study, P value < 0.05 was considered statistically significant.

Results

All variables and all symptoms of patients were improved using intra-oral low-level laser and this improvement was statistically significant (P value<0.05). There was also significant decrease in nasal airway resistance and significant increase in air flow (P value<0.05). Six month after treatment completion, there was no significant difference between the results of completion and the results of 8th treatment session (P value< 0.05).

Conclusions

Using intra-oral low-level laser is a suitable way to treat patients with chronic maxillary sinusitis.

Key words:Chronic sinusitis, maxillary sinusitis, low-level laser.

Low Level Laser Therapy: A Panacea for oral maladies

AIM

To review the applications of low level laser therapy on various soft and hard oral tissues. A variety of therapeutic effects of Low Level Laser Therapy have been reported on a broad range of disorders. It has been found amenably practical in dental applications including soft as well as hard tissues of the oral cavity. LLLT has been found to be efficient in acceleration of wound healing, enhanced remodelling and bone repair, regeneration of neural cells following injury, pain attenuation, endorphin release stimulation and modulation of immune system. The aforementioned biological processes induced by Low level lasers have been effectively applied in treating various pathological conditions in the oral cavity. With is article, we attempt to review the possible application of Low Laser Therapy in the field of dentistry.

A randomized clinical trial comparing pulsed ultrasound and erythromycin phonophoresis in the treatment of patients with chronic rhinosinusitis

Therapeutic ultrasound, an important physiotherapy modality, has been used successfully in the treatment of patients with chronic rhinosinusitis (CRS). No study has compared pulsed ultrasound (PUS) with erythromycin phonophoresis (EP). The aim of this randomized, double-blind, parallel group study with concealed allocation was to compare PUS with EP. Sixty CRS patients were randomly allocated into two groups. Group 1 had PUS and Group 2 had EP. Patients were treated 3 days a week for 10 sessions over 4 weeks. The severity of nine CRS symptoms was self-rated by patients on an ordinal scale of 0-3 (absent, mild, moderate or severe) at baseline and after the 10th treatment session. Individual symptom scores were summed to obtain a "Total Symptom Score" (TSS). The outcome measure included percentage improvement in the TSS. A statistically significant improvement in TSS occurred with both PUS and EP therapy groups (p < 0.05). The percentage improvement in the EP group was statistically greater than in the PUS group (67.2 versus 49.3%) (p = 0.03). The effect sizes in both therapy groups were large; PUS: d = 1.36 and EP: d = 2.15. EP was found to be superior over PUS therapy.