慢性副鼻腔炎に対するエアロゾル療法一特に鼻内手術併用療法の効果と限界一

抄録

The study was designed to evaluate the effects and limitations of aerosol therapy combined with intranasal operation for severe chronic sinusitis. Intranasal operation which exposes the maxillary and ethmoid sinuses widely to the middle meatus was performed on 6subjects to evaluate the amount of antibiotics to reach the maxillary sinus mucosa and serum during nasal nebulization of 2 ml of 5% dibekacine (DKB) using a jet nebulizer. DKB in the amount of 0.73 ± 0.79 jug/g was observed in the maxillary sunus mucosa which was sufficient to maintain the MIC level for sensitive bacteria. Intranasal operation was performed in 21 subjects with severe bilateral chronic sinusitis and 10 subjects with unilateral chronic sinusitis and 25 mg of DKB solution with 0.2 g of dexamethasone was nebulized 3 times a week for 3 months. Antral lavege was performed every 2 weeks. In subjects who showed purulent secretion in the antral lavege 1 month after the start of aerosol therapy, the antibiotic was changed depending on sensitivity of the bacteria. Effects of aerosol therapy on purulent rhinorrhoe, nasal obstruction, Xray findings, purulent secretion in the antral lavage fluid and the bacteria in the antral lavage were evaluated 1 month after termination of the therapy. In subjects with unilateral sinusitis, marked improvement was observed in each of the above parameters. However, the effects for severe bilateral chronic sinusitis were rather limited and more than marked improvement of purulent rhinorrhoe, more than moderate improvement of radiographic opacity of the maxillary sinus, and of purulent secretion in the antral lavage were observed in 52%,35.7% and 76% of the subjects, respectively, with negative culture of the antral lavage fluids in 71.4%.