The postnasal drip (PND) is an important feature of chronic sinusitis (CS). PND frequently causes abnormal sensations in the nasopharynx, cough, and sputum. The viscosity and the elasticity of the nasal mucus of CS patients has been found to be much higher than in normal subjects. This means that the nasal mucus of patients is stiffer and more elastic, and this results in a rope of mucus stretching from a sinus ostium along the mucus path into the nasopharynx. Hyperplasia and hypertrophy of glands in the nasal and sinus mucosa cause the hypersecretion of mucus. This phenomenon also contributes to the etiology of PND. Mucociliary clearance occurs from the anterior to the posterior part of the nose, and clearance was slower in about half of the patients. Under these circumstances, nasal mucus is retained in nasal cavity and drips into the nasopharynx when the quantity of the retained mucus increases.
From an etiologic point, the goal of PND in CS can be summarized as follows:
1. Decrease the viscosity and the elasticity of nasal mucus.
2. Decrease the amount of nasal mucus produced.
3. Improve the mucociliary clearance in the patients whose nasal mucociliary clearance is impaired.
The clinical management of PND is discussed in relation to the etiology of PND.

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We frequently encounter patients complaining of postnasal discharge in our daily practice. To our knowledge, there have not been any reports on bacteriological examination of postnasal discharge.
In this study, we performed bacteriological examinations on postnasal discharge specimens from 185 patients, and performed comparative bacteriological studies of postnasal discharge and rhinorrhea specimens from the same patient among 87 patients treated in our department or 27 affiliated institutions. The studies were performed under sterile conditions.
Oral resident bacteria are generally isolated from the posterior pharyngeal wall of healthy persons, and the isolate ratios of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa and enteric bacteria were increased in the postnasal discharge specimens from our patient cohort. The bacteria isolated from the postnasal discharge were also frequently isolated from rhinorrhea specimens from the same patient. Moraxella catarrhalis was repeatedly isolated from rhinorrhea specimens but not from postnasal discharge. Further investigation of Moraxella catarrhalis as the causative bacterium of paranasal sinusitis is required.

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Information concerning roentogenologic examinations and maxillary sinus puncture and irrigation therapy of pediatric sinusitis patients was obtained by questionnaire survey of hospitals in Japan.
The questionnaires were sent 250 hospitals in 1997, and answers were obtained from 193 of them (77.2% response rate). Maxillary sinus puncture and irrigation were performed in 31.8% of the hospitals.
The answers showed that 95% of the hospitals recognized maxillary sinus puncture and irrigation to be effective, 69% had experience in using it, more than 90% considered it to be difficult.
Maxillary sinus puncture and irrigation is still thought to be effective treatment for sinusitis in children, however its use in ENT practice actually decreasing, because ENT physicians are selecting cases in which puncture and irrigation therapy is effective.

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Periodic fluctuations in the size of the normal nasal mucosa were evaluated and analyzed by acoustic rhinometry.
Seven healthy volunteers (males 4, females 3, average age 29 years, range 24 to 35 years) without any nasal lesions served as the subjects of this study. An acoustic rhinometry (GM Co.) was used, and each subject remained quiet in a sitting position for 5 hours. Nasal cross-sectional area was evaluated every 15 minites in a quiet, air-conditioned room.
Periodic fluctuations in cross-sectional area were observed in 6 of the subjects, and the average cycle was 2.2hrs.. No significant difference was seen between the genders. The anterior and posterior area of the nasal cavity were highly correlated (r: 0.94), demonstrating simultaneous swelling and shrinkage of the nasal mucosa. The minimal cross-sectional area was set equal to 100% as a baseline, and fluctuation on one side of the nose was 66-139%, and fluctuaion on both sides was 80-121%.
Fluctuation in volume from the nasal entrance to a depth of 7cm was 69-143% on one side and 82-117% on both sides. Fluctuation tended to be less on both sides, but the sum of values on one side did not show any constant areas, as suggested by rhinomanometry.
This normal fluctuation of 70-140% in cross-sectional area and volume must be taken into consideration when applying acoustic rhinometry in clinical settings. All evaluations should be repeated at different times.

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Although malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma of adulthood, it is a rare tumor of the head and neck. We encountered a case of MFH arising from the maxillary sinus, and report on its diagnosis and treatment along with a review of pertinent papers. The patient was a 42-year-old male who presented with a four-month history of numbness in the left cheek. CT and MRI showed a left maxillary lesion with bone destruction of the anterior wall. Biopsy revealed MFH of the storiform-pleomorphic type. Immunohistochemically, the tumor stained positive for vimentin and α-1-antitrypsin, but negative for keratin, EMA, and p53. The patient was treated by preoperative Linac X-ray irradiation combined with intra-arterial infusion of Carboplatin and 5-FU followed by total maxillectomy. Pathological evaluation of the resected tumor showed a favorable response with extensive necrosis.

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The effect of ketotifen alone and in combination with beclomethasone dipropionate (BDP) and/or erythromycin derivatives was investigated in allergic sinusitis in children younger than 13 years of age. The subjects were 121 children with sinusitis associated with symptomatic perennial allergic rhinitis and were randomized into 4 treatment groups. Children with mucopurulent or purulent rhinorrhea were excluded from this study. Group A received 0.06mg/kg of ketotifen alone daily; group B received ketotifen and 300μg of topical BDP. Group C was given ketotifen with 10mg/kg of erythromycin or 5mg/kg of clarithromycin, and group D was administered ketotifen in combination with topical BDP and an erythromycin derivative. Each group was treated for 8 weeks. X-ray examination of the maxillary sinuses showed improvement rates of 44%, 59%, 48%, and 60% in groups A, B, C, and D, respectively. The degree of improvement was significantly correlated with subjective nasal allergic symptom improvement ratings in groups A, B, and C. The X-ray improvement ratings were significantly correlated with improvement ratings based on intranasal findings in groups B and C and with a decrease in eosinophils in the nasal discharge in groups A and B.
Overall evaluation suggests that a potent antiallergic therapy that includes a topical corticosteroid is useful for the treatment of allergic sinusitis in children, and that macrolide therapy may not be effective for allergic sinusitis.

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Initial treatment for Japanese cedar pollinosis has come into wide use as their effectiveness have been reported. However, the most appropriate starting time of administration and the best medicine have not been established. The effect of IPD for the initial treatment was examined in three regional facilities-Fukui, Kyoto and Osaka-which have different pollen counts. Tranilast was used in comparison. The correlation between clinical efficacy and chemical mediator in nasal lavage fluid was investigated. The amount of cedar pollen in 1997 was as follows-Fukui, 4835/cm²; Kyoto, 1285/cm²; Osaka, 1515/cm². The comparison of inhibitory effectiveness of symptom between IPD and Tranilast was not significant after the first peak of cedar pollen dispersion. However after the second peak of cedar pollen dispersion, IPD significantly inhibited symptoms. IPD's inhibitory effect showed a fine record that rated excellent at 48.1% and good at 74.1% after the first peak. On the other hand, the comparison of results between facilities was not significant. The change of eosinophil cationic protein (ECP) concentrations in nasal lavage fluid was correlated with clinical effect. IPD significantly decreased the secretion of ECP in comparison to Tranilast. However, no correlation was found between the change in histamine concentrations and clinical effect. These results suggest that ECP concentrations in nasal lavage fluid is an effective index of objective evaluation at the initial treatment for Japanese cedar pollinosis. In addition, the changes in ECP concentrations in nasal lavage fluid can expect the efficacy of an initial treatment and serve as a good index for selecting a suitable medicine.

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A case of child sphenoidal sinusitis with cystic expansion is reported here. A 10-year-old girl had been followed-up for common paranasal sinusitis by an otolaryngologist, whose chief complaint was left nasal obstruction. She was diagnosed with a nasal polyp and was sent to my hospital for surgical treatment. A large polyp was found in her left olfactory fissure, and CT imaging of the paranasal sinuses revealed that the lesion was localized in the sphenoidal sinus as a huge cyst. However, no destruction to the surrounding structures was observed. Endoscopic sinus surgery was performed under general anesthesia. After total removal of a large polyp expansion towards the nasal cavity of the sphenoethmoidal recess was recognized. The sphenoid sinus was completely packed with caseated substance, in which no fungus was detected morphologically. Subsequent to sphenoid sinus surgery her recovery was uneventful.
Localized lesions of the sphenoid sinus seems rare. Furthermore, inflammation of sphenoid sinus with cystic expansion is seldom reported in childhood. In a case of nasal polyp that is unresponsive to treatment, CT imaging is essential for an accurate diagnosis. When indicated endoscopic sinus surgery is the most efficacious procedure for sphenoid surgery in a child.

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Nasal obstruction is one of the principal symptoms of allergic rhinitis. Animal experiments are useful in studying the mechanisms of nasal obstruction. Acoustic rhinometry has been employed to evaluate nasal obstruction in adult humans by determining nasal cavity dimensions in terms of cross-sectional areas as a function of the distance from the nostril. We modified the equipment applied to humans for assessing the dimensions of the nasal airway geometry of small experimental animals. The aim of this study was to investigate the accuracy of measurements by modified acoustic rhinometry in small experimental animals. In seven guinea pigs, nasal cavity volume determined by acoustic rhinometry was 73.7±20.0% of the acutual volume. Acutual volume was estimated by impression material instilled into the nasal cavity of the animals (IM volume), and volumes measured by acoustic rhinometry were also significantly correlated with IM volumes. There was a significant negative correlation between volume obtained by acoustic rhinometry and nasal airway resistance in guinea pigs. Measurement of nasal airway resistance employed in this study is a method frequently used in the evaluation of nasal obstruction in guinea pigs. These results suggest that modified acoustic rhinometry is useful in evaluating nasal obstruction in small experimental animals.

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Anterior nasal atresia is a relatively rare condition that may cause airway obstruction. An 8-week-old newborn male with bilateral anterior nasal bony atresia was treated surgically via a sublabial approach. The stenotic bony apertures were widened using a surgical drill and tracheal tubes (I. D. 3.0mm) were placed in each nasal cavity for 4 weeks.
Three years after the operation, no recurrence was found. Fifty cases of anterior nasal atresia, including our case, have been reported in Japan. Only one case of bony stenosis was reported in 1938, and we believe that our patient is the second reported case of anterior nasal bony atresia in Japan.

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It is well known that allergic march includes atopic dermatitis, asthma and nasal allergy. However, there are few reports on the relationship between atopic dermatitis and nasal allergy. In this study, we examined the presence of nasal symptoms, eosinophils and nasal mucosal mast cells in nasal smear, and nasal provocative tests (house dust and histamine) in 103 patients with atopic dermatitis. Fifty-one cases (49%) showed nasal symptoms. In these cases, eosinophils in nasal smear and nasal mucosal mast cells were higher compared with than in the group without nasal symptoms. On the other hand, there were no differences in the nasal provocative tests between these two groups. The reasons for these results were unknown. Eosinophils and mast cells in the nasal mucosa may relate more closely to nasal symptoms. Also, the patients without nasal symptoms in spite of positive reactions to house dust in nasal provocative tests may have a possibility of developing nasal allergy in the future. This phenomenon may prove the existence of allergic march.

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