Although various antibacterial agents can be used for the treatment of paranasal sinusitis caused by MRSA, ABK (arbekacin; Habekacin^TM) is one of the drugs of choice. ABK is currently approved for clinical use mainly intravenously, only in Japan. But, even when it is administered by topical nebulization, either intermittently or continually, it has proved to be of excellent clinical benefit.
The drug was administered by topical nebulization to five cases of sinusitis caused by MRSA at St. Mary's Hospital in Himeji. Following its administration, the sinus infection was eliminated effectively in all the cases, without any associated side effects such as ototoxicity, nephrotoxicity or development of drug resistance. Furthermore, the cost of treatment is about twelve times lower than when it is administered intravenously. Although the infection was eliminated in all the cases, when the drug is administered by topical nebulization two of them later showed relapse of the MRSA infection, and needed repetition of the initial treatment protocol. In the five aforementioned patients with sinusitis caused by MRSA this new and effective drug was applied each week topically between four and twenty-nine times, on average, 11.4 times. In each of the cases, additional chemotherapy was selected as needed. Before each administration, 8.3 mg of ABK was dissolved in 1.0 cc of normal saline, and the drug was nebulized via the Jet-type nebulizer, FN-D 3100. The nebulizer treatment was administered intermittently in the outpatient clinic. Based on these results, it is recommended for the treatment of sinusitis caused by MRSA, that ABK be administered by topical nebulization, in addition to oral or intravenous antibiotic therapy. In the case of mere MRSA colonization, on the other hand, the administration of ABK alone is recommended until the organisms are eliminated.

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Aerosol depositions in the maxillary and ethmoidal sinuses were evaluated in 6 patients who underwent endoscopic sinus surgery. One percent Cefmenoxime hydrochloride (CMX) was the drug seleced to be administered by nebulization. The aerosol was generated at a flow rate of 3 l/min by a jet-type nebulizer, Azwell Nescojet AZ-11, and the diameter of the aerosolized particles ranged from 5 to 15μm.The diameters of the aerosolized particles generated by an ultrasonic-type nebulizer, Omron NE-U 12, were distributed in the range of 1 to 5μm, and the aerosol was generated at the flow rate of 17 l/min. In the maxillary sinus, the aerosolized particles gene-rated by the jet-type nebulizer were deposited to a greater extent than those generated by the ultrasonic-type nebulizer. The aerosol deposition pattern in the ethmoidal sinus was similar to that in the maxillary sinus. The concentrations of CMX in each sinus were above the MICs for the pathogens implicated in sinusitis. The results suggest that aerosol therapy could be useful as a postoperative treatment adjunct for sinusitis.

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Bacteria were isolated from the rhinorrhoea of 1060 patients with sinusitis. A total of 1081 bacteria cultures were established using samples taken from 778 patients. The cultures were identified as S. pneumoniae (40.4%), M. catarrhalis (26.4%), and H. influenzae (25.3%). Many of the S. pneumoniae cultures were resistant to AMPC (Amoxicillin), with only 18.3% showing sensitivity.
M. catarrhalis were frequently isolated in samples taken from babies and infants.
In school aged children and younger, the freguency at which M. catarrhalis was isolated decreased to about 10%. On the other hand, the frequency of MSSA increased in patients older than schoolchildren. About 1.7% of the 1081 bacteria cultures were classified as MRSA. MRSA bacteria were resistant to most antibiotics. Only 33.4% of the isolated bacteria cultures were sensitive to AMPC in vitro, 63.4% of the cultures were sensitive to SBTPC (Sultamicillin), and 46.6% of the cultures were sensitive to CAM (Clarithromycin). LVFX (Levofloxacin) was the most effective antibiotic, with 98.0% of the cultures showing sensitivity. CMX (Cefmenoxime), which is often used in aerosol therapies, was also effective, with 96.7% of the cultures showing sensitivity.

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Mucosal dysfunction and insufficient ventilation are believed to be the major factors predisposing to sinusitis. Ventilation of the paranasal sinuses is essential for the entry aerosols into their cavities. In this study, we compared the pressures between the human nasal cavity and the maxillary sinus and determined the efficiency of nasal mucociliary clearance by the saccharin test.
We simultaneously measured the nasal cavity and maxillary sinus pressures during quiet breathing in a human subject. An enlarged maxillary ostium, creation of an additional counter-opening at the inferior nasal meatus, insertion of a tube and YAMIK therapy markedly increased the differential pressures between the nasal cavity and the maxillary sinus. The differential pressures were increased most significantly with the creation of an additional counter-opening at the inferior meatus, and enlargement of the maxillary ostium. We simultaneously measured the pressures in the two cavities during normal breathing and hyperventilation a human subject. A counter-opening at the inferior meatus was created by operation in 10 of these patients (19 males and 6 females). In the results, the differences in pressures, compared during normal breathing and hyperventilation, were found to be significantly increased during hyperventilation (p<0.01). These results suggest that increased ventilation increased differential pressures between the nasal cavity and the paranasal sinuses due to the increase in the air flow rate in the nasal cavity, and also that when the respiratory frequency is increased the ventilatory exchange between the nasal cavity and the paranasal sinuses is increased.
It is suggested that the ventilatory exchange between the nasal cavity and the paranasal sinuses increases as the flow rate of air passing in the nasal cavity increases, and also that when the respiratory frequency is increased even slightly, the ventilatory exchange between the paranasal sinuses and the nasal cavity is markedly increased.
From these results, it is considered that the ventilatory exchange between the nasal cavity and the maxillary sinus was significantly increased when a counter-opening was created at the inferior meatus. The nasal mucociliary clearance and the air flow rate in the nasal cavity may increase following enlargement of the maxillary ostium and creation of a counter-opening at the inferior meatus, thereby allowing improved inhalation of aerosol particles into the paranasal sinuses.

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Ultrasonic nebulization is widely performed for inhalant therapy. We have been investigating the stability of various drugs when administered using a newly developed Ultrasonic Nebulizer and comparing our results to those for the conventional two-tank nebulizer. The Ultrasonic Nebulizer uses ultrasonic vibrations to nebulize solutions. The efficiency of the new nebulizer has been previously demonstrated. Here, changes in the properties of budesonide suspensions are reported. No changes in pH, apparant appearance or odor were observed when the Ultrasonic Nebulizer was used to administer budesonide suspensions.
Budesonide suspensions are highly stable when applied using the new Ultrasonic Nebulizer and should be effective. We conclude that the new ultrasonic nebulizing method can be utilized for inhalant therapy with many inhalant preparations.

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Patients are often dissatisfied with the smell and taste of medicines perscribed for local treatments, including nebulizer treatments. This dissatisfaction is especially apparent when patient responses to over-the-counter treatments and prescribed treatments are compared.
For this reason, we decided to add Mentha oil or various other essences to the medicine used for nebulizer treatments. The utility of these treatments, especially patient response, was then investigated.
The influence of these additives on the stability of the medicine was also examined.
Our results showed that, the refreshing smell of Mentha oil improved the efficiency of cefmenoxime hydrochloride (CMX) local nebulizer treatments for paranasal sinusitis.
The Mentha oil remained stable in the CMX solution with a ratio of 91.1% after 7 days in solution.
In addition to Mentha oil, grapefruit oil, melon essence, strawberry essence and lemon essence also showed good stability.

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The mucosal surface of the respiratory tract is equipped with the mucosal immune system. Secretory IgA plays an important role in this immune system and protects the host from microbial invasion via the respiratory tract. In the present study, we examine the mucosal immune responses in the respiratory tract against Haemophilus influenzae and discuss the efficacy of administering a mucosal vaccine by aerosol. Animal studies in mice have demonstrated that antigen-specific IgA responses were induced in the upper and lower respiratory tracts by intranasal as well as intratracheal immunization. The results suggest that aerosol vaccination might be useful for the prevention of respiratory tract infections. However, immune tolerance induced by longterm or frequent mucosal vaccination should be considered while developing vaccines for aerosol application.

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Nebulizer therapy for chronic sinusitis was accepted as an official therapy covered by the social insurance system in 1951. Since then, this therapy has become the treatment of choice for many otolaryngologists. However, several difficulties associated with nebulizer therapy have been encountered. For example, until coverage for the use of cefmenoxime hydrochloride began in 1996, no antibiotic drugs for nebulizer use were available. Presently, cefmenoxime hydrochloride is the only drug covered by social insurance for nebulizer use. The second difficulty is related to the clinical effectiveness of nebulizer therapy. Every paranasal sinus has its own drainage system between the nasal cavity and the paranasal sinuses. In chronic sinusitis, this drainage system is usually narrowed. Therefore, the effectiveness of nebulizer therapy could be increased by enlarging these drainage systems. We would like to stress that nebulizer therapy in combination with the enlargement of the drainage system between the nasalcavity and the paranasal sinuses is a potentially useful otorhinolaryngologic treatment.

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We investigated the effects of a topical application of oxatomide, an antiallergic agent, on allergic rhinitis attacks in actively sensitized guinea pigs. The topical application of an oxatomide nasal spray (0.025%) reduced the severity of allergic rhinitis, which was assessed by determining the leakage of dye and the release of histamine from the nasal cavities of guinea pigs. Furthermore, the oxatomide nasal spray treatment prevented an increase in dye leakage when guinea pigs and rats were treated with histamine. These results indicate that the topical application of oxatomide inhibits both the release and the action of histamine. Therefore, nasal sprays containing anti-allergics drugs may be beneficial for the treatment of allergic rhinitis.

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We investigated the efficacy of a new nasal device, the Jetlizer^TM. We evaluated the distribution of a powder-drug (DSCG) in the nasal mucosa by endoscopy and determination of the weight of the residual drug in the capsules of three devices, the Publizer^TM, Insufflator^TM and Jetlizer^TM. The use of Jetlizer^TM was associated with the best drug distribution, and this device exhibited the best ability for drug delivery. In the treatment of patients with allergy, topical treatment with antihistaminics, mast-cell stabilizes and steroids is essential, thus we recommed the use of a good nasal device like as Jetlizer^TM.

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