Aerosol therapy with a nebulizer (nebulizer treatment) enables administration of a high drug concentration to the region requiring medication and consequently a reduction of the general side effects. Thus, nebulizer treatment is considered to be safe and effective, and it has often been used for the treatment of inflammatory and allergic diseases of the upper airway. However, the efficacy of nebulizer treatment is not yet clearly understood. Therefore, its efficacy for the upper airway is assessed on the basis of evidence from basic and clinical studies reported so far. Regarding evidence on the value of nebulizer treatment for the upper airway, factors related to local deposition of drug aerosol particles, appropriate antibiotics for nebulizer treatment, efficacy of nebulizer treatment for rhinosinusitis, efficacy of hyperthermic aerosol therapy for allergic rhinitis, efficacy of nebulizer treatment for pharyngitis and laryngitis, and inventions for the increasing efficacy of nebulizer treatment are presented.

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Aerosolized nebulizer therapy is an ideal drug delivery system (DDS) because it can effectively deliver medications directly to the affected area, and is recognized as a useful route of administration of therapy in various fields. We planned a series of researches on the stability of medications used in nebulizer therapies. We comparatively investigated the aerosol characteristics and chemical stability in various nebulization therapies. The mesh-type ultrasonic nebulizer showed high concentrations of each drug emitted from a nebulizer, percent of respirable particles relative to the total number of emitted particles, and the effective index. We would also like to emphasize the fact that suitable nebulizer therapy can be provided to patients, including infants and the elderly, if devices and drug formulations can be improved. This newly nebulizer can effectively deliver medication and maintain its stability. Since the aerosol characteristics are different between ultrasonic nebulizers and jet-nebulizers, the most effective nebulizer for each patient should be selected based on its aerosol characteristics. Furthermore, the Procaterol Hydrochloride inhalation solution was stable to various types of nebulizers, demonstrating that this solution for inhalation can be used for various nebulization therapies. Pharmacists should take responsibility as the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes, and provide appropriate interventions in aerosol therapy.

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Several lines of scientific evidence have recently been accumulated for the use of nasal nebulization in the treatment of chronic rhinosinusitis (CRS). Objective findings, including CT scoring assessment, substantiate the basic concept that healing of osteomeatal complex diseases can lead to the improvement of other sinus diseases. According to the Guideline for the Management of Acute Rhinosinusitis 2010 published by the Japan Rhinologic Society, the EBM recommendation level of nasal nebulizer therapy combined with local treatment is judged as “C1”. The therapy also promotes wound healing processes after endoscopic sinus surgery (ESS). The ESS procedure improves deposition of aerosol particles through the larger sinus ostia. In addition, the use of topical nasal steroid spray has a role in the treatment of intractable CRS with eosinophilic infiltration.
In this paper, we also introduce evaluation of nitric oxide (NO) levels in the nasal airway by using a simple system with a handheld chemiluminescence NO analyzer. We attempted to assess whether local exhaled NO levels in the nasal cavity might reflect the degree of inflammation in the nasal and sinus mucosa.

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Aerosol inhalation therapy is one of the important methods of treatment of paranasal sinusitis in clinical practice. For evaluation of this therapy in clinical practice, we reported on the utilization of aerosol therapy in our clinic.
One of the characteristics of aerosol therapy in our clinic is that we have a personalized nebulizer booth to protect the privacy of the patients. All of the nebulizer units are closed off from both sides from the other units using partitions.
To avoid contamination of the nebulizer device, all attachments, including nose pieces, tubes and the chemical baths are washed carefully under running water. These attachments are sterilized by immersion into sodium hypochlorite solution. After chemical sterilization, the parts are allowed to dry out under hot air.
Since refrigerated drug mixtures have been reported to cause pollution of nebulizer devices, drugs used for aerosol therapy are mixed just before use, and the balance is disposed off after use on the same day.
Measure against environment pollution are important in aerosol therapy, because redundant aerosols can contaminate the environment. We have resolved this by adopting an exhaust duct system. The intake duct is located in front of the nebulizer device in each personalized booth, and any redundant aerosol taken into intake duct is trapped in the filter to avoid contamination of the outside environment.
In conclusion, these ingenuities at our clinic would contribute to the development of aerosol therapy in outpatient clinics of otorhinolaryngology.

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Aerosol therapy is a local drug therapy widely used in the otorhinolaryngology that is safe and effective. Its greatest challenge lies in the delivery of the aerosolized drug to the target site.
The effectiveness of aerosol therapy for chronic sinusitis can be enhanced by overcoming the following problems:
1) Problems related to nebulizers, the device used to generate aerosols
2) Problems related to the drug used
3) Biological problems in the patient
Specifically, the points that must be considered include the following:
1) Maximizing pressure changes in the nasal cavity and paranasal sinuses: the perspective of compression and vibration loading
2) Reducing the sizes of the particles delivered through the narrow sinus ostia: the perspective of particle size
3) Increasing the positive pressure used during administration of the drug solution within the range tolerated by the body: the perspective of flow rate
4) Ensuring that delivery into the nasal cavity is not obstructed by nasal hair, and switching from laminar flow to turbulent flow in order to enable aerosol particles to attach closely to the surface of the middle meatus and nasal mucosa: the perspective of the nozzle
5) Using the most useful drug for the illness
6) Ensuring that the sinus ostia are sufficiently large: enlargement by surgery
7) Preparation for inhalation: secretion removal
8) Convenience
9) Ease of maintenance and inspection

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Topical steroids are useful in the treatment of patients with allergic rhinitis as controller medications. Inhalation therapy using a nebulizer is advantageous, because it is associated with a lower risk of adverse effects than that associated with systemic drug administration. Recently, the portable mesh-type nebulizer was invented. Subsequently, we developed a new mesh-type nebulizer for the treatment of nasal diseases. The diameter of the mesh was changed from 5 mcm to 9 mcm. The aim of this study was to investigate the usefulness of this new portable device for the treatment of allergic rhinitis, to compare the effect of the mesh-type nebulizer and jet-type nebulizer in the treatment of allergic rhinitis, and to discuss the usefulness of inhalation therapy using a nebulizer.
We enrolled 10 patients with Japanese cedar pollen allergic rhinitis who visited our hospital, and randomly assigned them to 2 groups for treatment with two different kinds of nebulizers. The patients were instructed to inhale 0.4mg of 0.1% betamethasone sodium phosphate solution twice a day. The nasal symptoms and nasal resistance were compared before and after the treatment.
All of the patients could comfortably use these devices for 2 weeks. Both the groups showed significant improvement of the nasal symptoms after 2 weeks of the inhaled steroid therapy. The new mesh type of nebulizer was found to be useful for the treatment of allergic rhinitis. However, the devices must be sterilized before use, and the ideal medicine will be required for this treatment modality to become popular.

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