Elsevier

Auris Nasus Larynx

Volume 47, Issue 1, February 2020, Pages 18-24
Auris Nasus Larynx

Consensus guidance of nebulizer therapy for acute rhinosinusitis

https://doi.org/10.1016/j.anl.2019.08.007Get rights and content

Abstract

The guidance deals with the recommended applications, procedures, and safety management of nebulizer therapy for acute rhinosinusitis. In Japan, nebulizer therapy for sinusitis has been covered by public health insurance since 1958 and has been commonly carried out nationwide. The Japan Society for Infection and Aerosol in Otorhinolaryngology and the Oto-Rhino-Laryngological Society of Japan set up a working group to draw up a consensus guidance on nebulizer therapy for acute rhinosinusitis.

The device for nebulizer therapy are classified into jet, ultrasound, and mesh types. In Japan, cefmenoxime hydrochloride (CMX) was approved for use in nebulizer therapy since 1996. The widening of the obstructed lesions such as large polyps prior to nebulizer therapy were recommended. The numbers of times of nebulizer therapy is recommended for three times in a week for at least for 2 weeks (cure rate: 68%, eradication ratio: 48%). Concerns should be pay for the changes of activity of medicine due to the mixing and bacterial contamination. Pseudomonas cepacia growing in a short even in both saline and distilled water leads to contamination at high concentrations by 2 days.

Nebulizer therapy is an effective treatment based on a drug delivery system (DDS) to the nasal and paranasal cavities. The therapy effectively increases the local drug concentration by promptly and uniformly delivering drugs to a targeted local site. The therapy is safe with less systemic absorption and with few adverse reactions.

Introduction

Acute rhinosinusitis is a common upper respiratory tract infection in clinical practice and is defined as symptomatic inflammation of the nose and paranasal sinus persisting 4 weeks with an acute onset that present with respiratory symptoms, such as nasal obstruction, rhinorrhea, post nasal discharge, and coughing, accompanied by headaches, cheek pain, and a sensation of facial compression. In Japan, the practical guideline for management of acute rhinosinusitis was published in 2010 and recommended inhalation antimicrobial therapy denominated nebulizer therapy (inhalation therapy, aerosol therapy) after widening the middle nasal meatus [1,2]. However, there are a limited number of studies on the standard procedures for nebulizer therapy (inhalation therapy, aerosol therapy) and on the assessment of its efficacy for acute rhinosinusitis. This guidance was edited by the Japan Society for Infection and Aerosol in Otorhinolaryngology and the Oto-Rhino-Laryngological Society of Japan to provide the appropriate procedures of nebulizer therapy and to enhance its therapeutic effect for acute rhinosinusitis.

Nebulizer therapy was initially developed by Barach et al. for penicillin aerosol-induced bronchitis, bronchiectasis, and lung abscess [3]. They demonstrated the effectiveness of negative/positive pressure therapy with a penicillin aerosol for rhinosinusitis as “penicillin for maxillary empyema”. In Japan, nebulizer therapy for sinusitis has been covered by public health insurance since 1958 and has been commonly carried out nationwide.

Nebulizer therapy involves effective local inhalation of drugs, i.e., a drug delivery system (DDS). The therapy effectively increases the local drug concentration by promptly and uniformly delivering drugs to a targeted local site. Such local concentrations cannot be achieved by oral or systemic administration. Since drugs administered by nebulizer are particles, the nebulized drugs can be delivered to bended or retracted region was well as to low blood flow sites. Thus, the therapy is safe with less systemic absorption and with few adverse reactions.

Section snippets

Inhalation devices and nebulizing characteristics of liquid medicine

There are many different inhalation devices that are classified into jet (compressor), ultrasonic, and mesh type nebulizers [4]. Both the aerodynamic diameters of drug particles and nebulized drug amounts are important for the clinical use of these devices [5]. The aerodynamic diameters determine the drug delivery efficiency in the nasal and paranasal cavity, and the administration time is directly related to the nebulized drug amounts. The mean aerodynamic diameter used in otolaryngology is

Indication

Rhinosinusitis is divided into the four categories depending on how long the illness lasts: acute, subacute, chronic and recurrent. There have been reported many clinical studies on the efficacy of nebulizer therapy for both acute and chronic rhinosinusitis [8,9]. However, it is difficult to exactly differentiate acute exacerbation of chronic rhinosinusitis due to bacterial infection from recurrent rhinosinusitis. Therefore, in this guide, the nebulizer therapy is recommended to be applied for

Sterilization and disinfection of devices

Since aerosol particles containing infectious microorganisms and/or contaminants cause infections, it is necessary to pay full attention to the handling of the devices and drugs. The most hazardous thing is drug solutions contaminated with infectious microorganisms. It is recommended that nebulizer devices should be replaced after usage. Nevertheless, for both commonly-used jet type nebulizers installed with drug solutions and ultrasound nebulizers, particular parts should be exchanged and

Conclusion

In conclusion, this manual has outlined applications, procedures, and device use of nebulizer therapy for acute rhinosinusitis. Nebulizer therapy is an effective treatment based on a drug delivery system (DDS) to the nasal/paranasal cavity.

Conflict of interest

The authors have no conflicts of interest directly relevant to the content of this article.

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