Current concepts in topical therapy for chronic sinonasal disease

Journal of Otolaryngology - Head and Neck Surgery

Volumn 39, Issue 3, 2010, Pages 217-231

  Harvey, Richard J ^a,b   Psaltis, Alkis ^b   Schlosser, Rodney J ^c   Witterick, Ian J ^d  

^a ST VINCENT S HOSPITAL   (Australia)

^b ROYAL ADELAIDE HOSPITAL   (Australia)

^c MEDICAL UNIVERSITY OF SOUTH CAROLINA   (United States)

^d UNIVERSITY OF TORONTO   (Canada)

Author keywords

Antibiotic; Biofilm; Endoscopic sinus surgery; Irrigation; Sinusitis; Steroid; Surfactant; Topical

Indexed keywords

AMPHOTERICIN B; ANTIBIOTIC AGENT; ANTIINFLAMMATORY AGENT; PSEUDOMONIC ACID; SODIUM CHLORIDE; SURFACTANT; TOPICAL AGENT;

CELLULAR IMMUNITY; CHRONIC SINUSITIS; CLINICAL TRIAL; DRUG DELIVERY SYSTEM; DRUG MECHANISM; DRUG SAFETY; DRUG TOLERABILITY; EVIDENCE BASED MEDICINE; HUMAN; INNATE IMMUNITY; NEBULIZATION; NEBULIZER; PARANASAL SINUS; PRIORITY JOURNAL; REVIEW; STEROID THERAPY; UNSPECIFIED SIDE EFFECT;

ADMINISTRATION, TOPICAL; ANTI-INFECTIVE AGENTS; ANTI-INFLAMMATORY AGENTS; CHRONIC DISEASE; COMBINED MODALITY THERAPY; EOSINOPHILS; HUMANS; IRRIGATION; MUCOCILIARY CLEARANCE; NASAL MUCOSA; NEBULIZERS AND VAPORIZERS; OTORHINOLARYNGOLOGIC SURGICAL PROCEDURES; PARANASAL SINUS DISEASES; SODIUM CHLORIDE; SOLUTIONS; SURFACE-ACTIVE AGENTS; T-LYMPHOCYTES;

EID: 77953529639     PISSN: 19160216     EISSN: None     Source Type: Journal    
DOI: 10.2310/7070.2009.090161     Document Type: Review

References (127)

1. Harvey R, Hannan SA, Badia L, et al. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev 2007;(3):CD006394.
2. Brown CL, Graham SM. Nasal irrigations: good or bad? Curr Opin Otolaryngol Head Neck Surg 2004;12:9-13.
3. Rabago D, Barrett B, Marchand L, et al. Qualitative aspects of nasal irrigation use by patients with chronic sinus disease in a multimethod study. Ann Fam Med 2006;4:295-301.
4. Tomooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope 2000;110:1189-93. (Pubitemid 30439780)
5. Ferguson BJ. Antifungal nasal washes for chronic rhinosinusitis: what's therapeutic - the wash or the antifungal? J Allergy Clin Immunol 2003;111:1137-8.
6. Kern RC, Conley DB, Walsh W, et al. Perspectives on the etiology of chronic rhinosinusitis: an immune barrier hypothesis. Am J Rhinol 2008;22:549-59.
7. Harvey RJ, Goddard JC, Wise SK, et al. Effects of endoscopic sinus surgery and delivery device on cadaver sinus irrigation. Otolaryngol Head Neck Surg 2008;139:137-42.
8. Snidvongs K, Chaowanapanja P, Aeumjaturapat S, et al. Does nasal irrigation enter paranasal sinuses in chronic rhinosinusitis? Am J Rhinol 2008;22:483-6.
9. Hyo N, Takano H, Hyo Y. Particle deposition efficiency of therapeutic aerosols in the human maxillary sinus. Rhinology 1989;27:17-26. (Pubitemid 19088130)
10. Olson D, Rasgon B, Hilsinger R. Radiographic comparison of three methods for nasal saline irrigation. Laryngoscope 2002;112:1394-8. (Pubitemid 34875422)
11. Wormald P, Cain T, Oates L, et al. A comparative study of three methods of nasal irrigation. Laryngoscope 2004;114:2224-7.
12. Grobler A, Weitzel EK, Buele A, et al. Pre- and postoperative sinus penetration of nasal irrigation. Laryngoscope 2008;118:2078-81.
13. Dijkstra MD, Ebbens FA, Poublon RM, et al. Fluticasone propionate aqueous nasal spray does not influence the recurrence rate of chronic rhinosinusitis and nasal polyps 1 year after functional endoscopic sinus surgery. Clin Exp Allergy 2004;34:1395-400.
14. Chiu AG, Kennedy DW. Disadvantages of minimal techniques for surgical management of chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2004;12:38-42.
15. Valentine R, Athanasiadis T, Thwin M, et al. A prospective controlled trial of pulsed nasal nebulizer in maximally dissected cadavers. Am J Rhinol 2008;22:390-4.
16. Wormald P-J, Cain T, Oates L, et al. A comparative study of three methods of nasal irrigation. Laryngoscope 2004;114:2224-7.
17. Olson DEL, Rasgon BM, Hilsinger RL. Radiographic comparison of three methods for nasal saline irrigation. Laryngoscope 2002;112:1394-8.
18. Miller TR, Muntz HR, Gilbert ME, et al. Comparison of topical medication delivery systems after sinus surgery. Laryngoscope 2004;114:201-4.
19. Merkus P, Ebbens FA, Muller B, et al. The 'best method' of topical nasal drug delivery: comparison of seven techniques. Rhinology 2006;44:102-7.
20. Kayarkar R, Clifton NJ, Woolford TJ. An evaluation of the best head position for instillation of steroid nose drops. Clin Otolaryngol Allied Sci 2002;27:18-21.
21. Karagama YG, Lancaster JL, Karkanevatos A, et al. Delivery of nasal drops to the middle meatus: which is the best head position? Rhinology 2001;39:226-9.
22. Homer JJ, Raine CH. An endoscopic photographic comparison of nasal drug delivery by aqueous spray. Clin Otolaryngol Allied Sci 1998;23:560-3.
23. Homer JJ, Maughan J, Burniston M. A quantitative analysis of the intranasal delivery of topical nasal drugs to the middle meatus: spray versus drop administration. J Laryngol Otol 2002;116:10-3.
24. Aggarwal R, Cardozo A, Homer JJ. The assessment of topical nasal drug distribution. Clin Otolaryngol Allied Sci 2004;29:201-5.
25. Tsikoudas A, Homer JJ. The delivery of topical nasal sprays and drops to the middle meatus: a semiquantitative analysis. Clin Otolaryngol Allied Sci 2001;26:294-7.
26. Cannady SB, Batra PS, Citardi MJ, et al. Comparison of delivery of topical medications to the paranasal sinuses via "vertex-to-floor" position and atomizer spray after FESS. Otolaryngol Head Neck Surg 2005;133:735-40.
27. Benninger MS, Hadley JA, Osguthorpe JD, et al. Techniques of intranasal steroid use. Otolaryngol Head Neck Surg 2004;130:5-24.
28. Karagama YG, Lancaster JL, Karkanevatos A, et al. Delivery of nasal drops to the middle meatus: which is the best head position? Rhinology 2001;39:226-9.
29. Beule A, Athanasiadis T, Athanasiadis E, et al. Efficacy of different techniques of sinonasal irrigation after modified Lothrop procedure. Am J Rhinol Allergy 2009;23:85-90.
30. Harvey RJ, Debnath N, Srubiski A, et al. Fluid residuals and drug exposure in nasal irrigation. Otolaryngol Head Neck Surg 2009 [In press].
31. Pynnonen MA, Mukerji SS, Kim HM, et al. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol Head Neck Surg 2007;133:1115-20.
32. Passali D, Damiani V, Passali FM, et al. Atomized nasal douche vs nasal lavage in acute viral rhinitis. Arch Otolaryngol Head Neck Surg 2005;131:788-90.
33. Kim CH, Hyun Song M, Eun Ahn Y, et al. Effect of hypo-, iso- and hypertonic saline irrigation on secretory mucins and morphology of cultured human nasal epithelial cells. Acta Otolaryngol (Stockh) 2005;125:1296-300.
34. Ooi EH, Wormald P-J, Tan LW. Innate immunity in the paranasal sinuses: a review of nasal host defenses. Am J Rhinol 2008;22:13-9.
35. Psaltis AJ, Bruhn MA, Ooi EH, et al. Nasal mucosa expression of lactoferrin in patients with chronic rhinosinusitis. Laryngoscope 2007;117:2030-5.
36. Berry YJ. Negative side of nasal saline sprays: they can be harmful. Arch Otolaryngol Head Neck Surg 2003;129:1352.
37. Hogman M, Mork AC, Roomans GM. Hypertonic saline increases tight junction permeability in airway epithelium. Eur Respir J 2002;20:1444-8.
38. Slapak I, Skoupa J, Strnad P, et al. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg 2008;134:67-74.
39. Rogers DF. Mucoactive agents for airway mucus hypersecretory diseases. Respir Care 2007;52:1176-93; discussion 93-7.
40. Daviskas E, Anderson SD. Hyperosmolar agents and clearance of mucus in the diseased airway. J Aerosol Med 2006;19:100-9.
41. Quraishi MS, Jones NS, Mason J. The rheology of nasal mucus: a review. Clin Otolaryngol Allied Sci 1998;23:403-13.
42. Sleigh MA. Ciliary adaptations for the propulsion of mucus. Biorheology 1990;27:527-32.
43. Keojampa BK, Hoang Nguyen M, Ryan MW. Effects of buffered saline solution on nasal mucociliary clearance and nasal airway patency. Otolaryngol Head Neck Surg 2004;131:679-82.
44. Talbot AR, Herr TM, Parsons DS. Mucociliary clearance and buffered hypertonic saline solution. Laryngoscope 1997;107:500-3.
45. Homer JJ, Dowley AC, Condon L, et al. The effect of hypertonicity on nasal mucociliary clearance. Clin Otolaryngol Allied Sci 2000;25:558-60.
46. Daviskas E, Anderson SD, Gonda I, et al. Inhalation of hypertonic saline aerosol enhances mucociliary clearance in asthmatic and healthy subjects. Eur Respir J 1996;9:725-32.
47. Middleton PG, Geddes DM, Alton EW. Effect of amiloride and saline on nasal mucociliary clearance and potential difference in cystic fibrosis and normal subjects. Thorax 1993;48:812-6.
48. Wabnitz DA, Wormald PJ, Wabnitz DAM, et al. A blinded, randomized, controlled study on the effect of buffered 0.9% and 3% sodium chloride intranasal sprays on ciliary beat frequency. Laryngoscope 2005;115:803-5.
49. Wills PJ, Hall RL, Chan W, et al. Sodium chloride increases the ciliary transportability of cystic fibrosis and bronchiectasis sputum on the mucus-depleted bovine trachea. J Clin Invest 1997;99:9-13. (Pubitemid 27058287)
50. Min YG, Lee KS, Yun JB, et al. Hypertonic saline decreases ciliary movement in human nasal epithelium in vitro. Otolaryngol Head Neck Surg 2001;124:313-6.
51. Boek WM, Keles N, Graamans K, et al. Physiologic and hypertonic saline solutions impair ciliary activity in vitro. Laryngoscope 1999;109:396-9. (Pubitemid 29128537)
52. Olson DEL, Rasgon BM, Hilsinger RL Jr. Radiographic comparison of three methods for nasal saline irrigation. Laryngoscope 2002;112:1394-8.
53. Adam P, Stiffman M, Blake RL Jr. A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis. Arch Fam Med 1998;7:39-43. (Pubitemid 128435136)
54. Baraniuk JN, Ali M, Naranch K. Hypertonic saline nasal provocation and acoustic rhinometry. Clin Exp Allergy 2002;32:543-50.
55. Haavisto L, Sipila J, Suonpaa J. Nonspecific nasal mucosal reactivity, expressed as changes in nasal airway resistance after bilateral saline provocation. Am J Rhinol 1998;12:275-8. (Pubitemid 128750971)
56. Cassano P, Latorre F. Il test di provocazione nasale con soluzioni iperosmolari: dati normativi. Boll Soc Ital Biol Sper 1991;67:311-8.
57. Krayenbuhl MC, Hudspith BN, Brostoff J, et al. Nasal histamine release following hyperosmolar and allergen challenge. Allergy 1989;44:25-9.
58. Subiza JL, Subiza J, Barjau MC, et al. Inhibition of the seasonal IgE increase to Dactylis glomerata by daily sodium chloride nasal-sinus irrigation during the grass pollen season. J Allergy Clin Immunol 1999;104:711-2.
59. Pynnonen MA, Mukerji SS, Kim HM, et al. Nasal saline for chronic sinonasal symptoms: a randomized controlled trial. Arch Otolaryngol Head Neck Surg 2007;133:1115-20.
60. Gwaltney JM Jr, Hendley JO, Phillips CD, et al. Nose blowing propels nasal fluid into the paranasal sinuses. Clin Infect Dis 2000;30:387-91.
61. Van Hamme JD, Singh A, Ward OP. Physiological aspects. Part 1 in a series of papers devoted to surfactants in microbiology and biotechnology. Biotechnol Adv 2006;24:604-20.
62. Chiu AG, Palmer JN, Woodworth BA, et al. Baby shampoo nasal irrigations for the symptomatic postfunctional endoscopic sinus surgery patient. Am J Rhinol 2008;22:34-7.
63. Desrosiers M, Myntti M, James G. Methods for removing bacterial biofilms: in vitro study using clinical chronic rhinosinusitis specimens. Am J Rhinol 2007;21:527-32.
64. Le T, Psaltis A, Tan LW, et al. The efficacy of topical antibiofilm agents in a sheep model of rhinosinusitis. Am J Rhinol 2008;22:560-7.
65. Zabner J, Seiler MP, Launspach JL, et al. The osmolyte xylitol reduces the salt concentration of airway surface liquid and may enhance bacterial killing. Proc Natl Acad Sci U S A 2000;97:11614-9.
66. Brown CL, Graham SM, Cable BB, et al. Xylitol enhances bacterial killing in the rabbit maxillary sinus. Laryngoscope 2004;114:2021-4.
67. Psaltis AJ, Ha KR, Beule AG, et al. Confocal scanning laser microscopy evidence of biofilms in patients with chronic rhinosinusitis. Laryngoscope 2007;117:1302-6.
68. Harvey RJ, Lund VJ. Biofilms and chronic rhinosinusitis: systematic review of evidence, current concepts and directions for research. Rhinology 2007;45:3-13.
69. Vaughan WC. Nebulization of antibiotics in management of sinusitis. Curr Infect Dis Rep 2004;6:187-90.
70. Desrosiers MY, Salas-Prato M. Treatment of chronic rhinosinusitis refractory to other treatments with topical antibiotic therapy delivered by means of a large-particle nebulizer: results of a controlled trial. Otolaryngol Head Neck Surg 2001;125:265-9.
71. Antunes MB, Feldman MD, Cohen NA, et al. Dose-dependent effects of topical tobramycin in an animal model of Pseudomonas sinusitis. Am J Rhinol 2007;21:423-7.
72. Ponikau JU, Sherris DA, Weaver A, et al. Treatment of chronic rhinosinusitis with intranasal amphotericin B: a randomized, placebo-controlled, double-blind pilot trial. J Allergy Clin Immunol 2005;115:125-31.
73. Weschta M, Rimek D, Formanek M, et al. Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized, double-blind clinical trial. J Allergy Clin Immunol 2004;113:1122-8.
74. Ebbens FA, Scadding GK, Badia L, et al. Amphotericin B nasal lavages: not a solution for patients with chronic rhinosinusitis. J Allergy Clin Immunol 2006;118:1149-56.
75. Shirazi MA, Stankiewicz JA, Kammeyer P. Activity of nasal amphotericin B irrigation against fungal organisms in vitro. Am J Rhinol 2007;21:145-8.
76. Ha KR, Psaltis AJ, Butcher AR, et al. In vitro activity of mupirocin on clinical isolates of Staphylococcus aureus and its potential implications in chronic rhinosinusitis. Laryngoscope 2008;118:535-40.
77. Dalpiaz A, Gavini E, Colombo G, et al. Brain uptake of an anti-ischemic agent by nasal administration of microparticles. J Pharm Sci 2008;97:4889-903.
78. Uren B, Psaltis A, Wormald PJ. Nasal lavage with mupirocin for the treatment of surgically recalcitrant chronic rhinosinusitis. Laryngoscope 2008;118:1677-80.
79. Solares CA, Batra PS, Hall GS, et al. Treatment of chronic rhinosinusitis exacerbations due to methicillin-resistant Staphylococcus aureus with mupirocin irrigations. Am J Otolaryngol 2006;27:161-5.
80. Lee H, Churey JJ, Worobo RW. Antimicrobial activity of bacterial isolates from different floral sources of honey. Int J Food Microbiol 2008;126:240-4.
81. Lusby PE, Coombes AL, Wilkinson JM. Bactericidal activity of different honeys against pathogenic bacteria. Arch Med Res 2005;36:464-7.
82. Allen KL, Molan PC, Reid GM. A survey of the antibacterial activity of some New Zealand honeys. J Pharm Pharmacol 1991;43:817-22.
83. Mullai V, Menon T. Bactericidal activity of different types of honey against clinical and environmental isolates of Pseudomonas aeruginosa. J Altern Complement Med 2007;13:439-41.
84. Alandejani T, Marsan J, Ferris W, et al. Effectiveness of honey on Staphylococcus aureus and Pseudomonas aeruginosa biofilms. Otolaryngol Head Neck Surg 2009;141:114-8.
85. Visavadia BG, Honeysett J, Danford M. Manuka honey dressing: an effective treatment for chronic wound infections. Br J Oral Maxillofac Surg 2008;46:696-7.
86. Cooper RA, Molan PC, Krishnamoorthy L, et al. Manuka honey used to heal a recalcitrant surgical wound. Eur J Clin Microbiol Infect Dis 2001;20:758-9.
87. Gethin G, Cowman S. Manuka honey vs. hydrogel - a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. J Clin Nurs 2009;18:466-74.
88. Chambers J. Topical manuka honey for MRSA-contaminated skin ulcers. Palliat Med 2006;20:557.
89. Mavric E, Wittmann S, Barth G, et al. Identification and quantification of methylglyoxal as the dominant antibacterial constituent of manuka (Leptospermum scoparium) honeys from New Zealand. Mol Nutr Food Res 2008;52:483-9.
90. Adams CJ, Manley-Harris M, Molan PC. The origin of methylglyoxal in New Zealand manuka (Leptospermum scoparium) honey. Carbohydr Res 2009;344:1050-3.
91. French VM, Cooper RA, Molan PC. The antibacterial activity of honey against coagulase-negative staphylococci. J Antimicrob Chemother 2005;56:228-31.
92. Hwang PH, Woo RJ, Fong KJ. Intranasal deposition of nebulized saline: a radionuclide distribution study. Am J Rhinol 2006;20:255-61.
93. DelGaudio JM, Wise SK. Topical steroid drops for the treatment of sinus ostia stenosis in the postoperative period. Am J Rhinol 2006;20:563-7.
94. Lavigne F, Cameron L, Renzi PM, et al. Intrasinus administration of topical budesonide to allergic patients with chronic rhinosinusitis following surgery. Laryngoscope 2002;112:858-64.
95. Mastalerz L, Milewski M, Duplaga M, et al. Intranasal fluticasone propionate for chronic eosinophilic rhinitis in patients with aspirin-induced asthma. Allergy 1997;52:895-900.
96. Qvarnberg Y, Kantola O, Salo J, et al. Influence of topical steroid treatment on maxillary sinusitis. Rhinology 1992;30:103-12.
97. Parikh A, Scadding GK, Darby Y, et al. Topical corticosteroids in chronic rhinosinusitis: a randomized, double-blind, placebo-controlled trial using fluticasone propionate aqueous nasal spray. Rhinology 2001;39:75-9. (Pubitemid 32631617)
98. Kanowitz SJ, Batra PS, Citardi MJ. Topical budesonide via mucosal atomization device in refractory postoperative chronic rhinosinusitis. Otolaryngol Head Neck Surg 2008;139:131-6.
99. Sachanandani NS, Piccirillo JF, Kramper MA, et al. The effect of nasally administered budesonide respules on adrenal cortex function in patients with chronic rhinosinusitis. Arch Otolaryngol Head Neck Surg 2009;135:303-7.
100. Kang IG, Yoon BK, Jung JH, et al. The effect of high-dose topical corticosteroid therapy on prevention of recurrent nasal polyps after revision endoscopic sinus surgery. Am J Rhinol 2008;22:497-501.
101. Bhalla RK, Payton K, Wright ED. Safety of budesonide in saline sinonasal irrigations in the management of chronic rhinosinusitis with polyposis: lack of significant adrenal suppression. J Otolaryngol Head Neck Surg 2008;37:821-5.
102. Rabago D, Pasic T, Zgierska A, et al. The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. Otolaryngol Head Neck Surg 2005;133:3-8.
103. Storaas T, Andersson M, Persson CG, et al. Effects of benzalkonium chloride on innate immunity physiology of the human nasal mucosa in vivo. Laryngoscope 2000;110:1543-7.
104. Lange B, Lukat KF, Bachert C. Local tolerability of a benzalkonium chloride-containing homeopathic nasal spray. Allergologie 2004;27:102-10.
105. Greiff L, Andersson M, Wollmer P, et al. Hypertonic saline increases secretory and exudative responsiveness of human nasal airway in vivo. Eur Respir J 2003;21:308-12.
106. Middleton PG, Pollard KA, Wheatley JR. Hypertonic saline alters ion transport across the human airway epithelium. Eur Respir J 2001;17:195-9.
107. Anderson SD, Brannan JD, Chan HK. Use of aerosols for bronchial provocation testing in the laboratory: where we have been and where we are going. J Aerosol Med 2002;15:313-24.
108. Riedler J, Reade T, Dalton M, et al. Hypertonic saline challenge in an epidemiologic survey of asthma in children. Am J Respir Crit Care Med 1994;150:1632-9. (Pubitemid 24361739)
109. Karadag A, Kurtaran H, Tekin O, et al. Isotonic saline or hypertonic saline: which is best for sinusitis? J Fam Pract 2004;53:637.
110. Wendeler HM, Muller J, Dieler R, et al. Nasal irrigation using isotonic Emser salt solution in patients with chronic rhinosinusitis. Otorhinolaryngol Nova 1997;7(5-6):254-8.
111. Cho JH, Kwun YS, Jang HS, et al. Long-term use of preservatives on rat nasal respiratory mucosa: effects of benzalkonium chloride and potassium sorbate. Laryngoscope 2000;110:312-7.
112. Boston M, Dobratz EJ, Buescher ES, et al. Effects of nasal saline spray on human neutrophils. Arch Otolaryngol Head Neck Surg 2003;129:660-4.
113. Bernstein IL. Is the use of benzalkonium chloride as a preservative for nasal formulations a safety concern? A cautionary note based on compromised mucociliary transport. J Allergy Clin Immunol 2000;105:39-44.
114. McMahon C, Darby Y, Ryan R, et al. Immediate and short-term effects of benzalkonium chloride on the human nasal mucosa in vivo. Clin Otolaryngol Allied Sci 1997;22:318-22. (Pubitemid 28346968)
115. Psaltis AJ, Wormald P-J, Ha KR, et al. Reduced levels of lactoferrin in biofilm-associated chronic rhinosinusitis. Laryngoscope 2008;118:895-901.
116. Heatley DG, McConnell KE, Kille TL, et al. Nasal irrigation for the alleviation of sinonasal symptoms. Otolaryngol Head Neck Surg 2001;125:44-8.
117. Brook I. Bacterial contamination of saline nasal spray/drop solution in patients with respiratory tract infection. Am J Infect Control 2002;30:246-7.
118. Johannssen V, Maune S, Erichsen H, et al. [How does postoperative endonasal mucosa care affect the nasal bacterial flora? A study of two rinsing techniques using saline solution after paranasal sinus surgery.] Laryngorhinootologie 1996;75:580-3.
119. Nadel DM, Lanza DC, Kennedy DW. Endoscopically guided cultures in chronic sinusitis. Am J Rhinol 1998;12:233-41.
120. Faden H, Britt M, Epstein B, et al. Sinus contamination with Pseudomonas paucimobilis: a pseudoepidemic due to contaminated irrigation fluid. Infect Control 1981;2:233-5.
121. Bert F, Maubec E, Bruneau B, et al. Multi-resistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit. J Hosp Infect 1998;39:53-62.
122. Watson PJ, Jiru X, Watabe M, et al. Purulent rhinitis and otitis caused by Pseudomonas aeruginosa in sheep showered with contaminated 'shower wash.' Vet Rec 2003;153:704-7.
123. Keene WE, Markum AC, Samadpour M. Outbreak of Pseudomonas aeruginosa infections caused by commercial piercing of upper ear cartilage. JAMA 2004;291:981-5.
124. McGuckin MB, Thorpe RJ, Abrutyn E. Hydrotherapy: an outbreak of Pseudomonas aeruginosa wound infections related to Hubbard tank treatments. Arch Phys Med Rehabil 1981;62:283-5. (Pubitemid 11111009)
125. Romney M, Sherlock C, Stephens G, et al. Pseudo-outbreak of Pseudomonas putida in a hospital outpatient clinic originating from a contaminated commercial anti-fog solution - Vancouver, British Columbia. Can Commun Dis Rep 2000;26:183-4.
126. Pai VB, Nahata MC. Efficacy and safety of aerosolized tobramycin in cystic fibrosis. Pediatr Pulmonol 2001;32:314-27.
127. Scheinberg PA, Otsuji A. Nebulized antibiotics for the treatment of acute exacerbations of chronic rhinosinusitis. Ear Nose Throat J 2002;81:648-52.