Fumitoshi Tachibana

Platelet-Activating Factor and Leukotrienes in Acute Otitis Media, Secretory Otitis Media, and Chronic Otitis Media on the Acute Excerbation

The present study was carried out for the purpose of measuring platelet activating factor (PAF) and leukotrienes (LTs) in middle ear fluid (MEF) or in otorrhea of children with acute otitis media (AOM), with secretory otitis media (SOM), and with chronic otitis media (COM) on the acute exacerbation. PAF, LTC4, and LTD4+LTE4 concentrations were measured by radioimmunoassay in purulent MEFs obtained from 15 ears of 15 children with AOM, in mucoid or gluey MEFs from 16 ears of 15 children with SOM, and in purulent otorrhea from 9 ears of 9 children with COM on the acute exacerbation. PAF concentrations were 25.4 +/- 9.0 ng/mg total phospholipid (TPL) in AOM, 4.9 +/- 1.9 ng/mg TPL in SOM, 20.7 +/- 15.7 ng/mg TPL in COM, demonstrating significant differences between AOM and SOM (p < 0.05) and between COM and SOM (p < 0.01). LTC4 concentrations were 92.9 +/- 73.8 pg/mg total protein (TP) in AOM, 52.0 +/- 42.5 pg/mg TP in SOM, and 28.5 +/- 11.2 pg/mg TP in COM. LTD4+LTE4 concentrations were 326.5 +/- 177.0 pg/mg TP in AOM, 288.2 +/- 144.6 pg/mg TP in SOM, and 94.0 +/- 58.1 pg/mg TP in COM, demonstrating significant differences between AOM and COM and between SOM and COM (p < 0.01). The results obtained indicated that PAF was involved in the onset of AOM and COM on the acute exacerbation, and that LTs played an important role in SOM.

The Role of Leukotriene in Otitis Media with Effusion in Children

Children with otitis media with effusion (OME) were divided into two groups : a group administered Oxatomide which had anti-leukotriene (LT) effects (Oxatomide-administered group) (17 cases, 17 ears) and a control group (15 cases, 16 ears), and the concentrations of LTC4, LTD4 and LTE4 in middle ear effusion were measured by radioimmunoassay. In the Oxatomide-administered group, the LTC4 concentration was 28.7 ± 15.3 picograms per milligram of total protein (pg/mgTP) and total concentration of LTD4 and LTE4 (LTD4 + LTE4 concentration) was 80.3 ± 53.8 pg/mgTP. On the other hand, in the control group, the LTC4 concentration was 50.5 ± 42.5 pg/mgTP and the LTD4 + LTE4 concentration was 288.2 ± 144.6 pg/mgTP. The LTD4 + LTE4 concentration was significantly lower (p < 0.001) in the Oxatomide-administered group than in the control group, and duration of treatment for OME showed a tendency to be shorter in the Oxatomide-administered group than in the control group. On the basis of these results, it was suggested that LTD4 and/or LTE4 might be related to the prolongation of OME.

Clinical Efficacy of Clarithromycin Therapy for Chronic Sinusitis and Secretory Otitis Media in Children.

The clinical efficacy of clarithromycin was investigated in 34 children with chronic sinusitis, and 36 children with secretory otitis media accompanied by chronic sinusitis.1) Rhinoscopy showed reduced nasal mucosal swelling in 74.2%, decreased nasal discharge in 78.5%, decreased postnasal drip in 89.3% and improved quality of nasal discharge in 88.6%. Follow up X-ray films showed improved opacity of maxillary sinuses in 81.6%.2) There was improvement in 71.4% in the appearance of the tympanic membrane and in 66.7% in that of the tympanogram.3) The rate of clinical efficacy was 88.6% (marked improvement, 54.3%; some improvement, 34.3%) for chronic sinusitis and 79.6% (marked improvement, 38.8%; some improvement, 40.8%) for secretory otitis media.4) No side effects were observed.On the basis of these results, clarithromycin was judged to be useful in the treatment of children with chronic sinusitis and with secretory otitis media accompanied by chronic sinusitis.

Clinical Study of Laryngeal Cancer

One hundred and nine cases of laryngeal cancer were treated between 1987 and 1997 in the Department of Otorhinolalyngology at Obihiro Kousei Hospital. The average age of the patients was 65. 4 years old, and the male to female ratio was 21: 1. Based on histopathological diagnosis, 108 cases were reported as squamous cell carcinoma and one case was reported as spindle cell carcinoma. There were 15 cases of supraglottic carcinoma, 91 cases of glottic carcinoma and 3 cases of subglottic carcinoma. There were 33 cases in stage I , 35 cases in stage II, 22 cases in stage III and 19 cases in stage J Y. The five-year survival rates of the patients for stages I to IV were 100%, 90%, 66% and 65% respectively.

The Efficacy of Hemitonsillectomy and Adenotomy in Treatment of Upper Airway Obstruction in Children

Adenotonsillectomy is frequently performed on children with upper airway obstruction, since the most common cause is adenotonsillar hypertrophy. Removal of a minimal amount of tonsil tissue may be immunologically better, however, removal of a wider area may be necessary to enlarge the airway sufficiently. Based on the foregoing, removal of the palatine tonsil on only one side and adenotomy (hemitonsillectomy and adenotomy: HTA) was performed in 6 cases of upper airway obstruction in patients under 5 years old. Five of these cases underwent nocternal polygraphic recordings before and one week after HTA. Airflow, thoracic movement, mesopharyngeal pressure and oxygen saturation were simultaneously monitored and the following results were obtained: the maximum amplitude of mesopharyngeal pressure remarkably decreased, and the minimum oxygen saturation increased to a normal range postoperatively. Although all cases had good long term courses, two, both 5 years old, complained of snoring and sleep apnea again 30 or 37 months after HTA. On physical examination, the remaining palatine tonsils had hypertrophied while pharyngeal lymph follicles had not hypertrophied. Funnel chest, which had been observed in one of the 2 cases before HTA, had already completely disappeared. On polysomnographic examination, recurrence of upper airway obstruction was demonstrated. The remaining palatine tonsils were removed and thereafter the 2 cases improved both clinically and on the polygraphic test. The remaining 4 cases were investigated by questionnaires, which showed that they had no recurrence 5 to 39 months postoperatively. Pigeon chest, which had been observed in one of the 4 cases before HTA, had slightly improved. These results suggest that HTA is valuable for preservation of immunological function,