Hiroshi Kikumori

Arachidonic Acid Metabolites in Human Nasal Polyps

Arachidonic acid metabolites (AAMs) are known to be involved in inflammation. It is suggested that AAMs play an important role in the pathogenesis of nasal polyp. We have measured the levels of prostaglandin E2, 6-keto prostaglandin F1 alpha, thromboxane B2, leukotriene B4 and a mixture of leukotriene C4, D4 and E4 in both nasal polyp and maxillary sinus mucosa by radioimmunoassay. Our results showed that arachidonic acid metabolism in nasal polyps from allergic patients was more active than that from non-allergic patients. The arachidonic acid metabolism in nasal polyp was more active than in maxillary sinus mucosa among allergic patients. On the other hand, arachidonic acid metabolism in maxillary sinus mucosa was more active than that in nasal polyps among non-allergic patients. On the basis of these results, we hypothesized the causal mechanisms of nasal polyps as follows: The nasal polyp in allergic patients is caused by primary inflammation of the nasal mucosa, and sinusitis occurs secondarily. In non-allergic patients, the primary side of inflammation is located in the maxillary sinus mucosa, leading to the secondary formation of nasal polyp.

Nasal mucociliary clearance in patients with upper and lower respiratory diseases.

The nasal mucociliary clearance was measured in 71 subjects with nasal allergy (NA) (56 subjects without sinusitis and 15 with sinusitis), 12 subjects with bronchial asthma (BA) (7 without, 5 with) and 7 subjects with aspirin-induced asthma (AIA) using a saccharin test. The results were compared with those obtained in a control group of 15 healthy subjects. The saccharin time (ST) values for both NA and BA subjects without sinusitis (16.9 +/- 9.9 and 20.1 +/- 9.4 min, respectively) did not differ from that of the healthy subjects (16.3 +/- 5.3 min). However, ST values in NA and BA subjects with sinusitis (37.6 +/- 22.9 and 57.0 +/- 6.7 min, respectively) were significantly higher than those of healthy subjects (p < 0.01). The ST value of AIA subjects (13.0 +/- 5.4 min) showed no significant difference compared with that of the control group. These results suggest that allergic reactions do not influence the nasal mucociliary clearance and that the property of mucus complicated with sinusitis is important. Also, sinusitis observed in AIA may be somewhat different from ordinary sinusitis complicated with NA and BA.

Nasal Mucociliary Clearance in Upper and Lower Respiratory Tract Diseases.

The saccharine test was used to measure nasal mucociliary clearance in 71 patients with nasal allergy (56 without and 15 with chronic sinusitis), 12 patients with asthma (7 without and 5 with chronic sinusitis) and 7 patients with aspirin-induced asthma. The results were compared with those of a control group of 15 healthy subjects. The saccharine time (ST) in patients with nasal allergy without chronic sinusitis (16.9±9.9min) and in those with asthma without chronic sinusitis (20.1±9.4min) did not differ not significantly from that in the healthy subjects (16.3±5.3mm). But the ST in patients with nasal allergy and chronic sinusitis (37.6±22.9min) and in those with asthma and chronic sinusitis (57.0±6.7min) was significantry longr than in the controls (p<0.01). The ST in aspirin induced asthma (13.0±5.4min) was not higher than the ST in the control group. These results suggest that allergic reactions in patients with allergic diseases do not affect nasal mucociliary clearance and that the nature of the mucus and the relationship between ciliary movement and the mucus layer are important in nasal mucociliary clearance.

Autoimmune Hearing Loss with Systemic Symptoms; A Case Report.

We report a case of ASNHL (autoimmune sensorineural hearing loss) with systemic symptoms. The patient was a 64-year old female who consulted us with complaints of bilateral hearing loss and left tinnitus. Later, she had cranial polyneuropathy (L: V VII VIII, R: VIII XII), diabetes insipidus, headache and fever. Her blood sedimentation rate, CRP and γ-globulin were increased. Antinuclear antibodies and antihypophysis antibodies were found in her serum. Her general condition and hearing level were improved by steroid and cyclophosphamide therapy. Autoimmune vasculitis was suspected, but histopathological studies of granulation tissue around the left stapes and left superficial temporal artery were not specific. Steroid therapy is being continued.

Nasal Mucosal Hemodynamics in Nasal Allergy. Effect of Various Drugs.

Adrenaline, ipratropium or fenoterol was applied to one nasal cavity of patients with nasal allergy. The nasal mucosal blood volume (IHb) of both sides was measured with a tissue spectrum analyzer (TS-200, Sumitomo Electric Co. Ltd.) before and 5 min. after the application of the drugs.I) Unilateral application of adrenaline (0.01mg/ml, 0.12ml) decreased the IHb on the ipsilateral side but caused no change of the IHb on the contralateral side.II) Unilateral application of 20μg of ipratropium induced no change of IHb on either side.III) Unilateral application of 0.2mg or 0.4mg of fenoterol induced no change of IHb on either side.IV) Fenoterol (0.2mg) caused no significant difference in the IHb of patients with or without symptoms.V) In the patients treated with fenoterol (0.2mg), there was no significant difference of IHb between those who always used topical steroid and those who did not.These results suggest that the nasal mucosal capacitance vessels of patients with nasal allergy respond more to a-adrenergic stimulants than to β-adrenergic stimulants or anticholinergic agents.

Nasal Mucosal Hemodynamics in Nasal Allergy.

Although nasal mucosal hemodynamics in nasal allergy has been studied by various methods, it is still obscure. Using a tissue spectrum analyzer, we measured ISO2 and IHb in the nasal mucosa of patients with nasal allergy. ISO2 and IHbindicate O2 saturation in hemoglobin and tissue blood volume, respectively.i) In general, little difference in ISO2 or IHb was found beween patients with symptoms and patients without symptoms.ii) IHb in patients with perennial nasal allergy seemed to decrease when they had symptoms. On the other hand, IHb in patients with seasonal nasal allergy seemed to increase when they had symptoms.iii) In three patients with Japanese cedar pollinosis, IHb was increased during the season and was decreased at other times.

A case of mixed-type hearing loss induced by barotrauma.

A 23-year-old woman, who complained of hearing loss, tinnitus and fullness on the leftear following commercial air-craft ride, visited us on the 7th day after the onset. Pure tone audiogram showed severe mixed-type hearing loss (95dBHL). Exploratory tympanotomy on the 12th day, revealed dislocation of incudo-stapedial joint and perilymph fistula in the oval window. Hearing loss recovered to 59dBHL, post-operatively (improved 36dB). This was a rare casc, in which dislocation of middle ear ossicles and perilymph fistula occurred at the same time by barotrauma.