Hirotomo Homma

Subclassification of chronic rhinosinusitis with nasal polyp based on eosinophil and neutrophil.

Japanese patients with chronic rhinosinusitis with nasal polyps (CRSwNP), differing from European and U.S. patients, are suggested to show two distinct phenotypes: Th2‐polarized and Th1‐shifted immunity. The purpose of this study was to conduct clinical subgrouping of CRSwNP based on inflammatory cell infiltration, which was evaluated and supported by clinical backgrounds and immunological characteristics.

Multiplex analyses of cytokine and chemokine release from the cultured fibroblast of nasal polyps: the effect of IL-17A.

Abstract Conclusion: Our results demonstrate for the first time a potentially enhanced basal secretion of monocyte chemoattractant protein-1 (MCP-1) and interleukin (IL)-17A-stimulated secretion of IL-6 from nasal polyp fibroblasts, enhanced basal secretion of IL-6 from eosinophilic nasal polyp fibroblasts, and a remarkable up-regulation of IL-9 and granulocyte colony-stimulating factor (G-CSF) from nasal fibroblasts by IL-17A stimulation. Objectives: The fibroblast, one of the main cell types making up nasal polyps, is thought to be a target cell of various cytokines. Methods: Subcultured fibroblasts were established from human polyp biopsy tissues. Simultaneous quantification of 27 kinds of cytokines and chemokines in culture supernatants in unstimulated and IL-17A-stimulated conditions was performed with a human multiplex cytokine assay system. Results: The IL-17A receptor was expressed at similar levels in all three groups. In the eosinophilic group, basal secretion levels of IL-6 were significantly higher than those in the control and non-eosinophilic groups. Basal secretion of MCP-1 in both the non-eosinophilic and eosinophilic groups was also higher than that of the control group. Both IL-9 and G-CSF secretion were remarkably enhanced by IL-17A stimulation in all three groups. The receptor-mediated response by IL-17A significantly up-regulated IL-6 release alone in the non-eosinophilic and eosinophilic groups as compared with the control group.

Comparative analysis of cytokine release from epithelial cell cultures of the upper airway.

INTRODUCTION Upper airway epithelial cells show a multi-potential ability to produce a variety of cytokines/chemokines in the steady-state and under external stimuli. OBJECTIVE To compare various cytokines/chemokines released from primary cultures of human nasal epithelial cells (HNECs) derived from healthy controls and subjects with allergic rhinitis (AR), chronic rhinosinusitis with nasal polyps (CRSwNPs) in non- stimulated and IL-17A-stimulated conditions. METHODS The supernatants derived from HNECs of healthy control, AR, CRSwNPs were used to measure 20 of cytokines/chemo- kines in the non-stimulated and IL-17A-stimulated conditions. RESULTS AR and CRSwNPs showed significant up-regulation in the release of IL-6, IL-33, and thymic stromal lymphopoietin (TSLP), and the release of IL-6, TSLP, granulocyte macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor α (TNFα) in comparison with normal controls, respectively. Secretion of GM-CSF and TNFα were enhanced in patients with nasal polyps as compared with AR. Stimulation with IL-17A enhanced the secretion of IL-8 and granulocyte-colony stimulating factor (G-CSF) in the normal control, IL-6 and IL-8 in AR, and IL-6, TSLP, G-CSF, GM-CSF and TNFα in nasal polyps. CONCLUSION Epithelial cells derived from AR and CRSwNPs showed up-regulation of secretion of several cytokines/chemokines both in the steady state and after IL-17A stimulation, which may contribute to the inflammatory responses of AR and CRSwNPs.

Clinical application of a card-type odor identification test to olfactory assessment in Parkinson's disease

OBJECTIVES Current studies have provided valuable evidence that Parkinsons disease (PD) is closely associated with olfactory loss and that the use of olfactory testing is regarded as one of the potential screening tools for early diagnosis of PD. METHODS Twenty-six patients with PD, age- and sex-matched 14 patients with other neurological diseases and 10 healthy controls were evaluated the sense of smell by the Open Essence (OE). RESULTS The motor performance of the patients with PD was assessed using the Hoehn and Yahr scale. The OE scores for patients with PD were significantly lower than those with both the patients with other neurological diseases and controls. There was no significant difference of the OE scores between patients with other neurological diseases and controls. In the PD group, the OE score was not correlated with gender, smoking habit, disease duration, age at examination, or cognitive status. However, the OE scores were significantly correlated with Hoehn and Yahr stages. CONCLUSION OE was found to be practically self-administered, time-saving, reliable, and inexpensive method for correct diagnosis of olfactory dysfunction associated with PD.

Nasal Surgery improvesContinuous Positive AirwayPressure compliance and DaytimeSleepiness in Obstructive SleepApnea Syndrome

Background: The pressure level during nasal continuous positive airway pressure (CPAP) and the compliance may be influenced by the improvement in nasal patency resulting from nasal surgery. Methods: We investigated 12 male OSAS patients, diagnosed by standard polysomnography, nasal airflow resistance, and Epworth sleepiness scale (ESS), who were evaluated before and after nasal surgery under the use of CPAP. Results: The total nasal resistance was reduced after nasal surgery in all OSAS patients. A significant difference was observed in the ESS scores postoperatively. Nasal surgery significantly improved both the CPAP pressure and the compliance in all patients. Conclusion: Nasal continuous positive airway pressure (CPAP) intolerance in obstructive sleep apnea syndrome (OSAS) patients can be adequately improved by nasal surgery. The improvement of CPAP compliance may be brought about by the reduction in applied CPAP pressure after the improvement of nasal patency.

Maxillary sinus infundibulum narrowing influences sinus abnormalities in spite of the presence or absence of allergy

Abstract Conclusion. Maxillary sinus abnormalities were demonstrated to be associated with maxillary sinus infundibulum narrowing as well as nasal airflow resistance secondary to nonspecific nasal inflammation. Objectives. There is no consensus regarding the pathogenetic roles of allergy and anatomic variations in sinus mucosa abnormalities. We investigated the correlation between allergy and anatomic variations in sinus abnormalities in chronic rhinitis patients in the presence or absence of allergy. Methods: In all, 148 adult patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) were enrolled. Opacification of sinuses, the size of the maxillary sinus infundibulum, Haller cells, and concha bullosa were evaluated based on computed tomography (CT) images. Simultaneously, nasal airflow resistance was measured. Results: The AR group comprising 105 patients showed maxillary sinus opacification in 45 patients. In the NAR group including 43 patients, soft tissue opacification was observed in 13 patients. There was no significant difference in the incidence of sinus opacification between the AR and NAR groups. Both nasal resistance and the infundibulum size in both the AR and NAR groups with sinus opacification showed significant differences from those without sinus abnormalities. The presence of concha bullosa influenced the sinus opacification in both the AR and NAR groups.

Postoperative Management of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps: Impact of High-Dose Corticosteroid Nasal Spray

Introduction  Eosinophilic chronic rhinosinusitis (ECRS) is characterized by an eosinophilic inflammation driven by Th2-type cytokines. Glucocorticosteroids are the most common first-line treatment for ECRS with nasal polyps. Objective  We have evaluated the long-term treatment with double-dose intranasal corticosteroids in refractory ECRS nasal polyps resistant to the conventional dose and assessed the risk of adverse systemic effects Methods  Sixteen subjects were enrolled in this study. All subjects had ECRS after endoscopic sinus surgery that resulted in recurrent mild and moderate nasal polyps and were undergoing a postoperative follow-up application of mometasone furoate at a dose of 2 sprays (100 μg) in each nostril once a day (200 μg). All the patients were prescribed mometasone furoate, administered at a dose of 2 sprays (100 μg) in each nostril twice a day (400 μg) for 6 months. Results  The average scores of the symptoms during the regular dose of intranasal steroid treatment were 5.2 ± 2.2, but 6 months after the high-dose application, they had significantly decreased to 2.5 ± 1.4 ( p  < 0.05). The polyp size showed an average score of 1.38 during the regular dose which was significantly reduced to 0.43 ( p  < 0.01) by the double dose. Glycated hemoglobin (HbA1c) showed normal ranges in all the patients tested. The cortisol plasma concentration was also normal. Conclusion  Doubling the dose of the nasal topical spray mometasone furoate might be recommended for the treatment of recurrent nasal polyps in the postoperative follow-up of intractable ECRS.

Primary malignant lymphoma of the uvula

We experienced a very rare case of primary malignant lymphoma of the uvula. The patient was an 80-year-old Japanese woman with a one month history of oral discomfort. She had a uvular mass occupying the oropharyngeal space and received surgical treatment. Follicular lymphoma was diagnosed by immunohistochemical staining. In the general examination, PET-CT showed no abnormal accumulation in the body, and the marrow chromosome examination results were normal. From the above results, our case was considered stage IA (UICC) and we added postoperative radiotherapy (33.6Gy). At 3 years after the radiation therapy, no recurrence or metastasis was found. Correspondence to: Dr. Takeshi Kusunoki, Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital, 1129 Nagaoka Izunokunishi, Shizuoka 410-2295, Japan; Fax: +81-55-948-5088; E-mail: ttkusunoki001@aol.com

Cervical fistula caused by submandibular sialolithiasis

In oto-rhino-laryngology, cases of submandibuillar sialolithiasis are common. Submandibular sialoadentis with sialolith may cause severe complications such as deep neck abscess and sepsis. We introduce a rare case of a cervical fistula with abscess caused by submandibular sialolith. The patient had diabetes. We performed drainage of the left submandibular gland that included a Wharton duct stone and abscess by an external skin incision approach. Submandibular sialoadentis due to sialolith would likely progress to neck abscess and the formation of a neck skin fistula; moreover, the condition can be worsen by the coexistence of diabetes. This neck abscess with skin fistula could have caused potentially fatal complications such a carotid artery rupture or sepsis. In such cases the infected source should be carefully removed as soon as possible.

Tracheal stenosis due to huge adenomatous goiter

Background: Some thyroid anaplastic carcinoma and lymphoma have been reported to cause tracheal stenosis or choking. Begin thyroid tumors with dyspnea due to tracheal stenosis are exceedingly rare. Case presentation: We experienced a huge adenomatous goiter (resected specimen weight: 520g). Total thyroidectomy resolved the dyspnea and there was no tracheomalacia. Postoperative CT confirmed a normal tracheal lumen free from stenosis. Conclusions: We reviewed the CT findings of thyroid benign tumors with dyspnea and found that tumors occupied the space between the posterior wall of trachea and esophagus leading to tracheal stenosis as in our case. Such tracheal findings would actually lead to dyspnea. Correspondence to: Dr. Takeshi Kusunoki, Department of Otorhinolaryngology, Juntendo University of Medicine, Shizuoka Hospital 1129 Nagaoka Izunokunishi, Shizuoka 410-2295, Japan; Fax: +81-55-948-5088; E-mail: ttkusunoki001@aol.com