Keiko Kakizaki

Eosinophil chemoattractants in the middle ear of patients with eosinophilic otitis media

Background Patients with intractable otitis media associated with bronchial asthma have an extensive accumulation of eosinophils in the effusion and mucosa of the middle ear; this condition is called eosinophilic otitis media (EOM). It remained to be determined how eosinophils accumulate in the middle ear.

Human temporal bone study on the postnatal ossification process of auditory ossicles

Objective: In infancy the head of the malleus and body of the incus normally contain bone marrow, which is gradually replaced by bone and converted into vascular channels with age. This study was carried out to clarify the age at which ossification of the ossicles is complete and to examine factors influencing the ossification process. Study Design: Human temporal bone sections from 32 infants and children with or without congenital anomalies, aged 1 day to 9 years, who were born at term were studied. Methods: The percentage bone marrow area occupying the head of the malleus and body of the incus was calculated in three horizontal temporal bone sections for each case, using computer‐aided digital processing of images. Results: Bone marrow was observed in both the malleus and incus in children until 25 months of age, while after the age of 25 months no bone marrow tissue was present in either of the ossicles. It appeared that the bone marrow space disappeared somewhat earlier in the malleus than in the incus. The bone marrow space around the otic capsule disappeared much earlier than that within the ossicles. The age at completion of ossification was correlated with neither the presence of congenital anomalies nor the presence of residual mesenchyme in the middle ear. Conclusions: Ossification of the ossicles seems to occur steadily throughout fetal life and after birth during development of the middle ear. Although the clinical significance of postnatal residual bone marrow within the ossicles is not known, it possibly plays a role as a blood‐forming organ in early infancy. Key Words: Ossicles, bone marrow space, ossification, otic capsule, congenital anomaly.

Effectiveness of instillation of triamcinolone acetonide into the middle ear for eosinophilic otitis media associated with bronchial asthma

BACKGROUND Eosinophilic otitis media (EOM) is a newly recognized middle ear disease found in asthmatic patients. EOM is characterized by a highly viscous middle ear effusion that contains many eosinophils and is extremely unresponsive to conventional treatments for common otitis media. To our knowledge, no systemic study regarding the efficacy of treatments for EOM has been performed. OBJECTIVE To determine the effectiveness of instillation of triamcinolone acetonide, which is a suspension of steroids, into the mesotympanum and eustachian tube as a treatment for patients with EOM. METHODS We studied the efficacy of the instillation of triamcinolone acetonide in 43 ears of 24 patients with EOM. Efficacy was evaluated according to the length of the period without middle ear effusion or otorrhea. We also determined the otomicroscopic findings and the hearing levels before and after therapy. For controls, 27 ears of 14 patients treated by topical administration of betamethasone were similarly evaluated. RESULTS The middle ear effusion or otorrhea was controlled for more than 3 weeks after 1 instillation of triamcinolone acetonide in 35 ears, and the efficacy rate (81%) was significantly higher than that in the controls (7 ears, 26%). In the triamcinolone acetonide group, the average air conduction hearing level at the speech frequency range was significantly improved, and deterioration of the bone conduction hearing threshold was rarely found during therapy. CONCLUSION The instillation of triamcinolone acetonide into the mesotympanum and eustachian tube is an effective treatment for patients with EOM.

Clinical effects of clarithromycin on persistent inflammation following Haemophilus influenzae-positive acute otitis media

Abstract Conclusion: Additional treatment with clarithromycin (CAM) reduced persistent middle ear inflammation after acute otitis media (AOM) caused by Haemophilus influenzae in children. CAM is a treatment option for persistent inflammation following AOM and to prevent continuing otitis media with effusion. Objective: We conducted a clinical study to evaluate a new method of treatment for persistent inflammation after AOM in children. Methods: H. influenzae-infected children with AOM were treated acutely with antimicrobial agents, after which those still demonstrating effusion of the middle ear cavity received additional treatment with carbocysteine (S-CMC) alone or S-CMC combined with clarithromycin (CAM) for 1 week. The two regimens were compared in terms of clinical effects. Results: After the initial acute treatment, many patients still showed abnormal otoscopic findings. At the completion of additional treatment, there were no significant differences between the two treatment groups. However, 1 week after completion of additional treatment, the prevalence of a diminished light reflex was significantly lower in the CAM + S-CMC group than in the S-CMC group (p = 0.017). The prevalence of redness of the tympanic membrane also tended to be lower in the combined treatment group than in those receiving a single drug (p = 0.097).

Temporal bone histopathologic abnormalities associated with mitochondrial mutation T7511C.

Objectives: We previously reported a mitochondrial T7511C mutation in the tRNASer(UCN) gene in a Japanese family with nonsyndromic hearing loss (HL). However, the temporal bone histopathology associated with T7511C has not been reported. The aim of the present study is to report histopathologic findings of a temporal bone from a patient in the Japanese family with this mutation.

Reaeration of the Middle Ear after Tympanoplasty for Pediatric Cholesteatoma

Editor’s Note: A substantial amount of high-quality research in otology and related fields is conducted in Japan. In many cases, publications describing from these efforts appear only in the Japanese language. In an effort to provide a broader forum for these important contributions, Otology & Neurotology is pleased to republish selected abstracts from Otology Japan. Gratitude is extended to Kimitaka Kaga, M.D., Editor-in-Chief of Otology Japan, for choosing an excellent selection of articles from the 2003 and 2004 editions.Aeration of the middle ear cleft after tympanoplasty plays an important role in determining postoperative hearing and the recurrence of retraction cholesteatoma in patients with middle ear cholesteatoma. We investigated reaeration in each child with cholesteatoma after operation, and examined the relationship between the extent of reaeration and various clinical factors. Forty children aged 10 years or under were included in this study. They underwent posterior canal wall reconstruction tympanoplasty for middle ear cholesteatoma during 1995-2001. We evaluated the extent of aeration of the middle ear about one year after the first operation based on temporal bone CT images. The extent of reaeration was classified into four categories;A) to the mastoid antrum, B) to the attic , C) to the mesotympanium, and D) no aeration. We also analyzed the aeration with respect to the various clinical factors in each child. As controls, the aeration of the middle ear of adult patients who underwent posterior canal wall reconstruction tympanoplasty for middle ear cholesteatoma was also investigated one year after the first operation. The middle ear of the children was significantly well-aerated compared with the adults after tympanoplasty. The children with otitis media with effusion exhibited a significantly poor aeration of the middle ear postoperativery. The children with cholesteatoma localized in the mesotympanum or localized lateral to the ossicles showed significantly better aeration than those with big cholesteatoma extending to the entire attic or the antrum. The present study clearly showed that reaeration of the middle ear is significantly better in children than in adults. This may be due to the fact that the middle ear is in the process of pneumatization in young children. The children with otitis media with effusion usually have eustachian tube dysfunction and are prone to respiratory infections which affect the reaeration of the middle ear. In children with cholesteatoma extending to the entire attic, to preserve the mucosa of the attic is usually difficult. Removal of the mucosa of the attic may delay the reaeration of the attic and the antrum.