Shoji Ikezaki

Partial mastoid obliteration combined with soft-wall reconstruction for middle ear cholesteatoma.

Objectives: The objective was to analyze the surgical outcomes of tympanoplasty with partial mastoid obliteration and soft-wall reconstruction for middle ear cholesteatoma. Methods: Sixty-nine patients (73 ears) with fresh middle ear cholesteatomas, 42 men and 27 women aged 6 to 89 years, were retrospectively analyzed. The cholesteatomas were the pars flaccida and tensa types in 59 and 12 ears, respectively. The patients underwent canal-wall-down tympanoplasty with partial mastoid obliteration and soft-wall reconstruction. Follow-up computed tomography was performed 6 to 12 months after surgery. Hearing outcomes were evaluated by the arithmetic mean of the hearing levels at 500, 1000, and 2000 Hz. Results: Residual cholesteatoma occurred in 7 ears (9.6%) and recurrent cholesteatoma in 1 ear (1.4%). No cavity problem was seen. Primary evaluation of postoperative hearing was performed 6 to 12 months after ossiculoplasy. Of the 50 ears with available audiogram in this period, the postoperative air-bone gaps were ≤15 dB and ≤20 dB in 27 (54.0%) and 37 (74.0%) ears, respectively. The postoperative hearing level was within 30 dB in 22 ears (44.0%). The hearing gain was ≥15 dB in 24 ears (48.0%). Conclusions: The surgical outcomes of tympanoplasty with partial mastoid obliteration and soft-wall reconstruction for middle ear cholesteatoma were satisfactory with a low incidence of cholesteatoma recidivism and tolerable postoperative hearing without cavity problems.

Acetylcholine-induced ex vivo ATP release from the human nasal mucosa

OBJECTIVE The present study aimed at investigating ATP release in response to acetylcholine (Ach) and pharmacologically elucidating the intracellular signal transduction pathway of this reaction in an ex vivo experiment. METHODS The inferior turbinate mucosa was collected from 21 patients with chronic hypertrophic rhinitis who underwent endoscopic turbinectomy. The mucosa was shaped into a filmy round piece, and incubated with chemical(s) in Hanks balanced salt solution for 10min. After incubation, the ATP concentration was measured by a luciferin-luciferase assay. RESULTS The baseline release of ATP without stimulus was 57.2±10.3fM. The ATP release was significantly increased by stimulation with 100μM Ach. The Ach-induced ATP release was completely inhibited by removing extracellular Ca2+. Significant inhibition of the Ach-induced ATP release was also observed by the addition of 1μM atropine, 40μM 2-APB, 10μM CBX, and 100μM PPADS, whereas 30nM bafilomycin A1 did not affect the ATP release. CONCLUSION These results indicate that the Ach-induced ATP release from the human nasal mucosa is dependent on the pannexin-1 channel and purinergic P2X7 receptor, suggesting that these two molecules constitute a local autocrine/paracrine signaling system in the human nasal epithelium.

Electrical Impedance and Expression of Tight Junction Components of the Nasal Turbinate and Polyp.

Purpose: We investigated the electrical impedance and expression of tight junction components of the turbinate mucosa, nasal polyp, and normal skin. Procedures: The inferior turbinate and nasal polyp of patients with chronic rhinosinusitis and the postauricular skin of patients with otitis media were examined. Electrical impedance was measured in vivo using a tissue conductance meter. Expressions of claudin-1 and tricellulin were examined by fluorescence immunohistochemistry and quantitative RT-PCR. Results: Electrical impedance was higher in the skin than in the turbinate and polyp, but did not differ between the turbinate and polyp. Immunoreactivities for claudin-1 and tricellulin were seen in the epithelial/epidermal layer. Expression of claudin-1 was higher in the skin than in the turbinate and polyp. The polyp tended to show higher expression of claudin-1 but showed lower expression of tricellulin than the turbinate. The ratio of claudin-1 to tricellulin was highest in the skin and lowest in the turbinate. The correlation between expressions of the two tight junction components was strongly positive in the skin (r = 0.964) and negative (r = -0.527) in the turbinate and polyp. Conclusions: These results suggest that the roles of claudin-1 and tricellulin in barrier function may be complementary, and may thereby maintain a constant level of permeability of the mucosal tissues.