Shoko Kato

Mucociliary Disease of the Middle Ear during Experimental Otitis Media with Effusion Induced by Bacterial Endotoxin

Lipopolysaccharide (10 μg/mL) derived from Klebsiella pneumoniae was injected into the middle ear of guinea pigs. The animals were killed painlessly on days 1, 3, and 7 after inoculation, and the mucosal samples from two sites within the tympanic cavity, close to the tympanic orifice and distal to the orifice, were examined for ciliary activity and epithelial morphology. At day 1 and day 3 serous effusion was observed and deterioration of ciliary activity and morphologic changes were observed. No effusion was recognized at day 7, when the ciliary activity in the distal mucosa was still diminished and that in the proximal mucosa had recovered to a normal level. Our data have shown that lipopolysaccharide extracted from K pneumoniae can produce otitis media with effusion in laboratory animals, and dysfunction of cilia due to lipopolysaccharide probably is responsible for the accumulation of middle ear effusion. The mucociliary system is indeed an important defense system and failure of such a system, especially in the mucosa close to the tympanic orifice, can cause the buildup of effusions.

Functional Disorder of Eustachian Tube in Experimental Otitis Media with Effusion following Inoculation of Bacterial Endotoxin

A 10-μg/mL solution of lipopolysaccharide derived from Klebsiella pneumoniae was inoculated into the middle ears of guinea pigs. The animals were killed painlessly on the first, third, or seventh day after inoculation, and the mucosal samples from the bony portion of the eustachian tube were examined for ciliary activity and epithelial morphology. On the first and third days, when middle ear effusions were present, deterioration of ciliary activity and morphologic changes in the mucociliary system were observed. On the seventh day, when middle ear effusions were absent, the ciliary activity had recovered to normal. Our data show that endotoxin extracted from K pneumoniae can produce otitis media with effusion and that dysfunction of cilia caused by endotoxin is a factor responsible for the manifestation of otitis media.

Increased ciliary beating frequency of nasal mucosa following immunotherapy for allergy.

The present study was designed to elucidate the effect of immunotherapy on the beating frequency of nasal cilia in patients with nasal allergy. Of 40 patients with nasal allergy due to Dermatophagoides farinae, 20 were treated with immunotherapy by the use of D farinae extracts, and 20 control patients were treated with antihistamine tablets. Mucosal pieces were taken from the right inferior turbinate before and 1 year after the initiation of treatment, and the ciliary beating frequency (CBF) was examined by a photoelectric method. The use of antihistamine tablets did not increase CBF even when it relieved the nasal symptoms. Immunotherapy, on the other hand, increased CBF in 66.7% of patients when it alleviated their nasal symptoms. The CBF before immunotherapy of patients who showed an increased CBF after treatment was statistically higher than that of patients who did not.

Experimental otitis media with effusion induced by lipopolysaccharide from Klebsiella pneumoniae: Mucociliary pathology of the middle ear

We inoculated 100 micrograms/ml of lipopolysaccharide (LPS) from Klebsiella pneumoniae into the tympanic cavity of guinea pigs and examined the mucociliary pathology in the middle ear. Serous effusion was observed in the tympanic cavity of every animal on the first, third, and seventh day following the procedure, but the volume of the effusion had decreased to 0.2 ml on day 7. By that time, the ciliary activity in the opening to the eustachian tube within the middle ear had recovered to some extent, but in the middle ear distal to the opening no recovery was apparent. Our results show that cilia close to the eustachian tube play a more significant role in middle ear clearance than those in the middle ear distal to the tube. Compared with our previous study using 10 micron/ml of LPS, this study also demonstrates that inoculations with a higher concentration of LPS induces longer-term middle ear effusions.

Effects of bacterial endotoxin on the ciliary activity in the in vitro eustachian tube

SummaryWe have used a tissue culture technique and a photoelectric method to examine the direct effect of lipopolysaccharide (LPS) on the ciliary activity present in the eustachian tube. Since LPS possesses the major part of the biological activity of endotoxin, our results show clearly that LPS deteriorates the ciliary activity in a dose-response fashion: LPS does not deteriorate the ciliary activity up to 168 h if its concentration is 1ng/ml or less; 10 ng/ml LPS can cause deterioration of the ciliary activity with extended exposure (more than 96 h); LPS can cause dysfunction of the cilia rather quickly if the concentration is 100 ng/ml or more. Our results show that the ciliary activity in the eustachian tube under clinical conditions can be affected by endotoxin.

RAST in Diagnosis and Therapy of Allergic Rhinitis

Skin tests, RAST, nasal provocation tests, and other nasal allergy examinations were performed on 463 patients exhibiting symptoms of allergic rhinitis who were examined at the Department of Otolaryngology of Osaka City University Medical School, and comparisons were made between the RAST scores and the results of the other examinations. A study was also made of the change in grade of the allergic rhinitis and the change of the RAST score resulting from one year of immunotherapy. The rates of agreement for patients with positive skin test and RAST were 60 to 70% for house dust (HD), house dust mites, Japanese cedar, and cocksfoot, and 10 to 35% for common ragweed and the fungus group. The RAST was positive for house dust 1, house dust 2, and Dermatophagoides farinae in 80 to 90% of the patients with house dust or house dust mite allergic rhinitis, and for over 80% of the patients with pollinosis (Japanese cedar or common ragweed). In most cases, the RAST scores were unchanged by one year of specific hyposensitization, and in the cases in which the RAST scores did change, the treatment was ineffective.

A psychometric validation of the Japanese versions of new questionnaires on tinnitus (THI-12, TRS, TRSw, TSS, and TSSw)

Abstract Conclusion: The Japanese version of the Tinnitus Handicap Inventory-12 (THI-12), Tinnitus Rating Scale (TRS), TRS 1-week version (TRSw), Tinnitus Severity Scale (TSS), and TSS 1-week version (TSSw), which were developed in this study, showed high reliability and validity, suggesting their usefulness in clinical practice. Based on the THI severity grades, we propose that the severity grades of THI-12 (draft) are categorized into four groups: 0–4 points, 5–9 points, 10–14 points, and 15–24 points. Objectives: We developed Japanese versions of new questionnaires for evaluating the level of psychological distress and difficulty in activities of daily living due to tinnitus, and performed their psychometric validation to determine the reliability and validity. The THI-12 is an assessment consisting of 12 items, each of which is rated on a 3-point scale that was created by reducing the number of questions from the 25 items of the THI. The TRS, TRSw, TSS, and TSSw, which were self-evaluation questionnaires of tinnitus on an 11-grade integer Likert scale from 0 to10 points, were used as additional instruments to assess tinnitus severity and distress. Methods: The subjects were healthy adults, and patients with subjective tinnitus who were examined at the Otolaryngology Department of Keio University Hospital, Osaka City University Hospital, or Nagoya City University Hospital with a chief complaint of tinnitus between September 2010 and January 2011. In all, 38 healthy adult subjects and 113 patients with subjective tinnitus were included. We examined the reproducibility and the internal consistency for reliability. We also examined the relationship with the available scales (THI and Hospital Anxiety and Depression Scale, HADS) and group divergence for validity. Results: The psychometric validation showed high reliability and validity of the THI-12, TRS, TRSw, TSS, and TSSw.