Teruhiko Harada

Nasal Mucociliary Clearance Under Various Conditions

We applied the tagged-particle method or the saccharin method or both to the nasal mucociliary clearance. There was no effect of ageing on the transport time of saccharin in control subjects of ages under 60, and 70% of control subjects of ages more than 60 had the same transport time as that obtained in younger control subjects. The significant inverse correlation between the mucociliary transport rates with the particle method and the transport time with the saccharin method were established in control subjects, but not, however, in patients with chronic sinusitis. The mucociliary transport rates were measured under non-physiologic conditions of the nose: laryngectomy, chronic sinusitis, Sjögrens syndrome, and Kartageners syndrome.

Increased expression of matrix metalloproteinase-2 in nasal polyps.

Objective—The formation and growth of nasal polyps requires remodeling of the extracellular matrix. Matrix metalloproteinases (MMPs) are a family of endopeptidases that can collectively degrade almost all extracellular matrix components. The aim of this study was to investigate the role of MMPs in nasal polyps. Material and Methods—The expression of MMP-2 and -9 was investigated in the nasal polyps of 20 patients undergoing endonasal sinus surgery and compared with that in control nasal mucosal samples obtained from 20 non-allergic hypertrophic rhinitis patients. Tissue samples were either homogenized for reverse transcriptase polymerase chain reaction analysis or frozen for immunohistochemistry. Results—MMP-2 mRNA expression was observed only in the nasal polyp samples and not in the control tissues. MMP-9 mRNA was not expressed in either type of tissue. Similarly, MMP-2 expression was observed in the nasal polyps of chronic sinusitis patients but not in the inferior turbinate mucosa of the control subjects. MMP-2 positivity was present in basal cells in the surface epithelium and in infiltrating cells in subepithelial tissues. MMP-9-positive cells were not observed in either nasal polyps or inferior turbinates. These results suggest that MMP-2 expression is characteristic of nasal polyps. Conclusion—MMP-2 may play a role in the remodeling of nasal polyps.

Hearing impairment and quality of life for the elderly in nursing homes

OBJECTIVE The purpose of this study is to find out the effects of hearing impairment on the QOL of nursing home residents. METHODS We constructed the self-assessment questionnaire designed for evaluating the QOL for the elderly in nursing homes. The questionnaire is constructed of physical, social, communicational and psychological states. It was administered to 60 subjects >65 years of age (mean age: 79 years) living in nursing homes, with hearing threshold levels in the better ear ranging from normal to severe and their response were analyzed. RESULTS Chronbachs alpha-values of the questionnaire obtained ranged from 0.66 to 0.91 and was 0.84 overall. The reliability and validity of the questionnaire as well as its brevity, simplicity, ease of administration and interpretation, all satisfied its use in assessing the QOL of the elderly in nursing homes. It tended to decrease the points of communication scale, sociability scale and psychological scale (PGC Morale Scale) accordingly to elevate the threshold. As for subscales of communication, hearing disability was correlated statistically to the sociability and psychological. CONCLUSION Our questionnaire is regarded as a useful tool for evaluating the QOL of the elderly. Hearing loss affects the communication, sociability and psychological aspect of the QOL for the elderly in the nursing homes.

Inner Ear Damage and Passage through the round Window Membrane of Pseudomonas Aeruginosa Exotoxin a in a Chinchilla Model

By the use of computer-assisted morphometric analysis of the organ of Corti and/or measurements of action potential threshold changes, inner ear changes in chinchillas were evaluated 4 weeks after application on the round window membrane of a Pseudomonas aeruginosa exotoxin A solution. Severe inner ear damage was detected after application of 50 ng (5 μL at a concentration of 10 μg/mL) exotoxin A, whereas application of 5 ng exotoxin did not cause measurable inner ear damage. Perilymph concentrations of exotoxin A were measured with an enzyme-linked immunosorbent assay 1.5 to 19 hours after 50 ng, 0.5 μg, or 5 μg of exotoxin A was applied on the round window membrane. Only the highest concentration produced measurable levels of exotoxin in the inner ear fluids. It is concluded that exotoxin A present on the round window membrane of the chinchilla has the ability to penetrate into the inner ear and cause irreversible inner ear changes.

Pathophysiology of Streptococcus Pneumoniae Otitis Media: Kinetics of the Middle Ear Biochemical and Cytologic Host Responses:

Streptococcus pneumoniae is an important bacterial pathogen in the pathophysiology of otitis media. To elucidate the inflammatory responses that occur during pneumococcal otitis media, the kinetics of the biochemical and cytologic middle ear responses to heat-killed encapsulated and nonencapsulated pneumococci were studied in the chinchilla model. Inoculation of the middle ear cavity with at least 106 S pneumoniae cells induced an early, brief vascular response with leakage of small (albumin) followed by larger (α2-macroglobulin) proteins, followed by sustained influx of acute inflammatory cells and lysozyme. The threshold for a sustained lysozyme response was 1,000 times lower for nonencapsulated than for encapsulated pneumococci. These results indicate that nonviable S pneumoniae organisms with an intact envelope initiate the middle ear inflammatory response. Therefore, interventions that enhance the clearance of pneumococcal cells from the middle ear may reduce the inflammatory response and prevent chronic middle ear inflammation.

Lymphocyte subsets of maxillary mucosa in chronic inflammation

Subsets of infiltrating lymphocytes within maxillary sinus mucosae of patients with chronic sinusitis were investigated by immunoperoxidase staining of frozen sections with the use of monoclonal antibodies. The most commonly observed infiltrating cell type was suppressor/cytotoxic T cells (CD8+) and smaller subpopulations of lymphocytes were helper/inducer T cells (CD4+) and B cells (CD20+). Variable numbers of HLA-DR+ cells were commonly observed in the lamina propria. The fibrous type of chronic sinusitis was found to have more suppressor/cytotoxic T cells (CD8+) and lower CD4/CD8 ratio than the other histopathological types.

Early biochemical events in pneumococcal otitis media: Arachidonic acid metabolites in middle ear fluid

The concentrations of four arachidonic acid metabolites, prostaglandin E2, 6-keto-prostaglandin F1α, leukotriene B4, and leukotriene C4, were measured in middle ear fluid of chinchillas 6 to 72 hours after middle ear inoculation of log-phase, heat-killed encapsulated Streptococcus pneumoniae organisms. Compared with saline-inoculated ears, significant increases in the mean concentrations of all four metabolites were observed in the pneumococcus-inoculated ears 24 hours after inoculation, but not after 6, 48, or 72 hours. Since pneumococcus inoculation caused an influx of inflammatory cells as early as 6 hours after inoculation, before the increase in arachidonate metabolites, the initial stimulus for inflammatory cell chemotaxis is probably not metabolic products of arachidonic acid such as leukotriene B4. These metabolites may, however, amplify the subsequent inflammatory response.

Immunohistochemical localization of cytokines and cell adhesion molecules in maxillary sinus mucosa in chronic sinusitis

OBJECTIVE Chronic sinusitis is a common disease characterized by persistent inflammation of the nasal and paranasal sinus mucosa. Accumulating evidence supports the importance of proinflammatory cytokines and endothelial cell adhesion molecule (CAM) expression as an initiating process in tissue inflammation. This study was conducted to investigate the localization of major cytokines and CAMs in the maxillary sinus mucosa from patients with chronic sinusitis and from normal subjects. METHODS Maxillary sinus mucosal specimens from patients with chronic sinusitis (n = 10) and from normal subjects (n = 6) were immunostained with specific antibodies directed against the cytokines (IL-1alpha, IL-1beta, IL-6, IL-8 and TNF-alpha) and the CAMs (intercellular adhesion molecule-1, ICAM-1 and vascular CAM-1, VCAM-1). RESULTS The number of immunoreactive cells for IL-1alpha, IL-1beta, IL-6, IL-8, and TNF-alpha was increased significantly in patients with chronic sinusitis compared with normal controls. Immunoreactivity for ICAM-1 was also increased significantly in patients with chronic sinusitis compared with normal controls, whereas VCAM-1 is only minimally expressed or is absent in both groups. CONCLUSION These findings indicate that bacterial and/or viral infection may induce functional and morphologic changes in the maxillary sinus mucosa in chronic sinusitis through enhanced generation of specific cytokines in conjunction with CAMs.

Mucin gene expression in the effusions of otitis media with effusion.

OBJECTIVES The purpose of the study is to know if mucin gene expression can be detected in the middle ear effusion and if so, which mucin genes are expressed in the effusions. METHODS Mucin gene expression in the middle ear effusions obtained from five patients with otitis media with effusion were analyzed by reverse transcription-polymerase chain reaction. Ribonucleic acids (RNAs) were extracted from the effusion and the expression of 12 mucin genes was analyzed by reverse transcription-polymerase chain reaction. RESULTS Mucin gene expression examined by reverse transcription-polymerase chain reaction indicated the expression of MUC1, MUC4, MUC5AC, MUC6, MUC7, MUC8, MUC9, MUC11 and MUC12 mRNA in the effusion. This mucin gene expression was similar to that in BEAS-2B cell, a bronchial epithelial cell line. CONCLUSION Middle ear effusion can give us valuable information on mucin gene expression in the middle ear. There is similarity between mucin gene expression in the middle ear effusion and that in the bronchial epithelia.

Quantitative Analysis of Mucin and Lectin in Maxillary Sinus Fluids in Patients With Acute and Chronic Sinusitis

Objectives Sinusitis is characterized by quantitative and qualitative changes in mucus biosynthesis that contribute to sinus disease. In general, patients with acute sinusitis complain of purulent rhinorrhea, whereas those with chronic sinusitis complain of mucoid or mucopurulent rhinorrhea. Locally produced mucin largely contributes to the high viscoelasticity of mucus in sinusitis. In this study, the authors attempt to quantify the concentrations of mucin and lectin in the maxillary sinus fluids from these patients.