Yasuo Ishitani

Platelet-Activating Factor and Leukotrienes in Acute Otitis Media, Secretory Otitis Media, and Chronic Otitis Media on the Acute Excerbation

The present study was carried out for the purpose of measuring platelet activating factor (PAF) and leukotrienes (LTs) in middle ear fluid (MEF) or in otorrhea of children with acute otitis media (AOM), with secretory otitis media (SOM), and with chronic otitis media (COM) on the acute exacerbation. PAF, LTC4, and LTD4+LTE4 concentrations were measured by radioimmunoassay in purulent MEFs obtained from 15 ears of 15 children with AOM, in mucoid or gluey MEFs from 16 ears of 15 children with SOM, and in purulent otorrhea from 9 ears of 9 children with COM on the acute exacerbation. PAF concentrations were 25.4 +/- 9.0 ng/mg total phospholipid (TPL) in AOM, 4.9 +/- 1.9 ng/mg TPL in SOM, 20.7 +/- 15.7 ng/mg TPL in COM, demonstrating significant differences between AOM and SOM (p < 0.05) and between COM and SOM (p < 0.01). LTC4 concentrations were 92.9 +/- 73.8 pg/mg total protein (TP) in AOM, 52.0 +/- 42.5 pg/mg TP in SOM, and 28.5 +/- 11.2 pg/mg TP in COM. LTD4+LTE4 concentrations were 326.5 +/- 177.0 pg/mg TP in AOM, 288.2 +/- 144.6 pg/mg TP in SOM, and 94.0 +/- 58.1 pg/mg TP in COM, demonstrating significant differences between AOM and COM and between SOM and COM (p < 0.01). The results obtained indicated that PAF was involved in the onset of AOM and COM on the acute exacerbation, and that LTs played an important role in SOM.

Clinical Efficacy of Clarithromycin Therapy for Chronic Sinusitis and Secretory Otitis Media in Children.

The clinical efficacy of clarithromycin was investigated in 34 children with chronic sinusitis, and 36 children with secretory otitis media accompanied by chronic sinusitis.1) Rhinoscopy showed reduced nasal mucosal swelling in 74.2%, decreased nasal discharge in 78.5%, decreased postnasal drip in 89.3% and improved quality of nasal discharge in 88.6%. Follow up X-ray films showed improved opacity of maxillary sinuses in 81.6%.2) There was improvement in 71.4% in the appearance of the tympanic membrane and in 66.7% in that of the tympanogram.3) The rate of clinical efficacy was 88.6% (marked improvement, 54.3%; some improvement, 34.3%) for chronic sinusitis and 79.6% (marked improvement, 38.8%; some improvement, 40.8%) for secretory otitis media.4) No side effects were observed.On the basis of these results, clarithromycin was judged to be useful in the treatment of children with chronic sinusitis and with secretory otitis media accompanied by chronic sinusitis.

Clinical Studies on Roxithromycin Treatment of Chronic Sinusitis.

Roxithromycin (RXM) was administered to 191 patients with chronic paranasal sinusitis. The overall rate of excellent and good clinical response was 58.1% as judged by the attending otolaryngologists and 56.0% as judged by the committee.In bacteriological examinations performed on 39 patients before administration 52 organisms were isolated, and 25 (83.3%) of the 30 cultures examined showed sensitivities to RXM. Among patients infected with sensitive organisms the clinical efficacy rate (CER) was 81.0%.X-ray examinations were performed on 59 patients with an CER of 66.1%. The rates for excellent and good results were 75.9% for maxillary sinusitis and 78.3% for ethmoid sinusitis.Side effects, in the form of mild digestive symptoms, were noted in only 3 patients (1.6%), but no treatment was required even though RXM was administered for a long period of time, up to 178 days.These results indicate that RXM is effective in the treatment of chronic paranasal sinusitis.

Clinical Study of Laryngeal Cancer

One hundred and nine cases of laryngeal cancer were treated between 1987 and 1997 in the Department of Otorhinolalyngology at Obihiro Kousei Hospital. The average age of the patients was 65. 4 years old, and the male to female ratio was 21: 1. Based on histopathological diagnosis, 108 cases were reported as squamous cell carcinoma and one case was reported as spindle cell carcinoma. There were 15 cases of supraglottic carcinoma, 91 cases of glottic carcinoma and 3 cases of subglottic carcinoma. There were 33 cases in stage I , 35 cases in stage II, 22 cases in stage III and 19 cases in stage J Y. The five-year survival rates of the patients for stages I to IV were 100%, 90%, 66% and 65% respectively.

Objective Audiometry Using an Autonomic Reflex

Blood flow in the finger tip (FBF), blood pressure (BP) and pulse rate (PR) in the finger artery was measured after sound stimulation in 7 adults with normal hearing. A Laser Doppler flowmeter (ADVANCE ALF-21) and a finger arterial blood pressure monitor (Ohmeda 2300, Finapres) were used. FBF definitely decreased after stimulation with short pure tone of at least 25 dB over the hearing level. Although increasing responses of BP and PR after sound stimulation were observed, these responses were not clear. In two cases, since the backgrounds of FBF were unstable, an averaging technique was required for useful recording. Results obtained suggested that the recording of FBF could be useful for objective audiometry.

The effect of histamine on laryngeal mucosal blood volume in guinea pigs.

The present study was undertaken to investigate laryngeal microvascular reactivity to histamine in normal guinea pigs.Twelve guinea pigs were sedated with intraperitoneal sodium pentobarbital, a fissure was made in the larynx, and the intra-laryngeal space was opened. A probe of a spectro-photometric analyzer was placed lightly on the mucosa of the vocal fold and fixed.Hemoglobin (Hb) concentration and oxygen saturation of Hb were measured continuously by reflectance spectrophotometry; 10μl of isotonic saline was dropped on the laryngeal mucosa in the controls, and 10μl of histamine (104μg/ml) on the mucosa of the experimental animals.The results were as followed; 1) Visual inspection after histamine provocation showed laryngeal mucosal swelling and dilatation of the microvessels. 2) After histamine provocation, Hb concentration increased (p<0.01) and oxygen saturation of Hb decreased (p<0.01). 3) After saline dropping, these two parameters showed no significant change.Thus, histamine caused swelling of the laryngeal mucosa and increased the mucosal blood volume. This method is useful for observing allergic reactions in the laryngeal mucosa.

Treatment of cochlear tinnitus by infusion into the tympanic cavity through the Eustachian tube.

Ten patients (10 ears) with cochlear tinnitus were treated by infusion of dexamethason and mecobalamin solution through the Eustachian tube.This treatment was effective in cases. The rate of effectiveness was similar to that of transtympanic infusion procedur.No severe side effect was observed. This method of treatment seems to be useful since the ear drum is not punctured.