Airway inflammation is associated with increased permeability and leakage of plasma coagulation factors, leading to activation of the coagulation system in the extravascular space. We reported that significant concentrations of thrombin and thrombin-antithrombin complex were found in nasal secretion from patients with chronic rhinosinusitis. Thrombin and PAR-1 agonist peptide stimulated secretion of PDGF, VEGF and mucus (MUC5AC) from cultured airway epithelial cells. We also found higher expressions of PDGF, VEGF and their receptors in nasal polyps from patients with chronic rhinosinusitis, suggesting that thrombin-induced PDGF and VEGF may be involved in the formation of nasal polyps. Intranasal instillation with thrombin induced goblet cell metaplasia and mucus production in rat nasal epithelium in vivo. These results indicate that the activation of coagulation system occurs during the sinonasal inflammation and that thrombin plays a crucial role in tissue remodeling such as goblet cell metaplasia and formation of nasal polys.
Activated protein C (APC) and heparin are anticoagulant drugs in clinical practice and both have anti-inflammatory activities. Heparin plays regulatory roles in inflammation and subsequent tissue remodeling by binding nonspecifically to many proteins involved in the inflammatory process, including cytokines, growth factors, adhesion molecules and tissue-destructive enzymes. We reported that heparin inhibited TNF-α-induced secretion of mucus (MUC5AC) and IL-8 from cultured airway epithelial cells, and that intranasal instillation with heparin attenuated LPS-induced goblet cell metaplasia and neutrophil infiltration in rat nasal epithelium. Nasal administration with anticoagulant drugs, APC and heparin may provide a new therapeutic strategy for the treatment of chronic rhinosinusitis.

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OBJECTIVES: To determine the frequency of otorhinolaryngological tuberculosis in patients with pulmonary tuberculosis.
STUDY DESIGN: Prospective study.
PATIENTS: Seventy-two patients who were not yet taking antituberculosis drugs were hospitalized in our hospital tuberculosis ward from October 2008 to the end of September 2009.
METHODS: We conducted the following screening tests: questionnaire of symptoms, tympanic membrane and pharyngeal findings on examination, nasopharyngeal to laryngeal findings on flexible endoscopic examination, and palpation of the neck.
RESULTS: Five patients showed evidence of complicating otorhinolaryngological tuberculosis. One patient was diagnosed as having middle ear tuberculosis. Our study revealed a significantly higher complication rate of otolaryngological tuberculosis in younger people under the age of 40 years.
CONCLUSION: We suggest that screening tests for otorhinolaryngological tuberculosis are useful in tuberculosis patients under the age of 40 years.

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Placement of dental implants is currently routinely performed in many dental hospitals and institutions, as a result of which, associated complications have also increased. We report three cases as examples of maxillary sinusitis which have been caused by implant placement and sinus lift procedure. The first of these three cases involved a perforation of the maxillary sinus membrane and accidental insertion of foreign body materials into the sinus. We removed the iatrogenic foreign body from maxillary sinus with endoscopic sinus surgery. On the other hand, treatment of maxillary sinusitis following exposure to dental implants is very difficult, because the implants are still in situ and working. We should be aware that exposure of the maxillary sinus to the presence of dental implants may cause sinusitis at some stage in the future. In addition, sinus floor elevation must be considered in those case where exposure of the sinus to dental implants might be expected.

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We report the efficacy of a single 2.0g dose of a novel azithromycin microsphere formulation as compared with that of levofloxacin 500mg/day in patients with postoperative exacerbation of chronic rhinosinusitis. Thirty patients who had undergone endoscopic sinus surgery were divided into two groups (azithromycin microspheres group, n=15; oral levofloxacin group, n=15).
The primary endpoint was the clinical efficacy on Day 14. The overall clinical efficacy of antibiotic treatment was 83.3% (25/30 subjects); when analyzed by the antibiotic, the efficacy rate was 86.7% (13/15 subjects) in the azithromycin microspheres group and 80% (12/15 subjects) in the levofloxacin group. The bacteriological response (eradication rate) rate on Day 14 was 71.4% (10/14 subjects) in the azithromycin group and 92.3% (12/13 subjects) in the levofloxacin group.
These results indicate that the microsphere formulation of azithromycin is effective for the treatment of postoperative exacerbation of chronic rhinosinusitis.

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Suprahyoid muscles are composed of three different originated muscles, including the first branchial muscles (the mylohyoid and the anterior belly of the digastrics muscle), the second branchial muscles (the stylohyoid muscle and the posterior belly of the digastrics muscle), and the occipital somite (the geniohyoid muscle). The history of the suprahyoid muscles indicate that those muscles might differentiate along the history of the jaw of the vertebrates. And the hyoid bone in the human being does not connect any other bonny or cartilaginous structures, while the hyoid bone or cartilage in the another vertebrate connecting with the other branchial structures or the skull. It could be considered that the hyoid bone in the human being could act as a fulcrum of the submandibular bone and a tractor of the larynx, and the suprahyoid muscles could play successively both rolls of the hyoid bone for according to the functions including mastication, swallowing, speech production, singing, expression, and so on.

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Superselective intra-arterial chemotherapy combined with radiotherapy was performed for advanced nasal cavity and paranasal sinus cancers that were considered to involve the base of the skull or have some bone involvement to evaluate the efficacy of first line therapy and adverse events (AEs). Assessment of the efficacy of first line therapy, which took into consideration the postoperative pathological findings, demonstrated complete and objective response rates of 65% and 92.5%, respectively. Only one grade 4 AE occurred. The other AEs were all reversible and no serious AEs were observed. As our future therapeutic strategy, we have changed our practice and are investigating the possibility of superselective intra-arterial chemotherapy concurrent with 60 Gy radiotherapy regardless of the T classification followed by a salvage operation at the time of confirmation of residual or recurrent carcinoma while adopting a wait-and-see approach.

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[in Japanese]

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