Authorship：Lead author   Language：Japanese   Publisher：Society of Oto-rhino-laryngology Tokyo  

(Introduction) Even if the results of medical interview and rhinoscopic findings are suspicious for allergic rhinitis, all serum antibody titers and skin tests may be negative. In Europe and the United States, such cases are described as Local Allergic Rhinitis (LAR). We investigated the possibility of mite-LAR using a nasal provocation test with a commercially available HD disc, that can be performed in daily practice. Since cedar discs are not commercially available, we only examined the response to mite. The histopathological features of LAR in the nasal mucosa were compared with those of allergic and non-allergic rhinitis to aid in the investigation of the pathogenesis of LAR.

(Subjects, Methods) Twenty-one patients with symptoms of rhinitis who underwent surgical treatment at our department were included in the study. Endpoints included: (1) preoperative measurement of mite-specific IgE antibody titer in peripheral blood, (2) preoperative nasal provocation test (HD disc), (3) measurement of mite-specific IgE antibody titer in the mucosa of the inferior turbinate, and (4) HE staining and immunostaining with anti-CD40 antibody in specimens of the mucosa of the inferior turbinate.

(Results and discussion) 13 of the 21 cases were negative for mite-specific IgE antibody titer in peripheral blood, and 5 of the 13 cases were considered to have mite-LAR. In all groups, CD40-positive cell clusters were observed in the inferior turbinate mucosa. We describe the pathogenetic hypothesis of LAR and indicate that the establishment and standardization of a nasal provocation test is of great importance in the diagnosis of allergic rhinitis.

DOI： 10.11453/orltokyo.67.2_85

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Authorship：Lead author   Language：Japanese   Publisher：Japan Society of Immunology, Allergology and Infection in Otorhinolaryngology  

Skull base osteomyelitis (SBO) is classified into typical SBO secondary to otitis externa and central SBO, which is associated with various etiologies. We report two cases of SBO (one patient each with typical and central SBO) accompanied by multiple cranial nerve paralyses, which partially improved after treatment.

Case 1: A 92-year-old man with a history of diabetes mellitus was referred to our department for evaluation of right-sided otorrhea after cleaning the ear and right facial nerve paralysis. Bacteriological analysis of the otorrhea specimens revealed methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, and histopathological examination of the ear canal granulation tissue showed no malignant findings. Contrast-enhanced computed tomography (CT) revealed bone destruction surrounding the stylomastoid foramen, and he developed vagus nerve paralysis during the disease course. The patient was diagnosed with typical SBO, and only vagus nerve paralysis improved after antibiotic treatment.

Case 2: A 76-year-old man with a history of diabetes mellitus was referred to our department for evaluation of dysphagia and hypoglossal nerve paralysis during a nasal cleaning procedure performed at a primary care clinic. Contrast-enhanced CT revealed a destructive bone lesion at the clivus. During a nasopharyngeal biopsy under general anesthesia, we observed drainage of pus from the posterior space of the prevertebral muscle. Bacterial culture yielded P. aeruginosa growth, and histopathological findings showed only inflammation. Therefore, the patient was diagnosed with central SBO. Vagus nerve paralysis occurred during the disease course. Antibiotic treatment led to improvement of only hypoglossal nerve paralysis. The sequence of appearance of paralysis in these cases reflects spillover inflammation. Future studies are necessary to investigate factors that improve SBO-induced cranial nerve paralysis.

DOI： 10.24805/jiaio.3.1_21

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Rhinologic Society  

Background: Dupilumab is a fully human monoclonal antibody that blocks the common part of the interleukin(IL)-4 and -13 receptors. It has been indicated for treatment of inadequately controlled chronic rhinosinusitis with nasal polyps (CRSwNP) since March 2020 in Japan. In this study, we investigated the effects of dupilumab on eosinophilic CRS (ECRS) in CRSwNP.

Methods: A prospective observational study was performed in patients who started to use dupilumab from August to December 2020. End points included the SNOT-22 score, nasal polyp score, oral prednisolone (PSL) dose, and blood test data for total IgE, %eosinophils and levels of several cytokines.

Results: SNOT-22 scores decreased after 22/24 weeks of treatment (p < 0.01). Total IgE in blood decreased after an average of 13.3 weeks of treatment (p < 0.01), whereas %eosinophils increased significantly after the same period (p < 0.01). The required oral PSL dose was significantly lower after treatment compared with that before treatment. Vascular endothelial growth factor (VEGF) in blood decreased significantly after 15.6 weeks of treatment, but there were no significant differences in the blood levels of periostin and IL-4.

Conclusion: Patients with ECRS treated with dupilumab had rapid improvement in clinical outcomes. Total IgE and VEGF significantly decreased in the early period after treatment. While %blood eosinophils significantly increased and periostin and IL-4 in blood showed no significant changes.

DOI： 10.7248/jjrhi.61.607

DOI： 10.5631/jibirinsuppl.167.1_references_DOI_EhuA9ZmCYjxlvrTZax6AUGDEkFQ

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Other Link： https://search.jamas.or.jp/link/ui/2023108928

Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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