A head shake sensory organization test to improve the sensitivity of the sensory organization test in the elderly.

OBJECTIVE: The head shake sensory organization test (HS-SOT) is an expansion of the sensory organization test (SOT), which evaluates impairment of the patient's ability to apply vestibular input while actively moving the head. HS-SOTs has been proposed to increase the sensitivity of SOTs. The purpose of this study was to investigate the value of HS-SOTs in a healthy population with respect to age and compare the sensitivity of HS-SOTs with that of SOTs in the elderly population. METHODS: One hundred two (n = 102) healthy subjects were divided into 3 age groups: the young adult group (between 20 and 39 yr), the adult group (between 40 and 59 yr), and the elderly group (between 60 and 79 yr). The subjects underwent SOTs and HS-SOTs. RESULTS: The equilibrium scores of HS-SOTs underwent more significant change than those of SOTs in the elderly group. The equilibrium score ratio SOT2/HS-SOT2 (HS-SOT during SOT condition 2) decreased by 4% more in the elderly group compared with that of the young adult group. The ratio of SOT5/HS-SOT5 decreased by 54% more in the elderly group compared with that of the young adult group. CONCLUSION: In the elderly, equilibrium scores of HS-SOTs changed more than those of SOTs. In addition, SOT5/HS-SOT5 demonstrated more sensitive changes in the elderly than SOT2/HS-SOT2 did.

Epithelial Na+ channel (ENaC) expression in obstructive sialadenitis of the submandibular gland.

BACKGROUND AND OBJECTIVES: The epithelial sodium channel (ENaC) has a critical role in the control of sodium balance, blood volume, blood pressure and viscosity of extracellular water. In submandibular gland disease, viscosity of the saliva plays an important role in the pathophysiology. However, there has been little study into the relationship between expression of ENaC and obstructive sialadenitis. The aim of this study was to elucidate the ENaC expression in excretory duct obstruction of the submandibular gland. MATERIALS AND METHODS: Seven-week old male Sprague-Dawley 12 rats were enrolled in the study. The rats were decapitated and histological changes of the submandibular gland tissue examined on days 0, 1, 3, 7, 14 and 21 after submandibular gland duct ligation. The expression of ENaC mRNA in the submandibular gland tissue was tested by reverse transcriptase-polymerase chain reaction (RT-PCR). Quantitative analysis of the ENaC protein was performed through Western blotting and tissue localization of the protein was performed by immunohistochemical staining. RESULTS: By real time RT-PCR, the expression of ENaC (α, ß, γ) mRNA increased after ligation of the submandibular gland duct. α and γ ENaC mRNA expression began to increase after 1 day. But ß ENaC mRNA expression began to increase significantly after 14 days. The increase of ENaC mRNA expression lasted for 3 weeks. The expression of ENaC (α, ß, γ) protein was identified by Western blotting analysis, and ENaC protein was localized in ductal epithelial cells by immunohistochemistry. CONCLUSION: The expression of ENaC (α, ß, γ) was increased by excretory duct ligation of the submandibular gland in rats and ENaC was considered to have a certain role in the pathogenesis of obstructive sialadenitis.

Effects of cigarette smoking on mucin production in human middle ear epithelial cells.

OBJECTIVE: Otitis media (OM) is the most common disease in preschool age children related to passive cigarette smoking as risk factor. In this study, we investigate whether the cigarette smoking can induce the inflammation in human middle ear epithelial cell, and cigarette smoke-induced inflammation can increase the expression of MUC5AC gene and protein that was known to play an important role in OM with effusion. METHODS: After treatment of cigarette smoke solution (CSS) on immortalized human middle ear epithelial cells (HMEECs) with or without pretreatment by epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (AG1478), we observed expression of tumor necrosis factor-alpha (TNF-α), EGFR, MUC5AC mRNA by quantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and EGFR, MUC5AC protein by western blotting. RESULTS: Treatment of CSS increased expression of TNF-α mRNA dose dependently. Treatment of CSS upregulated the EGFR and MUC5AC mRNA in a time-dependent manner. CSS-induced upregulation of EGFR and MUC5AC mRNA was suppressed by the pretreatment of AG1478. EGFR and MUC5AC proteins were upregulated by the treatment of CSS and suppressed by the pretreatment of AG1478. CONCLUSIONS: Treatment of CSS on HMEECs increased the expression of MUC5AC mRNAs and proteins which play a major role in OM with effusion.

Psoriasin (S100A7), an antimicrobial peptide, is increased in human middle ear cholesteatoma.

CONCLUSION: Increased psoriasin in cholesteatoma epithelium may play a role in epithelial inflammatory response and differentiation. OBJECTIVES: Cholesteatoma is characterized by excessive keratinocyte differentiation leading to inflammation, granulation tissue, and osteolytic activity. Moreover, psoriasin may act as an antimicrobial peptide, stimulate granulocytes, and control keratinocyte differentiation. The purpose of this study was to investigate the differential expression patterns and the localization of psoriasin in cholesteatoma and in normal external auditory canal skin. MATERIALS AND METHODS: Expression levels of psoriasin mRNA were evaluated by real-time PCR and Western blotting. Cholesteatoma-affected and normal external auditory canal skin samples were immunostained with monoclonal antibody to psoriasin. Localization of immunoreactivity to psoriasin antibody was then compared. RESULTS: By real-time PCR, expression levels of psoriasin mRNA in cholesteatoma were significantly higher than in normal external auditory canal skin, and this was confirmed by Western blotting. Immunohistochemical staining revealed that psoriasin protein is mainly expressed in the granular layer and in the upper parts of the spinous layer in cholesteatoma epithelium, but that it is expressed in the superficial layer of normal external auditory canal skin.

Differential expression of toll-like receptors 2 and 4 in rat middle ear.

OBJECTIVE: The epithelial cells of the middle ear and Eustachian tube must maintain an adequate mucosal defense system against various antigenic stimuli. Since toll-like receptors (TLRs) are known to play a critical role in mucosal defense, we investigated their expression in the mucosa of the tubotympanum, nasopharynx, and oral cavity of the rat. METHOD: The expression of TLR2 and TLR4 was examined in the mucosa of the tubotympanum, nasopharynx and oral cavity of the rat using real time RT-PCR and Western blot analysis. RESULTS: Transcripts for TLR2 and TLR4 were detected in the mucosa of the tubotympanum, nasopharynx, and oral cavity of the rat. The expression of TLR2 and TLR4 in the middle ear was increased more than in the other anatomical areas. Differential expression of these molecules at the protein level was confirmed by Western blot analysis. CONCLUSIONS: Diverse expression of TLR2 and TLR4 in different parts of the tubotympanum and upper aerodigestive tract suggests region-specific functional modulation of the innate immune system. Differential expression of subtypes of the TLR in the normal physiology of the tubotympanum and upper aerodigestive tract also suggests that they may play a role in the pathophysiology of otitis media.

Increased expression of pigment epithelium-derived factor in allergic rhinitis.

OBJECTIVES: To investigate the expression of messenger RNA (mRNA) of the gene for pigment epithelium-derived factor (PEDF) (OMIM *172860) and PEDF protein and to localize the PEDF protein in the nasal mucosa of patients with allergic rhinitis and of control subjects. DESIGN: Investigation of PEDF mRNA and PEDF protein expression in the nasal mucosa using reverse transcription-polymerase chain reaction, Western blotting, and immunohistochemical staining. PARTICIPANTS: We used inferior turbinate mucosal samples from 10 patients with allergic rhinitis and 10 matched healthy control subjects. INTERVENTIONS: We extracted PEDF mRNA from the inferior turbinate mucosa samples and performed reverse transcription-polymerase chain reaction analysis. We used Western blotting to analyze differences in expression levels of PEDF protein between patients with allergic rhinitis and healthy controls, and the PEDF protein was localized immunohistochemically. RESULTS: The expression levels of PEDF mRNA and PEDF protein in the nasal mucosa were significantly increased in patients with allergic rhinitis compared with those in nonallergic controls. The PEDF protein was expressed in the epithelium and submucosal glands. CONCLUSIONS: We found that PEDF protein is expressed in the human nasal mucosa, and its expression is increased in allergic rhinitis. These results suggest a possible contribution of PEDF to the chronic inflammation of the nasal mucosa in allergic rhinitis.

The changes of MRSA infections in chronic suppurative otitis media.

OBJECTIVES: To investigate the epidemiologic and microbiological characteristics of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) infections in the otorrhea of chronic suppurative otitis media (COM) patients. DESIGN: Retrospective study of patients with newly identified MRSA infections from January 1998 through December 2006. A total of 2773 patients with a diagnosis of COM were included in this study. An antibiotic sensitivity test was performed for each isolate. RESULTS: The prevalence of MRSA in COM was 4.9 percent (137 of 2773 patients). The proportion of CA-MRSA rose from 0.7 percent in 1998 to 11.4 percent in 2006. However, the proportion of HA-MRSA did not change significantly, from 0.7 percent in 1999 to 1.3 percent in 2006. All of the CA-MRSA strains identified in our study were susceptible to trimethoprim/sulfamethoxazole (TMP/SMX). Rifampin susceptibility was also noted in 90 percent of the cases. CONCLUSIONS: CA-MRSA infections have risen dramatically in the past decade. CA-MRSA and HA-MRSA in COM differed in both clinical and microbiological aspects.

Inhibitory effect of caffeic acid phenethyl ester (CAPE) on LPS-induced inflammation of human middle ear epithelial cells.

CONCLUSIONS: The results suggest that the anti-inflammatory effect of caffeic acid phenethyl ester (CAPE) is due to its inhibition of tumor necrosis factor (TNF)-alpha expression and interleukin (IL)-8 production. The anti-inflammatory effect of CAPE is possibly through the inhibition of nuclear factor (NF)-kappaB via the suppression of inhibitor-kappaB-alpha (IkappaB-alpha) degradation. OBJECTIVES: CAPE is a biologically active component of propolis, a resinous material obtained from bee hives, which originates from conifer bark. The effect of CAPE on lipopolysaccharide (LPS)-induced inflammatory reactions is not known. The aim of this study was to evaluate the anti-inflammatory effect of CAPE on cultured human middle ear epithelial cells (HMEECs). MATERIALS AND METHODS: The effect of CAPE on LPS-induced TNF-alpha expression was evaluated in HMEECs by real-time reverse transcription polymerase chain reaction (RT-PCR). LPS-induced IL-8 production was determined by enzyme-linked immunosorbent assay (ELISA), and LPS-induced IkappaB-alpha degradation was followed by Western blot analysis. RESULTS: CAPE significantly inhibited LPS-induced up-regulation of TNF-alpha in a dose-dependent manner. IL-8 production by LPS was significantly suppressed by the CAPE pretreatment. Furthermore, LPS-induced IkappaB-alpha degradation was suppressed by the CAPE pretreatment.

Expressions of caspase-14 in human middle ear cholesteatoma.

OBJECTIVES: Cholesteatoma is characterized by an excessive proliferation and differentiation of keratinocytes with a progressive accumulation of keratin debris. Caspase-14 is a novel regulator of keratinocyte terminal differentiation. The purpose of this study was to investigate the expression patterns and localizations of caspase- 14 in cholesteatoma and in normal external auditory canal (EAC) epithelium. METHODS: The expression levels of caspase-14 mRNA were evaluated through real-time polymerase chain reaction (PCR) and Western blotting. Cholesteatoma and normal EAC epithelium were immunostained with a monoclonal antibody to caspase-14. The localizations of immunoreactivity to the caspase-14 antibody were compared between cholesteatoma and normal EAC epithelium through immunohistochemical staining. RESULTS: As shown by real-time reverse-transcription PCR, the expression level of caspase-14 mRNA in cholesteatoma epithelium was significantly higher than in normal EAC epithelium. Caspase-14 protein was detected in both normal EAC and cholesteatoma, but its expression was shown to be greater in cholesteatoma on Western blot analysis. As shown with immunohistochemical staining, caspase-14 protein was primarily expressed in the granular layer and the upper parts of the spinous layer in cholesteatoma epithelium and in the superficial layer of normal EAC epithelium. The expression of caspase-14 was more intense in cholesteatoma tissues than in normal EAC epithelium. CONCLUSION: The increased level of caspase-14 expression in cholesteatoma tissues may play a role in terminal differentiation of epithelium and accumulation of keratin debris from external matrix.

Expression of oncostatin M in chronic obstructive sialadenitis of the submandibular gland.

OBJECTIVES: We investigated the expression of oncostatin M messenger RNA (mRNA) and protein in normal submandibular glands and those with chronic obstructive sialadenitis and localized the expression of oncostatin M protein. METHODS: Submandibular glands from 10 patients with chronic obstructive sialadenitis as a study group and 10 normal submandibular glands as a control group were examined. Oncostatin M mRNA extracted from submandibular gland was used for reverse transcription-polymerase chain reaction and analyzed semiquantitatively. The difference in expression level of oncostatin M protein between the 2 groups was analyzed through Western blot analysis, and oncostatin M protein was localized immunohistochemically. RESULTS: The expression levels of oncostatin M mRNA and protein were significantly increased in the study group. The protein was predominantly localized in ductal epithelia and infiltrating inflammatory cells and was more strongly expressed in the study group also. CONCLUSIONS: Oncostatin M is expressed in both chronic obstructive sialadenitis and normal submandibular gland, and is up-regulated in chronic obstructive sialadenitis. These results suggest that oncostatin M is involved in the pathologic process of chronic obstructive sialadenitis. However, the physiologic role in normal glands, as well as a possible role in the development of chronic obstructive sialadenitis, remains to be elucidated.

Expression of neutrophil gelatinase-associated lipocalin in human salivary glands.

OBJECTIVES: We performed an observational study of RNA and protein expression in human tissue to examine the distribution of neutrophil gelatinase-associated lipocalin (NGAL) in normal and chronic inflammatory salivary tissues, and to investigate the expression level of NGAL in inflammatory conditions of salivary glands. METHODS: Normal salivary gland tissues and tissue samples of salivary glands with chronic sialadenitis were obtained. Expression of NGAL was investigated by reverse transcriptase-polymerase chain reaction, and semiquantitative analysis of these results was also performed. The differential localization and amount of immunoreactivity to NGAL protein was evaluated by immunohistochemistry and Western blot analysis in normal salivary gland tissues and salivary glands with chronic sialadenitis. RESULTS: NGAL messenger RNA transcripts were detected in the tissues from the salivary glands with chronic sialadenitis, but only a small amount was detected in the tissues from the normal salivary glands. A weak expression of NGAL protein was occasionally seen in a few ductal epithelial cells of normal salivary gland tissue. However, in tissue samples from glands with chronic sialadenitis, the NGAL protein was expressed strongly in ductal epithelial cells and infiltrating inflammatory cells. CONCLUSIONS: These results imply that NGAL is associated with the regulation of inflammation in salivary glands.

Up-regulation of protease-activated receptor 2 in allergic rhinitis.

OBJECTIVES: We compared the patterns of PAR-2 messenger RNA (mRNA) and protein expression in the nasal mucosa of subjects with and without allergic rhinitis. METHODS: Biopsy specimens were obtained from 10 patients with allergic rhinitis and 10 normal controls. RNA was extracted from the nasal mucosa, and semiquantitative reverse transcription-polymerase chain reaction was performed for PAR-2. Tissue sections were immunostained for PAR-2 by use of specific antibody. RESULTS: The expression levels of PAR-2 mRNA in allergic rhinitis nasal mucosa were significantly up-regulated as compared with those in normal nasal mucosa. PAR-2 immunoreactivity was observed in the epithelium and submucosal glands in both normal controls and subjects with allergic rhinitis. Stronger immunoreactivity for PAR-2 was observed in allergic rhinitis nasal mucosa as compared with normal nasal mucosa. CONCLUSIONS: These results suggest that PAR-2 may be involved in allergic nasal inflammation.

Differential expression of human beta defensin 2 and human beta defensin 3 in human middle ear cholesteatoma.

OBJECTIVES: The purpose of this study was to investigate the differential expressions of human beta defensin (hBD) 2 and hBD-3 in human middle ear cholesteatoma epithelium. METHODS: The expressions of hBD-2 and hBD-3 were analyzed by quantitative real-time reverse transcription-polymerase chain reaction (RT-PCR), Western blotting, and immunohistochemical staining. Samples were obtained from 10 patients who underwent middle ear surgery for middle ear cholesteatoma. RESULTS: Real-time RT-PCR and Western blot analysis showed that the messenger RNAs and proteins of hBD-2 and hBD-3 were higher in the cholesteatoma epithelium than in normal external auditory canal skin. In cholesteatoma epithelium, hBD-2 and hBD-3 activities were present in the upper granular layer and in the prickle cell layer, but in the normal skin they were poorly expressed in all layers. CONCLUSIONS: Increased expressions of hBD-2 and hBD-3 in cholesteatoma epithelium suggest that cholesteatoma, a chronic inflammatory state of middle ear keratinocytes, may induce an innate immune response. That the induction of hBD-2 was found to be more intense than that of hBD-3 in cholesteatoma epithelium implies that hBD-2 is the major effector in terms of chronic epithelial inflammatory responses.

Expressions of cyclooxygenase 1 and 2 in endotoxin-induced otitis media with effusion in the rat.

OBJECTIVE: Recently, a selective COX-2 inhibitor was developed and used for reducing the levels of inflammation-inducing prostaglandin (PG) whilst not inhibiting the release of protective PG by COX-1. COX-1 may be the critical isoform required for the production of PG with a homeostatic function, whereas COX-2 may be the main contributor to PG production in inflammation. The purpose of this study was to investigate COX-1 and 2 expressions in experimental endotoxin-induced OME in rats and to quantify their temporal expressions. METHODS: In a rat model, lipopolysaccharides (LPS) were inoculated into the middle ear cavity. Middle ear mucosa and temporal bone were samples at 0, 1, 3, 6, and 12h, and on days 1, 3 and 7 after instilling either LPS or sterile PBS. RT-PCR, Western blotting and immunohistochemical staining were performed to determine the expressions of COX-1 and COX-2. RESULTS: COX-1 mRNA and protein were detected in normal middle ear mucosa but their levels did not change after endotoxin instillation. However, COX-2 was not identified in normal middle ear mucosa, but COX-2 mRNA was maximally increased at 6h after endotoxin instillation and COX-2 protein was maximally increased at 12h. COX-2 expression, by immunohistochemical staining, was identified only at 12h after endotoxin injection. CONCLUSIONS: In this study, the basal expressions of COX-1 and COX-2 mRNA and protein in middle ear mucosa, as well as their regulations by endotoxin were investigated. COX-1 was not induced in middle ear mucosa by endotoxin whereas COX-2 was induced within 12h of stimulation. Our findings indicate that COX-2 inhibitor administration for the relief of inflammation should be considered within 12h of the initiation of an inflammatory process. These findings may provide an understanding of the mechanisms regulating PG formation in infection of the middle ear cavity.

Up-regulation of peroxisome proliferator-activated receptor gamma in perennial allergic rhinitis.

OBJECTIVES: To investigate the expression of peroxisome proliferator-activated receptor gamma (PPAR-gamma) messenger RNA and protein and to localize the PPAR-gamma protein in the nasal mucosa of patients with allergic rhinitis and control subjects. DESIGN: Prospective study. SETTING: Tertiary academic institution. Patients Twenty patients with perennial allergic rhinitis and 20 matched nonallergic patients. INTERVENTIONS: Inferior turbinate mucosa samples were obtained from 20 patients with perennial allergic rhinitis and 20 matched nonallegic patients. Peroxisome proliferator-activated receptor gamma messenger RNA was extracted from the inferior turbinate mucosae, and then reverse transcription-polymerase chain reaction was performed. Western blot testing was used to analyze differences in PPAR-gamma protein expression levels between patients with allergic rhinitis and normal controls, and the PPAR-gamma protein was localized immunohistochemically. RESULTS: The expression levels of PPAR-gamma messenger RNA and protein in the nasal mucosa was significantly increased in patients with perennial allergic rhinitis compared with controls. Peroxisome proliferator-activated receptor gamma protein was expressed in the epithelium, infiltrating inflammatory cells, and submucosal glands. CONCLUSIONS: Peroxisome proliferator-activated receptor gamma is expressed in the human nasal mucosa and is up-regulated in perennial allergic rhinitis. These results suggest a possible contribution for PPAR-gamma in chronic inflammation of the nasal mucosa in perennial allergic rhinitis.

Efficacy of sucralfate in the postoperative management of uvulopalatopharyngoplasty: a double-blind, randomized, controlled study.

OBJECTIVE: To evaluate the effectiveness of sucralfate in influencing throat pain, otalgia, analgesic requirement, bleeding, mucosal recovery, and incidence of postoperative bleeding in patients undergoing uvulopalatopharyngoplasty. DESIGN: A prospective double-blind randomized study. SETTING: University-affiliated tertiary referral hospital. PARTICIPANTS: Eighty adult patients with obstructive sleep apnea syndrome requiring uvulopalatopharyngoplasty were recruited and randomly allocated into either a sucralfate treatment group or a control group. INTERVENTIONS: All patients underwent uvulopalatopharyngoplasty. Patients enrolled in the sucralfate group (n=40) were instructed to gargle the sucralfate suspension and then to swallow. Patients enrolled in the control group (n=40) were instructed to gargle placebo suspension at the same doses and schedule. MAIN OUTCOME MEASURES: Postoperative throat pain, otalgia, amount of analgesic required, degree of strength (defined as patients' general well-being and return to regular daily activities), percentage of mucosal covering, and postoperative bleeding. RESULTS: Throat pain and otalgia occurred significantly less often in sucralfate group, with less analgesic requirement and with rapid mucosal healing and early return to regular daily activities. There was no significant difference in episodes of postoperative bleeding between the 2 groups (P=.37). CONCLUSIONS: Although sucralfate therapy may not provide complete analgesia after uvulopalatopharyngoplasty, it may reduce the amount of analgesic required, thus preventing dose-related adverse effects from the analgesic agent. It can also significantly reduce the total number of days needed to return to normal daily activities (P=.41).

Polymorphism of the CD14 gene in perennial allergic rhinitis.

OBJECTIVES: Allergic diseases have strong genetic backgrounds. Recently, a C-T polymorphism in the promoter region of CD14 has been associated with phenotypes of atopy in some populations. The aim of this study was to investigate the association of CD14/-159 polymorphism with total serum IgE levels and number of positive skin prick tests in Korean population with perennial allergic rhinitis. STUDY DESIGN: Prospective study. METHODS: Deoxyribonucleic acid obtained from 164 children with perennial allergic rhinitis and 160 healthy controls were typed for the promoter polymorphism of CD14 gene at position -159 by restriction fragment length polymorphism analysis. Genotype frequencies, total serum IgE levels, and the number of positive skin tests for each genotype were compared. RESULTS: There were no significant differences in the CD14/-159 genotype frequencies between the allergic rhinitis group and the control group. In the skin prick test-positive population, the CC homozygotes were associated with higher serum total IgE levels and greater number of positive skin tests compared with subjects with CT and TT alleles (P<0.05). CONCLUSIONS: The results from the present study suggest that CD14/-159 polymorphism may play a role in the development of perennial allergic rhinitis in Korean children.

Expression of secretory leukocyte protease inhibitor in middle ear cholesteatoma.

Secretory leukocyte protease inhibitor (SLPI) is a cationic protein and a member of the innate immunity-associated protein family. The main function of SLPI is to protect local tissue against the detrimental consequences of inflammation. We undertook this study to investigate the expression of SLPI in human middle ear cholesteatoma tissue as compared with normal external auditory canal skin. Cholesteatoma tissues and external auditory canal skin samples were obtained from eight patients during middle ear surgery. The expression levels of SLPI mRNA and protein were evaluated by real-time reverse transcription-polymerase chain reaction (RT-PCR) and western blotting. Immunohistochemical staining was performed in both tissue groups using anti-SLPI antibody. Real-time RT-PCR showed that SLPI mRNA levels in cholesteatoma tissues were increased 7.8-fold on average as compared with normal auditory canal skin. Western blotting analysis showed that SLPI protein expression in cholesteatoma epithelium is up-regulated versus external auditory canal skin epithelium. Immunohistochemical staining for SLPI showed that SLPI is expressed mainly in the stratum granulosum and in subepithelial inflammatory cells. These findings imply that SLPI contributes to host protection against inflammatory cell and destructive enzymes in the chronic inflammatory state of cholesteatoma by affecting the innate immune system.

Overexpression of placenta growth factor in human middle ear cholesteatoma.

CONCLUSIONS: The expression and localization of placenta growth factor (PlGF) within cholesteatoma were defined. The authors propose that PlGF is an angiogenic growth factor in cholesteatoma, and participates in the neoangiogenesis of cholesteatoma. OBJECTIVES: Middle ear cholesteatoma is characterized by the presence of a keratinizing squamous epithelium with hyperproliferative features. Such growth can only be supported by abundant blood vessels. Because proliferating tissues require an enhanced blood supply, angiogenesis appears to be a prerequisite for the expansion of cholesteatoma. This study aimed to analyze the presence of PlGF as an angiogenic growth factor in human cholesteatoma. MATERIALS AND METHODS: Tissue samples from human cholesteatoma and normal auditory meatal skin were obtained from patients during surgery for cholesteatoma of the middle ear. PlGF mRNA expression was quantified by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). PlGF was localized by immunohistochemical staining. Western blotting was used for detection of PlGF protein. RESULTS: Expression of PlGF mRNA was significantly elevated in the epithelium of cholesteatoma compared with normal auditory meatal skin. PlGF was detected on cholesteatoma by Western blotting. PlGF was detected in the suprabasal layer of cholesteatoma using immunohistochemical study, but was not detected in normal auditory meatal skin.

Treatment of ranula in pediatric patients with intralesional injection of OK-432.

OBJECTIVE: To assess the efficacy of treatment of a ranula in children by intralesional injection of OK-432. STUDY DESIGN: Retrospective analysis of 13 cases. METHODS: Review of medical records of pediatric patients with ranula treated by OK-432 sclerotherapy from 2002 through 2005. RESULTS: Among 13 cases, 9 were completely regressed by injection therapy alone. Three cases were incompletely regressed. One case was cured by surgical excision. The follow-up duration was 6 to 46 (mean 24.3) months. Adverse effects of OK-432 injection were tolerable, and no complication was observed. CONCLUSIONS: On the basis of our experience, sclerotherapy with OK-432 was a safe and effective primary treatment for a ranula in children. Further study will be needed to conclude its long-term effectiveness.