Laryngeal tuberculosis is usually a complication of pulmonary tuberculosis. Recent studies have described a change in the clinical features of laryngeal tuberculosis. We present 15 cases of laryngeal tuberculosis treated at the Osaka Prefectural Habikino Hospital between 1993 and 2000. The results showed a mean age of 51 years, a male predominance by 2.75 to 1, and a 20% incidence (n = 3) of negative chest radiographic findings. The prominent presenting symptom was hoarseness (73.3%), and systemic symptoms were relatively rare. Seven patients showed ulcerative lesions, 5 showed granulomatous lesions, and the remaining 3 showed nonspecific inflammatory lesions in the larynx. Laryngeal lesions did not show any predilection for specific laryngeal sites in our series. In contrast to earlier studies, our study shows variations in clinical features of laryngeal tuberculosis. Physicians should consider tuberculosis in the differential diagnosis of laryngeal disease.

The clinical features of tuberculous otitis media (TOM) have changed. This study was performed to evaluate changing trends in the clinical manifestations of TOM. We reviewed a series of 12 cases of TOM (13 ears) recently treated at Osaka Prefectural Habikino Hospital. The results showed a mean age of 41 years and a male predominance of 1.4 to 1. Central or total perforations of the tympanic membrane were observed in most cases, but none of the patients had multiple perforations. Nine patients (75%) had active pulmonary tuberculosis. Normal lung status or inactive pulmonary tuberculosis was significantly more frequent in the older age group. Diagnosis of primary TOM required more time than that of secondary TOM. Most cases of primary TOM had high infectiousness of the primary lesion. We summarize the clinical features of patients who should be evaluated for TOM.

Intranasal application of toluene diisocyanate (TDI) induced nasal allergy-like symptoms of sneezing and watery rhinorrhea and decreased the histamine content of the nasal mucosa in guinea pigs. However, in the animals pretreated with capsaicin (capsaicin desensitization) before sensitization with TDI, nasal allergy-like symptoms were not induced. Capsaicin desensitization also inhibited histamine release in the nasal mucosa induced by TDI. These findings suggest that antidromic impulses of capsaicin-sensitive sensory nerves stimulated by TDI cause histamine release from mast cells in the nasal mucosa, resulting in nasal discharge and sneezing in guinea pigs. Thus neurogenic inflammation via an axon reflex in the nose may contribute to the pathogenesis of vasomotor rhinitis.

We have reported the presence of a histamine synthesizing enzyme, histidine decarboxylase (HDC), and histamine degrading enzymes, histamine N-methyltransferase (HMT) and histaminase (diamine oxidase, DAO) in human nasal mucosa and the histamine content of the mucosa. In this study, we demonstrate the influences of the toluene diisocyanate (TDI) treatment on the histamine content and these enzyme activities in guinea-pigs as an animal model of respiratory hypersensitivity. Application of TDI to the nasal vestibuli induced intense nasal allergy-like and mild asthma-like responses in TDI-sensitized guinea pigs. Increases in the histamine content and HDC and HMT activities were observed in the nasal mucosa and lung of TDI-sensitized guinea pigs. No apparent changes in the histaminase activities were observed in either the nasal mucosa or the lung. These data suggest that the turnover rate of histamine is increased in the nasal mucosa and the lung of guinea pigs with respiratory hypersensitivity.

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Histamine content and enzyme activities of histamine metabolism, histidine decarboxylase (HDC), histamine N-methyltransferase (HMT) and histaminase (diamine oxidase, DAO) in human nasal mucosa were determined with a highly sensitive and specific fluorescent method which was combined with high performance liquid chromatography. Histamine content and HDC activity were determined in 10 specimens of nasal polyp, nine specimens of maxillary sinus and five specimens of inferior turbinate. HMT and histaminase activities were determined in 15 specimens of nasal polyp, nine specimens of maxillary sinus and five specimens of inferior turbinate obtained during surgical therapy. Histamine and activities of HDC, HMT and histaminase were detected in all specimens except the case of histaminase activity in one specimen of nasal polyp. The mean values of histamine content and activities of HDC, HMT and histaminase of human nasal mucosa were 137.3 nmol/g wet weight, 26.3 fmol/min/mg protein, 26.4 pmol/min/mg protein and 0.5 pmol/min/mg protein, respectively. Histamine content in the mucosal tissue of the maxillary sinuses was significantly higher than that of nasal polyps or inferior turbinates. There were no significant differences in HDC activities among three kinds of nasal mucosa. Activities of HMT and histaminase, including their kinetic constants (Km and Vmax values for histamine) indicated that HMT has a greater potential than histaminase for histamine degradation in the human nasal mucosa. The presence of these enzymes suggests that these activities constitute an important modulating factor in histamine mediated allergic and inflammatory reactions in human nasal mucosa.

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The nasal mucociliary clearance was measured in 71 subjects with nasal allergy (NA) (56 subjects without sinusitis and 15 with sinusitis), 12 subjects with bronchial asthma (BA) (7 without, 5 with) and 7 subjects with aspirin induced asthma (AIA) using a saccharin test. The results were compared with those obtained in a control group of 15 healthy subjects. The saccharin time (ST) values for both NA and BA subjects without sinusitis (16.9 ± 9.9 and 20.1 ± 9.4 min, respectively) did not differ from that of the healthy subjects (16.3 ± 5.3 min). However, ST values in NA and BA subjects with sinusitis (37.6 ± 22.9 and 57.0 ± 6.7 min, respectively) were significantly higher than those of healthy subjects (p < 0.01). The ST value of AIA subjects (13.0 ± 5.4 min) showed no significant difference compared with that of the control group. These results suggest that allergic reactions do not influence the nasal mucociliary clearance and that the property of mucus complicated with sinusitis is important. Also, sinusitis observed in AIA may be somewhat different from ordinary sinusitis complicated with NA and BA.