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Expression patterns of cytokeratins (CKs) in normal skin, in pars flaccida type cholesteatoma (PFTC), and in pars tensa type cholesteatoma (PTTC) were examined by means of one- and two-dimensional electrophoretic techniques. Both CKs 14 and 5 pair (CKs 14/5) and CKs 10/1 were found in all materials. Neither CKs 16/6 nor 19 was found in the skin. CKs 16/6 and 19 were both found in 3 out of 5 PFTCs, only CKs 16/6 in 1 out of 5 and neither CKs 16/6 nor 19 in 1 out of 5. CKs 16/6 and 19 were both found in 1 out of 3 PTTCs, only CKs 16/6 in 1 out of 3 and neither CKs 16/6 nor 19 in 1 out of 3. There was no significant difference in the CKs expression patterns between PFTC and PTTC. The expression of CKs 16/6 and 19 suggested that their matrix epithelia were hyperproliferative. However, not all of the cholesteatomas were always hyperproliferative. Patterns of the terminal differentiation of CKs 1, 5, 10 and 14 in the PFTC or the PTTC were basically the same as those in the skin. In the cholesteatoma, eack CK gradually diminished in molecular weight in the cornified layer and debris. Desmosomal proteins were abundant in skin but not in cholesteatomas.

Hiraide F, Watanabe K, Funasaka S, Kakoi H. The blood vessels in Reissner's membrane of the rat. Acta Otolaryngol (Stockh) 1994; 114: 1–3.Blood vessels on Reissner's membrane were electron-microscopically found in 24 out of 30 rats of the Wistar strain. The vessels were noted in the upper turns, mainly in the third turn of the cochlea. They originated from radiating arterioles in the upper spiral ligament and took straight courses radially down to the spiral limbus, and further to the modiolus, running along the surface of the scala vestibuli side of the membrane. Their diameter was approximately 4 µm. Bifurcated blood vessels were occasionally detected in 3 out of the 24 rats that possessed the vessels in the membrane. From the morphological point of view the blood vessels in Reissner's membrane may possibly have some function in the inner ear of the rat.

Two patients with sudden progressive profound hearing loss resulting from Ramsay Hunt syndrome are reported. Case 1: A 63-year-old woman was admitted to Jichi Medical School Hospital with sudden, progressing deafness of the left ear, vertigo, sore throat, and hoarseness. An otoscopic examination revealed the external ear and the tympanic membrane to be normal. Pure-tone audiometry revealed profound deafness in the left ear. A horizontal nystagmus in the non-affected direction was observed by gaze nystagmus test. An endoscopic examination revealed herpetic vesicles and shallow ulcers on the left side of the pharynx and the larynx. There was complete paralysis of the left recurrent nerve. Hearing acuity of the left ear did not recover at all with steroid hormone therapy. Case 2: A 75-year-old man was referred to the ENT Clinic by a dermatologist for hearing evaluation in Ramsay Hunt syndrome. The man had noticed severe otalgia and sudden progressive deafness of the right ear approximately 2 weeks prior to admission. Physical examination revealed herpetic vesicles and ulcers in the right external ear and lateral neck. Complete paralysis of the right facial nerve was noted. Profound hearing loss in the affected ear was observed by pure-tone audiometry. A gaze nystagmus test revealed a horizontal nystagmus in the non-affected direction. No recovery of the cochlear function was noted following administration of antiviral drug. The pertinent literature is briefly reviewed.

Histochemical studies on the distribution of various oxidative and dephosphorylating groups of enzymes have been made in the normal mucous lining of the middle ear in the guinea pig, cat, squirrel monkey and man. In general ciliated cells showed more strongly positive activity than other epithelial cells lining the middle ear cavity for various oxidative enzymes and hydrolytic enzymes except alkaline phosphatase in these animal species. Marked alkaline phosphatase activity was detectable on the cilia of the cat, whereas no enzyme activity was found on the cilia of other species. The significance of histochemical findings in the middle ear mucosa of several animals was discussed in light of physiological and pathological considerations.

Detailed anatomical characteristics of normal middle ear epithelium and a topographical distribution of cell types are described for the squirrel monkey. The following cell types were classified by using electron microscopy: 1) ciliated tall cell; 2) ciliated small cell; 3) non-ciliated columnar or cuboidal cell; 4) non-ciliated thin cuboidal or flat cell. Ciliated cells were found in the region of the Eustachian tube, anterior mesotympanum and hypotympanum. Columnar cells were found anterior to Jacobson's nerve and flat cells posterior to this nerve which served as a reference mark. Such findings are important in understanding normal physiology and are of special interest in interpreting pathological inflammatory alterations in man and animals ranging from mild (acute serous otitis media) to severe (chronic serous otitis media and mastoiditis).

Histochemical studies of various cellular components of the normal eustachian tube have been undertaken in the guinea pig, cat and squirrel monkey. Oxidative and hydrolytic enzymes were strongly active in ciliated columnar cells, less active in goblet cells, suggesting active metabolism. In general, cellular components of the subepithelial layer reacted strongly to the various enzymes. Of the glands studied, serous cells contained more oxidative enzymes than did mucous cells. Within the hyaline cartilage the chondrocytes demonstrated fairly strong enzyme reactions, the intercellular matrix none. These findings assist our understanding of normal eustachian tube physiology regarding ciliary clearance and lubrication and serve as a basis for understanding inflammatory diseases such as the middle ear effusions.

Chronic infection and allergy are considered to be the two major etiologic factors of nasal polyps. Whatever its cause may be, the initial phase of nasal polyp formation is represented by increased exudation from vessels, edema of the lamina propria and the bulging of the nasal mucosa. Nasal polyps were histologically classified into three types: edematous type, glandular and cystic type (ductal type) and fibrous type. Those of the edematous type and the glandular and cystic type are in the active stage of tissue reaction because of permeation of vascular fluid and marked infiltration of round cells. Contrastingly, the fibrous type polyps are in the healing stage of tissue reaction because of marked proliferation of fibroblasts and collagen fibers. The morphological structure of the nasal glands involved in the bulging mucosa determines the type of nasal polyps, whether edematous type or glandular and cystic type.