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It is known that the endotoxin of gram negative bacteria is not only antigenic, but also has many biological activities. In this study, endotoxin in human middle ear effusions (MEE) was measured quantitatively by the chromogenic substrate method which is more sensitive and accurate than Limulus assay.Fifty samples of MEE from 46 patients aged 2 to 84 years were classified into two groups, 24 mucoid and 26 serous. The endotoxin in the mucoid group was significantly higher (264.6pg/ml) than that in the serous group (27.5pg/ml). This suggests that bacterial endotoxin contributes greatly to induce otitis media with mucoid effusion.Audiometry showed that the majority of those with otitis media and mucoid effusion had conductive type deafness, while mixed type deafness was more common in those with serous effusion.

We evaluated the titers of anti-cefotiam antibodies in the sera of 44 patients before and after the intravenous administration of cefotiam. The anti-cephalosporin antibodies were detected using the passive hemagglutination inhibition test. Only three of 44 patients became positive for the antibody after the administration of cefotiam, though none of the patients showed no symptoms. It is possible that cephalosporin can induce immunological reactions based on the hapten mechanism.