Tomohiro Kawasumi

Background and Clinical Significance: Eosinophilic sialodochitis (ES), also known as sialodochitis fibrinosa, is a rare disorder characterized by recurrent salivary gland swelling caused by intraductal eosinophilic mucous plugs. Typical histopathological findings include eosinophils and Charcot–Leyden crystals within ductal secretions, and characteristic imaging findings include salivary duct dilatation and glandular swelling. Although rare cases associated with sialolithiasis or calcification have been reported, high-attenuation material within the salivary duct on computed tomography (CT) has not been clearly described in ES. Case Presentation: A 56-year-old woman with allergic rhinitis presented with recurrent swelling and pain in the right submandibular area. CT and ultrasonography revealed a large sialolith in the right submandibular gland and dilatation of Wharton’s duct. She underwent right submandibular gland excision for presumed chronic obstructive submandibular sialadenitis with a sialolith. Soon after surgery, she developed recurrent swelling of the right floor of the mouth, and CT showed persistent high-attenuation material along Wharton’s duct without residual sialolith. Ductal massage discharged a brownish gelatinous material. Histopathological examination revealed numerous eosinophils and Charcot–Leyden crystals in both the discharged mucous plug and decalcified sialolith, fulfilling Baer’s diagnostic criteria for ES. Physical extraction and anti-allergic medications were insufficient, whereas ductal irrigation with saline and triamcinolone acetonide markedly reduced mucous plug discharge. Symptoms were controlled during 18 months of follow-up. Conclusions: Retained eosinophilic mucin in ES may appear as high-attenuation ductal material on CT and contribute to salivary stasis and sialolith formation.

Background and Clinical Significance: Eosinophilic sialodochitis (ES), also known as sialodochitis fibrinosa, is a rare disorder characterized by recurrent salivary gland swelling caused by intraductal eosinophilic mucous plugs. Typical histopathological findings include eosinophils and Charcot–Leyden crystals within ductal secretions, and characteristic imaging findings include salivary duct dilatation and glandular swelling. Although rare cases associated with sialolithiasis or calcification have been reported, high-attenuation material within the salivary duct on computed tomography (CT) has not been clearly described in ES. Case Presentation: A 56-year-old woman with allergic rhinitis presented with recurrent swelling and pain in the right submandibular area. CT and ultrasonography revealed a large sialolith in the right submandibular gland and dilatation of Wharton’s duct. She underwent right submandibular gland excision for presumed chronic submandibular sialadenitis with a sialolith. Soon after surgery, she developed recurrent swelling of the right floor of the mouth, and CT showed persistent high-attenuation material along Wharton’s duct without residual sialolith. Ductal mas-sage discharged a brownish gelatinous material. Histopathological examination revealed numerous eosinophils and Charcot–Leyden crystals in both the discharged mucous plug and decalcified sialolith, fulfilling Baer’s diagnostic criteria for ES. Physical extraction and anti-allergic medications were insufficient, whereas ductal irrigation with saline and triamcinolone acetonide markedly reduced mucous plug discharge. Symptoms were controlled during 18 months of follow-up. Conclusions: Retained eosinophilic mucin in ES may appear as high-attenuation ductal material on CT and contribute to salivary stasis and sialolith formation.

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with epithelial remodeling, impaired mucociliary clearance, and altered nitric oxide (NO) metabolism. However, cell type-specific mechanisms underlying epithelial NO signaling remain poorly understood. This study investigated NO-related signaling in differentiated human sinonasal epithelial cells. Methods: Human sinonasal tissues were obtained from patients with CRSwNP (n = 20) and control subjects (n = 20). Air–liquid interface (ALI) cultures were established from donor-derived epithelial cells. Ciliated and non-ciliated cells were identified by immunostaining for acetylated α-tubulin and BCAM. Expression of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) was analyzed by quantitative RT-PCR. Intracellular NO-related fluorescence signals were evaluated using DAF-FM fluorescence imaging. Results: CRSwNP tissues exhibited significantly increased iNOS expression and elevated iNOS/eNOS ratios, whereas eNOS expression did not differ significantly from that in controls. ALI cultures reproduced differentiated sinonasal epithelium containing both ciliated and non-ciliated cell populations. DAF-FM fluorescence signals were significantly higher in ciliated cells than in non-ciliated cells (80.3 ± 25.3 vs. 49.3 ± 21.1). Non-selective NOS inhibition markedly reduced fluorescence signals in both cell types, whereas selective iNOS inhibition reduced but did not abolish signals in ciliated cells. Conclusions: NO-related signaling appears to differ among epithelial cell subtypes. Persistence of fluorescence signals after selective iNOS inhibition suggests a contribution of constitutive NOS activity in ciliated cells, whereas non-ciliated cells appear to rely more heavily on iNOS-dependent pathways. These findings support the hypothesis that altered epithelial NO signaling contributes to epithelial dysfunction and impaired mucociliary homeostasis in CRSwNP.

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is charac-terized by epithelial remodeling, impaired mucociliary clearance, and altered nitric oxide (NO) metabolism. However, the cell type–specific mechanisms of NO production and the functional roles of nitric oxide synthase (NOS) isoforms in sinonasal epithelial cells remain unclear. This study investigated NO production dynamics in air–liquid in-terface (ALI) cultures of human sinonasal epithelial cells. Methods: Human sinonasal epithelial cells were differentiated under ALI conditions. Expression of inducible NOS (iNOS) and endothelial NOS (eNOS) was analyzed by quantitative RT-PCR. Intracellular NO production was evaluated using the NO-sensitive fluorescent probe DAF-FM com-bined with laser scanning confocal microscopy. Cell type–specific NO production was examined in ciliated and non-ciliated epithelial cells using the NOS inhibitors L-NAME and 1400W. Results: CRSwNP tissues demonstrated significantly increased iNOS ex-pression and elevated iNOS/eNOS ratios compared with controls, whereas eNOS ex-pression showed no significant difference. ALI cultures successfully reproduced dif-ferentiated sinonasal epithelium containing ciliated and basal cells. DAF-FM fluores-cence revealed significantly greater NO production in ciliated epithelial cells than in non-ciliated cells. Non-selective NOS inhibition by L-NAME markedly suppressed NO production in both cell types, whereas selective iNOS inhibition by 1400W reduced but did not abolish NO production in ciliated cells. Conclusions: NO production mecha-nisms differ according to sinonasal epithelial cell subtype. Ciliated epithelial cells maintain both eNOS- and iNOS-dependent NO production, whereas non-ciliated cells predominantly rely on iNOS-derived NO. Dysregulated spatial NO signaling associated with ciliated cell loss may contribute to epithelial dysfunction and chronic inflammation in CRSwNP.

Background: Eosinophilic chronic rhinosinusitis (ECRS) is characterized by refractory nasal polyps and severely impaired mucociliary clearance (MCC). The molecular mechanisms underlying the modulation of mucociliogenesis following IL-4/13 blockade with dupilumab remain poorly understood, notwithstanding its proven clinical efficacy. Methods: Bulk RNA Barcoding and sequencing (BRB-seq) was performed on nasal polyp tissues collected from healthy controls (n = 6), patients with non-ECRS (n = 8), and patients with ECRS both before and four weeks after dupilumab treatment (n = 9) to identify the early molecular drivers underlying ciliary regeneration. Comprehensive gene-set scoring systems were developed to evaluate multiciliogenesis master regulators, master regulators of core/ciliary planar cell polarity (PCP) and PCP components. Interaction scores for epithelial-derived cytokines—thymic stromal lymphopoietin (TSLP), IL-25, and IL-33—were calculated based on ligand and cognate receptor subunit expression. Results: The ciliary master regulatory hierarchy (e.g., FOXJ1, RFX2/3), PCP components (CELSR1 and the ciliogenesis and planar polarity effector (CPLANE) module: FUZ, INTU, WDPCP), and structural ciliogenesis pathways were robustly restored following IL-4/13 blockade. The TSLP interaction score correlated with global mucosal damage, serving as a trigger for compensatory multiciliogenesis. The pre-treatment IL-33 interaction score emerged as a significant predictor of transcriptomic ciliary recovery (p < 0.05). DNASE1L3—the primary endonuclease for degrading eosinophilic extracellular traps (EETs)—remained persistently downregulated post-treatment. Conclusions: IL-4/13 blockade successfully restores the structural and directional “hardware” of the respiratory epithelium but fails to rectify the enzymatic “software” required for mucus degradation. This “residual molecular scar” may explain the persistent mucus hyperviscosity observed in some ECRS patients even after clinical polyp resolution.

Backgrounds: Many reported rates of positive results by nicking enzyme amplification reaction (NEAR) applied together with the Abbott ID NOW™ COVID-19 (AIN) test and dry patient samples is lower than rates provided by other nucleic acid amplification tests. Few studies have used fresh samples, however. Methods: We conducted this retrospective study using fresh samples to determine the correlations among fever, associated symptoms, and the NEAR detection rate. Quarantined cases of suspected SARS-CoV-2 infection at Kunimoto ENT clinic (Jan 14, 2022–May 7, 2023) who had been in close contact with SARS-CoV-2-infected individuals were enrolled. Specimens were collected by the thin-diameter nasal sterile swab from the nasopharynx and examined immediately. We evaluated the positive-result rates, fever, and symptoms. Results: The total number of close-contact patients evaluated was 661 and AIN-positive cases was 427. The detection rate in the fever ≥37.4°C patients was 97% (257/266), significantly higher than the corresponding rate in the <37.4°C patients (170/395) (p<0.00001). The detection rate in the patients with ≤1 symptoms other than fever was 98% (394/402). Conclusions: These results suggest that the AIN results are sufficiently dependable when fresh samples are obtained from patients with a fever ≥37.4°C, and with more than one symptom.

Background: The nasal septal swell body (NSB) is a thickened area of the nasal septum with erectile tissues, located above the nasal floor. We hypothesized that the presence of the NSB in this space exerts favorable effects to generate laminar nasal airflow by developing its morphology as adjusted to nasal septal deviation (NSD). Patients and Methods: We objectively measured the NSB morphology in 152 patients by computed tomography (CT) and assessed its relationship with the width of the inferior turbinate (IT), the severity of NSD, and the patency of the nasal airflow passage (NAP). Results: In the patients with moderate or severe NSD, the mean widths of the NSB, IT, and NAP were significantly narrower at the convex side compared to the paired concave side, with the degree being more prominent in the severe-NSD group. A positive correlation was observed between the degree of the NSD angles and the difference in the widths of the NSB (r = 0.805) and IT (r = 0.609). Conclusions: These results imply novel roles of the NSB in the maintenance of physiological nasal airflow to generate a laminar airflow from the nostrils toward the middle nasal meatus at a constant rate.

Aural rehabilitation with hearing aids can decrease the attentional requirements of cognitive resources by amplifying deteriorated-frequency sound in hearing loss patients and improving auditory discrimination ability like speech-in-noise perception. As aural rehabilitation with an intelligible-hearing sound also can be hopeful, the aim of this study was to evaluate the effectiveness of aural rehabilitation with intelligible-hearing sound for hearing loss patients. Adult native Japanese speakers (17 males and 23 females, 68.43 ± 9.23 years) with hearing thresholds exceeding 30 dB at any of the following frequencies: 125, 250, 500, 1000, 2000, 3000, 4000, 8000, 10,000, and 12,000 Hz in either ear, were recruited. on any side were recruited and underwent the Mini-Mental State Examination Japanese. We conducted a self-evaluation questionnaire for hearing problems of voice, a gap detection test, a fast speech test, a speech-in-noise test, a pure tone audiogram, and a speech perception test using a Japanese 67-S, cortical auditory-evoked fields, and magnetic mismatch negativity before and after the non-intelligible-hearing (N = 20) and intelligible-hearing (N = 20) sound therapy, which involved listening to music for one hour a day for 35 days. The better hearing ear was defined using a four-frequency pure-tone average at the thresholds of 500, 1000, 2000, and 4000 Hz. After the sound therapy, the speech-in-noise test with a signal-to-noise ratio +10 in the better hearing ear showed significant improvement (p < 0.05), and N1m-P2m amplitudes showed a significant increase in the Lt superior temporal gyrus in response to the stimulus from the better hearing ear (p < 0.05). A significant enhancement of the magnetic mismatch negativity amplitude at the Lt superior temporal gyrus was exhibited after the sound therapy (p < 0.01). Intelligible-hearing sound therapy can improve the ability of speech-in-noise perception in the better hearing ear and enhancement of central cortex response, which reflects the ability of working memory, was proved by cortical auditory-evoked fields and magnetic mismatch negativity. Intelligible-hearing sound therapy can be a valuable aural rehabilitation method for sensory neural hearing loss, the same as hearing aids.

The planar cell polarity (PCP) of epithelial ciliated cells is essential for effective mucociliary clearance (MCC) in the sinonasal mucosa. We hypothesize that MCC coordination is impaired in nasal polyp (NP) mucosae due to the suppressed expression of a series of CPLANE (ciliogenesis and planar cell polarity effector) complex proteins in chronic rhinosinusitis (CRS) patients. To investigate this hypothesis, we subjected sinonasal mucosal samples to live video recording to measure mucociliary transport velocity (MCTV) and scanning electron microscopy to evaluate surface morphology. The expression and distribution of a panel of PCP proteins, e.g., WDPCP and FUZ, were investigated in relation to inflammatory cytokine levels and clinical features. The mean MCTV of NP mucosae was significantly lower than that of the inferior turbinate mucosae. The CRS group with NPs (CRSwNP group) (n = 28) showed increased expression of IL-13 and CCL26 mRNA compared to CRS patients without NPs (n = 25) and controls (n = 30). WDPCP and FUZ mRNA levels were significantly decreased in NP mucosae compared to ethmoid sinus mucosae in CRSwNP patients. WDPCP protein distribution was reduced in the cytoplasmic region of ciliated cells in CRSwNP patients. We conclude that suppression of WDPCP in ciliated cells is responsible for the impaired MCC of nasal polyps with type-2 inflammation. This mechanism might explain the decreased clearance and the potential for worsening symptoms of CRSwNP.

The planar cell polarity (PCP) of epithelial ciliated cells is essential for effective mucociliary clearance (MCC) in the sinonasal mucosa. We hypothesize that MCC coordination is impaired in nasal polyp (NP) mucosae due to suppressed expression of a series of CPLANE (ciliogenesis and planar cell polarity effector) complex proteins in chronic rhinosinusitis (CRS) patients. To inves-tigate this hypothesis, we subjected sinonasal mucosal samples to live video recording to measure mucociliary transport velocity (MCTV) and scanning electron microscopy to evaluate surface morphology. The expression and distribution of a panel of PCP proteins, e.g. WDPCP and FUZ, were investigated in relation to inflammatory cytokine levels and clinical features. The mean MCTV of NP mucosae was significantly lower than that of the inferior turbinate mucosae. The CRS group with NPs (CRSwNP group) (n=28) showed increased expression of IL-13 and CCL26 mRNA compared to CRS patients without NPs (n=25) and controls (n=30). WDPCP and FUZ mRNA levels were significantly decreased in NP mucosae compared to ethmoid sinus mucosae in CRSwNP patients. WDPCP protein distribution was reduced in the cytoplasmic region of ciliated cells in CRSwNP patients. We conclude that suppression of WDPCP in ciliated cells is responsible for the impaired MCC of nasal polyps with type-2 inflammation. This mechanism might explain the decreased clearance and the potential for worsening symptoms of CRSwNP.