[in Japanese]

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[in Japanese]

View full abstract

[in Japanese]

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[in Japanese]

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　A variety of microbial communities exists in the human body known as the microbiome. There are mutual benefits for the host and microbes, which have a role as a barrier against potential pathogens. In turn, microbes are provided with nutrients from the host. Advances in sequencing technologies and new bioinformatics developments enabled us to further investigate the role of the microbiome in both of human health and disease such as obesity and autoimmune disease. The human palatine tonsils are the first handling sites for microbial and environmental antigens and are also the focus and entry sites for infections. It is hypothesized that changes in the bacterial diversity of the palatine tonsils would be associated with a development of disease such as focal tonsillar infection. To obtain a basic data as a control to understand the mechanisms of disease development, we investigated the diversity of the tonsillar microbiome in children without infection using a 16S rRNA analysis. Results were compared with those obtained by the bacterial culture. The most abundant species was Haemophilius followed by Sphingomonas, and anaerobes like Prevotella and Fusobacterium. These results were not consistent with previous results by Jensen et al. It is suggested that tonsillar microbes were remarkably different between the countries as shown in other organs. Differences in diet, environment, host genetics, and early microbial exposure may account for this result. On the other hand, anaerobes like Prevotella and Fusobacterium were not abundant from bacterial culture. The present PCR-based 16S rRNA analysis was able to detect microbes that are not easily cultured. Attention should be paid that anaerobes may have a role in tonsillar infection even in children. In future studies, diversity of microbes in adults and patients with focal infection of the tonsils should be examined.

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　OBJECTIVE: To study and compare the objective benefits of VIBRANT SOUNDBRIDGE^® (VSB) in patients with mixed and conductive hearing loss by disease category.
　METHODS: Two different groups were evaluated: 1) twenty cases of middle ear disease and 2) three patients with congenital aural atresia. Preoperative and postoperative aided and unaided free-field audiometry and speech recognition in quiet and noise were used to assess the hearing outcome.
　RESULTS: There was no change in residual hearing before and after surgery. Average functional gain including speech range from 1,000 Hz to 4,000 Hz was 35 dB in the middle ear disease group, and 50 dB in the congenital aural atresia group. The speech recognition score under quiet and noisy conditions improved significantly in both groups. Reoperations were performed to correct the gap between the FMT and round window membrane in two cases in the middle ear disease group.
　Conclusion: VSB operation with a round window vibroplasty is a safe and effective procedure for any disease with mixed and conductive hearing loss.

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　In Japan, the “First edition of Clinical practice guidelines for the diagnosis and management of acute otitis media (AOM) in children in Japan” was published in 2006. Three novel antibiotic drags (CVA/AMPC, TBPM-PI, and TFLX) were placed on the market from 2006 to 2010, and the protein-conjugated pneumococcal vaccine (PCV) was introduced in 2010. The objective of this study was to assess the current incidence of intractable AOM in young children. The subjects were 204 patients (age 0 to 5, 124 boys, 80 girls) who were hospitalized in the Department of Otorhinolaryngology of National Mie Hospital between January 2000 and December 2014 because of AOM. We conducted a retrospective study of the charts of these patients. Fifty patients who underwent ventilation tube insertion (VTI) due to recurrent otitis media in the same period were also analyzed. In the patients hospitalized because of AOM, 58.8% of them were one-year old children and 87.8% were in day care and/or had siblings. Between 2000 and 2014, which was divided into three periods (2000-2005, 2006-2010, and 2011-2014), the number of inpatients significantly decreased. Children aged one and two years admitted to the hospital also significantly decreased. The number of Streptococcus pneumoniae isolated from the middle ear or nasopharynx significantly decreased during the same periods. There were no significant changes in the number of Haemophilus influenzae. The number of patients who underwent VTI did not significantly decrease during the study period. We conclude that intractable AOM in young children is decreasing rapidly in these past several years. There is a possibility that the newly developed antibiotics and PCV are playing an important role in the decline.

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