Ultrastructure of mucous blanket in otitis media with effusion

[The modern approaches to the evaluation of the importance of chronic inflammation in the mucous membrane of the middle ear]

Despite the ever growing progress in antibiotic therapy and the advent of the new methods for this purpose, the number of patients suffering from chronic focal infection of the ENT organs has not decreased during the last decades which turns the problem of chronization of inflammation into a serious challenge for the physicians as exemplified by chronic inflammation in the mucous membrane of the middle ear. Pathological changes in the middle ear make up a large fraction of ENT diseases of importance not only for otorhinolaryngologists but also for the specialists in the related medical disciplines. The present article is an overview of etiological, pathogenetic, and pathomorphological aspects of chronization of the inflammation process that are known to occur in the mucous membrane of the middle ear. In the overwhelming majority of the cases, the main cause of the conversion of acute inflammation in the middle ear into the chronic condition is the inadequate (incorrect), inopportune or incomplete treatment of the acute inflammatory process in the middle ear.

Mouse middle ear ion homeostasis channels and intercellular junctions

Hypothesis

The middle ear contains homeostatic mechanisms that control the movement of ions and fluids similar to those present in the inner ear, and are altered during inflammation.

Background

The normal middle ear cavity is fluid-free and air-filled to allow for effective sound transmission. Within the inner ear, the regulation of fluid and ion movement is essential for normal auditory and vestibular function. The same ion and fluid channels active in the inner ear may have similar roles with fluid regulation in the middle ear.

Methods

Middle and inner ears from BALB/c mice were processed for immunohistochemistry of 10 specific ion homeostasis factors to determine if similar transport and barrier mechanisms are present in the tympanic cavity. Examination also was made of BALB/c mice middle ears after transtympanic injection with heat-killed Haemophilus influenza to determine if these channels are impacted by inflammation.

Results

The most prominent ion channels in the middle ear included aquaporins 1, 4 and 5, claudin 3, ENaC and Na⁺,K⁺-ATPase. Moderate staining was found for GJB2, KCNJ10 and KCNQ1. The inflamed middle ear epithelium showed increased staining due to expected cellular hypertrophy. Localization of ion channels was preserved within the inflamed middle ear epithelium.

Conclusions

The middle ear epithelium is a dynamic environment with intrinsic mechanisms for the control of ion and water transport to keep the middle ear clear of fluids. Compromise of these processes during middle ear disease may underlie the accumulation of effusions and suggests they may be a therapeutic target for effusion control.

The role of inflammatory mediators in the pathogenesis of otitis media and sequelae

This review deals with the characteristics of various inflammatory mediators identified in the middle ear during otitis media and in cholesteatoma. The role of each inflammatory mediator in the pathogenesis of otitis media and cholesteatoma has been discussed. Further, the relation of each inflammatory mediator to the pathophysiology of the middle and inner ear along with its mechanisms of pathological change has been described. The mechanisms of hearing loss including sensorineural hearing loss (SNHL) as a sequela of otitis media are also discussed. The passage of inflammatory mediators through the round window membrane into the scala tympani is indicated. In an experimental animal model, an application of cytokines and lipopolysaccharide (LPS), a bacterial toxin, on the round window membrane induced sensorineural hearing loss as identified through auditory brainstem response threshold shifts. An increase in permeability of the blood-labyrinth barrier (BLB) was observed following application of these inflammatory mediators and LPS. The leakage of the blood components into the lateral wall of the cochlea through an increase in BLB permeability appears to be related to the sensorineural hearing loss by hindering K⁺ recycling through the lateral wall disrupting the ion homeostasis of the endolymph. Further studies on the roles of various inflammatory mediators and bacterial toxins in inducing the sensorineumral hearing loss in otitis media should be pursued.

The effect of changes in ambient oxygen concentration on the bioelectric properties of middle ear mucosa

The purpose of the present study was to compare the effect of 24 h of exposure to 7% O2 (normal middle ear physiological conditions) vs. 21% O2 (found in the middle ear after ventilation tube placement) on transepithelial Na+ absorption and Cl- secretion in cultured gerbil middle ear epithelial cell monolayers. Although no difference in apical Na+ absorption was identified, the UTP-induced stimulation of apical Cl- secretion in the presence of apical Na+ channel blockade with amiloride was significantly enhanced after exposure to 21% O2 compared with 7% O2 exposure. In the presence of a calcium-activated Cl- channel inhibitor, DIDS, UTP-induced stimulation of Cl- secretion after 21% O2 exposure was decreased, suggesting a role for calcium-activated Cl- channels in middle ear Cl- secretion in response to relative hyperoxia.

The aetiology of otitis media with effusion: a review

Otitis media with effusion (OME) is the most common cause of deafness in children in the developed world. In this article we aim to present an overview of current research developments on the aetiology of OME and the resulting implications for treatment. In the model we describe, the primary event is inflammation of the middle ear mucosa, usually due to the presence of bacteria. This leads to the release of inflammatory mediators, which cause secretion of a mucin-rich effusion by up-regulating mucin genes. Prolonged stimulation of the inflammatory response and poor mucociliary clearance lead to persistence of the middle ear fluid, giving rise to the clinical presentation of OME. We describe OME in the following sequence: the initial production of the effusion, the composition of the effusion produced, and factors impairing clearance of the effusion.

A2 adenosine receptors in Mongolian gerbil middle ear epithelium and their regulation of Cl- secretion

The present study investigates the effects of adenosine and its analogues on Cl- secretion in primary cultures of gerbil middle ear epithelium. Short-circuit current (Isc), an index of transepithelial active transport, was measured on the same cells cultured on porous filters. Baseline Isc and transepithelial resistance were 27.0 +/- 0.7 microA cm-2 and 275 +/- 7 omega cm2, respectively (n = 178). Extracellular adenosine and its analogues elicited a sustained increase in Isc when added to apical or basolateral surfaces. Both the A2A selective agonist 2-p-(2-carboxyethyl)phenethylamino-5'-N-ethylcarboxamido adenosine and the A2A/A2B nonselective agonist 5'-(N-ethyl-carboxamido)adenosine (NECA) increased Isc, but NECA was more effective than CGS21680. A1 selective antagonist 8-cyclopentyl-1,3-dipropylxanthine did not reduce NECA-induced Isc. These results suggest the presence of both A2A and A2B receptors. NECA did not stimulate a rise in the intracellular Ca2+ concentration ([Ca2+]i) in single middle ear epithelial cells cultured on glass coverslips. Dibutyryl cAMP (dbcAMP) induced an initial transient increase in Isc followed by the sustained plateau. Addition of dbcAMP also caused a transient increase in [Ca2+]i. The protein kinase A inhibitor, N-[2-(p-bromocinnamylamino)ethyl]-5-isoquinolinesulfonamide, greatly reduced the increase in the Isc responses to NECA. 1,2-Bis-(2-aminophenoxy)ethane N,N,N',N'-tetraacetic acid-acetoxymethyl ester influenced neither the NECA-induced increase in Isc nor the dbcAMP-induced sustained phase of Isc, but greatly inhibited the dbcAMP-induced transient increase in Isc. Glibenclamide, a cystic fibrosis transmembrane conductance regulator (CFTR) channel inhibitor, reduced the NECA-induced Isc. These results indicate that extracellular adenosine and its analogues activate the cAMP-protein kinase A system, but not intracellular Ca(2+)-dependent mechanisms, leading to Cl- secretion, possibly through the CFTR Cl- channels in the cultured gerbil middle ear epithelium.

Video-microscopy for analysis of molecular dynamics in cells

Real-time analysis of molecular dynamics in living cells was studied by developed video-microscopes. Two new detective methods were reported, one is for analysis of ciliary movement and the other is the qualitative analysis of exocytosis of insulin-containing granules with a video-enhanced light/fluorescent microscope. For analysis of ciliary movement, glass beads were migrated in the flow. The migration speed parallel to the flow produced by ciliary beating was used as an index of the beating activity. When tracheal epithelium isolated from mouse was incubated with ambroxol, and expectorant known to activate ciliary beat frequency, the floating speeds of glass beads were changed with 1 min of incubation. The results suggest that the present method is useful not only for screening of expectorants but also for the study of molecular mechanisms underlying ciliary beat of tracheal epithelium. Visualization of the moment of the release of contents from insulin-containing granules was achieved using video-enhanced fluorescent microscopy in MIN6 cells of mouse insulinoma cell line. A fluorescent amino acridine dye, quinacrine, was found to be incorporated into low-pH secretory granules, including insulin, in the cells. The granules which incorporated quinacrine emitted a slightly blue-green fluorescence. Upon stimulation with glucose, release of the quinacrine fluorescence from granules were observed. The present method would be useful for quantitative analysis of secretion of insulin from MIN6 cells as well as pancreatic beta-cells.

Cell-surface glycoconjugate layer in the tubotympanic mucosa of the guinea pig as revealed by wheat germ agglutinin/gold labelling

To evaluate the protective function of the mucous blanket (MB) against lectin substances, we examined at the ultrastructural level whether intraluminal colloidal gold-labelled wheat germ agglutinin (WGA) could enter the MB-covered epithelial cell surface of the guinea pig tubotympanic mucosa. Post-embedding staining with WGA/gold on thin tissue sections was done in parallel for comparison. The cell surface glycoconjugate of the eustachian tubal and transitional epithelium had a typical bilayered structure: the outer MB and the microvilli-associated glycocalyx (MAG), which were interposed by the interciliary fluid zone. In squamous epithelium of the distal middle ear, the MB adhered to the MAG, thereby forming a monolayered coat of glycoconjugates at the cell surface. In the pre-embedding staining, WGA/gold did not bind with the MB and MAG in the eustachian tube, and exclusively bound with MB in the transitional area. Direct binding was also found with MAG and the apical plasmic membrane in the squamous epithelium. These findings indicate that MAG is occluded by MB lined with the interciliary fluid zone for luminal access of lectin at the proximal lumina of the tubotympanic epithelium. It is also suggested that MB existing at two sites possesses a different WGA-binding capacity: shielding as a "dust cover" in the eustachian tube and entrapping as a "flypaper" against lectin in the transitional area of the middle ear.

Pathophysiology of middle ear epithelium: a new role for prostaglandin E2

INTRODUCTION

Otitis media with effusion is a disease of the middle ear epithelium resulting from a decreased sol layer as well as increased mucus secretion and plasma-derived protein transudation, which causes mucus plugging. Because the epithelium keeps the middle ear cavities fluid-free and air-filled, we investigated its fluid transport capacities, which may be involved in both efficacy of the mucociliary clearance and drying-out of the posterior ear cavities (Yen PT et al: Acta Otolaryngol (Stockh) 113, 1993). We have established the absorptive capacity of middle ear epithelial cells in primary culture (Herman P, et al: Am J Physiol 262, 1992). However, the paucity of cells obtained by enzymatic digestion led us to develop a new model for further investigation of middle ear epithelial cell.

METHODS

We established a middle ear cell line (MESV) using simian virus 40 (SV40) infection of middle ear epithelial cells from the Mongolian gerbil.

RESULTS

Investigation of the transport processes using the short-circuit current technique showed that MESV cells retain most characteristics of the original middle ear epithelial cells. Transepithelial sodium transport from the apical to the basal side was responsible for the transepithelial lumen-negative potential difference.

CONCLUSION

The presence of high concentrations of prostaglandin E2 in the middle ear effusions has been documented. This work investigates the effect of prostaglandin E2 on the rate of transepithelial ion transport of MESV cells. Prostaglandin E2 increased the rate of electrogenic sodium transport by means of increase in the intracellular cyclic adenosine monophosphate (cAMP) content. Such a modulation of sodium transport in the course of otitis media could be responsible for the reduced periciliary sol layer that impairs the mucociliary clearance.

Ion transport processes and middle ear physiopathology. An experimental approach using cell culture

The role of the middle ear (ME) epithelium is primarily to keep the cavities air-filled and fluid-free. This condition requires elimination of mucus and cellular debris from the tympanic cavity by the ciliary activity. This clearance activity may be related to active ion transport processes in the epithelium. This paper presents a review of the experimental data suggesting the existence of ion transports in ME, and demonstrating the contribution of the culture of ME epithelial cells to the investigation of ion transport properties. Primary cultures of ME epithelial cells from Mongolian gerbils (Meriones unguiculatus) were undertaken. Polarized monolayers exhibited domes on non-porous supports. On porous supports, the absorptive function was shown to be related to a Na+ absorption from apical to basal sides of the epithelium, by means of apical amiloride-sensitive Na+ channels and basolateral Na+, K(+)-ATPase. In turn, this sodium absorption would generate an osmotic gradient and drive a water flow. An amiloride-induced chloride transport is also suggested. A hormonal modulation of these ion transport properties might play a role in the development of the mucociliary impairment that initiates chronic otitis media. The establishment of a middle ea cell line using wild-type SV 40 infection is in progress. This might provide further information on the physiology of the ME.

Glycoconjugates in the chinchilla tubotympanum

Various biotinylated lectins were used to characterize and semiquantitate glycoconjugate residues in the tubotympanum. Epithelial goblet cells were stained predominantly by WGA, LFA, SNA, RCA-I, Con-A, LCA, SBA, PHA-E, and UEA; this finding suggests they contain alpha-neuraminic acid, beta-galactose, alpha-mannose, N-acetyl alpha-galactosamine, and alpha-fucose. Glandular mucous cells were stained predominantly by WGA, LFA, SNA, and RCA-I; this finding suggests that they contain alpha-neuraminic acid and beta-galactose. The glandular serous cells were stained predominantly by Con-A, WGA, and LFA; this finding suggests that they produced alpha-mannose and alpha-neuraminic acid that represented serum-type glycoprotein. The positive staining of epithelial goblet cells and glandular mucous cells with PNA after neuraminidase digestion suggests that they produced mucin-type glycoproteins. The staining of the mucous blanket by WGA, LFA, SNA, RCA-I, LCA, PNA, SBA, PHA-E, and UEA suggests the presence of alpha-neuraminic acid, beta-galactose, N-acetyl alpha-galactosamine, and alpha-fucose. The epithelial cell (nonsecretory) surface was stained largely by WGA, LFA, SNA, RCA-I, Con-A, and LCA; this finding suggests the presence of alpha-neuraminic acid, beta-galactose, and alpha-mannose.

Effects of endotoxin and neutrophil lysate on experimental otitis media with effusion in cats

Middle ear effusion (MEE) from otitis media with effusion (OME) contains large amounts of chemical mediators and substances from bacteria, which may act on the mucosa itself and cause further changes in the inflamed mucosa and MEE. To clarify the effects of such substances in MEE, we instilled endotoxin (LPS) or allogeneic neutrophil lysate (NL) into the middle ear cavity of OME induced by Eustachian tube obstruction (ETO). ETO + LPS and ETO + NL groups showed retention of a large amount of MEE as a characteristic difference between ETO alone group and these groups. The instillation of LPS into the middle ear cavity of the ETO model significantly increased the number of total cells and the ratio of the concentrations of albumin to total protein in MEEs. The instillation of NL significantly increased the number of goblet cells in the middle ear. These facts indicate that the pathology of OME may change in response to various factors added to MEE. Hence, we propose that a vicious circle of self-mediated inflammation is a possible causative factor for chronic OME.

Changes of middle ear mucosa in secretory otitis media treated with ventilation tubes

The present study was designed to obtain the precise ultrastructural status of the middle ear mucosa of patients to whom ventilation tubes were applied for the treatment of secretory otitis media (SOM). This study comprised 14 children with SOM aged 5-11. Normal epithelium obtained from otosclerotic patients as controls was composed of three main cell types; basal, ciliated, and secretory. Electron microscopic observations revealed that ciliated cells were almost completely absent in the epithelium of patients with SOM. Secretory cells, on the other hand, were noted to be increased in number with cytoplasmic features indicating active secretory phase; abundant secretory granules in these cells featured both serous and mucoid characteristics. Following the application of ventilation tubes, the micrographs exhibited a vast number of ciliated cells. Furthermore, the secretory cells were less conspicuous and the secretory granules were mostly serous in type. The ultrastructural findings of this investigation strongly suggest that the application of ventilation tubes in cases of SOM stimulates ciliated cell regeneration, inhibits secretion of mucoid material, and activates serous secretion; all of which eventually shorten the recovery period.

The effect of middle ear effusions from children on in vitro ciliary activity

In an attempt to clarify the effect of middle ear effusions (MEEs) on ciliary activity, the ciliary beat frequency (CBF) of nasal epithelium from normal subjects was determined following incubation in Hanks' solution containing effusions from pediatric otitis media with effusion. Both serous and mucoid types of effusions increased CBF 15 min after incubation. The mucoid type of effusion was then found to decrease CBF 6 h after incubation. Since the pH and osmotic pressure of the solution containing the effusions were within the physiological ranges for normal ciliary beating, our findings show that MEEs can influence CBF in vitro.

Nasal mucociliary clearance in Sjögren's syndrome. Dissociation in flow between sol and gel layers

Nasal mucociliary clearance was measured with two methods in 8 patients with Sjögren's syndrome and in 6 normal subjects. The movement of two different tracers placed 1.5 cm posterior to the inferior turbinate tip was measured respectively. The transport rate of a 500 microns anion resin particle tagged with 99mTc was measured. The clearance of 10 microliters saline labelled with 99mTc was monitored and the clearance rate was calculated. Whereas the measurement with the particle method revealed the lowered transport rate in Sjögren's syndrome, measurement with the saline method did not reveal any difference in clearance rate between the two groups. Since the former method measures the transport of particle in the gel phase (the outer mucous layer) and the latter measures the clearance of both gel and sol (periciliary fluid) layers, it is postulated that there is a dissociation of flow between sol and gel layers in Sjögren's syndrome.