Granulocyte Protease Inhibition in Acute and Chronic Middle Ear Effusion

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Abstract
A comparative study was made of granulocyte proteases and protease inhibitors in middle ear effusions (MEE) from patients with acute otitis media (OMA) and serous otitis media (SOM). The mean concentrations of the granulocyte proteases, neutral protease and elastase were three- to fourfold higher in OMA as compared to SOM effusions. The mean concentration of granulocyte elastase in SOM effusions was approximately 1 400, and in OMA effusions 5 500 times higher than the corresponding plasma concentrations. In OMA patients the individual MEE/plasma ratios of the main plasma protease inhibitors, a-antitrypsin, antichymotrypsin and a2-mac-roglobulin, showed a positive uniform correlation with corresponding albumin MEE/plasma ratios. In SOM effusions, the concentration of a2-macroglobulin was low, indicating a restricted membrane passage in SOM. In SOM effusions both a-antitrypsin and the locally produced antileukoprotease showed a residual inhibitory capacity. In OMA effusions the inhibitory capacity of antileukoprotease was saturated, whereas there was a residual inhibitory capacity of cti-antitrypsin. However, in those OMA effusions, where large amounts of arantitrypsin complexes with granulocyte proteases were found, most of the remaining free a-antitrypsin was inactive.