A 40-year-old woman acutely developed an unsteady gait, vertigo, and tinnitus in the left ear one week after an upper respiratory tract infection. A neurological examination revealed severe gait ataxia and a mild lack of coordination in the left limbs. No gaze nystagmus, saccadic pursuit, ocular dysmetria or dysarthria were seen. The examination of cerebrospinal fluid was unremarkable. Repeated cranial MRI studies with Gd-infusion showed no abnormalities, thus suggesting that multiple sclerosis and an occlusion of the anterior inferior cerebellar artery to be highly unlikely. Pure-tone audiometry demonstrated neural deafness in the left ear. The auditory-evoked brainstem response demonstrated a prolongation of the I-III interpeak latency, thus suggesting a lesion within the left lower pons. This case suggests that acute cerebellitis can cause vertigo with unilateral neural deanfness.

View full abstract

Relapsing polychondritis (RPC) is a disorder characterized by inflammation and the destruction of the cartilaginous structures of multiple organs. The six typical diagnostic signs are bilateral auricular chondritis, nonerosive sero-negative inflammatory polyarthritis, nasal chondritis, ocular inflammation, respiratory tract chondritis and audiovestibular damage. We herein report three cases who were refrred to us for either auricular chondritis or respiratory tract chondritis. McAdam's criteria for diagnosing RPC (three or more out of six signs are needed) is reliable, but it sometimes takes a long time to make diagnosis. Daminani's expanded criteria for an early diagnosis of RPC are, therefore, considered to be beneficial. Tracheoplasty using silicon block was performed in one case and her airway has since maintained an adequate size.

View full abstract

We examined positional nystagmus in 16 patients with benign paroxysmal positional vertigo of the horizontal canal (HC-BPPV), using an infrared CCD camera. Of all 16 patients who had horizontal direction changing positional nystagmus with paroxysmal vertigo, geotropic type positional nystagmus was observed in 13 and apogeotropic type in 3. Ten of 16 patients underwent caloric tests under the ENG recordings. Canal paresis (CP) was recognized in 8 of 10 patients. Positional nystagmus and vertigo were more intense with the CP side down in geotropic type and with the CP side up in apogeotropic type. The direction changing geotropic positional nystagmus in our patients had a shorter latency, longer duration and less fatiguability compared with the positional nystagmus of the posterior canal BPPV. These features correspond to those of positional nystagmus in patients with HC-BPPV as previously reported. Fifteen patients were treated by Lempert's positional procedure and 73% of the patients recovered after a single treatment.

View full abstract

A case demonstrating a huge pleomorphic adenoma of the parotid gland is reported. The patient was a 55-year-old female who complained of palpitation, hypertension and a right cervical mass. The abnormal circulatory findings were not definitely confirmed by the preoperative laboratory date. However, the symptoms markedly improved after a parotidectomy. These findings suggest that a huge mass pressed against the common carotid artery which resulted in a reduced blood flow at the carotid sinus and thus inducing palpitation and hypertension through the baroreflex.

View full abstract

Several surgical techniques such as transmaxillary, transpalatal as well as a combination of both approaches have been used for the treatment of epipharyngeal angiofibroma. However, major complications such as palatal fistula and/or an insufficient epipharyngeal closure after surgery when using the transpalatal approach have been frequently reported. We therefore designed a modified approach for the transpalatal technique. The aim of this technique is to prevent the occurrence of complications by means of a palatal bone reconstruction during surgery. A representative case is herein presented. A 15- year-old boy was diagnosed to have angiofibroma of the epipharynx. The tumor was completely removed using this technique. He has been doing well without any complications after surgery. We therefore recommend a modified transpalatal technique for the treatment of epipharyngeal masses.

View full abstract

We classified patients complaining of dry mouth according to 4 items, including: the frequency of experiencing dry mouth, the degree of the disturbance on the patient's daily life, sings of oral mucosa on inspection and the function of the salivary gland. The function of the salivary gland was evaluated by synthesizing the total volume of saliva at rest and under stimulation, and the function of the lower lip salivar gland. Some patients complain of dry mouth even though the function of their salivary gland was normal. The relationship between feeling dry mouth and the function of the salivary gland is therefore not always simple. The main purpose of establishing such a classification system was to describe this medical problem both clearly and simply, and in order to determine the appropriate treatment and also follow the course. When investigating these 4 items, some patients were diagnosed to have an abnormal sensation in the mouth because the oral mucosa on inspection tended to be regarded as slight, and such findings were insufficient to prove their symptoms. We therefore consider that at least an examination of the salivary gland function is necessary for patients who complain of dry mouth.

View full abstract

In 1976, Lindeman proposed a new surgical method called “Tracheo-Esophageal Anastomosis” to treat long-standing dysphasia. This method had been thought to be reversible in terms of phonatory function, although no one has yet proved its reversibility in an actual case. We herein describe a case in which we succeeded in releasing the site of “Tracheo-Esophageal Anastomosis” in a case of unilateral piriform sinus cancer, while removing the tumor and also simultaneously performing a pharyngo-laryngeal reconstruction and tracheo-esophageal anastomosis. Lindeman's method was used to allow the patient to more quickly return to a normal lifestyle. The findings of this case are therefore considered to prove the reversibility of Lindeman's method regarding phonatory function.

View full abstract

The cases of pharyngocutaneous fistula after a total laryngectomy were analyzed in patients with laryngeal cancer treated at the Liaoning Provincial Tumor hospital in China and the Kyusyu Cancer Center hospital in Japan. The patients who underwent a total laryngectomy consisted of 145 males and 128 females at the Liaoning Provincial Tumor hospital, and 169 males and 12 females at the Kyusyu cancer Center hospital. A total of 45 patients (16.5%) at the Liaoning Provincial Tumor hospital and 35 patients (19.3%) at the Kyusyu Cancer Center hospital developed postoperative fistula. The present study demonstrates the following characteristic data for the Liaoning Provincial Tumor hospital: the male- to- f emale ratio of the patients undergoing a total laryngectomy was about 1:1 (145:128) ; a large number of female patients had supraglottic cancer, and there was a paucity of irradiated cases. The incidence of fistula of fistula was higher in the patients with stage III and IV supraglottic cancer and the age of such patients tended to range from 50 to 70. The preoperatively irradiated patients showed a high frequency of pharyngocutaneous fistula (42.9%, 15/35), which often required a surgical closure. Our study reveals the differences in the therapy and etiology of laryngeal cancer at both hospitals, and preoperative radiotherapy appears to be the most important factor influencing fistula formation, while it also affects the treatment of fistula.

View full abstract

The influence of swimming on nasal allergy was assessed by questionnaire in 52 cases of nasal allergy and 39 healthy individuals, who regularly went swimming. Most of the cases swam for 1 hour a week. In the nasal allergy group, 13.4% of the cases showed an improvement in the clinical symptoms, and 67.3% showed no remarkable changes. The nasal conditions deteriorated in less than 20% of the cases, most of whom showed only mild changes. Similar results were also observed in the control group. Further investigations are thus needed to evaluate the effect of swimming on nasal allergy.

View full abstract

In an epidemiological study, we examined the prevalence rate and aggravating factors of nasal allergy in the students of our division from 1995 to 1998 by questionnaire. We questioned the students regarding the symptoms of nasal allergy (itching, sneezing, nasal discharge and nasal blockade). Any atopic diseased of the students and family members were included in the history. Ninety-two out of 254 students (36.2%) had symptoms considered to qualify as nasal allergy. In the allergic group, 55.4% of the students showed a perennial pattern and 32.6% showed a seasonal pattern and another 12% showed both patterns. The positive rate of eye symptoms was significantly higher in the seasonal pattern students. There were several differences in the aggravating factors according to the seasonality attack. It was interesting to note that 63.3% of the students with a seasonal pattern, so-called pollinosis, has already consulted with medical doctors, on the other hand, only 38.8% of those with a perennial pattern had visited a doctor.

View full abstract

The post-operative quality of life (QOL) was studied using a questionaire survey for patients with maxillary sinus carcinoma. Nasal rhinanometry and olfactometry were performed to qualify the nasal function after reconstructive surgery. A total resection of the maxilla with an orbital resection was done in 3 patients, a total resection without an orbital resection in 2 patients, and a partial resection in 8 patients. All patients received reconstructive surgery of the maxilla with a free flap using the latissimus dorsi muscle and rib. The free bone flap of the scapula with the same consecutive vascular pedicle was also used for some patients. Seven patients received chemo - radiotherapy with intra-tumor mass reductive surgery. A questionnaire survey proved the health condition to be better for the patients with a partial resection or chemo - radiotherapy than for the patients receiving a total maxillectomy. However, patients who received a total maxillectomy without an orbital resection also showed favorable results. The cosmetic quality was better for patients with a total maxillectomy than for patients with chemo-radiotehrapy who complained of facial scar formation after radiotherapy and mass reductive surgery. Rhinanometry showed no patients to have any nasal obstruction after reconstructive surgery. An olfactometer showed the olfactory function to be well preserved except in the patients who underwent a total maxillectomy and an orbital resection. Based on these findings, reconstructive surgery with a free flap after a maxillectomy was shown to successfully maintain the QOL of these patients.

View full abstract

Endolymphatic hydrops and some blood circulation disorders in the inner ear have been frequently proposed as the mechanism for sudden low frequency sensorineural hearing loss. In a case of endolym- phatic hydrops the following three hypotheses have already been presented as follows: 1) mechanical changes in the vibration of the basilar membrane caused by high endolymphatic pressure. 2) osmolarity changes in the inner ear fluid. 3) the effect of high K+ in the perilymph leaking out from the endolymph. The appropriateness of these hypotheses are discussed. The two fomer points seem acceptable. Regarding blood circulation disorders, in the inner ear, a blockage of the external radiating artery, which thus reduces the magnitude of the endocochlear dc potential has been suggested. These above mentioned abnormalities cause a dysfunction in the outer hair cells of the upper cochlea which therefore may be the mechanism of sudden low frequency sensorineural hearing loss.

View full abstract

Based on personal investigation on the systematic evolution of the larynx, the author has classified the laryngeal physiology, including the basic and articular or phonetic component. 1. The laryngeal physiology at the end of laryngeal evolution developed an antagonistic physiology with the contraction adductor and abductor systems at the same time. It is thus called, basic physiology. 2. The basic physiology is a condition of laryngeal spasmus. Therefore, both adductor and abductor systems are relaxed. As a result, the vocal cords take on a middle position. 3. The articular physiology, since the vocal cords are in the midlle position, in which of the adductor or abductor is on the moving side and one of them controls another on the unmoving side in line with the central nerve, thus phonetic physiology comes into existence. 4. Regarding honetic physiology, first the adductor (by action of internal and lateralis) controls abductor. The arytenoid cartilage rotated inside. In addition to that, by action of ventralis the vocal cord extends and occures “point of power” at the processus vocalis. Moreover, the arytenoid cartilage and articulation are fixed by the transverse. Thus, phonetic physiology comes into existence. 5. In this vestigation, the justification of local theory of the phonation was confirmed with an analysis of the electromyograph.

View full abstract