We herein report the onset of transient bilateral hearing loss in a patient which occurred after undergoing spinal anaesthesia. A 52-yaer-old female underwent lumbar anaesthesia for surgery on a fracture in her left patella. The next day, she had headache and on the third postoperative day she complained of bilateral tinnitus and earfullness. A pure tone audiogram on the fourth postoperative day revealed a binlateral sensorineural hearing loss in the low frequency range. A few days after medication was started, her hearing returned to normal. It has been suggested that hearing loss such as that seen in this case is due to cerebrospinal hypotonia, which is similar to headache symptoms which sometimes occur following a lumbar puncture due to a loss of cerebrospinal fluid. Such cerebrospinal hypotonia causes perilymphatic hypotonia by way of the cochlear aqueduct and then relative endolymphatic hypertonia. Low tone hearing loss is likely caused by mimicking endolymphatic hydrops due to perilymphatic hypotonia. A wide cochlear aqueduct has been reported to be related to this mechanism. However, a wide cochlear aqueduct was not found in this case based on high-resolution CT scans and few other studies have reported a wide cochlear aqueduct to be related to the onset of transient hearing loss following a lumbar puncture. We therefore conclude that such a relationship remains unclear and further study is called for to elucidate this hypothesis.

View full abstract

A patient with a parathyroid adenoma showing primary hyperparathyroidism who underwent a removal of one enlarged parathyroid gland with a minimally invasive incision by intra-operative intact-PTH monitoring is reported. A 57-year-old male developed increased serum calcium, alkali phosphatase, and parathyroid hormones and thus was diagnosed to have primary hyperparathyroidism. ECHO, CT and an MIBI scintigram suggested an adenoma in the right-lower parathyroid gland. The enlarged right-lower parathyroid was surgically removed with a minimally invasive neck incision and the serum intact-PTH was simultaneously measured by an immune-electro-fluorescence assay. At 10 minutes after the removal of the right-lower parathyroid, the intact-PTH level was found to have decreased to 67% of the preremoval level. As a result, the surgery was completed without exploring any other glands. The pathological diagnosis was parathyroid adenoma and the patient achieved normocalcemia. lntraoperative intact-PTH monitoring is thus considered to be very useful for the successful treatment of pHPT by means of minimally invasive surgery.

View full abstract

To clarify the effectiveness of cetirizine prophylactic treatment for the health related QOL of cedar pollinosis patients, we conducted this study using SF-36 during the peak pollen season. Summary scores for PCS and MCS were calculated and an Automatic Interaction Detector (AID) analysis was performed to classify the cetirizine treated patients into high and low PCS and MCS groups. The results showed the PCS score to be higher than average for the group of male office workers/government employees, and lower than average for females 50 years of age or older who had frequent ocular itching. The MCS score was higher than average for the group of males who had occasional ocular itching and no nasal obstruction, but lower than average for the group of males who had more than occasional itching and who also blew their noses more than 11 times per day. We thus found the AID analysis to be effective for accurately classifying ceterizine treated patients into high and low PCS and MCS summary score groups.

View full abstract

We recoded snoring sounds of patients who attended our hospital with snoring as the chief complaint at the same time as carrying out polysomnography throughout the night, and analyzed the sound wave of the snoring sounds. We examined cases of adults and children. There were 10 adult cases where the causes of snoring had been confirmed through the ultra high speed MRI and endoscopy during sleep induced by a drug, and eight cases of children. We used the acoustic analysis system II manufactured by TDT for recording the snoring sounds and Time Frequency Representation (TFR®) manufactured by Avaaz Innovation. As a result, we assumed that, in the cases of adults, snoring caused by the palate molle does not consist of noise components to a large extent and consists of regular vibrations while snoring caused by the tonsils consists of noise components to a large extent and associated with irregular vibrations. In the case of children, we expected that the noise components of the adenoids and palatine tonsils would be dominant and the sound wave would be unclear, however; it was the case, only partially rather than wholly in all cases. We presumed that this is because, unlike adult cases caused by the tonsils, the palate molle is involved in the cases of children, to no small extent.

View full abstract

There are variety of methods for treating unilateral vocal fold paralysis. We applied combined arytenoid adduction with ansa cervicalis anastomosis to recurrent laryngeal nerve to a 60 year-old female who had unilateral vocal fold paralysis due to meningioma of the post cranial fossa. Follow-up data of her phonatry function test revealed improvement of MPT, MFR, Jitter, finaly more than 2 years after the operation.

View full abstract

To treat hoarseness due to a stiff or cicatricial vocal fold, we developed a new surgical method in which the vocal fold is replaced with a pharyngeal myo-mucosal flap. After the outer surface of the pharyngeal wall was exposed with the superior hone of the thyroid cartilage retracted anteriorly, an island mucosal flap, lined by the thyropharyngeal muscle, was harvested with this muscle elevated as a pedicle. A pharyngeal opening was closed with primary suture. An affected vocal fold was removed by laryngofissure, and the myo-mucosal flap was transferred to the laryngeal lumen along the lateral surface and over the anterior edge of the thyroid ala. A new vocal fold was formed with the mucosal and muscle flap, and the larynx was closed tightly. This surgery was performed in a patient with severe hoarseness after vertical partial laryngectomy. The voice markedly improved by surgery. Vocal function was also improved. Postoperative laryngeal videoendoscopy showed a good closure of the glottis during phonation. No complication with regard to swallowing or respiration occurred. These results suggest that a vocal fold reconstruction using a pharyngeal myo-mucosal flap is a useful surgery for a stiff or cicatricial vocal fold.

View full abstract

It is generally accepted that a vocal cord massive change with intact mucosal surface suggests the intramucosal tumor or cyst, but not the carcinoma of the squamous epithelium. In this report we described a 73-year-old woman who suffured from hoarseness. Laryngeal fiberscopy showed a whitish lesion at the membranous portion of the left vocal cord suggesting a mass under the mucosa. There was no epithelial abnormality. Laryngeal stroboscopy showed the disappearance of the mucosal wave at the lesion. As a result, pre-operative diagnosis was a vocal fold cyst. Under the general anesthesia, laryngeal microsurgery was performed and this laryngeal lesion was found to be a substantial tumor in the mucosa. Histopathological examination revealed the tumor was a well differentiated squamous cell carcinoma. Our experience of this rare case indicated that precise examination using laryngeal stroboscopy of mucosal wave as well as sequential voice function test are necessary for vocal cord massive lesion.

View full abstract

We experienced two patients who underwent abduction of vocal cord by Ejnell operation. Case 1: 62 years of age, female, adhesion of posterior vocal cords ; The patient came to our office complaining dyspnea on November 21^st in 2002. She underwent emergency tracheotomy under local anesthesia. Abduction of vocal cord by Ejnell operation was performed under general anesthesia on December 13^th. The tracheal tube was taken off on December 24^th and was discharged on December 28^th. Case 2: 20 years of age, male, adhesion of posterior vocal cords; The patient came to our office complaining exertional dyspnea on August 29^th in 2002. Abduction of vocal cord by Ejnell Operation was performed on February 21^st in 2003. The tracheal tube was taken off on February 28^th and was discharged on March 3^rd.

View full abstract

Additional or revised phonosurgical interventions for unilateral vocal cord paralysis were performed on 4 cases in 38 who had undergone vocal cord medialization during 1998 to 2003. For the initial operation, arytenoid adduction was performed in 1 case, direct pull of lateral cricoarytenoid muscle (LCA pull) was in 2 cases and combination of thyroplasty type I and arytenoid adduction in 1. For additional or revised operation, we performed thyroplasty type I in 2 cases and lipoinjection into the vocal cord in 2. Following the additional and revised operation, phonatory function was satisfactory in 2 cases and fair in 2. Progressive vocal cord atrophy and postoperative loosening of the thread in 2 cases with LCA pull procedure were considered responsible for insufficient improvement of the vocal function. Also, coexistence of sulcus of the vocal cord limited surgical results.

View full abstract