Spasmodic dysphonia (SD) is known to be, not a psychiatric disease, but a type of local dystonia. However, we have experienced many patients with SD and have noticed that it is not rare for such patients to have negative emotions. We herein investigated the distinctive features of SD compared those of with other psychiatric diseases of otolaryngology using interviews, psychiatric tests and questionnaires. Most SD patients are under 30 years of age and have been affected for more than two years. These features are clearly different from those of abnormal sensations in the throat or glossodynia. The proportion of SD patients who exhibit a tendency toward neurosis as a CMI is remarkably lower (12.9%) than that observed in patients with the above-mentioned psychiatric diseases. On the other hand, SD patients more often exhibit a tendency toward an irritable personality as a CMI. Such patients are often in situations that require them to speak a lot and are worried about voice strangulation of unclear etiology. These patients are not worried due to anxiety or fear, as in social anxiety disorder (SAD), but rather demonstrate a kind of irritability. A distinctive feature of SD is that the patient feels distressed to make phone calls, especially in noisy environments. This is because they try to speak loudly and may also experience some distortion in communication. We conclude the following：SD can occur due to character, environment, expected anxiety, a defensive posture and a long affected period and be strengthened by a second circuit of increased subglottic pressure and tight vocal cord closure. It is not easy to cut this circuit；therefore, we suggest that the best treatment method is Isshiki's thyroplasty type Ⅱ.

View full abstract

The ototoxicity and bacteriostatic activity of three different solutions, Burow's solution, Povidone-Iodine (ISODINE) solution and electrolyzed strong solution (ESAS), were studied in guinea pigs. Ototoxicity was evaluated using the eighth nerve compound action potential (CAP) measured using round window electrodes. The bacteriostatic activity was evaluated by measuring the diameter of the bacteriostatic ring of an agar plate containing MRSA. Bacteriostatic activity was noted in both Burow's solution and 1/5-strength Povidone-Iodine (ISODINE) solution. Full-strength Povidone-Iodine solution showed no ototoxic effects, unlike Burow's solution. ESAS exhibited no bacteriostatic activity or ototoxic effects.

View full abstract

We analyzed 20 patients with carcinomas of the external auditory canal that were treated in our hospital between 2005 and 2008. The patients were grouped according to the staging classification established by the University of Pittsburgh: T1 (3 patients),T2 (3 patients),T3 (4 patients),T4 (10 patients),N1 (one T2 and three T4 patients) and M1 (one T4N1 patient). The patients were also classified per the standard cancer staging method:stage 1 (3 patients), stage II (2 patients), stage III (4 patients) and stage IV (11 patients). Squamous cell carcinoma was implicated in 18 of the cases, basal cell carcinoma was observed in 1 case and the remaining case was diagnosed as verrucus carcinoma. The disease-specific 5-year survival rate was 77.4% for all cases, 100% for cases in stage I, II and III and 56.7% for stage IV cases. Of the 5 cases of stage IV carcinomas that required surgery, 3 of these cases survived and 2 of these cases eventually succumbed to the cancer. Of the 6 cases of stage IV carcinomas that did not require surgery, 3 of the cases survived, 2 of the cases eventually succumbed to the cancer and 1 of the cases died as the result of a separate disease. In recent years, we have changed our method of treatment for cases with middle ear invasion from subtotal temporal bone resection combined with chemoradiotherapy to lateral temporal bone resection. As a result, we have seen an increase in our 5-year survival rate. Therefore, this treatment strategy is considered to be an effective method in the treatment of carcinomas of the external auditory canal.

View full abstract

A 50-year-old male received medical treatment for chronic cough and lymphadenopathy. Because there was no improvement one month later, he was referred to our hospital. Elevation of the serum level of the soluble IL-2 receptor was noted, so a lymph node biopsy was performed. The pathological diagnosis was lymphadenitis, and malignant lymphoma was excluded from the differential diagnosis. An antibiotic was administered on an outpatient basis, but there was no improvement. Blood tests were done again, including additional parameters, and elevation of the serum level of IgG4 was found (1,100 mg/dℓ). A histological examination of the left submandibular gland and lymph nodes revealed infiltration by IgG4-positive plasma cells. Thus, the patient was diagnosed with IgG4-related disease. The size of the submandibular gland and lymph nodes decreased in response to treatment with prednisolone (PSL：30 mg/day). The patient's respiratory symptoms were also improved, and his serum IgG4 level was decreased. He is currently still receiving oral treatment with prednisolone (20 mg/day) and is in partial remission.

View full abstract

We herein report a case of drug-induced dyskinesia characterized by temporomandibular joint luxation. The patient was a 15-year-old male with no remarkable family history and no history of allergies. The patient underwent tonsillectomy following chronic tonsillitis, which was performed under general anesthesia. However, the patient experienced postoperative nausea and insomnia, and was administered a total of five doses of metoclopramide, along with two doses of haloperidol, during the time period between the surgery and the morning of the second postoperative day. Thereafter, on the morning of the second day after surgery, the patient presented with temporomandibular joint luxation, along with dyskinesia of the tongue. These symptoms were suspected to be side effects of the metoclopramide, and the drug was immediately discontinued. On postoperative day three, the myotonia subsided, and by postoperative day seven, the patient was able to consume solid food. The patient was discharged on postoperative day ten, and the involuntary movements of the tongue completely disappeared in the third month after surgery. Therefore, based on these findings, we concluded that the combination of metoclopramide, haloperidol and postoperative dehydration might have caused this phenomenon.

View full abstract