For the initial diagnosis of acoustic neuroma, past CT scans were regarded as unreliable, and therefore contrast-enhanced MRIs were used as the standard diagnostic approach. A diagnosis of internal auditory canal and cerebellopontine angle tumors is typically made by departments other than otolaryngology deparartments. Otolaryngology departments therefore tend to play a small role in such diagnoses. Cone-beam CT is a device that is smaller than previous CT models which makes it possible to obtain more precise images than were previously obtainable. We herein report 2 patients with a density area suggestive of an acoustic neuroma in the internal auditory canal and both were detected by cone-beam CT. Recently, patients suspected of having an acoustic neuroma, usually undergo an MRI and thereafter are managed by the neurology department. These days, fewer neuroma patients are managed by otolaryngologists. Currently, surgery is no longer the first choice for an acoustic neuroma and the range of treatment choices has greatly expanded. We believe that our findings show cone-beam CT to be novel diagnostic device that enables otolaryngologists to manage acoustic neuromas even in when they are located in the internal auditory canal. With further refinements of this device, improvements in the diagnostic accuracy of acoustic neuroma are thus expected.

View full abstract

We herein retrospectively examined 24 nasopharyngeal carcinoma (NPC) patients treated at Kyushu University Hospital between April 2004 and March 2014. Our series included 18 males (75.0%) and 6 females (25.0%) with a mean age of 54.7 years (range : 20 to 78). The 3-year cause-specific survival rate was 82.1%. Cervical metastases on initial presentation occurred in 20 patients (83.3%). The Stage Ⅲ+Ⅳ group comprised 66.7% of all patients, thus nearly all NPC patients presented with advanced stage disease. The patients presenting with Stage Ⅳ disease also had a poorer prognosis. Distant metastasis on initial presentation occurred in 4 patients (16.7%). The presence or absence of distant metastasis at the time of the initial visit did not affect the prognosis. Therefore, we recommend that patients with distant metastases additionally receive aggressive medical treatment, in particular combination chemotherapy with S-1. In other previous reports of aggressive treatment in Japan, platinum agents were selected as combination chemotherapy, thus suggesting that S-1 is being utilized with no comparable effects.

View full abstract

Regarding the pathogens that cause intractable acute otitis media in adults, mucoid type Streptococcus pneumoniae, which forms mucoid type colonies on blood agar plates, is well known, and the occurrence of otitis media due to this bacterial species is called mucosus otitis media. We encountered an adult patient with intractable acute otitis media due to Group A Streptococcus (GAS) who showed clinical characteristics that were similar to those observed in mucosus otitis media. A 55-year-old female visited the Eura ENT Clinic due to pharyngeal pain and left otorrhea. Left external acoustic meatus swelling, left serous otorrhea, and left mixed hearing loss were observed. A diagnosis of acute otitis media due to GAS was made by a rapid GAS antigen detection test using the otorrhea, and treatment with a series of antibiotics (garenoxacin, ceftriaxone, amoxicillin, and minocycline) was performed, but this regimen could not resolve the left otorrhea. She was therefore admitted in Nishinihon Hospital and received the drip intravenous infusion of piperacillin and a steroid. On the second hospitalization day, the otorrhea was resolved, and she thereafter steadily improved. In adults presenting with intractable acute otitis media, not only mucosus otitis media, but also acute otitis media due to GAS should therefore be considered in the differential diagnosis.

View full abstract

A 56-year-old woman visited our hospital because of epistaxis. She had a history of renal cell carcinoma (RCC) and had previously undergone left nephrectomy 3 years prior to this presentation. Endoscopic examinations showed the presence of a tumor with necrosis which easily bled into her left nasal cavity. Radiographic examinations (CT and MRI, and PET-CT) revealed a highly-vascular tumor which was located in her left nasal cavity, but no sinus invasion was observed. Therefore, the patient underwent endonasal surgical resection using endoscopy after first performing selective sphenopalatine arterial embolization. The tumor was completely resected. Pathological examinations showed the tumor to be metastatic carcinoma of RCC. We herein report a rare case of distant metastasis of RCC which occurred in the nasal cavity. Treatment with selective arterial embolization prior to endoscopic tumor resection was found to be useful and therefore this treatment modality should be one of the therapeutic options for metastatic RCC occurring in the nasal cavity.

View full abstract

Our 30 years of experience have demonstrated that ceramic ossicular replacement prostheses have a high affinity for human tissues, can be placed permanently in livingtissues, and cause no defense reactions in the human body. The hardness and rigidity of ceramics, however, may cause postoperative movement of the tympanic membrane or postoperative changes in the surrounding soft tissues, which may sometimes cause the ceramic ossicular prosthesis to separate from the reconstructed ossicular chain, thus resulting in an insufficient postoperative improvement in the patient's hearing ability. Our experience shows that normal, ceramic ossicular prostheses are unstable and often detach from the tympanic membrane, particularly in cases where the malleus handle is absent. To prevent such detachment, ceramic ossicular prostheses for use with cartilage are commercially available. However, we do not consider the use of such prostheses suitable for achievingour goal of shortening both the operating time and hospital stay and thereby making surgery less invasive for patients, since the use of ceramic ossicular prostheses requires an additional procedure for cartilage removal. A new ceramic ossicular replacement prosthesis, which connects the tympanic membrane with the stapes and therefore rarely causes any detachment from the tympanic membrane, has recently been developed and launched and became available in March 2013. We introduced this new product into our clinical practice and one patient has showed a marked improvement in hearing after surgery.

View full abstract