Nippon Jibiinkoka Gakkai Kaiho
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
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Volume 117, Issue 3
Displaying 1-16 of 16 articles from this issue
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Review article
Original article
  • A Clinical Study of Auditory Ossicular Malformations in 44 Ears
    Takayuki Ota, Kazuo Matsui, Koichi Kure, Wataru Kubota, Yoshihiko Esu, ...
    2014 Volume 117 Issue 3 Pages 175-183
    Published: March 20, 2014
    Released on J-STAGE: April 20, 2014
    DOIhttps://doi.org/10.3950/jibiinkoka.117.175
    JOURNAL FREE ACCESS
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    Generally reporting, among the various forms of conductive hearing loss, auditory ossicular malformation clinically treated by surgery had good hearing improvement.
    We conducted a retrospective review of 40 patients (44 ears) with auditory ossicular malformations who were treated in our hospitals between April 2004 and March 2011. We analyzed the following preoperative features, surgical methods, and results of surgery.
    An otomicroscopic examination, auditory ossicules reflection, tympanometory, and temporal bone high-resolution computed tomography were undertaken in all patients.
    We also investigated whether these preoperative examinations would enable surgeons to make a preoperative diagnosis.
    There were 13 males (14 ears) and 27 females (30 ears), with an average age of 19.0 years. Classification of the pathologic condition based on surgical findings showed separation of the incus-stapes joint in 24 ears, fixation of the malleus or incus in 6 ears, fixation of the stapes footplate in 7 ears, and multifocal ossicular malformations in 7 ears.
    Ossicular reconstruction was performed by the modified type III method in 27 ears (including IIIc in 21 ears, IIIi-M in 1 ears, IIIi-I in 5 ears) and by the modified type IV method in 7 ears (including IVc in 5 ears, and IVi-I in 2 ears), stapes surgery in 11 ears (include total stapedectomy in 9 ears and partial stapedectomy in 2 ears) and exploratory tympanotomy in 1 ear.
    Postoperative hearing evaluations based on the criteria classified by the Japan Otology Society in 2010 were obtained for all cases. The procedure was deemed successful when the postoperative hearing level met at least one of these three bench marks; (1) Air-bone gap less than 15dB, (2) Recovered hearing more than 15dB, and (3) Improved or preserved hearing less than 30dB. Hearing was evaluated at 1 year after surgery.
    The success rates of hearing improvement was 92.3%. The success rates of postoperative hearing improvement were satisfactory. Surgeons should treat auditory ossicular malformations actively.
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  • A Study of 9 Cases of Cervical Tuberculous Lymphadenitis with the Diagnosis of Cervical Tuberculous Lymphadenitis
    Yoshifumi Matsumoto, Yasunao Kogashiwa, Naoyuki Kohno
    2014 Volume 117 Issue 3 Pages 184-190
    Published: March 20, 2014
    Released on J-STAGE: April 20, 2014
    DOIhttps://doi.org/10.3950/jibiinkoka.117.184
    JOURNAL FREE ACCESS
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    The incidence of tuberculosis patients is high in Japan compared with the other developed countries. The ratio of extrapulmonary tuberculosis patients, for example cervical tuberculous lymphadenitis, tends to increase. In otolaryngology, the number of tuberculosis patients (especially those with cervical tuberculous lymphadenitis) is high and followed by pleuritis patients in extrapulmonary tuberculosis. Although otolaryngologists often diagnose extrapulmonary tuberculosis, it is difficult for them to diagnose appropriately because of various clinical features. Thus, we examined and presented the clinical history of 9 cases of tuberculosis patients in our Otolaryngology department and added a review of the related literature.
    We diagnosed 9 patients as having cervical tuberculous lymphadenitis from April 2002 to December 2012. They were 30 to 90 years old (mean 57.9 years old), and the male/female ratio was 3: 6.
    Five cases were diagnosed as the abscess types and 4 were the swelling types based on the imaging analysis of cervical tuberculous lymphadenitis. Four cases showed multiple lymphadenopathy and 5 showed a solitary involvement. Five sputum and 7 gastric fluid cultures were all negative, whereas 4 QuantiFERON tests were all positive. Fine-needle aspiration cytology was performed in 8 patients, and epithelioid cells were seen in 4 cases.
    Because tuberculosis presents various clinical features, if we obtained the atypical findings from those patients, it is important in the first instance to suspect tuberculosis. Based on the viewpoint for preventing the spread of infection, we should perform cellular analysis using ultrasound-guided fine needle aspiration after sufficient assessment of the spreading risk by sputum, gastric fluid culture and TB-PCR and QuantiFERON tests, and if a diagnosis remains difficult, the lymph node open biopsy need to be considered.
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  • A Clinical Study of Acute Epiglottitis in Adults
    Hiroshi Nonoyama, Mariko Arimoto, Shuntaro Inagawa, Ikue Uchida, Tohru ...
    2014 Volume 117 Issue 3 Pages 191-195
    Published: March 20, 2014
    Released on J-STAGE: April 20, 2014
    DOIhttps://doi.org/10.3950/jibiinkoka.117.191
    JOURNAL FREE ACCESS
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    Acute epiglottitis may trigger death because of serious airway obstruction. It is necessary to perform emergency and accurate airway intervention. In this retrospective study we present 216 cases of acute epiglottitis in adults. Airway management was done in 39 cases (18.1%), but most cases were treated conservatively. The mean patient age was 53 years and the male-to-female ratio was 1.9 to 1.0. The most frequent symptoms were sore throat (88%). The mean duration from symptom onset to consultation to our hospital was 1.9 days in the airway management group and 2.9 days in the conservatively treated group, which was statistically significant (p<0.05). Focusing on epiglottal swelling seen under the flexible laryngoscope, the percentage of airway management was 52.6% for swelling of the unilateral false vocal cords and 12.9% for swelling of the aryepiglottic fold. A statistically significant difference was also seen in complaints of respiratory difficulties (p<0.01), the rise of WBC (p<0.01), the rise of CRP (p<0.01), and diabetes mellitus (p<0.01).
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  • A Clinical Investigation of Pediatric Patients with Sleep-Disordered Breathing Who Suffered Perioperative Respiratory Complications of Adenotonsillectomy
    Makoto Ogawa, Kiyohito Hosokawa, Hidenori Inohara
    2014 Volume 117 Issue 3 Pages 196-205
    Published: March 20, 2014
    Released on J-STAGE: April 20, 2014
    DOIhttps://doi.org/10.3950/jibiinkoka.117.196
    JOURNAL FREE ACCESS
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    The aim of this study was to investigate the clinical background and identify the risk factors for perioperative respiratory complication in pediatric patients with sleep-disordered breathing (SDB) who underwent adenotonsillectomy (AT). Of the 186 pediatric subjects (male: 131, female: 55) undergoing AT as the first surgical treatment for SDB, 14 patients (male: 9, female: 5) fulfilled the following criteria: 1) disturbed ventilation, 2) cyanosis with an oxygen saturation of less than 90% on pulse oximetry during the perioperative period and 3) the subsequent need for medical intervention, including immediate intubation, continuous positive airway pressure (CPAP) or airway insertion. Among these 14 patients, nine were less than 3 years of age. In addition, 5 and 3 patients had hypotonia due to cerebral paralysis and metabolic disturbances, respectively. Seven had a short stature with an SD of worse than -1.5. A statistical analysis showed that cases with either an age of less than 3 years, hypotonia or a short stature had a high risk for suffering from respiratory complications, and suggested that low body weight and a high value for preoperative apnea-hypopnea index were additional risk factors. However, a chart review exhibited that, of the 14 cases with respiratory complications, the 8 cases whose age was under 3 years had either of hypotonia or a short stature. In thirteen of the 14 cases, respiratory complications were associated with the process of general anesthesia, and ten patients exhibited pharyngeal collapse. After surgery, 7 and 3 patients required intensive care in the ICU and the pediatric recovery unit, respectively. Based on these results, it is suggested that pediatric SDB cases under 3 years of age and either with hypotonia or a short stature have a high risk for respiratory complications associated with AT, and therefore AT for such patients should only be performed in medical facilities with an ICU or an equivalent department.
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  • A Case of Intracranial Abscess Caused by Peri-odontogenic Infection
    Hiroomi Homma, Hideki Takemura, Takefumi Yui, Tomohiro Ono, Aya Watana ...
    2014 Volume 117 Issue 3 Pages 206-208
    Published: March 20, 2014
    Released on J-STAGE: April 20, 2014
    DOIhttps://doi.org/10.3950/jibiinkoka.117.206
    JOURNAL FREE ACCESS
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    The authors report a case in which a 42-year-old woman developed an intracranial abscess in the temporal lobe as a result of a peri-odontogenic infection. A subdural abscess also developed in the middle cranial fossa, expanding directly from the base of the skull through the foramen ovale and the foramen spinosum.
    An operation involving a left-front temporal incision extending to the tragus was performed. Debridement and brain aspiration with drainage were carried out after the craniotomy via the same skin incision without operative complications. The patient left hospital 36 days after the operation without sequelae.
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