Nippon Jibiinkoka Gakkai Kaiho
Online ISSN : 1883-0854
Print ISSN : 0030-6622
ISSN-L : 0030-6622
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Volume 118, Issue 12
Displaying 1-18 of 18 articles from this issue
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Review article
Original article
  • Clinical Analysis of Evaluation of the Swallowing Function before Gastrostomy in an Acute-care Hospital for Elderly People
    Yurika Kimura, Keiko Ohno, Motomu Honjyo
    2015 Volume 118 Issue 12 Pages 1422-1428
    Published: December 20, 2015
    Released on J-STAGE: January 15, 2016
    DOIhttps://doi.org/10.3950/jibiinkoka.118.1422
    JOURNAL FREE ACCESS
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    　The Ministry of Health, Labour and Welfare, while defining a significant reduction of the medical fee points for gastrostomy in the medical fee revision of fiscal year 2014, assigned additional fee points for evaluation of the swallowing function by videofluoroscopy (VF) or videoendoscopy (VE) prior to gastrostomy. In addition, for facilities that carried out more than 50 gastrostomy operations, evaluation of the swallowing function was made mandatory in all cases and 35% of oral ingestion recovery rate to require the full amount calculation. Therefore, we evaluated the data on swallowing function evaluation in patients and gastrostomy at our hospital. During a 3-year period from February 2012, 114 patients who underwent gastrostomy at our hospital were enrolled. We evaluated the background disease, indications for gastrostomy, conduct/non-conduct of swallowing function tests prior to gastrostomy, videoendoscopic score (VE score), and the functional oral intake score before and after gastrostomy in the patients.
    　The predominant background diseases were cerebrovascular disease (33%), Parkinson's syndrome (26%), and Alzheimer's disease (11%). The indications for gastrostomy were dysphagia (38%), request for gastrostomy from other hospitals or nursing care home (24%), and malnutrition due to anorexia (18%). The severity of the dysfunction was classified based on the VE score as mild (28%), moderate (47%), or severe (25%).
    　Dysphagia did not reach the majority of reasons for gastrostomy and not few of background diseases were progressive neurological diseases such as Parkinson's disease. Therefore, it remains under debate whether it is necessary to perform swallowing functional evaluation by VE or VF in all cases prior to gastrostomy. In some cases in which gastrostomy was indicated, the VE scores were not so high. Therefore, a comprehensive evaluation based on the pathophysiology and social background is needed to judge the indication for gastrostomy. Leading support and participation in the calculation of additional fee points for the evaluation of swallowing function is an urgent issue for otolaryngologists.
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  • Adverse Events of Sublingual Immunotherapy in 207 Patients with Japanese Cedar Pollinosis
    Yukiko Ogawa, Atsushi Yuta, Masahiko Arikata, Hideaki Kozaki, Nobuo Oh ...
    2015 Volume 118 Issue 12 Pages 1429-1435
    Published: December 20, 2015
    Released on J-STAGE: January 15, 2016
    DOIhttps://doi.org/10.3950/jibiinkoka.118.1429
    JOURNAL FREE ACCESS
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    　Sublingual immunotherapy (SLIT) for Japanese cedar pollinosis is effective, however, caution must be exercised against allergen-specific adverse events (AEs) during SLIT.
    　Purpose: The purpose of this study was to clarify the AEs of SLIT in a large cohort of patients with Japanese cedar pollinosis.
    　Methods: We conducted a detailed survey, by both questionnaires and direct interviews, of 207 patients receiving SLIT at our clinic.
    　Results: Eighty-four of the 207 patients (40.5%) developed AEs, with AEs involving the oral cavity and throat being the most common (56 patients; 27.1%). Sixteen patients (7.9%) had local mucosal swelling, but the swelling resolved in all the cases. Other allergen-induced symptoms such as nasal symptoms (29 events, 14.0%), eye symptoms (14 events, 6.8%) and ear symptoms (20 events, 9.7%) were also recognized. All the AEs were minor, and discontinuation of SLIT was not necessitated in any of the patients because of AEs. There were 52 AEs (25.0%) in the up-dose phase and 61 AEs (29.3%) in the maintenance phase. However, only 4 of the 161 patients (2.5%) developed AEs during the pollen season. Most AEs developing during the maintenance phase occurred in the first few weeks. In 60% of the cases, the AEs disappeared within 2 weeks, and in 6.0% (5 events), they persisted for longer than 2 months. There were no age-or sex-related differences in the prevalence of cedar pollen-specific IgE, or in the adherence to the treatment.
    　Conclusion: AEs in SLIT were shown in many patients, however, the severity of AEs was mild and no events interfered SLIT.
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  • A Case of Stevens-Johnson Syndrome Developing during Chemoradiotherapy for Maxillary Sinus Cancer
    Kousuke Yoshifuku, Kengo Nishimoto, Tsutomu Matsuzaki, Shigeto Matsush ...
    2015 Volume 118 Issue 12 Pages 1436-1442
    Published: May 13, 2015
    Released on J-STAGE: January 15, 2016
    DOIhttps://doi.org/10.3950/jibiinkoka.118.1436
    JOURNAL FREE ACCESS
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    　Herein, we report a case of drug-induced Stevens Johnson syndrome (SJS). A 56-year old female visited our hospital complaining of right cheek pain. Local examination revealed that the right ostium of the maxillary sinus was open and that the maxillary sinus mucosa was invaded by tumor. Biopsy revealed a histopathological diagnosis of squamous cell carcinoma. We therefore diagnosed the patient as a case of maxillary sinus carcinoma (T3N0M0) based on the CT, MRI and FDG-PET findings
    .　During chemoradiotherapy for maxillary sinus cancer, the patient developed oral mucosal inflammation of progressively worsening severity; we initially thought that the symptom was a side effect of the treatment; however, several days later, skin lesions appeared throughout the body. We consulted a dermatologist, who suspected SJS. The patient was initiated on high-dose steroid therapy (steroid pulse therapy), and the symptoms improved.
    　Because of SJS is a fatal drug eruption, early diagnosis and prompt treatment are important. In patients receiving chemoradiotherapy showing severe oral mucosal inflammation outside the irradiation area or oral mucosal inflammation associated with skin lesions throughout the body, it is necessary to bear in mind the possibility of SJS.
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  • Introduction of Percutaneous Dilational Tracheotomy in Otolaryngology Residency Training
    Yasushi Furuta, Nayuta Tsushima, Akira Nakazono, Atsushi Fukuda, Shogo ...
    2015 Volume 118 Issue 12 Pages 1443-1448
    Published: December 20, 2015
    Released on J-STAGE: January 15, 2016
    DOIhttps://doi.org/10.3950/jibiinkoka.118.1443
    JOURNAL FREE ACCESS
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    　In 2009, we introduced percutaneous dilational tracheotomy (PDT) in otolaryngology residency training. PDT was performed in 21 cases and five residents had an opportunity to learn PDT. No major complications occurred. Decannulation was achieved in 17 of the 18 cases, excluding 3 mortalities. All residents felt that their knowledge of PDT had advanced. Introduction of PDT has great significance in otolaryngology residency training.
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  • Evaluation of the Effectiveness and Safety in a Multi-center Clinical Trial of VIBRANT SOUNDBRIDGE® in Japan
    Katsumi Doi, Sho Kanzaki, Kozo Kumakawa, Shin-ichi Usami, Satoshi Iwas ...
    2015 Volume 118 Issue 12 Pages 1449-1458
    Published: December 20, 2015
    Released on J-STAGE: January 15, 2016
    DOIhttps://doi.org/10.3950/jibiinkoka.118.1449
    JOURNAL FREE ACCESS
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    　Middle ear implants (MEIs) such as the Vibrant Soundbridge® (VSB) are attractive and alternative treatments for patients with conductive, sensorineural, and mixed hearing loss who do not benefit from, or who choose not to wear, conventional hearing aids (HAs). Recent studies suggest that MEIs can provide better improvements in functional gain, speech perception, and quality of life than HAs, although there are certain risks associated with the surgery which should be taken into consideration, including facial nerve or chorda tympanic nerve damage, dysfunctions of the middle and inner ears, and future device failure/explantation.
    　In Japan, a multi-center clinical trial of VSB was conducted between 2011-2014. A round window vibroplasty via the transmastoid approach was adopted in the protocol. The bony lip overhanging the round window membrane (RWM) was extensively but very carefully drilled to introduce the Floating Mass Transducer (FMT). Perichondrium sheets were used to stabilize the FMT onto the RWM. According to the audiological criteria, the upper limit of bone conduction should be 45 dB, 50 dB, and 65 dB from 500 Hz to 4,000 Hz. Twenty-five patients underwent the surgery so far at 13 different medical centers. The age at the surgery was between 26-79 years old, and there were 15 males and 10 females. The cause of conductive or mixed hearing loss was middle ear diseases in 23 cases and congenital aural atresia in two cases. The data concerning on the effectiveness and safety of VSB was collected before the surgery and 20 weeks after the surgery. Significant improvements of free-field Pure Tone Audiogram (PTA) from 250 Hz to 8,000 Hz were confirmed (p<0.001). Hearing gain up to 40 dB was achieved in the 1,000 Hz to 4,000 Hz range. No deterioration in either air conduction or bone conduction at PTA was noted at 20 weeks after the surgery. Monosyllable speech perception in both quiet and noisy conditions improved significantly (p<0.001). The speech discrimination score in both quiet and noisy conditions improved significantly too (p<0.001).
    　In the future, it is likely that there will be an increasing population even in Japan that will meet the criteria for MEIs such as VSB. However, the long-term efficacy and safety of these devices should be established.
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Skill up lecture
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