The Japanese guideline for otitis media with effusion recommends insertion of a tympanotomy tube in cases with contact or adhesion of the tympanic membrane. However, there are complications associated with the insertion of a tympanotomy tube, such as perforation and retraction of the tympanic membrane. In an attempt to minimize such complications, we performed subannular tube insertion. We reviewed 11 cases (13 ears) of adhesive otitis media, atelectatic ear or chronic otitis media with perforation, that had received subannular tube insertion. The tube insertion was performed under general anesthesia in all the cases. A radial incision was made on the postero-inferior wall of the external auditory canal, the tympanomeatal flap was elevated with the fibrous annulus, and then a Goode T-tube was inserted into the middle ear under the fibrous annulus; the tube was then covered with a meatal flap. At more than 3 months after the surgery, the tube was still found in situ in 7 of the 13 ears. The average duration of the tube remaining in situ was 9 months (1-29 months). The condition of the tympanic membrane was satisfactory in the cases in which the tube remained in situ. This method allowed ventilation of the middle ear, rendering tympanotomy unnecessary. It was useful for the treatment of persistent otitis media with effusion, atelectatic ear and adhesive otitis media, while preventing complications such as perforation and retraction tympanic membrane. However, in almost a half of the cases, the tube failed to be retained in situ. We need to develop a method to prevent early extrusion of the tube.
Background: Peritonsillar abscess (PTA) may cause severe complications, therefore, prompt and appropriate treatment are crucial.
Objective: 1) To identify the causative pathogenic bacteria and drug resistant variants in cases of PTA in the Tokyo Nishitama area. 2) To study the relationship between the frequency of progression of tonsillitis to PTA after treatment and the prescribed antibiotic treatment.
Subjects and Methods: At first, a total of 214 PTA patients who visited our hospital from April 2010 to March 2016 were enrolled, and we obtained the data on the antibacterial drugs used in these cases. Then, 119 PTA patients seen from April 2010 to March 2014 were included, and we obtained the data on the pathogenic bacteria isolated from the pus and blood cultures and the prevalence of drug resistance from the medical records. Finally, we performed a retrospective cohort study of 397 cases of tonsillitis treated from April 2010 to March 2016 to compare the frequency of development of PTA in patients who had/had not received fluoroquinolones. Furthermore, we performed a subgroup analysis for patients with a past history of tonsillitis or PTA.
Results: Prescriptions from previous hospitals for PTA included cephalosporins in 37% (31/84 prescriptions) of cases and fluoroquinolones in 25% (21/84 prescriptions) of cases. Streptococcus species such as group A β-hemolytic streptococci and anaerobic bacteria accounted for 67% (98/66 strains) and 13%(13/98 strains) of the bacteria isolated from the pus cultures in the PTA cases. The proportion of bacteria that were resistant to fluoroquinolones was as high as 45%. The frequency of development of PTA was significantly higher (risk ratio=11.8, p= 0.032) in the tonsillitis patients who had been treated with fluoroquinolones. Subanalysis of cases with a history of tonsillitis or PTA showed the same results.
Conclusions: Our findings suggest that caution should be exercised in administering fluoroquinolones to patients with tonsillitis with a past history of tonsillitis or PTA. Further study is needed in the future.
Extrapulmonary small cell carcinoma arising from the pharynx is rare. We have experienced 4 cases of pharyngeal small cell carcinoma. All the patients were male, and the mean age was 66 years old. The primary site was the oropharynx in 2 cases and the hypopharynx in 2 cases. All the patients initially underwent surgical resection, followed by chemotherapy or chemoradiotherapy. Three patients died because of distant metastasis. One patient is still alive without disease. Twenty-four cases of pharyngeal small cell carcinoma have been reported to date. An analysis of these 28 cases, including our 4 cases, revealed that 20 of the cases had died because of pharyngeal small cell carcinoma. Thus, pharyngeal small cell carcinoma appears to be associated with a relatively poor prognosis similar to that of pulmonary small cell carcinoma. Patients with T3/4 or metastatic diseases have an especially poor prognosis. When the primary site is resectable with minimum invasion, surgery followed by chemotherapy or chemoradiotherapy might offer a better chance of inhibiting local recurrence, compared with other strategies.
We studied the clinical efficacy during the Cypress season by allergen-specific sublingual immunotherapy (SLIT) of cedar pollen.
Methods: The subjects were 180 patients with combined cedar and cypress pollinosis treated by SLIT with cedar pollen. There were 105 males and 75 females, with a mean age of the subjects of 37.0 ± 17.0 years. The clinical efficacy of the SLIT was studied in the moderate cedar- and cypress- pollen-scattering year of 2016. The scores on the quality of life and face scale (FS) of the Japanese rhino-conjunctivitis QOL questionnaire (JRQLQ No. 1) and the total nasal symptom-medication score (TNSMS) were assessed by the patients during both the cedar pollen and cypress pollen seasons. A post-seasonal survey of the efficacy of SLIT was performed after each of the cedar pollen and cypress pollen seasons.
Results: According to the survey, in the patients who had not yet been started on the SLIT, the symptoms were more severe during the cedar pollen season than during the cypress pollen season. The percentages of patients in whom the SLIT was judged to be effective by the patients themselves was 68.7% during the cedar pollen season, and 38.7% during the cypress pollen season. When the patients compared the efficacy of the SLIT between the two pollen seasons, 42.2% answered that their symptoms were equivalent during both seasons, and 54.9% said that the symptoms became worse in the cypress pollen season. There were no differences in the average scores on each item examined between the two pollen seasons, the changes in the scores varied among individual cases. The TNSMS became worse by 1 point in 27.2% of all cases. Of the group of patients with a FS score of 1 point during the cedar pollen season, which is considered as indicative of the treatment efficacy, 43.3% showed worsening of the FS score during the cypress pollen season. In the group of patients who indicated that their symptoms were similar during both the cedar and cypress pollen seasons before the SLIT, 30.4% showed worsening of the TSNMS during the cypress pollen season. However, 8 of the 30 (26.7%) patients who indicated that their symptoms were more severe during the cypress pollen season than during the cedar pollen season before the SLIT showed improved scores in the cypress pollen season after the start of the SLIT.
Conclusion: This result revealed both cases where SLIT was effective and those where it was insufficiently effective during the cypress pollen season, even among cases where the therapy was effective during the cedar pollen season.
There have been several reports of synchronous HPV-associated tonsillar carcinomas, however, there are no reports until date of synchronous HPV-associated carcinomas arising in the oropharynx and nasal cavity. Herein, we report the case of a 64-year-old man with synchronous HPV-positive SCCs of the tonsil and nasal cavity.
A 64-year-old man presented with pain in the throat on swallowing. He also had 3-year history of excessive lacrimation. Initial CT imaging showed masses in the right tonsil and right nasal cavity. PET-CT revealed no evidence of lymph node metastasis or distant metastasis. Biopsies of the right tonsillar tumor and right nasal cavity revealed poorly differentiated carcinoma at both sites. Immunohistochemistry revealed positive staining for p16 in both the right tonsillar and right nasal cavity carcinomas. Evidence of HPV infection was searched for using multiplex-PCR. HPV-16 and HPV-45 were detected from the right tonsillar tumor, and HPV-59 from the right nasal cavity tumor. The right tonsillar tumor was classified as T3N0M0, and the right nasal cavity tumor as T4aN0M0. After complete staging, the patient received concomitant weekly cisplatin plus radiotherapy at a total dose of 70 Gy. Both tumors responded well to chemoradiotherapy, and at the follow-up conducted 2 years after completion of the chemoradiation therapy, there was no evidence of recurrence or metastasis.