Practica Oto-Rhino-Laryngologica

Recent Understanding of Prostanoids and Leukotrienes in the Pathogenesis of Airway Inflammation

Takeshi Shimizu

2007 Volume 100 Issue 3 Pages 157-166
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.157

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Arachidonic acid metabolites, prostanoids and leukotrienes, are important mediators in airway inflammation. Over the last decade, selective receptors of these mediators have been identified, and the biological functions of these receptors have been clarified in detail. Prostaglandin (PG)D₂, thromboxane A₂, and cysteinyl leukotrienes may augment allergic inflammation. On the contrary, PGE₂, PGI₂, and lipoxins may be potent anti-inflammatory mediators involved in airway inflammation.
PGE₂ receptors are characterized into four subtypes: EP1, EP2, EP3, and EP4. In our study, EP agonists inhibited mucus secretion and IL-8 release from cultured human airway epithelial cells in vitro. An in vivo study revealed that mucus production and neutrophil or eosinophil infiltration caused by LPS stimulation or allergic inflammation were inhibited by the subcutaneous injection of EP agonists in rat nasal epithelium. These results indicate that PGE₂ acts as an anti-inflammatory mediator via EP receptors, and that EP agonists may constitute a new therapeutic strategy.
In this article, recent knowledge of prostanoid and leukotriene functions in the pathogenesis of airway inflammation is reviewed. Their selective receptors and synthetic enzymes may provide novel targets for future drugs.

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A Strategy against Posterior Mediastinal Goiter

H. Nakano, [in Japanese], [in Japanese], [in Japanese], [in Japanese], ...

2007 Volume 100 Issue 3 Pages 168-169
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.168

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Clinical Study of Patients with Bullous Myringitis (BM)

Is BM Merely an Acute Otitis Media (AOM)?

Takashi Hiramatsu, Yoshiro Mori

2007 Volume 100 Issue 3 Pages 171-179
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.171

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Bullous myringitis (BM) is an acutely painful condition of the ear characterized by bulla formation on the tympanic membrane. The etiology is unknown despite its recognition over a hundred years ago by Lowenberg (1892). BM was described in early articles as occurring in association with acute otitis media; however, BM has different features from AOM: usually unilateral, more often in school age children and frequently in adults, and almost always with a self-limited clinical course.
We studied 74 patients with BM aged 0 to 83 years (average age: 8.53), of which 65 patients had allergic rhinitis and others nasal disorders. Most patients had a sudden onset of very severe otalgia, but rarely had a high temperature. In all cases, bulla formations on the tympanic membrane were unilateral, and 54 of 69 patients had significant bulging of the pars tensa, whereas only 44 of 69 patients had significant middle ear fluid. As other findings of the tympanic membrane, including a patient who strongly blew the nose, 24 of 72 patients had bleeding and 32 of 36 patients with analysis of recorded photography had significant bulging of the pars flaccida.
Merifield (1966) considered that BM is a mechanical injury, which follows upper-respiratory infection of any sort (eg, Eustachian tube insufficiency, fever etc). We thought that BM might be a middle ear barotrauma: abnormal nasopharynx pressure due to allergic rhinitis and others nasal disorders caused a sudden reflux of secretions and air from the nasopharynx into the middle ear such that a vibration and positive pressure suddenly struck the tympanic membrane.

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Report of a Case of Middle Ear Adenoma

Sayaka Suzuki, Taeko Okuno, Yuko Hata, Nobuhiko Kurita

2007 Volume 100 Issue 3 Pages 181-186
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.181

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Middle ear adenoma (MEA) is a distinctive, rare entity that appears to be derived from the epithelium of the middle ear mucosa.
A 39-year-old woman came to Mitsui Memorial Hospital, complaining of right tinnitus and ear fullness. Her right tympanic membrane was swollen by a middle ear mass lesion, and imaging studies such as CT and MRI of the temporal bone demonstrated a middle ear tumorous lesion that extend expansively. She did not feel otalgia or vertigo, and there was no otorrhea, facial palsy, nor facial spasm. Her right audiogram showed slight hearing loss (Pure tone average: 25.0dBHL) and her right tympanogram was Type B or C1. Thus, we performed a right ear operation. At surgery, a soft yellowish tumor was found in the middle ear from the promontory, which adhered closely to the tympanic membrane, but had not destroyed the ossicles or tympanic membrane. The facial canal was intact. The tumor was removed without complication. A frozen-section diagnosis could not exclude the possibility of carcinoma, but the symptoms and signs strongly suggested a benign tumor, so we performed tumor removal and Type III tympnoplasty. The histological features and immunochemical study of the tumor showed neuroendocrine differentiation with no sign of malignancy. The postoperative course was uneventful, with no evidence of recurrence 17 months after surgery.

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A Case Report of Nasal Cavity Cancer Successfully Resected with Reconstruction of Nasal Defects Using an Auricular Helix Free Flap

Akihiro Sakai, Yumi Ueno, Michiaki Yokoyama, Noboru Yamanaka

2007 Volume 100 Issue 3 Pages 187-191
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.187

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Surgical treatment of nasal cavity cancers usually results in defects of the nasal tip, ala and collumela, which causes a significant deterioration of QOL for the patients. We used an auricular helix free flap to reconstruct the nasal defects after successful resection of nasal cavity cancer. Donor vessels of the flap, the superficial temporal artery and vein, were anastomosed to the superior thyroid artery and external juglar vein respectively using vascular grafts. The flap successfully became established and the patient has satisfactorily accepted its appearance. We suggest that auricular helix free flap is one of appropriate surgical reconstruction methods for nasal defects with the advantage of resemblance in the color and contour of nose.

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Foreign Body in the Maxillary Sinus Identified by MRI

Hideki Toyota, Yuji Imate, Koichi Watanuki, Hiroshi Yamashita

2007 Volume 100 Issue 3 Pages 193-196
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.193

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We report a case of a foreign body in the maxillary sinus, in which magnetic resonance imaging (MRI) was useful in reaching the diagnosis. The patient was a 37-year-old man, who presented at our hospital with fever and a headache after he had received dental treatment in a local dental clinic. The symptoms were suspected to be due to migration of a piece of agar impression material, which was used for the dental treatment, into the maxillary sinus; however, a computed tomography scan did not show the foreign body clearly. Using MRI, we were able to distinguish the material from hypertrophic mucous membranes in the maxillary sinus. In addition, we performed another MRI of the impression material itself to compare with the MRI of the patient, which suggested the strong possibility of migration of the impression material into the maxillary sinus.

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Mycosis of the Sphenoid Sinus with Oculomotor Paralysis: A case report

Miwa Kitamura, Hideyuki Murata, Koichi Tomoda

2007 Volume 100 Issue 3 Pages 197-200
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.197

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An 80-year-old male consulted the Department of Ophthalmology for headache, left blepharoptosis, and diplopia, and was diagnosed with left oculomotor paralysis. Neurological examinations revealed no abnormalities. A shadow was detected in the sphenoid sinus, and the patient was referred to the Department of Otorhinolaryngology. CT revealed a shadow in which the inner area was not uniform, without bone destruction, in the left sphenoid sinus. Under a tentative diagnosis of sphenoiditis-related oculomotor paralysis, endoscopic sphenoidectomy was performed. The sphenoid sinus was occupied by a fungal mass, suggesting fungal sphenoiditis. In the sinus, there was no bone defect. After surgery, conservative therapy such as steroid therapy and follow-up were continued. After 2 months, oculomotor paralysis subsided. Aspergillus was detected in the fungal mass. We reviewed the literature regarding the pathogenesis of peripheral cranial paralysis related to noninvasive mycosis of the sphenoid sinus.

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A Case Report of Arytenoid Dislocation Treated by Manually Closed Reduction

Ritsuko Yoneda, Takayuki Mochizuki, Yukiko Mochizuki, Hajime Hirose, K ...

2007 Volume 100 Issue 3 Pages 201-206
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.201

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Arytenoid dislocation is relatively rare among traumatic laryngeal disorders. It can be caused by traffic accidents or endotracheal intubation, and the incidence appears to be increasing. We report a case of arytenoid dislocation associated with insufficient glottal closure caused by endotracheal intubation. The patient was a 67-year-old woman who underwent total gastrectomy under general anesthesia. Hoarseness was noted immediately after surgery and it continued for a week postoperatively. Fiberscopic examination revealed restricted adduction of the left vocal cord and CT scan indicated posterior dislocation of the left arytenoid. The case was treated by manually closed reduction, with obvious improvement in glottal closure.

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Fat Injection with an Electric Injector

Shinya Okada, Etsuyo Tamura, Hiroyuki Fukuda, Masahiro Iida

2007 Volume 100 Issue 3 Pages 207-210
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.207

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Sixteen patients with glottic insufficiency received intra-fold autologous fat injection therapy with an electric injector.
Using the electric injector made minute control possible.
Fourteen of the sixteen patients who had been given the above therapy showed an extended maximum phonation time, which was maintained for about six months after the injection.
We think that using an electric injector facilitates easier and more accurate fat injection.

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Cervical Desmoid Tumor that Seemed to be a Recurrence Following Submandibular Gland Surgery

Yosuke Nakashimo, Yoshio Nakao, Noriaki Tanimitsu, Nobuharu Tagashira, ...

2007 Volume 100 Issue 3 Pages 211-216
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.211

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A desmoid tumor is characterized by benign fibrous breeding and develops from connective tissue of skeletal muscle, fascia, and aponeurosis.
In addition, the tumor tends to infiltrate locally and extensively and the tumor spreads between the muscles and on the fascia.
There is overwhelmingly predominance in women epidemiologically.
It commonly occurs in the exterior abdominal wall and the abdominal cavity with the abdominal wall. Cervical desmoid tumor is rare.
We encountered a case of cervical desmoid tumor which caused a recurrence 6 years after the initial treatment. We investigated recurrence factors and discussed the treatment regimens in previous literature.

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A Case Report of Malignant Lymphoma in the Buccal Space

Tsuyoshi Okuni, Toshinori Matsui, Tadashi Kojima, Tetsuo Himi

2007 Volume 100 Issue 3 Pages 217-222
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.217

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The buccal space is a potential anatomical space bounded by the buccinator muscle medially and the parotid space posteriorly. This space chiefly consists of adipose tissue named the Buccal fat pad. Other contents are the parotid duct, facial nerve, accessory parotid gland, buccinator lymph nodes, facial artery and vein. Here we report a case of malignant lymphoma arising in the Buccal space.
A 78-year-old woman presented with a painless tumor in her left cheek. The tumor had been present for approximately nine months and was slowly enlarging. Magnetic resonance imaging (MRI) and computed tomography (CT) of the head and neck demonstrated a 32mm×30mm×27mm tumor in the left buccal space. We surgically removed this tumor through the transoral approach. The pathologic diagnosis was follicular lymphoma grade 2 and there was no lesion in other organizations, therefore, she was not treated with radiotherapy and chemotherapy. No sign of recurrence or metastatic lesion has so far been found postoperatively.

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Examination of 39 Cases of Amyotrophic Lateral Sclerosis, by Otolaryngology

Mainly Investigated for the Term from Onset until Tracheostomy and Contracting Otitis Media with Effusion

Shunji Tanimoto, Eiken Matsuda

2007 Volume 100 Issue 3 Pages 223-229
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.223

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From 1989 to 2005, we investigated 39 cases of amyotrophic lateral sclerosis (ALS) that were first examined by an otolaryngologist at this hospital.
As a background of ALS patients, we investigated the following items: onset type, chief complaints and diagnosis at the time of the first examination by an otolaryngologist. In addition, the following items were examined to investigate the time from intervention of an otolaryngologist to ALS treatment, the term before the first examination by an otolaryngologist to tracheotomy, and the one before contracting otitis media with effusion (OME) from the onset of ALS.
Patients were often first seen for a tracheostomy. The chief complaints of half of the patients were breathing difficulties. An otolaryngologist was consulted about two years after the appearance of ALS. Moreover, tracheostomy was performed at the time of the first medical examination. Few patients had undergone evaluation of swallowing function. After tracheostomy, OME was contracted three to four years after the appearance of disease.
It is preferable in ALS treatment for otolaryngologists to evaluate the swallowing function and explain the operations that prevent aspiration to the patient and family, while building up a closer connection with a neurologist about six to twelve months after the appearance of disease.
Over the natural terminal course, when coming to use a respirator, there is a possibility of contracting OME three to four years after onset, and positive examinations by otolaryngologists are necessary.

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Comparing Food Intake among Various Diets after Tonsillectomy

Mai Kadota, Takao Imai, Mahito Ito, Kiyohito Hosokawa, Atsushi Hanamot ...

2007 Volume 100 Issue 3 Pages 231-236
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.231

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We compared caloric intake between liquid diet and Terumeal soft^® (TERUMO) for two days after tonsillectomy. Terumeal soft is a paste type nutritious diet. Average caloric intake of iced Terumeal soft per day in one patient (704kcal) was significantly higher than the average caloric intake of liquid diet (493kcal). During this study, using a questionnaire survey, we compared the degree of pain and easiness of deglutition between patients eating liquid diet and patients eating Terumeal soft. We also compared the evaluations of taste and appearance between liquid diet and Terumeal soft. There was no significant difference in the degree of pain and easiness of deglutition between liquid diet and Terumeal soft. The evaluations of taste and appearance of Terumeal soft were significantly better than those of liquid diet. We concluded that the reason caloric intake of Terumeal soft was higher than that of liquid diet was that the taste and appearance were better, not that Terumeal soft decreased pain during eating or Terumeal soft was easier to deglute. The important thing that we should do to promote food intake by patients after tonsillectomy is to improve the taste and appearance of the food, rather than increasing the easiness of deglutition or decreasing the pain during eating. From this perspective, Terumeal soft is better than liquid diet for two days after tonsillectomy.

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Treatment of Tubal Stenosis

M. Morita

2007 Volume 100 Issue 3 Pages 238-239
Published: March 01, 2007
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.100.238

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