Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
Volume 101, Issue 12
Displaying 1-14 of 14 articles from this issue
  • Masahiko Yamamoto, Tomoe Yoshida
    2008 Volume 101 Issue 12 Pages 887-894
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    Recent medical advances in imaging have facilitated the ability to visualize minute structures, and the technology is progressing further to allow stereoscopic imaging. In the field of computed tomography (CT) scan, stereoscopic image technology is progressing. In otolaryngology, diagnoses based on conventional Roentgen-rays require significant knowledge and energy because of the anatomical complexity, but the availability of CT scan has changed that situations. CT scans allow three- dimensional visualization (3D-CT), which provides so much more information. The images obtained are easy to understand. In otolaryngology, fine structures can be seen due to the delicacy of the image, and it is useful in the diagnosis of many diseases. In the future, stereoscopic imaging is expected to become a main stream. Herein, we present some 3D-CT images of various otolaryngology diseases.
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  • Endoscopic Observation
    M. Tsujimura, [in Japanese], [in Japanese]
    2008 Volume 101 Issue 12 Pages 896-897
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
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  • Takanori Mori, Nobuaki Hiraki, Koichi Hashida, Gunji Nagatani, Narihis ...
    2008 Volume 101 Issue 12 Pages 899-904
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We investigated the clinical usefulness of distortion product otoacoustic emissions (DPOAEs) for the prediction of hearing outcomes in idiopathic sudden sensorineural hearing loss (ISSNHL).
    Thirty-two patients with ISSNHL (time from the onset to the start of treatment≤14 days) were enrolled in the study. They received steroid administration (400mg/day of hydrocortisone sodium succinate followed by tapered doses) combined with hyperbaric oxygen therapy. DPOAEs (f2/f1=1.2, L1=80dBSPL, L2=70dBSPL, geometric mean (GM) of f1 and f2=531-5, 500Hz, every one-third octave) were measured before and after treatment. The degree of hearing recovery was classified into four categories (complete recovery, good recovery, satisfactory recovery, no change) according to the criteria of the Ad Hoc Committee of the Japanese Ministry of Health, Labour and Welfare.
    The DPOAE output in the high-frequency range (GM of f1 and f2≥2, 781Hz) before treatment was higher in the complete recovery group than in the other three groups. The DPOAE output at 2, 781Hz and 4, 375Hz was significantly higher in the complete recovery than in the satisfactory recovery and no change groups (Student's t-test, p<0.05). However, the improvement of the DPOAE output after treatment did not statistically differ at any frequency among the four groups.
    These results indicate that the DPOAE output in the high-frequency range before treatment can be a prognostic indicator of hearing outcomes in patients with ISSNHL.
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  • Hidetake Matsuyoshi, Ryosei Minoda, Eiji Yumoto
    2008 Volume 101 Issue 12 Pages 905-912
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We investigated the present conditions of benign paroxysmal positional vertigo (BPPV) in Kumamoto prefecture. Horizontal semicircular canal BPPV (H-BPPV) is not a rare finding, but this condition was found in 70.6% of BPPV. Of H-BPPV, 80.6% featured direction changing geotropic nystagmus, and 19.4% direction changing apogeotropic nystagmus.
    Most of the institutions participating in this investigation were medical offices without hospitalization institution, where it seemed that BPPV patients had an initial checkup. Therefore, we thought our findings reflected the present conditions of the BPPV medical examination. This present study confirmed that physical therapy was effective for H-BPPV that featured direction changing geotropic nystagmus and posterior canal BPPV. We consider it necessary to enlighten an appropriate therapeutic method about H-BPPV featured direction changing apogeotropic nystagmus.
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  • Shuichiro Hayashi, Maya Oishi, Ken Hayashi, Atsushi Shinkawa
    2008 Volume 101 Issue 12 Pages 913-916
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    Sixty-six cases diagnosed with otosclerosis underwent small fenestra stapedotomy in our clinic. During surgery, the stapes footplate became mobile in 6 cases, so-called “floating stapes”. Considering the risk of sensorineural hearing loss, we chose tympanoplasty type IV placing a Y-shaped ceramic between the incus and the footplate, rather than stapedectomy.
    Improvement of the hearing level was evaluated by the standard of the Otological Society of Japan as the improvement of the hearing level. The success rates of hearing improvement were 100%. There were no cases showing progressive sensorinual hearing loss. Postoperative vertigo occurred in only one case and was very mild.
    The stapes is fractured not infrequently or becomes mobile during surgery for otosclerosis in Japan. In order to avoid the risk of sensorineural hearing loss due to perilymph leakage following stapedectomy, the method that we used in the present series was considered one of the good options under these circumstances, However we consider that recurrence of hearing loss due to refixation of the stapes is possible in the future.
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  • Yoichi Matsuda, Tomoyuki Kurita, Yoshihisa Ueda, Shinsuke Ito, Tadashi ...
    2008 Volume 101 Issue 12 Pages 917-924
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    Middle ear cholesterol granuloma is still an intractable ear disease, and its pathogenesis has not been clearly demonstrated. In this study, we evaluated treatment of middle ear cholesterol granuloma.
    We reviewed middle ear cholesterol granuloma in 16 ears that underwent surgical treatment at Kurume University Hospital between 1990 and 2006.
    Cases that were healed by ventilation tube insertion only and those combined with other middle ear disease such as cholesteatoma were excluded from this study. We analyzed the relation between preoperative findings of the tympanic membrane and postoperative course. Preoperative findings of the tympanic membrane were grouped into the swollen type or retracted type. The cases that underwent myringotomy more than twice, showed persistent otorrhea from the tympanic ventilation tube, or the ventilation tube was missed were classified as showing a poor postoperative course. Cases without the above symptoms were classified as showing a good postoperative course. The hearing results were analyzed using the Guidelines for Evaluating Hearing Results after Middle Ear and Mastoid Surgery published by the Otological Society of Japan (2000).
    The postoperative courses of patients with a swollen tympanic membrane were significantly poorer. The postoperative courses of those with a retracted tympanic membrane and those undergergoing ossicular chain reconstruction showed significantly better results. However, 3 of 4 cases showing swollen tympanic membrane achieved a good passage. Such cases underwent posterior tympanotomy with ossicular chain reconstruction.
    Success rate for hearing improvement at about 14 post operative days was 75%. Yet, beyond 6 months postoperatively, the success rate deteriorated to 62.5%. Cases showing a poor hearing result at 14 postoperative days never showed a permanently improved hearing result.
    To acquire better postoperative results in patients with swollen tympanic membrane, posterior tympanotomy with ossicular chain reconstruction is highly recommended.
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  • Rie Kanai, Ken-ichi Kaneko, Shinya Hori, Yumi Ito
    2008 Volume 101 Issue 12 Pages 925-930
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    The present study evaluated the incidence of otitis media with effusion (OME) after head and neck surgery in patients who had been free from OME preoperatively.
    The subjects were 47 patients (90 ears; 22 males, 25 females; mean age 46.8 years; range 16-85 years) who had undergone head and neck surgery in our department. All ears had been free from middle ear diseases preoperatively. The operations were performed under general anesthesia in 42 cases, including 40 cases of nitrous oxide (N2O) anesthesia, and local anesthesia in 5 cases. Surgical sites were the middle ear in 2 cases, the nose in 9, the throat in 17, and the neck in 19. Otomicroscopic findings and tympanograms were evaluated three times; on the day before surgery, 1-2 days and 5-9 days after surgery.
    At the first-postoperative inspection of the ear drums, middle ear effusion was observed in 6 ears (6.7%). Effusion disappeared in all ears at the second-postoperative inspection. Tympanograms, which were type A in all ears before surgery, changed to type B in one ear (1.1%), type C1 in 8 ears (8.9%) and type C2 in 9 ears (10.0%) at the first-postoperative testing. All ears returned to type A except in one ear (from type C2 to type C1) at the second-postoperative testing. The average of intratympanic pressure was -17.5±2.2daPa (mean±SEM) and -59.6±8.4daPa in preoperative and the first-postoperative testing, respectively (p<0.001). The second-postoperative pressure was -22.6±2.7daPa, which did not significantlly differ from the preoperative pressure.
    In conclusion, we found that head and neck surgery might cause a decrease in intratympanic pressure. Temporary OME occurred in 6.7% ears and nitrous oxide (N2O) was used in all OME cases. We suppose that dysfunction of the eustachian tube was triggered by surgery and that N2O was related to the decrease in intratympanic pressure. Furthermore, continuation of negative intratympanic pressure promoted postoperative OME.
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  • the Effectiveness and Toxicity
    Nozomi Nomi, Kazuhide Yoshida, Satoru Kodama, Masashi Suzuki
    2008 Volume 101 Issue 12 Pages 931-936
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    Nasopharyngeal carcinoma (NPC) is difficult to diagnose in the early stage due to a lack of typical symptoms. In addition, the surgical treatment of NPC is very difficult to perform due to the anatomical characteristics. Most NPCs are histologically classified as undifferentiated or poorly differentiated carcinoma, and these histological cancers are sensitive to radiotherapy. NPCs are also sensitive to chemotherapy. Recently, some randomized trials investigating the efficacy of chemotherapy combined with radiotherapy in NPC have demonstrated that the combination of chemotherapy and radiotherapy significantly improved disease-free/progression-free survival rates compared to those with radiotherapy alone. In the present study, we investigated the efficacy of concurrent chemoradiotherapy (CCRT) for NPC. Thirteen NPC patients treated with CCRT in our hospital between 1999 and 2004 were analyzed retrospectively. The three-year overall and progression free survival rates were 90% and 80%, respectively. The efficacy of CCRT was favorable. However, various adverse events also occurred. In the early phase of CCRT, most patients were complicated with leucopenia and mucositis. In addition, all patients suffered from dry mouth, and most suffered from intermittent otorrhea and hearing impairment for a prolonged period. Two severe adverse events occurred: one patient showed extensive brain necrosis, and the other showed massive hemorrhage from a pseudaneurysm of the internal carotid artery. Although CCRT is effective for NPC, patients should be treated with caution regarding the toxicity of CCRT. Long-term follow-up is also necessary.
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  • Kayoko Higashi-Shingai, Hidenori Inohara, Katsumi Mori, Yoshiaki Kawas ...
    2008 Volume 101 Issue 12 Pages 937-941
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    A hemangiopericytoma is a rare perivascular mesenchymal tumor originating from Zimmerman's pericytes and shows variable malignant potential. Here we report two additional cases of hemangiopericytoma in the head and neck region. One was located in the sinonasal cavity, and the other was in the parapharynx. Endonasal surgery was performed for the sinonasal tumor. Preoperative embolization followed by endoscopic sinus surgery achieved complete excision of the tumor with reduction of intraoperative hemorrhage. There has not been any recurrence for over 65 months to date. The parapharyngeal tumor was excised by retraction of the submandibular gland (cervical approach). There has not been any recurrence for over 96 months to date. Immunohistochemical analysis was helpful for definitive diagnosis of the two tumors. Here in we discuss the diagnosis and treatment of hemangiopericytoma.
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  • Ryuki Otaka, Yusuke Abe, Seigo Ueda, Miki Takahara, Nobuyuki Bandoh, T ...
    2008 Volume 101 Issue 12 Pages 943-949
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    Basaloid squamous cell carcinoma (BSCC) is a histologically distinctive variant of squamous cell carcinoma that was first reported by Wain in 1986. BSCC has been reported to be biologically aggressive and carries a poor prognosis because of frequent lymph node and distant metastases. We report here in two cases of basaloid squamous cell carcinoma.
    The first patient was a 72-year-old male, who presented with masses on the oral floor and in the left neck. The tumor was treated superselective intra-arterial infusion chemotherapy combined with radiation therapy. The patient is currently alive without tumor growth 11 months after the treatment. The second patient was an 54-year-old female, who presented with masses in the oropharynx and in the left neck. Superselective intra-arterial infusion chemotherapy combined with radiation therapy was also performed in this case. The patient is also currently alive without tumor growth 10 months after the treatment. In both cases, the characteristic microscopic features of BSCC were observed, which are comedo necrosis and peripheral palisading. Superselective intra-arterial infusion chemotherapy combined with radiation therapy was very valuable to promoto the quality of life of these patients.
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  • Tetsu Iwanaga, Kenji So, Motoyasu Katsura, Ninpei Yamaguchi, Satoru Ko ...
    2008 Volume 101 Issue 12 Pages 951-954
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    A mild reaction to surgical sutures after thyroid surgery is common, but severe reaction with microabscesses and granulomatous masses is extremely rare. We report a case of wound infection around the silk sutures after thyroid surgery. A 40-year-old woman complained of abscess in the anterior region of the neck. Subtotal thyroidectomy for Basedow's disease was performed when she was 36-year-old. There-after she developed fistula, granulation, and subcutaneous tumors around the scar. A CT scan of the neck demonstrated a small collection suspected to be microabscesses along both sides and anterior to the trachea. Culture tests for bacteria were negative and her blood count did not show any leukocytosis or eosinophilia. Under general anesthesia, we performed debridement for wound infection using ultrasonically activated scalpels and nylon suture. Ten months after surgery, she has shown an uneventful course.
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  • Akio Tsuchiya, Yusuke Honma, Masaru Kawasaki
    2008 Volume 101 Issue 12 Pages 955-959
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We analyzed 8 cases of bronchial foreign bodies in our hospital from 2003 to 2007. Patients' ages ranged from 9 months to 6 years old, with a mean of 2.3 years old. The ratio of males to females was 1:1. We detected abnormal findings such as atelectasis and emphysema in 5 patients by chest X-ray. However, in 3 patients, there were no abnormal findings. CT scan was able to clarify the localization of foreign bodies in all cases. Therefore, CT scan was useful for the diagnosis of bronchial foreign bodies. We removed the foreign bodies by ventilation bronchoscopy under general anesthesia in all cases. It was very important to observe the bronchus before and after the removal of foreign bodies using a flexible fiberscope to identify foreign bodies and remove them precisely. It is also very important for otorhinolaryngologists, anesthesiologists, pediatricians, etc., to work together in order to comprehensively treat bronchial foreign bodies.
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  • K. Ichimura
    2008 Volume 101 Issue 12 Pages 960-961
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
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  • K. Yane
    2008 Volume 101 Issue 12 Pages 962-963
    Published: December 01, 2008
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
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