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101 巻, 3 号
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青柳 優2008 年 101 巻 3 号 p. 159-174
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーThis study describes the history, stimulus tones, detection techniques, source generators and clinical applications of auditory steady-state responses (ASSR). The most important benefit of ASSR in objective audiometry is that it can provide an accurate assessment of hearing at different audiometric frequencies in a frequency specific manner, if sinusoidally amplitude-modulated tones are used as tonal stimuli. Power spectrum analysis and phase coherence using fast Fourier transform are useful for the automatic detection of threshold because of the sinusoidal response waveform configuration. Because the detectability of ASSR changes under different arousal states, 40-Hz ASSR is suitable for waking adults and 80-Hz ASSR for sleeping children in the assessment of hearing. Regarding the sources of those responses, 40-Hz ASSR is considered the steady-state version of the middle latency response and 80-Hz ASSR is considered the steady-state version of auditory brainstem response (ABR). Bone conduction stimuli are also useful in the assessment of conductive hearing loss, though the responses are not reliable at the intensity level of 60dB or higher. The difficulty in predicting a hearing level of 500Hz or less using the 80-Hz ASSR threshold can be explained by auditory filter. Its advantage is that the thresholds at 4 different frequencies in both ears can be predicted more rapidly than ABR using the multiple simultaneous stimulation technique. In addition, the ASSR to clicks may provide a rapid screening technique. Finally, it may be helpful in assessing suprathreshold hearing to use ASSRs to sounds that sweep their intensity (sweep technique) or actual speech sounds. In this respect, ASSRs may contribute to the objective fitting of hearing aids in young children.抄録全体を表示PDF形式でダウンロード (2312K) -
扇 和弘, 鈴木 弟, 小嶋 章弘, 藤枝 重治2008 年 101 巻 3 号 p. 176-177
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (1932K) -
稲垣 太郎, 清水 重敬, 岡本 伊作, 古瀬 寛子, 湯川 久美子, 萩原 晃, 小川 恭生, 林 麻美, 鈴木 衛2008 年 101 巻 3 号 p. 179-183
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーA patient with laryngeal cancer had difficulty in eating during radio-chemotherapeutic treatment. Transfusion without vitamins had been given for 40 days, then dizziness on walking and nystagmus developed.
Equilibrium function tests showed a saccadic pattern of the ETT, inhibition of the OKP and the reduced caloric responce, but the normal VEMP. Symmetrical high-intensity lesions from the thalamus to the brain stem was observed on MRI-FLAIR.
Since Wernicke encephalopathy was suspected, administration of vitamin B1 was started. Four days later, dizziness improved and appetite was increased. ETT, OKP and MRI findings improved.
Although thiamine deficiency in the blood was not proved, Wernicke encephalopathy was highly suspected. The equilibrium function tests and MRI findings suggested a lesion from the thalamus to the abducens nucleus. Thiamine administration improved the symptoms rapidly. It is necessary for undernourished patients to take a vitamin supplements to prevent Wernicke encephalopathy.抄録全体を表示PDF形式でダウンロード (2008K) -
星野 知之, 松本 真吏子, 木倉 幹乃, 児玉 章2008 年 101 巻 3 号 p. 185-188
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーA slow glowing glomus tympanicum tumor was found and surgically removed in a 69-year-old man. He initially consulted an ENT clinic complaining of fullness of the ear and tinnitus in 1997. Red tinge of the eardrum caused by an intratympanic tumor was noted at that time. Though the signs and symptoms had not deteriorated, the patient was referred to our clinic on suspicion of the glomus tumor 8 years later in 2005. A soft tissue density mass measuring 2.5mm was found on the promontory on 2mm thick axial CT image but hearing and tympanometry remained normal. In April 2006, the tumor was successfully removed from the promontory without any residual complications. Histological and immuno-histochemical study confirmed the diagnosis. The natural history and the growth rate of the tumor are discussed.抄録全体を表示PDF形式でダウンロード (4305K) -
宮田 政則, 今村 俊一, 遠藤 周一郎, 水越 昭仁, 上條 篤, 松崎 全成, 増山 敬祐2008 年 101 巻 3 号 p. 189-194
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーAlthough the main symptom of facial nerve neurinoma is facial paralysis, it has been reported that about 30% of patients with facial nerve tumor do not demonstrate symptoms of facial paralysis at the initial diagnosis. Although facial nerve neurinoma is a benign tumor that can be completely treated by surgical extraction, irreversible facial paralysis is almost unavoidable. Therefore, one method is to wait until facial paralysis has clearly developed before performing surgery. However, enlargement of the tumor may cause destruction of adjacent organs and serious complications. Therefore, we must carefully consider the surgical timing as well as how we explain the risk of complications to the patient.
In this case, there was an interval of six years from the initial diagnosis of neurinoma until the patient consented to surgery. The tumor had extended from the horizontal portion of the facial nerve to the parotid gland, and destroyed not only the facial canal but also the structures of the middle ear and the posterior wall of the external auditory meatus, causing conductive hearing loss. Severe facial paralysis and moderate conductive hearing loss was present at the time of surgery. Postoperative functional loss was minimized by performing tympanoplasty type III and facial nerve reconstruction by interposition to the hypoglossal nerve.抄録全体を表示PDF形式でダウンロード (6496K) -
秋月 裕則, 近藤 英司, 大山 晴三, 阿部 晃治, 田村 公一, 武田 憲昭2008 年 101 巻 3 号 p. 195-200
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーWe reported two cases of multiple paranasal mucoceles, in which MRI was useful to choose the appropriate surgical approach. The first case was a 53-year-old woman, with right visual disturbance due to spheno-ethmoid mucoceles. CT showed a large mucocele in the right spheno-ethmoid sinus, which was closely associated with the right optic nerve. However, MRI could detect a small mucocele lateral to the large one and showed that the small one, but not the large one, involved the optic nerve. The surgical treatment with an endonasal endoscopic approach and navigation-assisted endoscopic drainage of both mucoceles was performed, resulting in complete recovery of visual acuity.
The second case was a 52-year-old woman with three paranasal mucoceles. CT showed two mucoceles in the right maxillary sinus. However, MRI showed that the lateral lesion was separated from the medial wall of the nasal cavity by two other medial lesions in the maxillary sinus. Surgical treatment was performed by an external approach and drainage of the three mucoceles was successful.抄録全体を表示PDF形式でダウンロード (5275K) -
辻榮 仁志, 渡邉 昭仁, 谷口 雅信2008 年 101 巻 3 号 p. 201-205
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーThe NBI (Narrow Band Imaging) system is based on modification of the spectral features with an optical color separation filter narrowing the bandwidth of spectral transmittance. This imaging modality emphasizes the structure of the mucosal surface as well as capillary structures. We present a 74-year old man diagnosed with oropharyngeal superficial carcinoma by electronic fiberscope with NBI system for otolaryngologists. Surgery was successfully performed with minimal damage using a Davis mouth gag.
Using an electronic fiberscope with NBI system for otolaryngologists, superficial carcinomas can be more easily detected and methods of treating superficial carcinomas are facilitated.抄録全体を表示PDF形式でダウンロード (7638K) -
谷光 徳晃, 中尾 芳雄, 中下 陽介, 田頭 宣治2008 年 101 巻 3 号 p. 207-214
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーFifty patients with squamous cell carcinoma of the hypopharynx were treated at Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital from September 1993 to August 2005. Of these 50 cases, 45 were male and 5 were female and the average of age was 64.4. All cases were pathologically diagnosed as squamous cell carcinoma. The primary lesion was located in the pyriform sinus in 26 cases, the postcricoid in 13 cases, the posterior pharyngeal wall in 10 cases and was unclassified in 1 case. Our guideline for the treatment of hypopharyngeal cancer is a combination of radiotherapy, chemotherapy and surgery. The schedule of combination therapy is as follows: all patients were treated with irradiation of 40Gy (and chemotherapy if possible). When the primary lesion responded almost completely to 40Gy irradiation, the patient subsequently received full-dose irradiation. If a complete response was not obtained, the patient underwent radical surgery. Of 50 patients, 44 patients could be treated radically in this schedule. As a result, almost all of the patients treated with surgery were especially advanced cases. The cause-specific 5-year survival rate of all patient was 46.0%. There were significant differences in suvival between T3 stage and T4 stage, between below N1 stage and beyond N2 stage. Of 15 patients who died of disease, 9 (60%) died of distant metastasis. Eight of these 9 patients were diagnosed with N2b stage. We thought that our guideline for the treatment of hypopharyngeal cancer was reasonable because of the increased possibility of preservation of larynx and that patients with multiple metastasis to cervical lymph nodes should receive chemotherapy strictly.抄録全体を表示PDF形式でダウンロード (1008K) -
吉福 孝介, 永野 広海, 黒野 祐一2008 年 101 巻 3 号 p. 215-220
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーA case of laryngeal hemangioma is reported. On esophagogastroduodenoscopy, a 67-year-old man demonstrated a dark red mass in the larynx and was referred to our clinic. Fiberscopic examination showed the presence of laryngeal hemangioma in the left false vocal cord extending to the piriform sinus. CT and MRI findings were compatible with those of laryngeal hemangioma; however, the feeding artery was not detected by angiography.
After performing tracheostomy under local anesthesia in order to secure the airway and obtain a good surgical field, the tumor was vaporized with CO2 laser under laryngo-micro-surgery and injected with 5% ethanolamine oleate, a sclerosing agent which has been used endoscopically in the treatment of esophageal varicus.
One day after the surgery, a severe edema in the larynx was observed. However, the tumor size gradually reduced day by day and was localized in the left arytenoid three weeks after surgery.抄録全体を表示PDF形式でダウンロード (7590K) -
宮田 耕志, 福島 英行, 藤木 暢也, 本多 伸光, 西田 明子, 足立 恒道, 辻村 美佳, 塚本 達雄, 木谷 芳晴, 浜口 清海2008 年 101 巻 3 号 p. 221-226
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーParathyroidectomy (PTx) is the most powerful therapeutic strategy for secondary hyperparathyroidism in patients with chronic renal failure. However, in some cases, identification of pathological parathyroid glands at PTx is not easy, resulting in sustained hyperparathyroidism. In this study, we employed methylene blue dye to discriminate abnormal parathyroid glands in 20 cases during PTx.
Methylene blue solution at a dose of 5mg/kg was administered intravenously at the time of skin incision. In 19 of 20 cases (95%), parathyroid glands of various sizes were stained dark blue, whereas the thyroid gland was stained light blue. The dye of the canulated vein as well as pseudohypoxia indicated by pulse oxymetry was observed as a side effect of the dye in most cases as previously reported.
Intraoperative infusion of methylene blue could be a useful method of identifying parathyroid glands without any serious side effects. This might provide a beneficial tool to shorten the surgical duration and reduce the incidence of complications following PTx.抄録全体を表示PDF形式でダウンロード (6235K) -
金泉 秀典, 吉崎 智一, 三輪 高喜, 古川 仭2008 年 101 巻 3 号 p. 227-231
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーThyroid tumor is one of the most common diseases encountered by otolaryngologists and head and neck surgeons. Most patients are young and female and have good prognosis. Therefore, surgery for thyroid tumor needs cosmetic consideration. Various approaches have been proposed to minimize or avoid an undesirable scar on the neck. As a result of these studies, enodoscopic thyroid surgery has been introduced. We performed endoscopic thyroid surgery using an optical device for sinus surgery which is familiar and conveniently available to otolaryngologists. The main incision was made below the clavicle on the chest wall. A second incision was placed on the lateral neck for insertion of an endoscope. After dissecting the layer under the platysma, two segments of Kirschner wire were horizontally inserted, then lifted up to obtain a working space. Vessels were incised with an ultrasonically activated scalpel or vessel sealing system. Magnified endoscopic vision permitted easy identification of the reccurent nerve. Use of a short endoscope improved surgical manageability. This method of endoscopic thyroid surgery offers cosmetic advantages to otolaryngologists.抄録全体を表示PDF形式でダウンロード (4268K) -
永野 広海, 吉福 孝介, 黒野 祐一2008 年 101 巻 3 号 p. 233-236
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーEsophageal candidosis is not a rare disease. It is caused by Candida albicans, which is normally indigenous in the oral cavity and the large intestine, but becomes pathogenic due to ingestion of antibiotics, steroids and immunosuppressants, complication of malignant tumors, and HIV infection.
We encountered 4 patients who consulted our hospital with a chief complaint of foreign body sensation of the larynx and were diagnosed with esophageal candidosis by upper gastrointestinal endoscopy. The patients were a 79-year-old woman with diabetes as an underlying disease, a 69-year-old man with laryngeal cancer (after radiotherapy), a 54-year-old man with laryngeal cancer (after laryngectomy), and a 46-year-old woman with no underlying disease. The clinical symptoms resolved rapidly within 1 month following oral administration of antifungal agents.抄録全体を表示PDF形式でダウンロード (4219K) -
福家 智仁, 山田 弘之, 宮村 朋孝, 富岡 利文2008 年 101 巻 3 号 p. 237-242
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーWe report a suspected case of Wegener's granulomatosis with poor eyesight, hoarseness, dysphagia and hearing loss. The variety of neurological symptoms made diagnosis difficult. But Wegener's granulomatosis was suspected because of the PR-3ANCA level. Symptoms were improved by steroid and cyclophosphamide administration, but the patient stopped cyclophosphomaide on his own initiative and hearing loss worsened thereaftered. Readministration of cyclophosphamide improved the hearing, but poor eyesight and recurrent nerve paralysis persisted.抄録全体を表示PDF形式でダウンロード (3055K) -
平林 秀樹2008 年 101 巻 3 号 p. 244-245
発行日: 2008/03/01
公開日: 2011/10/07
ジャーナル フリーPDF形式でダウンロード (1827K)
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