Practica Oto-Rhino-Laryngologica

Rehabilitation for a Patient with Peripheral Facial Palsy

Katsuhiko Nakamura, Noriaki Takeda

2008 Volume 101 Issue 6 Pages 413-421
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.413

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Synkinesis is the most unpleasant sequelae of peripheral facial palsy. It is an abnormal involuntary associate facial movement such as eye closure during smiling and mouth movement during blinking. Synkinesis strongly reduces the quality of life; however, treatment of synkinesis is difficult. We developed new rehabilitation therapies to prevent and to treat the synkinesis.
We developed a mirror biofeedback rehabilitation method to prevent synkinesis involving eye closure during mouth movement. We instructed a patient to move his mouth while keeping their eyes open symmetrically using a mirror (mirror biofeedback). Thirty minutes of daily training was continued for a period of 10 month.
To evaluate the degree of synkinesis, we computed the % eye opening, as a percent ratio of the width of the eyelid of the affected side relative to the normal side.
The % eye opening was compared between patients with and without the training. The % eye opening was significantly greater in the group with training than in the control group. This outcome indicates that our mirror biofeedback rehabilitation effectively to prevents involuntary eye closure during mouth movements.
EMG biofeedback rehabilitation is used to prevent synkinesis of involuntary mouth movement during eye closure.
To treat the synkinesis of eye closure during mouth movement, we developed a combination therapy of mirror biofeedback rehabilitation with botulinum A toxin injection. Botulinum A toxin is injected into the orbicularis oculi muscle that shows involuntary associate movement. After botulinum A toxin injection, mirror biofeedback rehabilitation was continued for a period of 10 months.
The % eye opening was compared before and after treatment. The % eye opening during mouth movement was significantly improved after treatment. This outcome indicated that combination therapy with mirror biofeedback and rehabilitation with botulinum A toxin injection is an effective treatment for facial synkinesis after facial palsy.

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Laser Therapy for Bulky Hypopharyngeal Hemangioma

S. Hirano, [in Japanese]

2008 Volume 101 Issue 6 Pages 422-423
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.422

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Review of the Result of Hearing after Type IV Tympanoplasty

Yoichi Matsuda, Tomoyuki Kurita, Yoshihisa Ueda, Shinsuke Ito, Tadashi ...

2008 Volume 101 Issue 6 Pages 425-430
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.425

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We reviewed the postoperative hearing results in 32 ears that were underwent type IV tympanoplasty between 1995 and 2005 at Kurume University Hospital.
Hearing results were analyzed depending on the type of ossicular chain reconstruction, type of the columella, difference in canal resection and staged surgery using the guide line for hearing results following middle ear and mastoid surgery by the Otological Society of Japan (2000). The that society defined successful hearing results were as follows; The difference between air conduction and bone conduction is less than 15dB or the postoperative hearing level is less than 30dB or the hearing gain is more than 15dB.
Overall success rate of surgery was 63%. The success rate of cases in which the columella was made from auricular cartilage was significantly poorer as compared to cases of autografted or artifical ossicles. The hearing outcome after staged surgery was significantly better than that after of ossicular chain reconstruction performed during the initial surgery.

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Microbial Pathogens in Pediatric Acute Otitis Media

Recent Trend in a Tokyo Hospital

Kohtaroh Tanaka, Tomoya Ichikawa, Jun Yano

2008 Volume 101 Issue 6 Pages 431-434
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.431

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The management of pediatric acute otitis media (AOM) has recently become more difficult due to increasing antibiotic resistance of pathogens. To investigate and clarify the trends of microbes and antibiotic susceptibility significantly contributes to the treatment of AOM. A retrospective chart review was conducted for 123 children with AOM treated between April 2006 and March 2007. Two hundred twenty five samples of middle ear fluid were obtained by tympanocentesis and 39 samples from otorrhea. Of 225 middle ear fluid samples, 156 samples (69%) were positive on microbial culture and 196 isolates were detected. Thirty isolates were penicillin G susceptible streptococcus pneumoniae (PSSP) and 53 were penicillin G intermediately resistant streptococcus pneumoniae (PISP). There were no penicillin G resistant streptococcus (PRSP). Thirty eight haemophilus influenzae were beta-lactamase non-producing ampicillin susceptible (BLNAS), 15 were beta-lactamase non-producing ampicillin resistant (BLNAR), 13 were beta-lactamase producing ampicillin resistant (BLPAR). There were no beta-lactamase producing ampicillin and clavulanate acid resistant (BLPACR). Of 39 otorrhea samples, 33 samples (85%) were positive on microbial culture and 60 isolates were detected. Two isolates were PSSP and 10 were PISP. There were no PRSP. Eleven were BLNAS, and one was BLNAR. There were no BLPAR or BLPACR. These findings suggest that relatively high proportions of pathogens isolated from AOM in our institute were susceptible to amoxicillin.

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The Value of Electroneurography in Acute Peripheral Facial Nerve Palsy

Shujiro Minami, Seiichi Shinden, Naoki Oishi, Taku Yamashita, Koichiro ...

2008 Volume 101 Issue 6 Pages 435-439
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.435

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Objective: To evaluate the use of electroneurography (ENoG) as a prognostic indicator in acute peripheral facial paralysis in a general hospital. Design: Retrospective study. Participants: The patients had been treated for a sudden onset unilateral facial paralysis during an 18 month period (2005. 7-2006. 12). Main outcome measures: ENoG was performed 7 to 14 days after the onset facial palsy. The recovery of facial nerve function was documented by Yanagihara's grading system. All patients were followed monthly until recovery or up to 6 months after onset. Results: One-hundred ten patients with acute peripheral facial paralysis, including Bell's palsy (86%), Ramsay-Hunt Syndrome (6%), trauma (6%), and others (2%) underwent ENoG test. Patients were divided into 5 classes according to the ENoG value; [40%-] 41%, [20-40%] 24%, [10-20%] 9%, [0-10%] 11%, [0%] 15%. The recovery rate in each group was; [40%-] 98%, [20-40%] 96%, [10-20%] 90%, [0-10%] 58%, [0%] 24%. The patients whose ENoG values were greater than 10% showed a 96% chance of recovery (sensitivity 0.88, specificity 0.86). Patients with a greater ENoG value recovered significantly faster. Conclusion: ENoG provides accurate information predicting the prognosis and recovery rate of patients with facial palsy.

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Chondroid Syringoma of the External Auditory Canal: A Case Report

Katsuki Niwa, Akihiro Kurita, Akihiro Shiotani

2008 Volume 101 Issue 6 Pages 441-443
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.441

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Chondroid syringoma (so-called mixed tumor) of the skin is usually a firm or polypoid tumor and histologically composed of epithelial components, showing glandular or ductal differentiations, and myxoid or chondroid stroma. Eighty to ninety percent of chondroid syringoma of the skin occur in the head and neck region, particularly around the nose. Chondroid syringoma of the external auditory canal is extremely rare. We report a case of chondroid syringoma in a 60-year-old man, who presented with a solid tumor in the left external auditory canal. The tumor was totally excised along with the overlying skin. Histologically, the tumor consisted of ducts with lumina of varying sizes lined by two or several layers of epithelial cells. Glandular ductal sizes were large or small, and large ducts are cystic. There are aggregates of eosinophilic collagen fiber and basophilic mucoid in the stroma. Those lead this case to the diagnosis of chondroid syringoma. We report a rare case of chondroid syringoma of the external auditory canal.

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Extramedullary Plasmacytoma of the Epipharynx: A Case Report

Kaori Kayano

2008 Volume 101 Issue 6 Pages 445-452
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.445

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We report a case of extramedullary Plasmacytoma of the epipharynx in an 80-year-old woman. She complained of a sensation of occlusion in the epipharynx. Physical examination, computed tomography, and magnetic resonance imaging showed a mass measuring 15mm in diameter in the epipharynx without associated cervical lymphadenopathy. Biopsy of the lesion showed extramedullary plasmacytoma. There were no abnormalities with respect to serum immunoglobulin levels, serum or urinary protein levels, or bone marrow biopsy findings. Surgical resection of the tumor was performed by the endoscopic transnasal method with a CO₂ laser. Immunohistochemical examination of the resected mass demonstrated monoclonality for immunoglobulin heavy-chain IgG and lambda-light chain in the tumor cells. Additionally, a rearrangement band was identified on Southern blot analysis of tumor extract using the probe for imunoglobulin heavy chain.
Because the surgical margin was positive for tumor cells, additional resection was performed. However, there was no apparent tumor in the further resected tissue specimen. There has not been any sign of local recurrence or development of multiple myeloma 13 months after surgery.
We suggest that surgery is the optimal choice for treating extramedullary plasmacytoma of the head and neck when the tumor is localised and resectability is good.

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A Case of Sinonasal Mucinous Intestinal-Type Adenocarcinoma of the Ethmoid Sinus

Takao Ogawa, Satoshi Seno, Hironori Sakurai, Mikio Suzuki, Takeshi Shi ...

2008 Volume 101 Issue 6 Pages 453-457
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.453

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Mucinous intestinal-type adenocarcinoma is a rare malignant tumor of the nasal cavity and paranasal sinus. We describe a case of mucinous intestinal-type adenocarcinoma of the ethmoid sinus in a 69-years old man. He had no history of wood dust inhalation. CT and MRI demonstrated a large mass that extended from the ethmoid sinus to the anterior skull base. We perfomed anterior craniofacial resection of the tumor, and postoperative radiotherapy (60Gy). Histopathologic examination showed that the tumor contained atypical intestinal mucosa, papillary growth, well formed glands distended with mucus. The prognosis was very poor. Local recurrence, and metastases to the lung and brain were found 7 months after the surgery. The patient died at 4 months postoperation.

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A Case of Metastatic Renal Cell Carcinoma to the Paranasal Sinuses

Yuki Kobayashi, Naoki Kanai, Yoshiya Ishida, Tetsuji Wada, Yasuaki Har ...

2008 Volume 101 Issue 6 Pages 459-464
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.459

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We report a 58-year-old man with metastasis from renal cell carcinoma to the left paranasal sinuses. The patient had undergone right nephrectomy eight years before and total thyroidectmy and left nephrectomy because of metastases three years before. He complained of upper gingival swelling and computed tomography and Magnetic Resonance imaging demonstrated a hypervasculer tumor of the left maxillary sinus, ethmoidal sinus, and nasal cavity. Although he had already had lung and paraaortic lymph node metastases, we performed lateral rhinotomy for the paranasal sinus tumor resection after emobolization in order to avoid massive epistaxis from the tumor. Recurrence of the Paranasal sinus has not been seen for 10 months postoperatively.

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Two Cases of Incomplete Type and Suspected Type of Behçet's Disease

Takuma Sekita, Akio Kondo, Noriaki Takeda

2008 Volume 101 Issue 6 Pages 465-471
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.465

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We report two cases of an incomplete type and a suspected type of Behçet's disease that met the diagnostic criteria. Both patients complained of acute sore throat with multiple oropharyngeal aphthous ulcers. The first case had additional diagnostic symptoms of genital ulcers, skin lesions of erythema nodosum with gastrointestinal ulcers, leading to a diagnosis of incomplete type of Behçet's disease. The second patient had additional diagnostic symptoms of genital ulcers with positive HLA-B51 and abnomal signals on brain MRI, leading to a diagnosis of suspected type of Behçet's disease.

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A Case of Lemierre Syndrome

Hiroshi Nakanishi, Maki Arai, Seiji Hosokawa, Satoshi Iwasaki, Kunihir ...

2008 Volume 101 Issue 6 Pages 473-477
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.473

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We present a case of Lemierre syndrome characterized by thrombophlebitis of the internal jugular vein with multiple septic emboli to the lung caused by peritonsillar abscess.
A 67-year-old male was admitted with progressive fever and sore throat caused by peritonsillar abscess. Despite drainage of the peritonsillar abscess and antibiotic therapy with imipenem following cefozopran, his condition worsened, and he presented with swelling, pain, and erythema of the right side of the neck. Contrast-enhanced computed tomography (CT) of the neck demonstrated thrombosis of the right internal jugular vein. CT scan of the thorax showed bilateral multiple septic emboli. Based on these findings, a diagnosis of Lemierre syndrome was made. The patient was treated with clindamycin and heparin in addition to imipenem and recovered slowly.
Lemierre syndrome is one of the complications of acute tonsillitis or peritonsillar abscess, which causes thrombophlebitis of the internal jugular vein, leading to metastatic abscess, septic emboli, and significant mortality. Lemierre syndrome should be considered in cases of acute tonsillitis or peritonsillar abscess because the frequency of this syndrome is increasing.

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Clinical Analysis of 4 Cases of Thyroglossal Duct Cyst Papillary Carcinoma

Katsuro Sato, Sugata Takahashi

2008 Volume 101 Issue 6 Pages 479-484
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.479

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Four cases of thyroglossal duct cyst (TDC) papillary carcinoma treated in our department were clinically analyzed. Patients were 36, 59, 60, and 63 years old, respectively. Although TDC carcinoma was located in the midline of neck in 2 of the 4 cases, the lesion was located atypically in the lateral neck in the other 2 cases. Preoperative diagnoses were TDC carcinoma accompanied by thyroid carcinoma, TDC accompanied by benign thyroid tumor, thyroid carcinoma with cervical lymph node metastasis, and primary unknown metastatic neck carcinoma, respectively. Radiological features included a solid part in the cyst wall on CT in 3 of the 4 cases, and calcification of the solid part in 2 of the 3 cases. In the preoperatively diagnosed as malignant, one case was diagnosed as having malignancy at 5th fine needle aspiration cytology (FNA) during follow-up. The case who was not thought to be malignant preoperatively was diagnosed as papillary carcinoma on intraoperative frozen section (FS) histopathological diagnosis. Three of the 4 cases were accompanied by thyroid gland papillary carcinoma and total thyroidectomy was performed. In the diagnosis of patients with cervical cystic mass, TDC carcinoma should be considered even when the lesion arises in elderly patients or in the lateral neck. On radiological diagnosis, the presence of a solid portion as well as calcification were important CT finding. Repeated FNA and FS histopathological diagnoses were essential for the accurate diagnosis and treatment of TDC carcinoma. In the patient with TDC carcinoma arising in the midline accompanied by thyroid carcinoma, dissection by Sistrunk's procedure, total thyroidectomy and paratracheal dissection followed by isotope therapy is considered a proper treatment strategy. For the lateral neck cases, neck dissection should be done, and total thyroidectomy followed by isotope therapy is needed for patients complicated by thyroid carcinoma.

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Tips for Successful Myringotomy

S. Kakehata, [in Japanese]

2008 Volume 101 Issue 6 Pages 486-487
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.486

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The Utility of Aural Treatments before and after the Tympanoplasty

N. Fukushima

2008 Volume 101 Issue 6 Pages 488-489
Published: June 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.488

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