Practica Oto-Rhino-Laryngologica

Neurotologist's Role in Acoustic Neuroma

Kazuo Ishikawa

2008 Volume 101 Issue 8 Pages 565-573
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.565

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It has become possible to make a diagnosis of small acoustic neuroma localized within the internal auditory meatus in the presence of normal or mild hearing impairment. From the viewpoint of functional preservation, it is deemed that a turning point has come in terms of the neurotologist's role in the management of patients with acoustic neuroma, especially in cases with small tumors. As a neurotologist, one is expected to locate the tumor while it is small, and follow the time-course of the tumor's growth and cochleo-vestibular symptoms, and then adopt the most beneficial treatment policy for the patient among the three treatment options of surgery, gamma-knife application, and follow up. To determine the optimal policy, one should take into consideration one's own experience, as well as the patient's social and familial background on an individual basis. When considering hearing preservation surgery, a middle cranial fossa approach could be the most promising and desirable. Some important check points for making a diagnosis of acoustic neuroma are also presented.

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Hypertrophic Pachymeningitis Resulting from Inflammation of Otitis Media

A. Sasaki, [in Japanese], [in Japanese], [in Japanese]

2008 Volume 101 Issue 8 Pages 574-575
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.574

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Varicella-Zoster Virus Infection Involving Lower Cranial Nerves: A Report of Three Cases

Nozomi Nomi, Satoru Kodama, Toshiaki Kawano, Kazuhide Yoshida, Tetsuo ...

2008 Volume 101 Issue 8 Pages 577-585
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.577

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Varicella-Zoster virus infection sometimes causes multiple nerve paralysis. We report three cases of multiple cranial nerve paralysis due to Varicella-Zoster virus infection. The first patient, a 58-year-old man, presented with right otalgia, dysphagia and hoarseness. There were painful vesicles on the right auricle, and clinical examination demonstrated right hearing impairment and right vocal paralysis. There was no facial palsy. He was diagnosed with VIIIth, IXth and Xth cranial nerve palsy. The second patient, a 60-year-old woman, presented with right otalgia, vertigo, right hearing loss, and dysphagia. There were painful vesicles on the right auricle, and clinical examination demonstrated right hearing impairment, right canal paralysis and deviation of the tongue. Right facial palsy appeared on the 5th disease day. She was diagnosed with VIIth, VIIIth and XIIth cranial nerve palsy. The third patient, a 70-year-old woman, presented with right otalgia and dysphagia. There were painful vesicles on the right auricle and in the larynx, and clinical examination demonstrated soft palatine paralysis, right vocal cord paralysis and atrophy of the right sternocleidomastoid muscle. She was diagnosed with IXth, Xth and XIth cranial nerve palsy. Serum antibody titers for Varicella-Zoster virus were significantly elevated in all patients. All patients were successfully treated with intravenous or oral steroid and intravenous acyclovir.
Varicella- Zoster virus infection should be considered, particularly if unilateral cranial nerve palsy with pain is identified.

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Removal of Polyvinyl Alcohol from the Eternal Auditory Canal

Mitsuru Yanai, Takuya Arakawa, Tatsuya Hayashi, Yasuaki Harabuchi

2008 Volume 101 Issue 8 Pages 587-589
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.587

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We report the case of a 6-year-old girl with a small, round-shaped foreign body, composed of polyvinyl alcohol, in her right external auditory canal. This foreign body was originally a component of toy beads with which children are able to make variously shaped objects by sticking them together using water. Polyvinyl alcohol is a water-soluble polymer and is employed as an adhesive agent. In our case, it was not easy to remove it because it had fully adhered to her external auditory canal.
It is important to note that this kind of foreign body should not be attempted to be removed by water irrigation, as this would cause it to dissolve and stick to the tissue.

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Three Cases of Mikulicz's Disease as an IgG4-related Disease

Sei-ichi Nakano, Motohisa Yamamoto, Teiji Takemura, Naozumi Ishimaru, ...

2008 Volume 101 Issue 8 Pages 591-597
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.591

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We reported three cases of Mikuhcz's disease. Mikulicz's disease was diagnosed by the following criteria: 1) symmetrical enlargement of the lacrimal and salivary glands lasting at least 3 months', 2) the lacrimal and salivary glands were microscopically involved in the infiltration of inflammatory cells, 3) sarcoidosis and other lymphoproliferative diseases were excluded. Three patients with Mikulicz's disease were all characterized by elevated IgG4 concentration in the serum and prominent infiltration of IgG4-positive plasmacytes in the minor salivary glands. On the contrary, there were no findings indicating sicca syndrome or anti-SS-A and SS-B antibodies, which characterize Sjögren syndrome. It is suggested that Mikulicz's disease is an IgG4-related plasmacytec disease, with a pathogenesis differing from that of Sjögren syndrome.

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Clinical Analysis of Parotid Carcinoma

Hajime Ishinaga, Shinobu Arima, Atsushi Yuta, Kazuhiko Takeuchi, Yuich ...

2008 Volume 101 Issue 8 Pages 599-604
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.599

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Parotid carcinoma is relatively rare in head and neck cancer, and its treatment is still controversial because of its diverse histology.
A total of 37 cases of parotid carcinoma were treated in our hospital between 1991 and 2005. In terms of the therapeutic strategy, patients with low-grade carcinoma were treated by surgery alone with preservation of the facial nerves, whereas those with high-grade carcinoma underwent surgery with facial nerve resection and full-dose radiotherapy.
We performed neck dissection in only N+ patients. The 5-year, cause-specific survival rate in the 37 patients with parotid carcinoma was 67.5%, being 76.0% for those with low-grade cancer and 58.0% for those with high-grade cancer. Our study suggests that more extensive surgery is required for those with high-grade malignancy in order to improve the 5-year survival rate.

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A Case of Fish Bone Migration in the Deep Neck

Shinichi Ohba, Takeshi Kusunoki, Shin Ito, Hidenori Yokoi, Masayuki Fu ...

2008 Volume 101 Issue 8 Pages 605-609
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.605

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Ingested foreign bodies are not unusual. In most cases, these foreign bodies are easily removed. We report a relatively rare case of a fish bone migrating into the parapharyngeal space, which was removed through a cervical incision. A 30-year-old-woman with a 3-week history of sore throat since ingesting a fish bone had complained of a left-sided neck mass and pain. The ingested fish bone penetrated the pharynx and migrated to the substernocleidmastoid muscle. Furthermore, a parapharyngeal neck abscess had formed. The fish bone was successfully removed via neck exploration and the patient recovered well.

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Investigation into the Two Cases of Vocal Cord Palsy by Varicella-Zoster Virus

Noriko Tamaruya, Yuko Hata, Nobuhiko Kurita, Taeko Okuno

2008 Volume 101 Issue 8 Pages 611-615
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.611

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We encountered two cases of multiple cranial nerve palsy involvement with varicella-zoster virus, where X cranial nerve palsy, more specifically vocal cord palsy, had recovered after prolonged progress. The patients were a 57-year-old female who complained of hoarseness and dysphagia and a 51-year-old male who complained of hoarseness, right hearing impairment and right facial palsy. The first patient had IX·X nerve palsy and the second patient had VII·VIII·IX·X nerve palsy. Both cases showed complete vocal cord palsy because of X cranial nerve involvement. In the first case, vocal cord palsy had persisted for eleven months, then recovered quickly during the twelfth month. In the second, vocal cord palsy recovered slowly over ten months. In case of X cranial nerve palsy due to varicella-zoster virus, we should consider that each case may show an individual recovery process with a widely varied time course.

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Evalution of Dysphagia Using Secretion Scale

Daisuke Oyake, Tomoyuki Okada, Masahiko Fukasawa, Shigeki Sato, Izumi ...

2008 Volume 101 Issue 8 Pages 617-620
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.617

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This study retrospectively investigated the value of both endoscopically visible oropharyngeal secretions in the hypopharynx and miss-swallowing frequency in the prediction of food and liquid aspiration. Videoendoscopy was performed in Fourty-three patients. A four-level rating scale was employed to determine the severity of accumulated oropharyngeal secretions. On this secretion scale patients graded 0 and 1 could eat, but those graded 3 could not. It was found that the accumulation of endoscopically visible oropharyngeal secretions located within the laryngeal vestibule was highly predictive of the aspiration of food or liquid. The Results are discussed in terms of integrating this information with clinical bedside examinations.

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A Modified Transcervical Approach to Benign Parapharyngeal Tumors

Tetsu Iwanaga, Noriyuki Sakihama, Haruo Yoshida, Fujinobu Tanaka, Haru ...

2008 Volume 101 Issue 8 Pages 621-626
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.621

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The aim of this paper was to describe our surgical technique and retrospective review of the treatment of benign parapharyngeal tumors. We used a modified transcervical approach in twelve patients with large tumors. Pathological diagnose comprised 7 cases of pleomorphic adenoma, 4 cases of schwannoma, and 1 case of oncocytoma. The mean maximal tumor diameter was 4.8cm (range: 2.0-9.0cm) and the mean vertical distance from the skull base was 1.3cm (range: 0-3.5cm). The mean surgical time was 198 minutes (range: 104-369 minutes), and the mean blood loss was 82ml (range: 25-200ml). The average follow-up time was 37 months (range: 8-74 months) and there was no clinical or radiological signs of residual or recurrent tumor. The modified transcervical approach facilitates the removal of large tumors, but only in benign cases.

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Multiple Foreign Bodies (Screw and Bell) in the Bronchus and the Small Intestine: A Case Report

Wakako Kanda, Serei Hosokawa, Rieko Yamamoto, Jun Okamura, Matsumi Tsu ...

2008 Volume 101 Issue 8 Pages 627-630
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.627

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Accidental ingestion of foreign bodies is a common pediatric problem. Here we describe multiple foreign bodies (a screw and a bell) in the left bronchus and the small intestine of a 20-month-old child. After the ingestion episode, the patient was initially examined at the pediatric department of her local hospital. A screw was detected in the esophagus and a bell was detected in the small intestine. The patient underwent an endoscopic procedure under general anesthesia. However, the screw was not seen in the esophagus. Chest X-ray of the left side demonstrated that the screw was in the left bronchus. The patient was referred to our hospital, and underwent a removal of the screw under bronchoscopy. Fifty-one hours after ingestion episode, the bell was excreted.
Diagnosis of such cases requires the greatest care, because even if a foreign body is found in the gastrointestinal tract, there may still be another foreign body in the bronchus.

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Case Report: Toxoplasmic Intraparotid Lymphadenitis

Takayuki Kawabata, Koji Torihara, Hidekazu Naono, Keiji Matsuda, Hirok ...

2008 Volume 101 Issue 8 Pages 631-636
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.631

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Toxoplasmosis usually manifests as a cervicofacial lymphadenopathy in adults, and its manifestation as a parotid mass is very rare. In this article, we present the case of a 48-year-old with acquired intraglandular parotid toxoplasmosis which clinically mimicked a parotid gland tumor. We performed superficial parotidectomy, suspecting a malignant tumor. However, the postoperative histopathology, indicated toxoplasmic lymphadenitis. Serological tests revealed high levels of both IgM and IgG antibodies against Toxoplasma in the serum. We concluded that the disease was due to active infection with Toxoplasma gondii. Through the postoperative administration of specific antibiotic agents, the patient remained symptomatically well without signs of systemic or local toxoplasmosis. The infection was believed to have been transmitted via the patient's pet rabbit.

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Management of Recurrent Acute Otitis Media

M. Ito

2008 Volume 101 Issue 8 Pages 638-639
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.638

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Widening the Natural Ostium and Nebulizer for Chronic Sinusitis

M. Kawamoto

2008 Volume 101 Issue 8 Pages 640-641
Published: August 01, 2008
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.101.640

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