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Kenya Inukai, Yutaka Yamamoto, Sugata Takahashi
2009 Volume 102 Issue 12 Pages
1005-1009
Published: 2009
Released on J-STAGE: June 10, 2011
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Otolaryngologists often have difficulty in examining persons suffering from vertigo or dizziness who also have psychiatric problems. Depression—the most frequent cause of suicide—is especially likely to be overlooked in daily intervention. We investigated how those who were potentially depressed and also vertiginous consulted otolaryngologists using the Self-Rating Questionnaire for Depression (SRQ-D).
We used the SRQ-D to survey 194 vertiginous persons—114 with idiopathic vertigo, 40 with benign paroxysmal positional vertigo, and 40 with Meniere’s disease. Controls were 194 non-vertiginous persons matched by gender and age. Subjects were grouped based on SRQ-D scores, i.e. those scoring 16 or more points (positive) and those scoring 15 or fewer points. Chi-square tests were conducted.
Positivity among vertiginous subjects was 13.4% and that among control subjects 2.1%. Positivity among those with idiopathic vertigo was 12.3% and that among control subjects 1.8%. Positivity among those with benign paroxysmal positional vertigo was 7.5% and that among control subjects 2.5%. Positivity among those with Meniere’s disease was 22.5% and that among control subjects 2.5%. Positivity among subjects who were vertiginous (p<0.01), had idiopathic vertigo (p<0.01), and had Meniere’s disease (p<0.05) was thus significantly higher than among control subjects.
SRQ-D is therefore considered useful in identifying those suspected of depression among vertiginous patients to advise them to seek psychiatric counseling.
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Tadahiko Wada, Michitaka Iwanaga, Nobuhiro Hakuba, Yasuyuki Hiratsuka, ...
2009 Volume 102 Issue 12 Pages
1011-1015
Published: 2009
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The incidence of tuberculosis in Japan, including tuberculous otitis media, has increased alarmingly. Predisposing factors remain, however, to be clarified—particularly in view of how clinical features have changed—with the use of effective antitubercular therapy and improved economic and social conditions. Otolaryngologists must thus be aware of tuberculous in chronic otitis media and its varied manifestations. We report the two cases of tuberculous otitis media and its presentation and clinical manifestation. Tuberculous otitis media diagnosis was corroborated by pathohistological, microbiological, and molecular biological tests.
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Ryo Ota, Akihiro Katada, Tatsuya Hayashi, Yasuaki Harabuchi
2009 Volume 102 Issue 12 Pages
1017-1021
Published: 2009
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External auditory canal (EAC) carcinoma is a comparatively rare disease. We herein report a case of adenoid cystic carcinoma of the EAC. In March 2004, a 67-year-old woman was referred to our department because of swelling and pain in her left ear. We suspected an EAC tumor, and a biopsy of the lesion was performed. The presence of an adenoid cystic carcinoma was confirmed, and the patient underwent an excision of the EAC and postoperative irradiation. No evidence of recurrence was seen at a Five-year follow-up examination. Adenoid cystic carcinoma of the EAC is a rare disease. Most patients only complain of ear pain. This symptom is similar to that of otitis externa. The lack of specific clinical signs makes a diagnosis of adenoid cystic carcinoma of the EAC difficult. Early recognition by biopsy is essential because the management and prognosis of this disease are determined by the extent of the tumor. We suggest that if an EAC tumor is suspected, a biopsy should be immediately performed for the early diagnosis and treatment of this condition.
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Atsuhito Takahashi, Kazuhiko Shoji, Takehiro Iki, Masanobu Mizuta, Mam ...
2009 Volume 102 Issue 12 Pages
1023-1027
Published: 2009
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Endoscopic sinus surgery (ESS) is a globally disseminated, well-documented procedure. To determine whether post-ESS wound healing would benefit from wet dressing using calcium alginate fiber (Algoderm
®) nasal packing, we monitored 173 subjects—106 men and 67 women— with nasoparanasal disease treated using ESS between April 2005 and March 2008. We evaluated postoperative pain on a numerical rating scale (0–5), and the postoperative complications of nasal bleeding and infection of the 173, 116 patients (67%), scored pain as ≥2 on the day after surgery, but dropped to <20%, on the day after surgery on postoperative day (POD) 7, 16% patients felt strong pain when Algoderm
® was removed.
Postoperative complications involved 9 subjects (5.2%) with postoperative bleeding and 78 (45.1%) with high fever (≥37.5°C). Almost all fever lasted until POD2. When Algoderm
® was removed, infection-free wound healing was confirmed in almost all patients. Algoderm
® had no foul smell in any case.
Nasal packing with Algoderm
® thus appears beneficial postoperatively in ESS-treated subjects.
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Yuki Komabayashi, Takashi Osaki, Akihiro Katayama, Yasuaki Harabuchi
2009 Volume 102 Issue 12 Pages
1029-1032
Published: 2009
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Gunshot wounds are uncommon in Japan because gun possession is illegal. We report a case with a shotgun wound to the cheek. The patient was a 64-year-old man who was accidentally shot with a shotgun while hunting. He was alert and had no apparent neurological defects. He complained of cheek pain and nasal bleeding, and a bullet wound was observed in his left cheek. Computed tomography revealed a bullet lodged in the left maxillary sinus. We removed the bullet during endoscopic sinus surgery.
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Takuya Sasaki, Akihiro Katada, Toshihiro Nagato, Kan Kishibe, Takeshi ...
2009 Volume 102 Issue 12 Pages
1033-1037
Published: 2009
Released on J-STAGE: June 10, 2011
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Epithelial-myoepithelial carcinoma (EMCa) comprises less than 1% of all salivary gland neoplasms and mainly involves the major salivary glands, especially the parotid gland. We report on a case of an EMCa arising from the parotid gland. An 86-year-old woman visited our hospital with a painless mass in the left subaural region which had been present for two years. Head and neck imagings revealed a 28×30 mm mass in the left parotid gland. There was no apparent facial nerve involvement on clinical evaluation. A pleomorphic adenoma was suspected following cytodiagnosis of a needle biopsy specimen. The tumor was resected with the left superficial part of the parotid gland on November 6, 2006. Histopathological and immunohistochemical examination revealed that the inner cells had differentiated to the ductal epithelium and outer cells to the myoepithelium. Consequently, the final diagnosis was an epithelial-myoepithelial carcinoma. Two years after surgery, the patient’s postoperative course has been uneventful.
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Atsuo Ikeda, Takeshi Asakawa, Yasuyuki Nomura, Ryoji Hirai, Teruo Toi, ...
2009 Volume 102 Issue 12 Pages
1039-1043
Published: 2009
Released on J-STAGE: June 10, 2011
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Intractable oropharyngeal mucosa disease is common and its diagnosis may be delayed if the mucosal lesion is simply a symptom of systemic disease. We report two cases of pemphigus vulgaris localized in the oropharyngeal mucosa.
Case 1: A 50-year-old man showed multiple oropharyngeal erosiones and was biopsied at his first visit. The histopathological diagnosis was pemphigus vulgaris and antidesmogleinauto antibody 3 based on a blood examination positive. Case 2: A 66-year-old woman originally diagnosed histopathologically with inflamed mucosa was reconsiderd for pemphigus vulgaris and checked for antidesmogleinauto antibodies 1 and 3, both found to be positive. Based on the additional immunopathological findings of the earlier rechecked specimen, the definitive diagnosis was pemphigus vulgaris. Both cases were treated by steroids. The numerical value of antidesmogleinauto antibody gradually decreased based on the recovery from symptoms.
We found antidesmogleinauto antibody blood testing to be valuable for diagnosis and for evaluating therapeutic effect and symptom progress. It is also important to check for antidesmogleinauto antibody early with such intractable oropharyngeal mucosal disease patients.
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Yuki Kobayashi, Nobuyuki Bandoh, Mitsuru Asanome, Kazuhiko Hokunan, Ch ...
2009 Volume 102 Issue 12 Pages
1045-1048
Published: 2009
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We report a 14-year-old male with acute suppurative thyroiditis originating in a right piriform sinus fistula. After he manifested anterior cervical swelling, he was found in computeded tomography and ultrasonography to have an abscess in the right thyroid lobe. He was treated with surgical drainage and antibiotics. Three months after treatment, pharyngoesophagography showed right piriform sinus fistula, which was resected cervically. No recurrence of acute suppurative thyroiditis has been seen in the 30 months since surgery.
Although right side piriform sinus fistula is relatively rare, it should be considered among the causes of acute suppurative thyroiditis or cervical abscess on the right side.
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Ryusuke Hori, Makito Tanabe
2009 Volume 102 Issue 12 Pages
1049-1054
Published: 2009
Released on J-STAGE: June 10, 2011
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A 53-year-old woman seen for pharyngalgia with pharyngolaryngeal aphta did not respond to antibiotics administered to treat acute pharyngolaryngitis. Sweet’s syndrome was suspected when typical cutaneous lesions appeared four days after she was hospitalized. Although systemic corticosteroids promptly relieved cutaneous and systemic symptoms, she suffered a relapse when corticosteroids were discontinued. Tonsillectomy, recommended in subject with Sweet’s syndrome having a history of chronic tonsillitis, was done, but minor relapses occurred 9 months thereafter. She continues to take corticosteroids under careful follow-up.
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Hiroyuki Yano, Izumi Koizuka, Ryuichi Mochizuki
2009 Volume 102 Issue 12 Pages
1055-1059
Published: 2009
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We report a case of rheumatoid nodule of the larynx. A 71-year-old woman seen for reported hoarseness had developed rheumatoid arthritis 15 years earlier that was treated using prednisolone and methotrexate. She suffered marked hoarseness following a sudden severe coughing. A few days later, white nodular lesions with a rough surface were observed in the bilateral vocal cords. The cricoarytenoid joint was not noticeably inflammed. Laryngo-micro-surgery was conducted to improve vocal facility. She was definitively diagnosed postoperatively a rheumatoid nodule of the larynx based on pathological and clinical findings. Few studies have been made of laryngeal rheumatoid lesions and no rheumatoid nodule of the larynx has been reported to date in Japan. Laryngeal rheumatoid lesions may have a serious or fatal outcome, necessitate early diagnosis and treatment.
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Kazuhiko Yamamura
2009 Volume 102 Issue 12 Pages
1061-1064
Published: 2009
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Mumps is a common disease in childhood and has many complications, but laryngopharyngeal edema is extremely rare. I report herein on an adult case of mumps with laryngopharyngeal edema. An 18-year-old man, diagnosed as having mumps, came to our hospital complaining of dyspnea and swelling of the submandibular and subaural regions. Fiberscopic findings revealed marked edema of the vallecula and left arytenoid. The patient was admitted to our hospital and treated with intravenous steroids. His edema was soon improved with the treatment and he was discharged without undergoing a tracheostomy. The edema in the current case was caused by circulatory disturbance of the lymphatic flow due to swelling of the submandibular glands. This finding suggests that the airway should always be examined laryngoscopically in any case of mumps with combined swelling of the parotid and submandibular glands.
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Takashi Iizuka, Hidenori Yokoi, Takuo Haruyama, Gen Sugita, Masayuki F ...
2009 Volume 102 Issue 12 Pages
1065-1069
Published: 2009
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Cervical cystic lymphangioma usually develops in subjects less than two years old, but we report a case in an adults 23-year-old woman reporting cervical swelling continuing for three years had been diagnosed as having a relativery soft cervical tumor. Bloody liquid was aspirated twice from the tumor and we conducted angiography for suspected hemangioma, but no tumor staining was seen. Under a clinical diagnosis of lymphangioma indicated by computed tomography (CT), magnetic resonance imageing (MRI), and cervical echo graphic findings, the tumor was surgically extirpated. The definitive pathological diagnosis was lymphangioma. No recurrence has been seen 5 years since surgery.
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Fumiyuki Goto, Tomoko Tsutumi, Kaoru Ogawa
2009 Volume 102 Issue 12 Pages
1071-1075
Published: 2009
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Introduction: Anxiety and depression are closely related to mental and physical disease prognosis. This makes it important to know anxiety and depression levels in patients with physical or mental disorders who visited the department of otorhinolaryngology. We evaluated the anxiety and depression levels in such patients using a hospital anxiety and depression scale (HADS).
Methods: Subjects were 67 individuals whose degree of anxiety and depression was decided on HADS. Subjects were then divided into 4 groups—group I, no anxiety or depression; group II, depression alone, group III, anxiety alone, and group IV, both anxiety and depression. We then looked at the relationship between these results and their major perceived problems.
Results: Groups I had 39 subjects II 7, III 8, and IV 13. Anxiety and depression were correlated (r=0.56; p<0.0001). 90% of subjects reported dizziness, tinnitus, or throat discomfort. Those with throat discomfort had the highest anxiety score, while those with anxiety most commonly reported dizziness.
Conclusions: Our results suggest that subjects may have anxiety and/or depression. The evaluation of anxiety and depression based on physical complaints may be difficult for otorhinolaryngologists, but it is important to do so where possible to increase the focus on the subject's physical illness and perceived problems.
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