The role of allergy, particularly allergic rhinitis (AR), in otitis media with effusion (OME) is discussed. Because both OME and AR are common in young children, these disorders are occasionally observed in the same patient. Many clinical and experimental reports have discounted allergies as a cause of middle ear effusion (MEE) because type I allergic reactions in the nose cause eustachian tube dysfunction but do not induce MEE, since the associated tubal dysfunction has a short duration. It has been shown that allergy-induced tubal dysfunction significantly disturbs the clearance of MEE. Since clinical and experimental studies have demonstrated the efficacy of treatment for allergy in patients or animals exhibiting both diseases, combination treatment for allergy and OME in patients with both diseases should be initiated.
Mycoplasma pneumoniae infection leading to the development of primary atypical pneumonia causes diverse complications involving other organs and the nervous systems. There have been only a few reported cases of otolaryngologic complications of Mycoplasma pneumoniae infection, including otitis media and acoustic nerve impairment. A twenty-five-year-old woman was admitted to our hospital because of acute bilateral sensorineural hearing loss associated with Mycoplasma pneumoniae infection. The patient showed a markedly elevated mycoplasma complement fixation titer and had bilateral acute otitis media. The hearing loss has been improved by the application of several medications. Further research is thus called for to elucidate the pathophysiology of acute hearing loss associated with by Mycoplasma pneumoniae infection.
A case of inverted tooth, which was removed by endonasal surgery is reported. The patient was a 17-year-old-boy who had no symptoms. A white mass was incidentally detected in his right nasal cavity, and the tooth was removed easily by an endoscopic endonasal approach. An endoscopic approach is useful for removing an inverted tooth because it is less invasive to the patient than the conventional approach.
Metastatic carcinoma to the head and neck region from distant organs is rare. Especially, there have been few reports about hepatocellular carcinoma that metastasizes to the head and neck region. We encountered a 73-year-old male with hepatocellular carcinoma with metastasis to the nasal sinus. The tumor occupied the anterior part of the nasal cavity and the patient developed recurrent nasal bleeding. Surgical treatment was performed three times and the QOL improved with each treatment. The patient died about 3 months later due to the primary disease. In this report the risks of metastatic carcinoma to the head and neck region from distant organs are also described.
Superselective intra-arterial infusion with docetaxel and concomitant radiotherapy were performed in 18 patients with squamous cell carcinoma of the oral cavity. Their average age was 60.9 years ranging from 28 to 83 years. Four had stage III disease and 14 had stage IV disease. Subsites were the tongue in 9 oral floor in 4 and others in 5. For primary tumors the response rate was 94.4% (CR16, PR1) and the complete response rate was 88.8%. For neck lymph node metastasis the initial complete response rate was 6.7% and the response rate was 73.3%. Toxicities included mucocitis (grade 3: 11.1%) and leukocytopenia (grades 3 and 4: 33.3%). The rate of organ preservation was 66.6%. The five-year survival rate was 59.2%. Based on the results for organ preservation superselective intra-arterial chemo-radiotherapy is effective.
In Japan the numbers of patients with HIV (Human Immunodeficiency Virus) infection and AIDS (Acquired Immunodeficiency Syndrome) has increased gradually, while in other developed countries it has decreased remarkably. At present, the combined number of HIV and AIDS patients in Japan is supposed to be about 12,000. In Japan, most patients are concentrated in the major cities, therefore medical employees working in rural areas would be less likely to recognized this disease. However, at the present time, patients have become more scattered from urban areas to rural areas. Generally, most symptoms of AIDS start in the oro-pharyngeal region. Particularly candida infection frequently appears as a disturbance of immune response. Therefore, oto-rhino-laryngologists working in rural areas may encounter such patients. Our hospital is located in an agricultural district. We report a patient with recurrent intractable stomatitis who visited our clinic for oral-pharyngeal pain, and was finally diagnosed as having AIDS. A Case; A 42-year-old man consulted our clinic in May 2004. An oro-pharyngeal examination demonstrated white furred regions with or without ulcer dotted over the oral mucosa. Culture of a white furred region demonstrated candida albicans. The symptoms responded immediately to anti-fungal medicine. However, the symptoms recurred soon after stopping the medicine. Laboratory examination showed high levels of IgG and low levels of CH50. Based on persistent recurrence and examination data, we suspected that he might have immune functional disorders. Further laboratory examination demonstrated that he has been infected with HIV. Early detection could allow the patient to receive treatments earlier and save his life, as well as preventing him from infecting other people. Our report indicated that oto-rhino-laryngologists, particularly those working in rural areas should be reminded of the sings of HIV infection.
Branchio-oto-renal (BOR) syndrome is an autosomal dominant inherited disorder characterized by malformation of the external ear, cervical fistula, hearing loss, and renal anomalies. Branchio-oto (BO) syndrome is a part of BOR in which the phenotype shows only cervical fistula and hearing loss. We experienced two cases of BO syndrome in a Chinese family. Computed tomography (CT) with the injection of iodized oil through the external orifices revealed that these fistulas were originating from the 2nd pharyngeal arch remnants. Although both cases had Mondini type of anomaly, the shape of the kidneys as well as the renal function were normal. We excised the bilateral fistulas using nylon thread as a guide following a method previously reported. This is a simple and useful procedure involving only a small incision, which produces a favorable cosmetic result. The otoralyngologist - head and neck surgeon must be familiar with the embryology of the branchial apparatus, anatomy, and clinical manifestations as well as have knowledge of BOR and BO syndrome to establish an early diagnosis and appropriate therapy.
Head and neck osteosarcomas are rare. A 33-year-old woman received radiation therapy for lymphoepithelioma of the epipharynx in her childhood. After twenty-two years, she presented with a swelling of the right cheek. We did a work up, and diagnosed her radiation-induced osteosarcoma of the jaw. We treated her with neoadjuvant chemotherapy, surgery including skull base resection, and adjuvant chemotherapy. A small skin recurrence developed after one year, but it was resected under local anesthesia, and there have been no recurrences since. We think that skull base surgery with a combined approach is a usefull method in therapy for osteosarcomas in the skull base region.
We report a case of thyroid metastasis from breast carcinoma. A 41-year-old woman with a history of breast cancer was referred to our department for the treatment of a thyroid tumor with hoarseness. She had undergone mastectomy 2 years ago, with subsequent chemotherapy. During the 2-year interval, there had been no clinical recurrence of breast carcinoma. Total thyroidectomy was performed for the thyroid tumor. Pathological examination demonstrated metastatic breast carcinoma to the thyroid. The thyroid is usually considered to be a rare site of metastatic involvement from primary carcinoma of other organs. However, in a patient with a history of malignant tumor, the possibility of metastatic disease should be considered.
We report a case of trabecular adenoma of the thyroid. A 68-year-old woman complained of front neck swelling in November 2007 and neck echo demonstrated a mass in thyroid. The mass was diagnosed as papillary carcinoma based on fine needle aspiration performed in Ogori Daiichi General Hospital. Therefore, the tumor was surgically resected at our hospital. After surgery, the tumor was diagnosed as hyalinizing trabecular adenoma on histological examination. The cytology of hyalinizing trabecular adenoma resembles those of papillary carcinoma and medullary carcinoma, although the former tumor is categorized in the benign tumors. Therefore, the tumor is often misdiagnosed as papillary carcinoma or medullary carcinoma. Hyalinizing trabecular adenoma is very rare.
There are a variety of morbid conditions that can cause atrophy of the vocal folds. We performed type 3 thyroplasty (Type 3) for atrophy of the vocal folds, and obtained a favorable outcome in terms of vocal function. This case is reported in this paper. A 47-year-old male patient worked as a voice trainer for professional singers. In February 2006, he underwent emergency surgery for pontine hemorrhage. After discharge from the ICU, he found that his voice was weak and high-pitched. After discharge from the hospital, the patient was referred to our hospital with a chief complaint of difficulty in speaking loudly. At the initial examination, marked atrophy of the bilateral vocal folds was observed. There was no vocal fold paralysis. Before corrective surgery, the patient's speaking fundamental frequency (SFF) was 255 Hz, lowest pitch was 217 Hz. Since a decrease in SFF was recognized on manual testing, the patient was judged as having an indication for a Type 3 procedure. Speech analysis was conducted during surgery, and the SFF and lowest pitch were adjusted to 108 Hz and 103 Hz, respectively. The voice parameters improved, as follows: SFF: 110 Hz, lowest pitch: 73 Hz, respectively, post operatively. We encountered a patient in whom atrophy of the vocal folds as a result of surgery for pontine hemorrhage led to a weak and high-pitched voice. Type 3 procedure was found to be useful as treatment for this patient.
Relapsing polychondritis is a relatively rare autoimmune disease which shows the recurrence of progressive inflammation of cartilaginous structures such as auricular and nasal cartilage. Laryngotracheal involvement occurs in more than 50% of cases during the course of the disease, which sometimes results in airway obstruction. We report a case of relapsing polychondritis with the initial symptom of dyspnea. A 52-year-old female was hospitalized with hoarseness and dyspnea. Fiberscopic examination showes edema of the larynx and trachea. She required a tracheostomy due to airway stenosis. The manifestation of saddle nose and histological findings regarding the tracheal cartilage led to a diagnosis of relapsing polychondritis. After steroid therapy was started, the tracheal chondritis was improved. However, a T-tube was still positioned in the larynx because dyspnea and laryngeal stenosis did not show improvement.
Introduction: Treatments for acute peripheral vertigo have not been well investigated. The most suitable drug for controlling acute vertigo should suppress both vertigo and accompanying nausea. The purpose of this study was to evaluate the effect of four different drugs on acute peripheral vertigo: (A) hydroxyzine hydrochloride (25 mg, i.v.); (B) 0.5% metoclopramide (2 ml, i.v.); (C) sodium bicarbonate (40 ml, i.v.); and (D) a cocktail of diphenhydramine hydrochloride (30 mg) and dyprophylline (26 mg) (both i.m.). Methods: Forty-two patients with acute peripheral vertigo (average age: 59.5±18.1 years) with spontaneous nystagmus were assigned to four treatment groups (A-D, above). Patients with central vertigo and vestibular neuritis were excluded. The number of patients in each group was as follows: A, n=11; B, n=11; C, n=11; and D, n=9. Patients were instructed to evaluate their subjective symptoms of nausea and vertigo before and 30 minutes after drug treatment. They rated the severity of their symptoms on a 0-to-10 scale, with 10 representing the most severe symptoms and 0 a lack of symptoms. Results: Group A patients (hydroxyzine hydrochloride; 25 mg, i.v.) reported the highest level of relief from vertigo and nausea after drug treatment, whereas group C (sodium bicarbonate; 40 ml, i.v.) and D (diphenhydramine hydrochloride (30 mg)-dyprophylline (26 mg) cocktail; i.m.) patients reported only the slight relief of these symptoms. Group B patients (0.5% metoclopramide; 2 ml, i.v.) experienced partial symptom relief; their vertigo remained unchanged. Thus, hydroxyzine hydrochloride (A) was the most effective in controlling both nausea and vertigo, whereas sodium bicarbonate (C) and diphenhydramine hydrochloride and dyprophylline (D) only slightly suppressed vertigo and nausea. Metoclopramide (B) only suppressed nausea. Conclusions: Hydroxyzine hydrochloride (A) was the most suitable for treating acute peripheral vertigo. Doctors should be familiar with the contraindications of these drugs. Some of these drugs may potentially be used in combination to control the symptoms of acute vertigo more effectively.