Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 103, Issue 3
Displaying 1-16 of 16 articles from this issue
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Editorial
  • Diagnosis and Treatment of Nasopharyngeal Carcinoma Based on Biological Feature
    Tomokazu Yoshizaki
    2010 Volume 103 Issue 3 Pages 185-192
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.185
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    Nasopharyngeal carcinoma (NPC) is located in the highest portion of the pharynx, and is thus located near the skullbase. It encounters various anatomical structures such as the internal carotid artery and demonstrates intracranial invasion via the anatomical course of these vessels and nerves. In addition, NPC shows highly metastatic features, which are mainly attributable to Epstein-Barr virus (EBV) gene expressions. Especially, LMP1, an EBV primary oncogene, upregulates metastatic multisteps. Also, inactivation of the apoptotic pathway by the EBV gene reserves the normal cellular signal transduction for apoptosis which is inactivated by gene mutations in usual head and neck cancer. Thus, NPC is sensitive to apoptosis inducing treatment such as chemotherapy and radiotherapy. Moreover, EBV could be a therapeutic target for NPC. Treatment of NPC with the anti-viral agent cidofovir showed prolonged disease control. These exploratory studies were based on clinical observations. NPC still has many unsolved features. How EBV infects epithelial cells? Why does the immune system allow them to stay in cancer cells? The clues to solve these questions may also lie in the daily clinical observation.
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Original articles
  • A Case of Facial Nerve Paralysis Caused by Pediatric Congenital Cholesteatoma
    Ryoji Hirai, Minoru Ikeda, Yasuyuki Nomura, Shuntaro Shigihara, Hiroyu ...
    2010 Volume 103 Issue 3 Pages 197-200
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.197
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    We report a rare pediatric case of congenital cholesteatoma initially manifesting as facial paralysis. A 3-year-old boy seen for acute facial palsy had developed left facial paralysis on January 4, 2008, undergoing predonisolone therapy by a local pediatrician from January 10. Upon referred on March 5, facial palsy was a severe Grade V in House-Brackman classification. Middle-ear computed tomography showed soft tissue filling the mastoid antrum through the epitympanic recess to the tympanic cavity. Endoscopic examination identified swelling of the tympanic membrane and a yellowish-white tumor of the tympanic cavity. Based on a diagnosis of congenital cholesteatoma, he underwent surgery under general anesthesia on June 27. The cholesteatoma lesion occupied the tympanic cavity, extending to the aperture of the mastoid antrum. In staged surgery, the exposed facial nerve in the tympanic cavity appeared hyperemic and adjacent to the cholesteatoma lesion. Postoperatively, facial paralysis improved incompletely remaining in Grade III in House-Brackmann classification.
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  • A Case of Wegener’s Granulomatosis Developing with Isolated Otitis
    Marie Takaoka, Akira Hagiwara, Tatsuya Hasegawa, Yasuo Ogawa, Nobuhiro ...
    2010 Volume 103 Issue 3 Pages 201-208
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.201
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    Wegener’s granulomatosis is often characterized by nasal and sinus disorders but rarely by isolated otitis. We report a case of localized Wegener’s granulomatosis involving hearing difficulty but otherwise asymptomatic. A 76-year-old woman suffering from otitis media with effusion of the left ear was treated with antibiotics combined with myringotomy and drainage tube insertion. Despite temporary hearing recovery, otitis media relapsed in both ears, necessitating methylpredonisolone, which cured the middle-ear granulation, effective by improving hearing. Systemic examination shared slightly elevated serum P-ANCA but negative C-ANCA. Computed tomography showed a nodule in the chest and transbronchial lung biopsy (TBLB) detected chronic pneumonia. Following otitis media and mastoiditis, she suffered facial palsy, necessitating masotoidectomy, during which granulation was found in the mastoid cavity with pathologically confirmed inflammatory change but no sign of specific vasculitis. Despite the absence of pathological proof, her clinical course and steroid sensitivity strongly suggested Wegener’s granulomatosis by exclusion. Methylpredonisolone at 30 mg/day/body weight was again administered and hearing and facial palsy improved. Four months later, unilateral laryngeal paralysis developed with IX and XII paralysis, against which a greater methylpredonisolone dose was used combined with cyclophosphate, to good effectiveness. Persistent otitis media is one potential risk of Wegener’s granulomatosis, but specific findings may be difficult to obtain from the middle ear, making medical history taking and immunological study essential to diagnosis. These patients must be followed up long enough to prevent recurring symptoms and cranial nerve paralysis.
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  • Breast Carcinoma Metastasis to the Temporal Bone
    Koji Miyata, Hideyuki Fukushima, Toshiki Maetani, Akiko Nishida, Nobuy ...
    2010 Volume 103 Issue 3 Pages 209-213
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.209
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    Carcinoma rarely metastasizes to the temporal bone. We report breast carcinoma metastatic to the temporal bone. A 69-year-old woman treated for breast carcinoma 22 years earlier and seen for left otalgia was found in computed tomography (CT) and magnetic resonance imaging (MRI) to have an abnormal left temporal bone lesion. Biopsy under local anesthesia yielded a histopathological diagnosis of metastatic breast carcinoma. She has been treated with aromatase inhibitor and bisphosphonate, and the metastatic lesion has not grown.
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  • The Efficacy of Allergen-specific Subcutaneous Immunotherapy for Japanese Cedar Pollinosis
    Hitomi Ogihara, Atsushi Yuta, Yukiko Miyamoto, Satoko Usui, Kazuhiko T ...
    2010 Volume 103 Issue 3 Pages 215-220
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.215
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    Background: We studied the efficacy of allergen-specific subcutaneous immunotherapy (SCIT) for Japanese cedar pollinosis.
    Methods: Twenty-three patients treated with SCIT (eleven male and twelve female, mean ages of 40.6 years old) and fifteen patients with initial drug therapy (eight male and seven female, mean ages of 57.6 years old) were selected for this study. The clinical symptom score (0-4 points/day) and medication score during the periods of Japanese cedar pollen scattering, calculated from the patients' diaries as advised by the practical guideline, for the management of allergic rhinitis in Japan (2005), were compared in both groups of subjects. The influence of the treatment years of SCIT was also studied, by comparing the two groups of subjects who had experienced the first or more than second pollen season after receiving SCIT.
    Results: SCIT showed significantly better results than initial drug therapy in comparison with the symptom, and medication score, during the pollen season. Continuous SCIT is therefore recommended over a period of several years to reduce the symptom in affected patients.
    Conclusion: We presented the effectiveness of continuous SCIT over several years for rhe control of Japanese cedar pollinosis.
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  • Cough Symptoms in Pollinosis Patients
    —Large-scale Questionnaire Survey in the Osaka Area—
    Nobuo Kubo, Hideyo Asai
    2010 Volume 103 Issue 3 Pages 221-227
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.221
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    The number of Japanese cedar and/or cypress pollinosis patients has been clearly increasing. Not only nasal symptoms but also pharyngo-symptoms impair the QOL of pollinosis patients. In this study, the correlations with coughs and the other symptoms with the QOL, were studied. Four thousand, seven hundred and sixty-five patients with seasonal allergic rhinitis were enrolled in the Osaka area as subjects in this study. Thirty-nine point nine percent of patients had a cough: 49.7% of those began to cough with pollen scattering and 33.6% of them began to cough during the pollen scattering peak period. Moreover in 52.0% of those patients with a cough, the coughing became most severe during the scattering peak. The onset of coughing showed the highest correlation with nasal obstruction and/or mouth respiration with obstruction, so it seemed that nasal obstruction participated as an exacerbating factor of the cough in pollinosis patients.
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  • A Case of Cerebral Spinal Fluid (CSF) Rhinorrhea Associated with Multiple-locus Meningoencephalocele
    Ayako Furuya, Tomohiro Ono, Tomoaki Mori, Aya Kaburagi, Kiyoaki Kamaka ...
    2010 Volume 103 Issue 3 Pages 229-234
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.229
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    Many cases of traumatic cerebral spinal fluid (CSF) rhinorrheas arise from head injury or surgery. Cases of nontraumatic CSF rhinorrhea arise rarely due to tumors or inherent bone defects. We report a case of CSF rhinorrhea associated with meningoencephalocele at two bone defect loci requiring surgery.
    A 65-year-old man experienced watery rhinorrhea of the right nasal cavity in March 1997, followed a year later by meningitis yielding the diagnosis of CSF rhinorrhea. Computed tomography (CT) showed two bone defects and the associated meningoencephalocele in the right ethmoidal cell and left sphenoidal sinus. Initial skull base reconstruction surgery was conducted only for the right side where the symptom occurred. Ten years later, recurrent meningitis necessitated the left side skull base reconstruction surgery for a large infected defect for which could not obtain endoscopic sinus surgery closure. Combined transcranial surgery eventually attained sufficient closure.
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  • Parotid Gland Metastasis From Renal Cell Carcinoma: A Case Report
    Junko Matsumoto, Yuji Imate, Hiroshi Ebisumoto, Hiroshi Yamashita
    2010 Volume 103 Issue 3 Pages 235-241
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.235
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    Renal cell carcinoma is potentially highly metastastic to any organ, with that to the head and neck not unusual. We report a case of parotid metastasis from renal cell carcinoma. A 70-year-old man who had undergone left nephrectomy for renal cell carcinoma in 1987 was found to have lung metastasis surgically removed between 1996 and 1998. In August 2005, he presented with a parotid mass necessitating superficial parotidectomy with facial nerve preservation. The pathological diagnosis was metastatic renal clear cell carcinoma. Six months later, this tumor recurred deep in the parotid gland lobe, requiring total parotidectomy.
    We discusss the diagnosis and management of parotid gland metastasis in renal cell carcinoma.
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  • A Case of IgG4 Disease
    Taketoshi Nogaki, Tomohisa Umiyama, Keiichiro Okuno
    2010 Volume 103 Issue 3 Pages 243-248
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.243
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    Immunoglobulin G4 (IgG4) is thought to be involved in inflammatory IgG4-related disease pathology typically diagnosed clinically as Mikulicz’s disease or autoimmune pancreatitis. A recent proposal classifies IgG4-related disease as systemic, and we report a case believed to be IgG4-related disease.
    A 76-year-old man was first seen on May 30, 2008, for submental swelling gradually developing since autumn 2007. Physical findings were a dry oral cavity, submental swelling and lymph node swelling. Magnetic resonance imaging (MRI) showed mediastinal lymph node hyperplasia and blood tests increased soluble IL-2 receptors, suggesting malignant lymphoma. Submaxillary gland biopsy on August 8, 2008, showed no clear malignant findings histopatholpgically, but noted chronic sialadenitis. IgG4 immune staining showed IgG4-positive plasmacytes infiltration and blood tests confirmed increased IgG4. Based on these findings, we diagnosed the case as IgG4-related disease, initiating oral prednisolone at 40 mg/day. Submaxillary gland swelling decreased significantly and soluble IL-2 receptors returned to normal. When MRI showed that submaxillary gland and lymph node swelling had been eliminated, prednisolone administration was gradually decreased.
    Subjects with IgG4-related disease may have bilateral cervical lymph node swelling and increased soluble IL-2 receptor levels, and this case suggests the importance of considering IgG4-related disease in differential diagnosis.
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  • Clinical Analysis of Lymphangioma in the Neck
    —The Effects of Local OK-432 Injection Therapy—
    Takao Ogawa, Masayuki Shibayama, Takeshi Shimizu
    2010 Volume 103 Issue 3 Pages 249-255
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.249
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    Lymphangioma is a congenital malformation of the lymphatic system. Although histologically benign, the lesion can expand into the surrounding tissues and, in rare cases, can cause life-threatening complications.
    Between 1996 and 2008, 12 patients with lymphangioma in the neck visited the Department of Otolaryngology, Shiga University Hospital. Each diagnosis was confirmed using ultrasound, computerized tomography, and magnetic resonance imaging examinations. Nine of the 12 patients were treated using local OK-432 injection therapy. Complete remission of the lymphangioma was obtained in 8 cases (88%). Partial remission was obtained in the remaining treated case, and the residual mass was surgically resected. The adverse effects of OK-432 therapy included high fever (38 to 39°C) in 7 patients, severe pain in 1 patient. These effects subsided within 15 days. The three untreated patients were monitored. In two cases, the aesthetic problem resolved with an increase in body size. In the remaining case, the lymphangioma spontaneously regressed.
    These results suggest that local OK-432 injection therapy is an effective treatment for patients with lymphangioma in the neck and should be considered as a primary treatment.
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  • A Case of Neck and Mediastinal Gas Gangrene Using PMX
    Takehiro Iki, Kazuhiko Shoji, Atsuhito Takahashi, Masanobu Mizuta, Mam ...
    2010 Volume 103 Issue 3 Pages 257-264
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.257
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    We report a case of gas gangrene of the neck, which, although rare, may be fatal if spread to the mediastinum. A 58-year-old man seen for anterior neck swelling, sore throat, mild dyspnea, and epigastralgia was found in computed tomography (CT) to have gas spread from deep neck spaces to the lower tracheal carina of the mediastinum.
    Tracheotomy and open neck debridement were conducted immediately upon admission, but planned mediastinal drainage via thoracotomy was changed to a transcervical approach via thoracoscopy due to the man's rapidly deteriorating condition. Septic shock and acute respiratory distress syndrome (ARDS) appeared during surgery. Postoperative management included a medical ventilator, antibiotics, gamma globulin, norepinephrine and two-day polymyxin B-immobilized fiber column (PMX) hemoperfusion, after which he recovered and was discharged without sequlae.
    ARDS treatment requires high positive end-expiratory pressure and low-volume ventilation. PMX is also beneficial.
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Original articles
  • Effectiveness of Garenoxacin Mesilate for Adult Otitis Media
    Masakatsu Taki, Fumiaki Nin, Tatsuhisa Hasegawa, Tatsuya Matsunami, Hi ...
    2010 Volume 103 Issue 3 Pages 265-271
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.265
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    Background: Garenoxacin mesilate (GRNX) is a novel oral des-fluoro(6) quinolone with potent antimicrobial activity against common respiratory pathogens, including resistant strains. Some researchers showed high efficacy of GRNX for acute otolaryngological infectious diseases. However, there are few reports on its efficacy in the treatment of adult otitis media.
    Objective: The aim of this study was to investigate the effectiveness of GRNX for adult otitis media.
    Material and Method: We reviewed thirty adult patients with acute exacerbation of chronic otitis media and seven adult patients with acute otitis media from June 2008 to July 2009. We examined the clinical efficacy and biological response of GRNX in these patients.
    Results: Clinical efficacy rates were 93% in acute exacerbation of chronic otitis media and 100% in acute otitis media. In acute exacerbation of chronic otitis media, bacteriological eradication rates were 9/12 in MSSA, 2/2 in MRSA, 1/2 in P. aeruginosa, 1/1 in P. mirabilis and 1/1 in S. marcescens. The overall eradication rate in acute exacerbation of chronic otitis media was 75%. In acute otitis media, four strains were isolated: CNS, S. pyogenes, M. catarrhalis and PSSP. These were all eradicated.
    Conclusion: The clinical efficacy of GRNX for adult otitis media in this study was superior to those of previous reports. GRNX is very useful for the treatment of acute exacerbation of chronic otitis media and acute otitis media in adults.
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  • Rapid Preparation of Burow’s Solution for Treatment of Intractable Chronic Suppuration of the External Ear Canal and Middle Ear
    Tomohisa Hirai, Noriyuki Fukushima, Kunihiko Ono, Masaaki Hajima, Yosh ...
    2010 Volume 103 Issue 3 Pages 273-276
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.273
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    We evaluated the effectiveness of quarter-strength rapid-preparation Burow’s solution for treating intractable chronic suppuration of the external ear canal and middle ear compared to nondiluted solution.
    Material was 32 ears of 24 subjects—12 men and 12 women—from aged 12 to 89 years with disease persisting from 1 month to 35 years. This consisted of chronic otitis externa in 8 ears, fungal otitis exrerna in 8, chronic otitis media with perforation in 8, postoperative mastoid cavity problems in 5, and chronic granulated myringitis in 3.
    Quarter-strength rapid-preparation Burow’s solution was dripped into the ear canal or small cotton balls soaked in the solution were applied.
    Overall, 17 (53%) of the 32 ears were cured and 10 (31%) were improved. Quarter-strength Burow’s solution showed almost the same effectiveness as non diluted solution, excluding the fact that it required frequent treatment. The piercing pain effects due to treatment was less (9%) than with the nondiluted solution (37%) and no case of tympanic perforation occurred, compared to one case seen in treatment with nondiluted solution.
    We recommend using quarter-strength rapid-preparation Burow's solution and avoiding direct use on the intact eardrum.
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  • Study of the Safety and Pharmacokinetics of Dexamethasone Cipecilate (NS-126C), a Steroid Nasal Spray
    —Phase I Clinical Study in the Elderly and at a High Dose—
    Minoru Okuda
    2010 Volume 103 Issue 3 Pages 277-286
    Published: 2010
    Released on J-STAGE: June 22, 2011
    DOIhttps://doi.org/10.5631/jibirin.103.277
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    In a placebo-controlled double-blind phase I clinical study to determine safety and pharmacokinetics, dexamethasone cipecilate (NS-126C) was administered at 400 μg once a day to healthy elderly subjects 65 years or older or at 800 μg once a day to healthy nonelderly subjects for 14 days.
    Analysis results of subjective symptoms, objective findings, anterior rhinoscopy, laboratory tests, adrenal function tests, physical examination, nasal fungal tests, and nasal ciliary function tests showed no adverse events in the elderly or study drug-related adverse events in the nonelderly. No adrenal function effect was observed.
    Pharmacokinetic examination showed that plasma levels of the unchanged drug and its principal metabolite DX-17-CPC were less than the quantitation limit (<16 pg/ml) in all elderly subjects. In nonelderly subjects, these were detected in 3 of 6 subjects but at levels below 3 times the quantitation limit.
    These findings confirmed NS-126C safety at 400 μg once a day in the elderly and at 800 μg once a day in the nonelderly for 14 days, together with extremely low systemic exposure.
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Technical notes
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