We studied the cost-effectiveness and relative performance of numerical examinations in diagnosing vestibular schwannoma (VS), and problems in VS treatment.
We checked VS prevalence in 1,860 suspected subjects, clinical examination sensitivity and specificity such as auditory brainstem response (ABR), X-ray imaging, equilibrium test, speech discrimination score, computed tomography (CT), and magnetic resonance imaging (MRI). VS prevalence in the 1,860 was 1.7%. ABR sensitivity and specificity were superior to other clinical examinations but CT and/or MRI, making ABR the most efficient, economical screening for diagnosing VS. The 5% occurrence of false-negative ABR cases must, however, be taken into careful account.
Our treatment implements ultrasonic bone curettage to open the internal auditory canal to remove VS. We also reviewed types of post-treatment follow-up.

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Therapeutic options for vertigo may be pharmacological or non pharmacological. Intractable dizziness may require conventional drug therapy or vestibular exercises. We set up a single-group outpatient vestibular exercise course and evaluated its benefit. Subjects numbered 18 having chronic vertigo whose etiology included unilateral canal paresis following vestibular neuritis. Time from disease onset to the introduction of vestibular exercise was from 6 to 70 months (average ±std: 22.1±21.1). Small-groups home-based vestibular exercise consisted of a 2-hour lecture and practice in which subjects were taught exercises to be done 4 times a day at home. Symptoms of vertigo were obtained using Japanese version of the dizziness handicap inventory (DHI) and static posturography at the initial visit and before, 2 months, and 4 months after rehabilitation. The DHI score at the initial visit was 38.6±26.0 compared to 12.3±10.2 4 months after rehabilitation. The static posturography area did not change before or after therapy. We recommend that future studies objectively assess how the DHI score could be improved.

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We report a case of infantile middle-ear teratoma. A 6-month-old girl was first seen and reported to have a history of refractory left-ear otitis media. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a tumor occupying the tympanic cavity and eustachian tube. The tumor, was biopsied twice transaural, under general anesthesia, contained squamous epithelium, striated muscle, and adipose tissue, suggesting middle-ear teratoma. The tumor was resected completely in canal wall tympanoplasty with mastoidectomy under general anesthesia. Histologically, the heterogeneous tumor consisted of tissues including squamous epithelium, sebaceous gland and hair follicle, skin appendages, adipose tissue, striated muscle, cartilage, minor salivary-gland-like tissue, and bone. Mature middle-ear teratoma was diagnosed due to the absence of immaturity and malignancy. The girl remains recurrence-free in the 3 years since surgery.

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External auditory canal cholesteatoma involving the zygomatic arch root is rare.
A 15-year-old youth with aural stenosis had a history of right temporomandibular joint trauma and right external auditory canal cholesteatoma surgery. Computed tomography (CT) showed soft tissue density from the attic to the root of the zygomatic arch. The lesion showed high signal intensity in diffusion-weighted magnetic resonance imaging (MRI) and the case was diagnosed as external auditory canal cholesteatoma, subsequently resected combining retro auricular and pre auricular approaches.

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Depending on where olfactory disturbances occur, causes of dysosmia are classified as central-nerve-related, olfactory-mucosa-related, or respiratory.
Subjects with olfactory disturbances treated from 2000 to 2008 were diagnosed in interviews, blood tests, computed tomography (CT), olfactory cleft endoscopy, and olfaction tests. Results were evaluated, and dysosmia treated based on the cause and degree.
Common causes include chronic sinusitis and the common cold (viral infection). Intractable cases involve congenital and post traumatic dysosmia.

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Paranasal sinus cyst may cause orbital manifestations such as visual disturbance, diplopia, and oculomotor disturbance. We treated 15 cases—11 men and 4 women—of paranasal cyst with orbital symptoms from January 2005 to December 2009. We assessed the chief orbital complaint, lesion site, case history, history of sinus surgery, first diagnostic visit, and prognosis. Four of the 15 with visual disturbance were analyzed further.
Subjects were 31 to 71 years old (mean; 61.3 years). Of the 15, 11 (73.3%) had postoperative cysts and 4 (26.7%) had idiopathic cyst. Among paranasal sinus cysts, 4 were maxillary, 3 each anterior ethmoid and frontoethmoid, 2 sphenoethmoid, 1 each posterior ethmoid, frontal, and sphenoid sinuses. Of the 15, 12 had first seen ophthalmologists and 2 an internist. Time from orbital symptom onset to the first diagnostic visit averaged 5.9 (0 to 44) days. Chief complaints were visual disturbance in 4, diplopia in 7, and oculomotor disturbance in 4. All underwent endoscopic sinus surgery, after which orbital symptoms disappeared in most. Visual acuity returned to expected levels after surgery in the 4 with visual disturbance.
Of orbital manifestations, visual disturbance was considered the most serious clinical feature because vision loss may become permanent without immediate surgical exploration. We consider specifically treating the involved sinuses soon after diagnosis to be of primary concern.

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We report a rare pediatric case of granular cell tumor (GCT) arising from the subglottis. A 10-year-old boy seen for hoarseness was found in flexible fiberscopic examination to have a submucosal mass below the left vocal cord. The tumor was completely removed in direct laryngoscopy under general anesthesia. Histologically, the tumor showed the proliferation of large cells with abundant eosinophilic granular cytoplasm and oval nuclei and a surface entirely covered by stratified squamous epithelium. Immunohistochemically, S-100 protein was positive. Although a polypoid mass was seen 3 months after surgery, reexcision confirmed it to be postoperative granulation eliminating the possibility of recurrence. He remains free of recurrence 29 months after surgery. The number of pediatric laryngeal GCT reported appears to be increasing, possibly due to progress in indirect laryngoscopic devices.

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Aim: Recurrent laryngeal nerve paralysis (RLNP) may occur for many reasons. We report transient RLNP apparently due to mediastinal hemorrhage and hematoma. We detail this case and review the literatures.
Subject: A 69-year-old woman referred for sudden hoarseness and breathing difficulty had suffered a heavy coughing attack one night before symptoms appeared. Clinical examination showed right RLNP and diffuse brownish ecchymosis on the anterior chest. Upper mediastinal computed tomography showed a monotonous low-density area surrounding and compressing the trachea. FDG-PET showed no abnormality.
Clinical course: Based on the clinical history and CT/MRI/FDG-PET, we suspected upper mediastinal hematoma. RLNP was assumed due to nerve compression by the hematoma. Paralysis decreased in one week and the hematoma disappeared in two months.
Conclusion: RLNP due to upper mediastinal hematoma is rare, and differential diagnoses of malignant lymphoma and esophageal or lung cancer should be considered. Detailed clinical examination and CT/MRI/FDG-PET were useful in differential by diagnosing this case.

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The clinical importance of microscopic multicentricity in papillary thyroid carcinoma remains to be clarified. To gain knowledge from its clinical features, we reviewed 126 cases of papillary thyroid carcinoma from 2005 through 2010, treated primarily by surgery. We analyzed subject profiles, tumor size, stages T and N, invasion to surrounding organs, and surgical procedure. Of the 126 subjects, 13 (10.3%) had microscopic multicentric lesions (microscopic group), most often in pT1-2N1b disease (46.2%, p=0.00006, χ²), while pN0 disease was extremely rare (0%, p=0.0097, χ²). Macroscopic and microscopic multicentricity correlated significantly (p=0.015, χ²). No significant difference was seen between subjects with and without microscopic lesions in gender or primary tumor histology and size. Nodal metastasis involving the lateral compartment (N1b) was significantly more common in microscopic group subjects (10/13: 27/113, p=0.00026, χ²), with a significantly higher rate of overt invasion by metastatic nodes to surrounding organs (4/13: 3/66, p=0.012, χ²). The microscopic group tended to undergo total thyroidectomy more often than the macroscopic group (9/13: 42/113, p=0.053, χ²). Total thyroidectomy is the surgical method of choice in the presence of microscopic multicentric lesions to minimize local recurrence. Surgeons should keep in mind that resection required may be greater in cases with deep extracapsular invasion by metastatic nodes.

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Zenker’s diverticulum results from increased intrapharyngeal pressure and is very rare in Japan. We report a case of huge Zenker’s diverticulum treated by diverticulectomy. A 73-year-old man seen for dysphagia and anterior neck swelling after eating was suspected of Zenker’s diverticulum from computed tomography (CT) and magnetic resonance imaging (MRI) findings. We diagnosed the Zenker’s diverticulum by barium esophagram play, conducting the diverticulectomy due to the lesion size and clinical symptom. Clinical symptoms disappeared after surgery and no postoperative recurrence or esophageal stenosis has occured. Zenker’s diverticulum is so rare in Japan that no guidelines exist now.

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In a prospective study of rhinosinusitis treatment efficacy in 163 subjects at 30 medical facilities between 2008 and 2009, we studied isolation of three major pathogenic bacteria-Streptococcus pneumoniae, Haemophillus influenzae, and Moraxella catarrhalis. We also examined clinical garenoxacin (GRNX) efficacy in 106 acute rhinosinusitis cases and 57 acute chronic rhinosinusitis exacerbation cases using Japan Acute Rhinosinusitis Clinical Guideline 2010 clinical scoring. Isolation of S. pneumoniae was 50.0% (22/44), H. influenzae 43.2% (19/44), and M. catarrhalis 6.8% (3/44) in 106 acute rhinosinusitis subjects. Drug-resistant strains accounted for over 50% in S. pneumoniae and H. influenzae. Isolation of the three bacterial pathogens in 57 acute chronic rhinosinusitis exacerbation subjects was 50.0% (9/18) in S. pneumoniae, 27.8% (5/18) in H. influenzae, and 22.2% (4/18) in M. catarrhalis. Drug resistance exceeded 40% in S. pneumoniae and H. influenzae. In efficacy studies of 97 subjects, GRNX at 400 mg/day in 54 with acute rhinosinusitis was 100%—marked improvement in 51.9% (28/54) and moderate in 48.1% (26/54). Efficacy in 43 acute chronic rhinosinusitis exacerbation subjects was 95.3%—marked improvement in 79.1% (34/43) and moderate in 16.3% (7/43).
These results show the usefulness of clinical scoring in diagnosing diseases severity and in studying the efficacy of antimicrobial agents. Data clearly indicated the high clinical and bacterial efficacy of garenoxacin in treating adult rhinosinusitis.

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