The pathophysiology of eosinophilic chronic rhinosinusitis (ECRS), a type of refractory chronic sinus inflammation accompanied by numerous infiltrations of activated eosinophils in paranasal sinus mucosa and/or nasal polyps, remains unknown, and several complex mechanisms are considered to promote eosinophil accumulation. Inflammatory entities, including cytokines—IL-5 and GM-CSF, chemokines such as eotaxin, and chemical mediators such as CysLTs are reportedly related to eosinophilic sinonasal mucosal inflammation. ECRS should be managed by focusing directly on inhibiting local eosinophil infilitration. Related surgical procedures include mechanical removal of diseased mucosal lesions and opening the bony wall septum of affected sinuses to enhance postoperative maintenance. Local and/or systemic steroids and leukotriene receptor antagonists are also recommended. Local steroid administration effectively prevents nasal polyposis relapse. Meticulous follow-up is needed in all cases because although adequate combinations of surgery and postoperative therapy keep most subjects with ECRS enjoy some relief, no treatment yet completely reliefes ECRS.
A 64-year-old woman referred for two days of left-ear tinnitus. The patient was diagnosed as having mite parasitize action. Otomicroscopic examination shows a small mite moving from the tympanic membrane to the external ear. After the mite was removed, tinnitus ceased. As far as we know, this is first report case to be reported of a mite (Dermatophagoides pteronyssinus) on the tympanic membrane. It is important to concerned patients with tinnitus about mite parasite in tympanic membrane and external canal.
A 66-year-old woman referred for right cheek swelling was found to have a soft mass filling the right nasal cavity. Computed tomography and magnetic resonance imaging showed a huge right maxillary sinus tumor with bone destruction. Biopsy showed the tumor to consist of small round atypical cells immunohistochemically positive for cytokeratin, EMA, synaptophysin, and CD99, but negative for desmin and chromogranin. The diagnosis was primitive neuroectodermal tumor. Chemotherapy followed by heavy charged particle radiotherapy shrank the tumor dramatically. She died of multiple lymph node, lung, liver, and bone metastasis.
We report a case of dental-impression silicone in the right nasal cavity. A 68-year-old man seen for a stuffy right nostril had undergone dental implantation 8 months earlier. Computed tomography (CT) showed an abnormal shadow in the right maxillary sinus and a radiopaque mass in the right mid meatus. Sniffing, discharged a nasal foreign body into the oral cavity, found to be silicone used in dental implantation. Care is thus warranted in such treatment for foreign bodies in the nasal and maxillary sinus.
Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade extra nodal often gastric condition. MALT lymphoma of the head and neck has been reported in the salivary gland, thyroid, larynx, orbit, and skin. A 76-year-old woman seen for double vision was found in neuro opthalmological examination to have trochlear and oculomoter nerve palsy. Epipharyngeal endoscopy showed a submucosal tumor in the posterior epipharynx wall. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a mass lesion of the epipharynx, pterygopalatine fossa, and cavernous sinus. Endoscopic tumor biopsy performed twice for the epipharynx and for the pterygopalatine fossa was pathologically difficult to differentiate from lymphoid tissue and lymphoma hypertrophy. Clonal Southern blot analysis showed clonal rearrangement of the heavy immunoglobulin gene chain, yielding a diagnosis of MALT lymphoma.
Late postoperative cervical metastasis (LCM) greatly influences prognosis in cases such as squamous cell carcinoma of the tongue. Indications and preferred prophylactic neck dissection of the clinically negative neck (N0) in tongue carcinoma remain controversial and non standardized. We studied adequate neck dissection area, focusing on T2N0, T2N1 and T3N0 tongue carcinoma. We retrospectively analyzed surgical efficacy in 61 cases with stage I-T1N0, stage II-T2N0, stage III-T2N1 and T3N0 and stage IV-T2-3 N2b-c. All were treated initially with surgery alone. In 13 T1N0 cases, tumors were removed with a 15-20 mm surgical margin, showing LCM in 2. In 18 T2N0 cases, resected with the same surgical margin, LCM was seen in 9. In 5 T2N1 cases performed with partial tongue resection and radical neck dissection (RND), no LCM was seen. In 3 of 4 T3N0 cases, including level I resection, LCM occurred. In 9 stage IV pull-through cases and RND, LCM ocurred in 2. In 30% (9/30) of stage II LCM, 44.4% (4/9) was salvaged by RND. Five-year cumulative survival in 61 was 71.1%, 87.5% in stage I, 76.8% in stage II, 65.6% in stage III, and 55.4% in stage IV. We concluded that local resection is feasible (1) in T1N0 and early T2N0, (2) local and level I-III neck dissection in late T2N0 and T2N1, (3) local dissection, pull-through technique and level I-IV neck dissection in T3N0 and (4) local dissection, pull-through and level I-V neck dissection in stage IV.
Pediatric thyroid gland carcinoma is uncommon, representing less than 1% of all thyroid cancer. We report cases of thyroid carcinoma in a 9-year-old boy and a 12-year-old girl, both with dyspnea and lateral cervical tumors, and both found in computed tomography (CT) and fine-needle aspiration cytology. Lung metastasis was found in chest CT on presentation. Because both were in the bilateral cervix, we conducted total thyroidectomy and bilateral selective neck dissection level 2-6. Case 1 had recurrent laryngeal nerve and tracheal invasion. Radioactive iodine therapy was administered to both postperatively for lung metastasis. Children with well-differentiated papillary and follicular carcinoma are reported to have a substantially better prognosis than adults despite comparatively high regional and distant metastasis incidence. Appropriate diagnosis, surgical procedure choice, and careful follow-up are thus important in pediatric thyroid cancer.
Angioedema, occurring in the pharynx and induced by Angiotensin-Converting Enzyme inhibitor (ACEi), is life-threatening and requires emergency treatment. A 69-year old woman referred for recurrent oral edema and neck swelling had been taking oral ACEi due to hypertension for over 5 years. She had no history of food allergy or marked family history. Examination showed soft diffuse bilateral oral floor swelling with normal-color mucosa. She did not report dyspnea, dysphagia, or pain. Blood tests showed normal levels of C3, C4, CH50, and C1 inhibitor function. Although most ACEi-associated angioedema occurs within the first week of administration, we diagnosed angioedema due to ACEi based on laboratory results. Once ACEi administration was stopped, oral floor swelling disappeared. It is thus important in angioedema treatment to check oral medication.
Radiation therapy in head and neck malignancy may trigger mucositis poorly controlled by nonsteroidal antiinflammatory drugs (NSAIDs). Having already reported early opioid efficacy in radiation-induced mucositis pain in head and neck cancer, we discuss whether this resulted in severe side effects and opioid addiction. Of 11 persons (26.2%) with nausea, 3 could not tolerate opioid. Of 33 (78.6%) with constipation, all were controlled by purgatives. Seven had mild sleepiness. None had severe opioid side effects in radiation-induced mucositis pain treatment, but I showed opioid dependence after 128-days opioid administration. While opioid administration in radiation-induced mucositis pain may not cause addiction, lomg-term opioid use should be carefully monitored.
The voice analyzer (VA) software program we developed for quantitatively analyzing voice quality uses zero-cross-picking to find individual basic pitch periods. Two such periods extracted from a voice waveform were analyzed to calculate the acoustic energy of harmonics separately from that of noise components. The program determines the ratio of harmonics to noise (Ra), F0, jitter, shimmer, APQ, and PPQ. Sustained vowel /a/ from 28 subjects without evident vocal problems such as hoarseness and 49 subjects with hoarseness were examined. Average female and male Ra among the nonhoarse were 31.9 dB and 34.4 dB, jitter 0.254% and 0.246%, and shimmer 0.168% and 0.116%. Among those with hoarseness, all parameter scored worse than in the nonhoarse in proportion to auditory impression.
We report a case of oral allergy syndrome treated with immunotherapy for Japanese cedar pollinosis. The 54-year-old male subject, it should be noted, was the author himself. The subject suffered oral itching from eating fruits-peaches, apples etc-, but continued eating peaches. Since June 2009, he underwent weekly injections of allergen-specific subcutaneous immunotherapy for Japanese cedar pollinosis. By August 2009, he ate peaches, then other fruit, without oral symptoms. This case suggests that such allergen-specific subcutaneous immunotherapy is effective in rapidly treating pollinosis with oral allergy syndrome.