Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 105, Issue 10
Displaying 1-17 of 17 articles from this issue
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Editorial
  • Investigation of Revision Surgery for Chronic Sinusitis
    Shinichi Haruna
    2012 Volume 105 Issue 10 Pages 899-909
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.899
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    The key points in the performance of revision surgery for chronic sinusitis are the mental state of the patient, the morphological changes, and the pathological condition. Revision surgery is mainly performed for cases with insufficient primary surgery, recurrent frontal sinusitis and eosinophilic rhinosinusitis. As for the reoperation, the procedure is more complex than the primary operation, especially because of diverse factors including patient-related and disease-related issues.
    The key points pertaining to the surgery are as follows;
    1. All sinuses must be opened and a single cavity, as wide as possible, must be made.
    2. The difficulty in the procedure depends on the number of turbinates and agger nasi remaining.
    3. The frontal and the sphenoid sinus should be surgically opened as landmarks, even if there are no pathological lesions.
    4. There are limitations to the treatment of the pathological mucosa in the frontal sinus.
    5. When the extent of the pathological involvement of the mucosa in the olfactory cleft is severe, excessive resection should not be performed to avoid mucosal adhesion after surgery.
    6. Pathological mucosa should be completely removed using a microdebrider or several surgical forceps.
    7. Bleeding and edema of the mucosa are less severe when antibiotics and systemic steroids are administered before the operation.
    Although long-term observation after reoperation in cases with recurrent disease have indicated satisfactory results, some 8% of all re-operated cases of eosinophilic rhinosinusitis required re-revision surgery.
    With advances in the diagnostic imaging techniques, in medical devices such as endoscopes and navigation systems, and the pathological diagnostic techniques, revision surgery can be performed precisely and safely, and the outcomes of the patients are thought to have improved.
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Original articles
  • A Clinical Study of Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL): about the Correlation between the Duration from the Onset to the Start of Treatment and Hearing Outcome
    Masashi Furukawa, Hiroshi Kajikawa, Naoki Matsushiro, Takahiro Kitamur ...
    2012 Volume 105 Issue 10 Pages 913-918
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.913
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    We studied 804 patients with idiopathic sudden sensorineural hearing loss (ISSNHL) regarding the correlation between the duration from the onset to the start of treatment and hearing outcome. An analysis of the 804 yielded the following results:
    1) The overall cure rate was 30.0%.
    2) The cure rate was better in patients with a shorter duration (within about 10 days) between the onset and the start of treatment.
    3) In patients with mild hearing loss (Grade 1, 2), the cure rate was better in patients with a shorter duration.
    4) In patients with severe hearing loss (Grade 3, 4), the cure rate of over 8-10 days was clearly worse, and it is very important to start treatment within 8-10 days.
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  • Two Cases of Cerebellar Infarction Masquerading as an Acute Peripheral Vestibular Disorder
    Kiyoshi Hiruma, Tsutomu Numata
    2012 Volume 105 Issue 10 Pages 919-923
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.919
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    We report on two cases of cerebellar infarction which were thought to be examples of acute vestibular disorder before being diagnosed with MRI. Case 1: A 44-year-old man, who had vertigo and nausea, showed right-beating spontaneous and positional nystagmus. As he could not get up from bed at all after admission, caloric testing and rotational testing were performed. These tests did not show canal paresis and the visual suppression test was normal. After that, MRI was performed and showed cerebellar vermis infarction without brain stem involvement which was thought to be in the PICA (posterior inferior cerebellar artery) area. A paleocerebellum lesion showing only truncal ataxia and no neuro-otological abnormalities, was thought to be responsible for the symptom. Case 2: A 71-year-old man, referred to our hospital with vertigo and bilateral hearing loss, showed right-beating spontaneous nystagmus. Finger-nose testing and diadochokinesia were normal and truncal ataxia did not appear. Though MRI was performed to rule out an acoustic neuroma, it showed cerebellar infarction without brain stem involvement which was thought to be in the SCA (superior cerebellar artery) area. Cases of acute-onset vertigo or dizziness, including vestibular neuritis, must not be diagnosed without examining the true origin of the symptoms.
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  • Clinical Analysis of Six Surgical Cases Suspected of Perilymphatic Fistula
    Kyoko Shirai, Sachie Kawaguchi, Akira Hagiwara, Koji Otsuka, Noriko Ko ...
    2012 Volume 105 Issue 10 Pages 925-931
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.925
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    The diagnosis of perilymphatic fistula (PLF) is made by the presence of a fistula found intraoperatively. It is difficult to make a diagnosis without surgery. The timing of the surgery is still controversial. We studied the clinical features and neuro-otlogical test results to analyze the factors influencing the diagnosis and treatment results.
    Six patients with PLFs were treated surgically at our institutions from January, 2010 to August, 2010. All patients complained of a hearing loss. In all patients, the hearing recovered after surgery. Positional nystagmus and vertigo were observed in 66.6% of the patients. Vertigo improved in all patients postoperatively. The period from the onset to surgery was 8.2 days in average.
    In 4 patients, the presence of a fistula or lymphorrhea was confirmed surgically but were not found intraoperatively in 2 patients. The period from the onset to surgery contributed more to hearing recovery than the hearing level at the first consultation. Improvement of vestibular symptoms is expected regardless of the period from the onset to surgery. The signs, such as progressive hearing loss, nystagmus-related changes, and an increase in dizziness in the position with the affected ear down are important. These results suggest that surgical treatment should be considered at an early stage when PLFs is suspected.
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  • A Case of Ear Pick Injury in which 3D-CT was Useful for Diagnosis and Treatment
    Nobuya Fujita, Toshiaki Yamanaka, Kazuhiko Nario, Hiroshi Hosoi
    2012 Volume 105 Issue 10 Pages 933-937
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.933
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    We report on a case of injury caused by an ear pick in which 3D-CT was useful for diagnosis and determining the treatment. The patient was a 36-year-old woman who complained of tinnitus and hearing loss in the left since she had pushed an ear pick into the ear. The eardrum had no abnormalities at the time of the first medical examination. However, 3D-CT revealed disruption in the incudomalleolar joint, transposition of the malleus. Traumatic ossicular disruption was diagnosed. The disruption in the incudomalleolar joint and coalescence of the handle of the malleus and the incus long process were identified during a tympanoplasty, as observed on 3D-CT scans. Ossicular chain reconstruction (II-c type) by PORP was performed between the incus and eardrum. Postoperative hearing improved markedly. Therefore, we conclude that to obtain good hearing improvement it is desirable to undertake surgery for traumatic ossicular disruption and that the surgical procedure can be decided on the basis of accurate diagnosis with 3D-CT.
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  • A Case of Traumatic Disruption of the Ossicular Chain Detected with Reconstruction Techniques Multiplanar and Three-dimensional Computed Tomography
    Aya Murai, Kozo Tamura, Akira Doi, Shin Kariya, Kazunori Nishizaki
    2012 Volume 105 Issue 10 Pages 939-944
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.939
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    High-resolution computed tomography (CT) demonstrates the osseous structures of the temporal bone, and is particularly useful for diagnosis of middle ear diseases leading to conductive hearing loss. The axial and coronal section planes are commonly used for a conventional CT diagnosis of the temporal bone. In recent years, oblique section plane reformatted by high-resolution multiplanar reconstruction (MPR) CT images and three-dimensional (3D) CT images have allowed more detailed examinations of the ossicular chain. The creation of additional MPR images and 3D reconstruction images from the original CT data set can help overcome the limitations of conventional CT images by providing a more anatomically meaningful display of complex structures in the temporal bones. We report herein on the MPR-CT and 3D-CT findings of a case of traumatic ossicular chain disruption. A 27-year-old female had fractures of the cranial base, temporal bone, mandible, zygomatic bone, and optic canal sustained as the result of a traffic accident. She also had tinnitus and hearing loss in her right ear, and was referred to the Department of Otolaryngology. Her tympanic membranes were intact, and audiological examination revealed severe conductive hearing impairment in the right side. Conventional axial and coronal CT images showed no remarkable findings without temporal bone fracture, and the diagnosis of ossicular chain disruption was confirmed by intraoperative findings. We performed a type III-i tympanoplasty, and both conductive hearing loss and tinnitus improved. MPR-CT images and 3D reconstruction CT images showed the disruption in the ossicular chain. In conclusion, recent developments of image-processing technologies including MPR and 3D reconstruction provide a better understanding of middle ear diseases.
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  • A Case of Extramedullary Plasmacytoma of the Paranasal Sinus which Progressed into Multiple Myeloma
    Aya Watanabe, Toshikazu Shimane, Hiroshi Gomibuchi, Naokazu Fujii, Tai ...
    2012 Volume 105 Issue 10 Pages 945-950
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.945
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    A plasmacytoma is a mass of neoplastic plasma cells (terminally differentiated B cells) that often grows in the nasal cavity and paranasal sinus. Herein, we report on a case of extramedullary plasmacytoma of the nasal cavity that progressed to multiple myeloma. A 58-year-old male with tumors of the nasal cavity underwent tumorectomy at another hospital in 1988, in April and in November 2006. Histopathologic results indicated plasmacytoma. He was referred to our department in February 2007. The initial examination identified dark red bilateral masses with a smooth surface in the inferior nasal meatus, indicating a recurrence of extramedullary plasmacytoma of the nasal cavity. The patient underwent another tumorectomy and subsequent radiotherapy (45 Gy) in May 2007. Follow-up examination detected an increase in IgA levels from June 2008. Although no new lesions were found in the nasal cavity, and although fludeoxyglucose (18F)-positron emission tomography detected no abnormalities, IgA levels continued to rise. A bone marrow biopsy performed in 2011 indicated disease progression to multiple myeloma. Around the same time, the patient complained of pain in the posterior region of the neck, and magnetic resonance imaging detected lesions suspected as being multiple myeloma in the posterior region of the cervical and upper thoracic vertebrae. Pathological fractures were also found in the cervical vertebrae. The patient received radiotherapy to the cervical and thoracic vertebrae and is currently undergoing chemotherapy. The prognosis in patients with extramedullary plasmacytoma is poor once the disease has progressed to multiple myeloma. Disease progression is difficult to detect at the early stage, even with regular tests and medical examinations. Thus, regardless of the recurrence of lesions, it is important to employ a proactive strategy, such as bone marrow biopsy, for long-term regular follow-up in patients with extramedullary plasmacytoma.
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  • A Case of Sphenoid Fibrous Dysplasia Compressing the Orbital Apex
    Mami Matsunaga, Takayuki Nakagawa, Eriko Ogino, Juichi Ito
    2012 Volume 105 Issue 10 Pages 951-955
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.951
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    Fibrous dysplasia is a benign proliferative bone disorder and sometimes involves the craniofacial bone including the skull base and orbit. A 40-year-old male presented visual disturbance and headache. Image examinations revealed fibrous dysplasia arising from the sphenoid, which compressed the right orbital apex. Endoscopic endonasal surgery was performed to resect the fibrous dysplasia around the right orbital apex, resulting in improvement of the visual disturbance. The endoscopic endonasal approach may be the primary choice for resection of fibrous dysplasia causing compression of the orbit.
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  • Selective Intraarterial Chemotherapy Combined with Radiotherapy for Maxillary Sinus Cancer
    Yoshifumi Fujita, Kazumasa Suzuki, Yoshiaki Mori, Ai Komatsu, Takashi ...
    2012 Volume 105 Issue 10 Pages 957-961
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.957
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    We experienced 10 patients with maxillary sinus cancer who underwent selective intraarterial chemotherapy via superficial temporal artery and conventional concurrent radiotherapy from 2003 to 2010 at Yokosuka Kyosai Hospital.
    Under the T classification only 1 case was T2, and the other 9 cases were T4a.
    Between 2003 and 2007, 6 patients were given intraarterial chemotherapy with cisplatin (or nedaplatin) and 5-fluorouracil. After 2008, 4 patients were given intraarterial chemotherapy with docetaxel, cisplatin (or nedaplatin), and 5-fluorouracil.
    The CR rate of CRT was 80%. The 5-year overall survival rate was 66.7%, and the 5-year disease specific survival rate was 74.1%.
    This method demonstrated good efficacy in patients with locoregionally advanced maxillary sinus cancer.
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  • A Case of Squamous Cell Carcinoma Arising in a Free Forearm Flap 16 Years after Oral Reconstruction
    Takashi Nasu, Shuji Koike, Daisuke Noda, Akihiro Ishida, Takatoshi Fur ...
    2012 Volume 105 Issue 10 Pages 963-968
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.963
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    We report on a patient with a prior history of squamous cell carcinoma (SCC) of the oral mucosa, who developed a second primary SCC on the cutaneous surface of the flap 16 years after oral reconstruction. A 75-year-old man underwent surgical resection of buccal mucosal SCC and reconstructive surgery with a forearm flap in 1995. Furthermore, he underwent the removal of a tongue SCC adjacent to the skin flap in 2007. In 2011, 16 years after the first operation, an SCC was found that had developed in the skin flap of the free forearm flap. It was resected and the area of resection was reconstructed with a pedicled pectoralis major myocutaneous flap and delto-pectoralis skin flap. After pathological re-examination of the tongue SCC in 2007, it was identified as a second primary SCC in the skin flap. As the carcinogenic mechanism in this case, we speculated that: at first, mucosal epithelial cells with genetic alteration adjacent to the skin flap grew in a patch of the normal skin epithelium and, through clonal expanstion, ingrew in a lateral direction, eventually developing a field lesion, taking over the normal skin epithelium; second, through prolonged exposure to factors such as saliva or dietary substances, neoplastic changes were triggered in the skin.
    We should follow patients closely for the long-term after reconstructive surgery due to the prospect of squamous cell carcinoma arising in the skin of a free flap.
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  • A Case of Spindle Cell Lipoma of the Arytenoid
    Takuro Okada, Nobutoshi Funato, Yasuo Ogawa, Mamoru Suzuki
    2012 Volume 105 Issue 10 Pages 969-972
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.969
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    Lipomas usually occur in the posterior neck and the limbs. Lipomas of the oropharynx, hypopharynx, larynx are very rare, typically accounting for less than 1% of all hypopharyngeal and laryngeal benign neoplasms. Histologically, spindle cell lipoma is characterized by mature adipose cells mixed with collagen-forming spindle cells.
    We present a case of a 79-year-old male with a 6-month history of dysphagia who had a spindle cell lipoma arising from the arytenoid. Flexible videolaryngoscopy showed a single white mass, covered with normal mucosa. A computed tomography (CT) scan and magnetic resonance imaging (MRI) of the neck showed a round mass measuring 1.5 cm at its maximum diameter. Videofluorography of swallowing showed contrast medium reflux toward the larynx. The mass was removed using a KTP laser through a direct-suspension laryngoscope. Postoperative videoendoscopic and videofluoroscopic deglutition studies showed the normal swallowing.
    It is important to follow up the patient for the long term to check for recurrence and malignant transformation.
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  • A Case of Primary Hyperparathyroidism with Brown Tumor of the Maxilla
    Tetsuro Wakasugi, Gunji Nagatani, Jun-ichi Ohkubo, Hiroki Koizumi, Aki ...
    2012 Volume 105 Issue 10 Pages 973-980
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.973
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    Brown tumors are thought to be a sequela of bone remodeling caused by persistent excessive levels of parathyroid hormone. It may occur in any bone in the body, and may manifest itself as multiple bone lesions mimicking bone metastasis of a malignant tumor. We herein report on a rare case of primary hyperparathyroidism associated with a brown tumor of the maxilla.
    A 52-year-old woman with a 6-month history of increasing cheek swelling, pain in the costal region, and epigastric pain was referred to our hospital. CT and MRI revealed a large osteolytic mass in her left maxilla protruding toward the nasal cavity and underneath the cheek. CT also showed a mass just behind the right thyroid lobe. On systemic bone scintigraphy, marked isotope uptake was observed in multiple bones. Under a tentative diagnosis of malignant maxillary tumor with multiple bone metastasis, open biopsy of the maxilla was performed via an anterior antrostomy. The histopathological finding did not indicate malignancy, but was consistent with brown tumor. Further systemic examinations were then carried out; Hypercalcemia and hyperparathyroidism were found on serological tests; multiple osteolytic lesions in the costae, cranium, and phalanges of the hand were seen on radiological examinations; and isotope uptake was identified behind the right thyroid lobe on 201Tl-Cl/99mTcO4−-subtraction scintigraphy. The patient was diagnosed as having a parathyroid tumor associated with primary hyperparathyroidism and brown tumor, and received intravenous bisphosphonate, which turned out to be ineffective. She eventually underwent resection of the parathyroid tumor. The histopathological diagnosis was parathyroid adenoma. Except for temporary hypocalcemia with tetany, her postoperative clinical course was uneventful. The bone lesions including the brown tumor of the maxilla gradually decreased thereafter.
    We should be aware that not only metastatic malignant tumors but also hyperparathyroidism may cause multiple osteolytic lesions. The clinical characteristics, diagnosis, and treatment of hyperparathyroidism with brown tumor were bibliographically reviewed.
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  • A Case of Thyroid Papillary Carcinoma and Pulmonary Adenocarcinoma Coexisting in the Same Cervical Lymph Nodes
    Takatoshi Inaoka, Morimasa Kitamura, Shigeru Hirano, Ichiro Tateya, Sh ...
    2012 Volume 105 Issue 10 Pages 981-987
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.981
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    Positive histological findings of a metastatic lymph node are often a guide to the detection of the primary lesion and can help clinicians in deciding appropriate therapeutic disciplines. We report on a case of a 64-year-old woman who presented with a lung tumor, a thyroid tumor and lymphadenopathy detected in a CT scan, and in whom we had difficulty interpreting the disease state. Biopsy of a supraclavicular lymph node demonstrated histological features of both papillary carcinoma and poorly differentiated adenocarcinoma. Transbronchial lung biopsy showed adenocarcinoma with signet-ring cells and fine needle aspiration of the thyroid tumor revealed papillary carcinoma. These findings made it difficult to determine the origin of each histological component, suggesting two possibilities; double cancer of the lung and thyroid, or transformation of papillary carcinoma into adenocarcinoma in the metastatic foci. Detection of activating epidermal growth factor receptor (EGFR) mutation in the adenocarcinoma samples obtained from the lung lesion motivated us to use erlotinib, a tyrosine kinase inhibitor, which was effective against the lung tumor and metastatic lymph nodes in the neck and the mediastinum. Total thyroidectomy and neck dissection following the targeted therapy a half year later revealed papillary carcinoma in the thyroid tumor without histological presentation of adenocarcinoma, and coexistence of adenocarcinoma and papillary carcinoma in seven lymph nodes. From these histological findings and the fact that the targeted therapy was effective against lung and lymph node lesions, we diagnosed that the adenocarcinoma originated from the lung tumor, not from transformation of the papillary carcinoma. One year after the surgery, no sign of recurrence has been observed for the thyroid lesion, and the patient is now receiving outpatient chemotherapy using bevacizumab and docetaxel.
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Original articles
  • Coblation Tonsillectomy—Evaluation of the Clinical Efficacy and a Medical Economics Survey
    Gen Sugita, Masamitsu Kohno, Akihito Togawa, Muneki Hotomi, Noboru Yam ...
    2012 Volume 105 Issue 10 Pages 989-997
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.989
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    Objective: Less invasive surgeries have recently been developed to fulfill patients’ and medical economical needs. To evaluate an advantage of coblation tonsillectomy against cold dissection (conventional) tonsillectomy, we compared the operation time, intra- and postoperative bleeding, and postoperative pain between the two methods.
    Study Design: A retrospective study on 67 patients who underwent tonsillectomies with the conventional method and 71 patients with the coblation method was performed in Wakayama Medical University Hospital from 2007 to 2010.
    Results: Statistically significant differences were found in the coblation method as to shorter operation time, smaller amount of intraoperative bleeding, and lower postoperative VAS scores compared with the conventional method. In addition, the coblation tonsillectomy could shorten the duration of hospitalization from 7 days to 5 days in considerable number of patients resulting advantages in both patients’ social activity and medical economy.
    Conclusions: Coblation tonsillectomy demonstrated a shorter operation time, less intraoperative bleeding, and less postoperative pain compared to the conventional method. Based on the result, coblation tonsillectomy may have an advantage over the conventional method in terms of less invasive surgery and medial economics.
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Original articles
  • Clinical Efficacy of High-dose Administration (200 mg 3 times daily) of CDTR-PI in Treating Acute Sinusitis and Acute Aggravation of Chronic Sinusitis in Adults
    Koji Hagino, Akiko Ishihara, Takuro Sumi, Akio Hatanaka, Yuki Wasano, ...
    2012 Volume 105 Issue 10 Pages 999-1009
    Published: 2012
    Released on J-STAGE: October 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.999
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    Drug-resistant S. pneumoniae and H. influenzae, which have been major causes for otolaryngological infections are now being more frequently detected in recent years. In contrast, Cefditoren Pivoxil (CDTR-PI) still preserves high antibacterial activity against both PRSP and BLNAR which are common drug-resistant bacteria, and high-dose medication with this drug is recommended at the time of acute sinusitis or acute aggravation of chronic sinusitis. However, there have been few reports on the clinical efficacy of high-dose administration of CDTR-PI in the treatment of adult sinusitis. Here we examined the clinical efficacy of the treatment of CDTR-PI 200 mg 3 times daily in the treatment of these diseases.
    CDTR-PI 200 mg was prescribed 3 times daily for 7 to 14 days (8.2±2.2 days) in 61 patients who came for consultation during the period from June, 2009 to December, 2010. The clinical efficacy rate of the doctor’s judgment was 89.8% (53/61). Based on the scoring judgment, marked improvement was demonstrated in 20 patients, and moderate improvement was found in 30 cases, which meant that 50 of 61 (82.0%) patients exhibited remarkable improvement. S. pneumoniae was detected in 7 patients, eradicated in 3 patients, and decreased in 1 patient. H. influenzae was detected in 8 patients, eradicated in 4 patients, and decreased in 2 patients. Adverse events were observed in 8 patients with diarrhea but it was not serious.
    In conclusion, the treatment with CDTR-PI 200 mg 3 times daily was found effective for acute sinusitis or acute aggravation of chronic sinusitis in adults.
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Technical notes
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