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105 巻, 11 号
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論説
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阪上 雅史2012 年 105 巻 11 号 p. 1013-1021
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありWe have recently taken patient postoperative QOL into consideration together with hearing outcomes and the cholesteatoma recurrence rate, and would like to introduce our strategy for better postoperative QOL in this review.
1. It is not necessary to shave hair behind the ear.
2. It is recommended to remove packing in the ear canal a few weeks postoperatively and to keep the ear canal free of gauze.
3. The first surgical option for chronic perforated otitis media is a simple underlay myringoplasty with fibrin glue.
4. It is not necessary to perform mastoidectomy in patients with chronic perforated otitis media.
5. Simple surgical methods for primary cholesteatoma are desirable to prepare for recurrence of cholesteatoma.
6. Planned canal wall up method and atticotomy/scutumplasty are recommended for busy businessmen with attic cholesteatoma in order to achieve a dry ear canal quickly and reduce the incidence of postoperative visits to an outpatient clinic.
7. After the CO2 laser was introduced into stapes surgery in my department to cut the posterior and/or anterior crus, stapedotomies have been easily performed and patients have rarely complained of vertigo or dizziness postoperatively.
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カラー図説
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新鍋 晶浩, 飯野 ゆき子2012 年 105 巻 11 号 p. 1022-1023
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありPDF形式でダウンロード (635K)
臨床
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村上 力夫, 村上 真美2012 年 105 巻 11 号 p. 1025-1031
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありWe attempted to establish a method to objectively evaluate the hearing level in 2–4 years of age with otitis media with effusion (OME) who are difficult to examine by pure-tone audiometry, by using distortion product otoacoustic emission (DPOAE). One hundred seventy-nine children with OME were examined by DPOAE, pure-tone audiometry, and tympanometry during the course of the OME and after complete recovery from OME. In order to minimize the variables of DPOAE, we introduced parameters (%DP score, calculated as DP score÷Personal DP×100 〈%〉). We determined that sum of all signal-to-noise ratio (SN), calculated as DP response amplitude minus noise floor for all frequencies, was DP score. Personal DP score was defined as the DP score at the time of complete recovery of each patient. We examined the correlation by regression analysis between the %DP score and the loss of hearing level, and obtained a high correlation coefficient -0.90; regression analysis revealed a determination coefficient 0.86 of the regression curve. Younger children showed higher correlation coefficient and higher determination coefficients between these two parameters than the older group of children. Almost all the cases of OME fell on this regression curve. Accordingly, we supposed that OME infants who cannot be examined by pure-tone audiometry may fall on this regression curve.
Thus, it was revealed that the loss of hearing level in infants with OME can be evaluated objectively by using the regression curve of the aforementioned parameter of DPOAE.
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―クモの巣異物を含む75例の臨床的検討―中村 陽祐, 伊藤 和行, 武田 真紀子, 松田 英賢, 小田 直治2012 年 105 巻 11 号 p. 1033-1037
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありThe clinical consideration was carried out in cases of foreign bodies in the external auditory canal from 75 examples treated in our hospital between January 2005 and December 2010. They represented 0.35% of the total number of outpatients during the same period. The patients were 44 men and 31 women. Their mean age was 42.9 years (range, 3-84 yr). In classification of the foreign bodies as organic (16) and inorganic (57), spiders accounted for the largest number of organic materials and toys for inorganic materials. Complications observed included inflammation of the external auditory canal, hematoma, inflamed eardrums, and so on, in 12 of the 60 examples examined.
We actually came across one case where the external auditory canal foreign body comprised a spider’s nest complete with a living spider. Though it was a living foreign body, it had apparently been there for some time. To the best of our knowledge, this is a very new case and we are reporting it in the literature for the first time.
With cases involving foreign bodies in the external auditory canal, cooperation of other departments, such as the emergency department, is effective. In order to reduce complications, interdepartmental cooperation at the time of the initial medical examination in the emergency room is required, such as referral to an otolaryngologist or an otolaryngological consultation.
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西川 仁, 日高 浩史, 小林 俊光2012 年 105 巻 11 号 p. 1039-1045
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありWe report on a clinical study of 367 patients with epistaxis who visited the Department of Otolaryngology-Head and Neck Surgery at Tohoku University Hospital between 2008 and 2011. We noted epistaxis more frequently in males than in females (male:female ratio, about 1.6:1). The mean age was 60 years, and the number of patients in their 60s and 70s tended to be higher. Epistaxis occurred more frequently in winter, and the number of patients was lower in summer. The site of bleeding was most often Kiesselbach’s area (50%). Another 25% showed bleeding from an unidentifiable site and no other frequent site of bleeding was observed besides Kiesselbach’s area. More than 80% of cases were treated with electrical coagulation or gauze packing containing antibiotic ointment. Re-bleeding was observed in 19% of cases. Comparing re-bleeding and non-re-bleeding cases, the percentages of patients with bleeding from Kiesselbach’s area and treated with electrical coagulation were significantly lower in re-bleeding than in non-re-bleeding cases, and percentages with bleeding from unidentifiable sites and treated with gauze packing were significantly higher. No relationships were seen between re-bleeding, systemic complications and anticoagulant therapy.
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黒田 優美, 上條 篤, 高橋 吾郎, 山本 卓典, 遠藤 周一郎, 森山 元大, 増山 敬祐2012 年 105 巻 11 号 p. 1047-1051
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありWe report on a case of acquired choanal atresia which arose from palatal deformation caused by syphilis that the patient had had 40 years ago.
The 64-year-old male patient had been complaining of a severe nasal obstruction that he had endured for a year. The uvula and bilateral palatine arches had adhered to the posterior pharyngeal wall, and the bilateral nasal choanae were found to be completely closed.
The patient then underwent transnasal endoscopic surgery with a navigation system under general anesthesia. He was also treated with a mucosal flap and stented to prevent restenosis. A rolled silicone-plate was placed in the choanae for five days postoperatively. Sufficient patency of the choanae was been achieved and has been maintained. Restenosis has not been seen for 2 years postoperatively.
Our findings suggest that the mucosal flap is effective in avoiding restenosis of the neochoanae.
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市瀬 彩, 鈴木 宏明, 鬼頭 良輔, 工 穣, 宇佐美 真一2012 年 105 巻 11 号 p. 1053-1057
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありPrimary signet ring cell carcinoma of the eyelids is a rare tumor. We report herein on the case of a 74-year-old man who noticed swelling of the left eyelid four months previously. The histopathological diagnosis was signet ring cell carcinoma based on a biopsy of the eyelid. Enhanced MRI showed that the tumor had infiltrated the orbit. A systemic examination did not find out any other primary tumor and there was no metastasis. We performed orbital exenteration and postoperative radiotherapy. Six months later, PET-CT detected the recurrence of the carcinoma and lymph node metastasis. In general, primary signet ring cell carcinoma of the eyelids is a diagnosis of exclusion. Periorbital metastases from primary infiltrating carcinomas elsewhere are well known, especially breast carcinoma and gastrointestinal carcinoma. Therefore, a systematic examination is very important to detect the primary carcinoma. To establish the therapy for primary signet ring cell carcinoma, accumulation of cases is required.
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加藤 明子, 大淵 豊明, 橋田 光一, 今里 圭, 池嵜 祥司, 小泉 弘樹, 鈴木 秀明2012 年 105 巻 11 号 p. 1059-1063
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありThe intraparotid facial nerve schwannoma is a rare entity, accounting for less than 5% of all parotid tumors. Because it does not show specific clinical characteristic or imaging findings, preoperative diagnosis is very difficult. We report herein on 3 cases of intraparotid facial nerve schwannoma.
The patients were a 47-year-old woman (case 1), a 31-year-old man (case 2), and a 34-year-old man (case 3). Their chief complaint was a pre- or subauricular painless mass in all cases. None of them showed preoperative facial nerve palsy. A schwannoma had not been suspected until the postoperative histopathological examination in case 1, intraoperative nerve stimulation in case 2, and intraoperative frozen-section analysis in case 3. In cases 1 and 2, the tumor was totally removed with preservation of the facial nerve. On the other hand, in case 3, the tumor had merged with the main trunk of the facial nerve, and therefore, intracapsular removal was performed. The postoperative clinical course was uneventful in case 1. Facial nerve palsy occurred in the other two cases after surgery; mild and temporary in case 2, and noticeable and persistent in case 3.
Because of the rarity of intraparotid facial nerve schwannomas and the difficulty of preoperative diagnosis, this tumor is usually discovered unexpectedly following occurrence. Once the tumor has been confirmed as a facial nerve schwannoma, complete tumorectomy often conflicts with functional preservation. We should be aware of the possibility of this rare entity in the management of parotid gland tumors.
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高梨 芳崇, 日高 浩史, 小林 俊光2012 年 105 巻 11 号 p. 1065-1067
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありA 59-year-old woman presented with an asymptomatic pigmented lesion on the lower right gingival mucosa. She had received dental treatment two years previously. The pathological findings of the lesion showed irregular black fragments in mucosa. Immunohistochemical analysis of the specimen failed to demonstrate positive staining for melanin and ruled out other pigmented lesions such as malignant melanoma or melanocytic nevus. The diagnosis was consistent with an amalgam tattoo.
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櫟原 新平, 河田 了, 長谷川 恵子, 西川 周治, 東野 正明, 李 昊哲, 寺田 哲也, 栗栖 義賢, 辻 求2012 年 105 巻 11 号 p. 1069-1072
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありKimura’s disease is a chronic non-neoplastic entity that was first described by Kimura et al. in Japan in 1948. It predominantly occurs in Asian males during the second and third decades of life. The major physical manifestation of this disorder is slowly enlarging subcutaneous masses often found in the head and neck, especially in the salivary glands, with or without lymphadenopathy, usually in association with peripheral blood and tissue eosinophilia in combination with a markedly increased serum IgE concentration. A 31-year-old male presented to our department with a 5-year history of a swelling of infraauricular region. Peripheral blood examination revealed slight eosinophilia. MRI showed a slight ill-defined mass in the parotid gland with a low-intensity signal in both T1- and T2-weighted images. We could not arrive at the correct histological diagnosis by fine needle aspiration cytology. A superficial parotidectomy was performed, and histopathological examination revealed multiple hyperplastic lymph follicles with a reactive germinal center in the subepithelial layer. A large number of eosinophils had infiltrated the interfollicular areas. Therefore, based on the histopathology, the diagnosis of Kimura’s disease was confirmed.
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鈴木 克佳, 林 泰広, 袴田 桂, 久保田 亘, 野田 和洋, 木下 佳奈, 近藤 玄樹2012 年 105 巻 11 号 p. 1073-1078
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありWe report on a case of a 79-year-old female with squamous cell carcinoma of the lip. The tumor arose primarily from the oral commissure and invaded widely both the cutaneous and mucosal sides of the cheek. En block massive resection including the orbicularis oris muscle and also some parts of both the cutaneous and mucosal sides of the check was performed. The large defect was reconstructed with a combination of a forearm free flap and an advancement flap of the red lip. Using only a forearm free flap for a large defect may cause functional and cosmetic deformity problems. However, the combination of a free flap and a local flap is preferable for both a functional and cosmetic solution to these problems. Both the lip function and aesthetic appearance were satisfactory after the procedure. The patient also remains recurrence-free after the surgery. This technique should be considered as a valuable option for advanced lip cancer.
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小泉 弘樹, 大淵 豊明, 永谷 群司, 寳地 信介, 柴田 美雅, 加藤 明子, 若杉 哲郎, 高橋 里沙, 鈴木 秀明2012 年 105 巻 11 号 p. 1079-1083
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありAcute epiglottitis is a relatively common inflammation of the throat that may cause acute upper airway obstruction.
We retrospectively analyzed the clinical characteristics of 64 consecutive patients with acute epiglottitis who were treated in our department from April 2005 through March 2011. The patients consisted of 46 men and 18 women, 20-83 years of age with an average of 53.8 years.
More than 90% of patients complained of pharyngeal pain and painful swallowing. There was no correlation between the severity of laryngeal edema and oropharyngeal finding. Severe laryngeal edema was associated with high white blood cell (WBC) counts in the peripheral blood. Patients who underwent tracheostomy showed a higher WBC count and CRP level than those who did not. For predicting the indication of trachostomy and/or severe laryngeal edema, the cutoff values of the WBC count and CRP level were found to be approximately 19000/μl and 14 mg/dl, respectively.
These results indicate the importance of laryngeal examination for the diagnosis of acute epiglottitis. When laryngeal examination is infeasible, the WBC count and CRP level could be a rough yardstick to avoid overlooking acute epiglottitis.
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鬼頭 良輔, 大島 章, 根津 公教2012 年 105 巻 11 号 p. 1085-1090
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありTraumatic retropharyngeal hematomas are a rare, but potentially life-threatening emergency requiring an early diagnosis and airway management.
We present the case of a 67 year-old man, who was involved in a rear-end collision as a passenger in one of the cars, and was taken to our hospital by ambulance. At first, he complained of only mild cervical pain, and there were no focal neurologic findings. However, he complained of gradual difficulty in swallowing and increasing dyspnea. Five hours after the accident, endotracheal intubation was carried out to maintain the airway. On CT imaging a huge hematoma was revealed in the prevertebral space reaching to the mediastinum.
Surgical evacuation of the hematoma and tracheostomy were performed on the 5th day after injury. The patient’s postoperative course was uneventful, and he was discharged on the 21st postinjury day. A careful medical history and an appropriate diagnostic approach are essential for the management of such life-threatening situations.
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相馬 啓子, 國弘 幸伸2012 年 105 巻 11 号 p. 1091-1100
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありWe analyzed 107 patients (59 males and 48 females, ages ranging from 22 to 72 years, with an average of 45.9 years) who were victims of traffic accidents. In general, they did not complain of smell or taste disorders. In 70% of the patients, the accidents were associated with a car, and there in many of these collision cases the diagnosis consisted of a post traumatic syndrome like whiplash injury. Tests conducted in these patients to assess smell and taste function. We found smell disorders in 28% of these patients with an intrvenous olfaction test, with an odor stick identification test for Japanese in 45%. As for taste disorders, electrogustometry revealed a disorder in 55%, and a filter-paper disk assay using taste solutions showed a disorder in 76% of our patients. In the cases where a rear-end collision had occurred, the taste threshold significantly increased in comparison with collisions which had occurred from the side. The taste disorder was recognized bilaterally in most patients, but there were few cases of serum zinc deficiency. Imaging rarely revealed any damage to the brain, therefore we were not able to identify a focal lesion. Our results suggested, however, that the central olfactory or gustatory pathway had been damaged by acceleration/deceleration forces.
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薬物
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太田 康, 山田 智佳子, 滝沢 克己, 力武 諒子2012 年 105 巻 11 号 p. 1101-1106
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありOmalizumab (Xolair®) is an anti-IgE antibody drug that alleviates IgE-dependent allergy reactions via binding to serum IgE thereby reducing its level. In Japan, omalizumab has been prescribed for patients with severe allergic asthma since 2009. Because of the mechanism of action, omalizumab is expected to have positive effects on otorhinolaryngological symptoms, such as hay fever, allergic rhinitis, allergic sinusitis, and eosinophilic sinusitis.
This study involved patients with eosinophilic sinusitis who were treated at the Department of Otorhinolaryngology, Japanese Red Cross Medical Center. Omalizumab was prescribed for 4 patients by the Department of Respiratory Medicine, and we therefore investigated the potential efficacy of the drug for the disease. Two of the 4 patients showed a tendency for improvement with omalizumab, while other two showed clear improvement of paranasal sinus pathology. These results would suggest that omalizumab could be a definitive treatment alternative for eosinophilic sinusitis, for which no curative therapeutic drugs or methods (besides the oral administration of steroids) are currently available. Detailed studies are needed to further evaluate the efficacy of omalizumab for eosinophilic sinusitis.
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市村 恵一, 菊池 恒, 今吉 正一郎2012 年 105 巻 11 号 p. 1107-1116
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありAccording to the treatment choice for pollinosis in Practical Guideline for the Management of Allergic Rhinitis in Japan, combined treatment with intranasal corticosteroids (NS) and oral non-sedative antihistamines (AH) is recommended for moderate, severe, and most severe cases of pollinosis. NS have been proved to be superior to other drugs for alleviation of any nasal symptom and are regarded as the mainstay of treatment in Western countries. Furthermore, combined treatment with NS and AH has shown to be equivalent in efficacy to NS alone. However, some say combination therapy is required for cedar pollinosis in our country, because it is associated with more severe symptoms. In order to verify this hypothesis the add-on effect of AH to NS was examined. Twenty-six patients with cedar pollinosis were enrolled in this study. They were divided into 2 groups. Group 1 received only intranasal mometasone furoate (MF), and group 2 received intranasal MF and oral epinastine hydrochloride. Almost all patients were treated in the early stages of the disease and all received medication during the entire season. Control of the total nasal score and each nasal score was excellent in both groups in any stage. There were no significant differences in any items compared. Usage of NS alone suffices as an early stage treatment option for Japanese cedar pollinosis. A controlled study with the combined use of NS and AH and single use of NS after massive pollen dispersion is the next step.
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研修ノート
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坂下 哲史, 加藤 匠子2012 年 105 巻 11 号 p. 1118-1119
発行日: 2012年
公開日: 2012/11/01
ジャーナル 認証ありPDF形式でダウンロード (329K)
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