Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 105, Issue 2
Displaying 1-15 of 15 articles from this issue
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Editorial
  • Recent Advances in Cancer Immunotherapy
    Kazuaki Chikamatsu, Keisuke Masuyama
    2012 Volume 105 Issue 2 Pages 87-94
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.87
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    Cancer immunotherapy is designed to activate and up-regulate the host immune responses against tumor cells and is currently in use or under investigation for cancer treatments. Although tumor cells can use a variety of mechanisms to create an immunosuppressive environment, many agents and strategies to reduce or eliminate tumor-induced immune suppression are either being developed or already in clinical trials. This review deals with recent advances in cancer immunotherapy, focusing on new strategies to enhance antitumor immunity.
    Numerous approaches have been tested for the development of therapeutic cancer vaccines. Recently, several promising reports suggest that clinical benefit has been shown in randomized phase III trials for vaccines against prostate cancer, follicular lymphoma, and melanoma. Moreover, in 2010, the first patient-specific immunotherapy (sipuleucel-T) was approved by the FDA for the treatment of prostate cancer. On the other hand, some chemotherapeutic agents such as cyclophosphamide and docetaxel, have direct effects on the immune system that is likely to contribute to an improved antitumor immunity. Therefore, cancer immunotherapy combined with chemotherapy may represent one approach for breaking tumor-induced immune suppression. To date, a number of monoclonal antibodies are in use or under evaluation. Among these antibodies, blocking negative immunoregulatory receptors, CTLA-4 and PD-1, also represent a new strategy to induce antitumor immunity by manipulation of the immune system. In clinical trials, these antibodies could increase anti-tumor T-cell immunity and result in objective tumor regression in some patients. Thus, accumulating data from recent cancer vaccine trials, the manipulation of immune suppression using chemotherapeutic agents, and the use of immune-stimulatory antibodies raise the hope that immunotherapy could become the fourth modality of cancer treatment.
    Based on these new findings, in our hospital, a clinical trial using dendritic cells combined with low dose cyclophosphamide and docetaxel in patients with relapsed and refractory head and neck squamous cell carcinoma is under way (UMIN000003725, ClinicalTrials.gov identifier, NCT01149902). In the near future, various immunotherapeutic modalities will most probably be applied as novel approaches in the treatment of head and neck cancer.
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Original articles
  • Three Cases of Adult Mumps Deafness with Acute Vestibular Symptoms
    Masahito Tsubota, Hajime Nakagawa, Yukio Watanabe
    2012 Volume 105 Issue 2 Pages 99-104
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.99
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    We report three cases of adult mumps deafness with acute vestibular symptoms. Case 1: A 61 year-old woman whose mumps infection was initially diagnosed elsewhere was seen by us 1 week later for vertigo and nausea. Neurootological examination showed positional left-beating nystagmus and spontaneous right-beating nystagmus changed the next day. Caloric testing showed left canal paresis and audiogram tracing showed severe sensorineural left ear hearing loss. Two weeks after drip infusion, she had recovered from vertigo and nausea but not from hearing loss. Case 2: A 27 year-old woman seen initially for left tinnitus and hearing impairment was found in audiogram tracing to have mild sensorineural left ear hearing loss. Several days later, she had left parotid gland swelling and hearing deterioration. Based on a diagnosis of mumps deafness, we treated her with drip infusion. Four days after admission, she felt vertigo and nausea. Neurootological examination showed spontaneous right-beating nystagmus. She recovered from vertigo and nausea 1 week later but not from hearing loss. Case 3: A 29 year-old man with mumps initially diagnosed elsewhere and experiencing right hearing impairment 2 days after diagnosis, reported vertigo and nausea 2 days after admission. Neurootological examination showed spontaneous left-beating nystagmus. 1 week later, he had recovered from vertigo and nausea but not from hearing loss. Adult mumps deafness with vestibular symptoms occurs at a high rate compared to that in children. We strongly suggest inviting subjects to undergo mumps vaccination to prevent such cases.
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  • A Case of Traumatic Luxation of the Stapes into the Vestibule
    Yoichi Hasegawa, Makito Tanabe, Etsuo Yamamoto, Hiroyuki Oiki
    2012 Volume 105 Issue 2 Pages 105-109
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.105
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    Traumatic luxation of the stapes into the vestibule is relatively rare.
    A 13-year-old girl suffered left-ear hearing loss and vertigo after earpick trauma. The use of 3-dimensional computed tomography (3D-CT) indicated stapes luxation and incudostapedial joint disruption. Exploratory tympanotomy showed the expected ossicular chain disruption. Repositioning the stapes in its original position and myringoplasty recovered hearing loss.
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  • A Case of Middle-Ear Capillary Hemangioma
    Yoshihiro Ikemiyagi, Masahiko Yamamoto, Tomoe Yoshida, Toshiyuki Nomur ...
    2012 Volume 105 Issue 2 Pages 111-118
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.111
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    We report a case of capillary hemangioma extending from the middle ear to the mastoid cell and external auditory meatus.
    A 59-year-old man with bloody left-ear otorrhea was found in otoscopic examination to have a dark red hemorrhagic mass filling in the left external auditory meatus.
    Biopsy of the mass showed capillary hemangioma.
    Temporal bone computed tomography (CT) showed dense soft-tissue from the middle ear to the mastoid cell and external auditory meatus.
    Gadolinium-enhanced magnetic resonance imaging (MRI) showed strong contrasting meatus and middle-ear enhancement.
    The tumor, which was removed in a transmastoid approach under general anesthesia, was shown pathologically to be pyogenic granuloma with outstanding inflammatory change with capillary hyperplasia.
    Pyogenic granuloma is usually secondary change from capillary hemangioma due to trauma, infection, etc.
    The clinical course and radiological examination suggested that middle-ear capillary hemangioma with the secondary change occurred as pyogenic granuloma progressed to the meatus.
    Pyogenic granuloma has been reported in Japan, but not capillary hemangiomas, which rarely occurs in the ear.
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  • Clinical Study of Patients with Carcinoma of the External Auditory Canal
    Shoji Ikezaki, Akiko Katoh, Koichi Hashida, Nobusuke Hohchi, Jun-ichi ...
    2012 Volume 105 Issue 2 Pages 119-122
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.119
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    Carcinoma of the external auditory canal is a relatively uncommon entity, accounting for only 1% of all head and neck carcinomas, and its management is not fully established. We herein conducted a retrospective clinical analysis of 10 consecutive cases of this disease who visited our department between 2003 and 2011.
    The patients were 3 men and 7 women with an average age of 65.8 years. The clinical stage was T1 in 8 cases and T2 in 2 cases. The histopathological type was squamous cell carcinoma in 7 cases, basal cell carcinoma in 2 cases, and carcinoma in situ in 1 case. The most frequent complaint was otorrhea, typically, bloody otorrhea.
    One patient received heavy ion radiotherapy, and the other 9 patients underwent surgery; partial resection of the external auditory canal in 3 cases and lateral temporal bone resection in 6 cases. Two patients received postoperative chemoradiotherapy for microscopic residual tumor; one of them developed neck recurrence, and underwent neck dissection followed by another chemoradiotherapy. The patient who received heavy ion radiotherapy died 21 months after the start of treatment and one of the patients who underwent surgery died of another disease, whereas the other patients remain alive and without evidence of tumor with follow-up periods of 6-91 months.
    These results indicate that surgery rather than radiotherapy is recommended as an initial treatment for carcinoma of the external auditory canal in the early stages.
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  • A Case of IgG4-related Disease in the Sinus and Nasal Cavity
    Yuko Matsuyama, Tomoyasu Tachibana, Michihiro Nakada, Yuya Ogawara, Ik ...
    2012 Volume 105 Issue 2 Pages 123-128
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.123
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    IgG4-related disease appears in multiple organs, such as the salivary gland, pancreas, bile duct, and retroperitoneum. It shows elevated serum IgG4 and histopathological IgG4-positive plasma cell infiltration. We report a case of IgG4-related disease of the sinus and nasal cavity. A 70-year-old man complained of left nasal obstruction and nasal bleeding. Computed tomography showed a mass with bone destruction of the left inferior nasal concha and maxillary sinus. Biopsy findings were consistent with IgG4-positive plasma cell infiltration and serum IgG4 was elevated. Inhalation-steroid therapy was very effective in this case with symptoms and local findings relieved in a few months. About 2 years later, the serum IgG4 level had normalized. We concluded that inhalation-steroid therapy was useful in treating for IgG4-related disease of the sinus and nasal cavity, serving as index of curative effect.
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  • A Case of Primary Paranasal Sinus Rhabdomyosarcomas in an Adult
    Akane Sugimoto, Sei Kobayashi, Rio Akiyama, Aya Uzuki, Kenichiro Ikeda ...
    2012 Volume 105 Issue 2 Pages 129-133
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.129
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    Primary rhabdomyosarcomas (RMS) of the nose and paranasal sinuses is very rare in adults, and this treatment is usually conducted based on standardized therapy protocols such as the German Cooperative Soft Tissue Sarcoma Study (CWS) and the Intergroup Rhabdomyosarcoma Study (IRS).
    We report a case of paranasal sinus RMS.
    A 57-year old man seen for epistaxis, underwent multimodality treatment surgery, chemotherapy (VAC: vincristine, actinomycin D and cyclophosphamide), and radiation. When RMS remained, we switched from VAC to cyclophosphamide and topotecan (CT) reported in a pediatric oncology group Phase II study. The man survived 6 years and 2 monhts.
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  • A Case of Dacryocystocele Treated Using T Shaped Silicon Sheet
    Kayoko Kawashima, Manabu Tamura, Toshiya Tsujimoto
    2012 Volume 105 Issue 2 Pages 135-140
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.135
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    Dacryocystocele (DCC) is rare in adults. We report the appearance of swelling with medial canthus diagnosed as DCC. Despite endonasal dacryocystorhinostomy (EN-DCR), swelling reappeared. Subjects showed symptomatic improvement when T shaped silicon sheet (T sheet) was inserted.
    We considered the cause to be chronic sinusitis.
    Working with an ophthalmologist, we found that to enforcing DCR under endoscopy in otolaryngology to be useful.
    If a conventional silicon tube offers no relief, T sheet insertion offers a simple, useful alternative.
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  • A Case of Parotid Gland Warthin Adenocarcinoma
    Masahiro Matsui, Shio Hironaka, Hitosuke Tameno, Nobuo Takagi
    2012 Volume 105 Issue 2 Pages 141-144
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.141
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    Warthin’s tumors are benign salivary-gland tumors whose rare malignant change has, to our knowledge, been reported in only 39 cases. We report a case of parotid Warthin adenocarcinoma arising from a preexisting parotid epithelial component. The case was of a 43-year-old woman reporting a 3-month history of right parotid swelling. We conducted right parotidectomy without complications of facial nerve palsy. Histologically, this tumor was diagnosed as adenocarcinoma aring from Warthin’s tumor. The woman shows no evidence of recurrence. Because of their rarity, malignant Warthin’s tumor cannot be evaluated accurately, and the identification of additional cases would help better elucidate the tumor.
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  • Group A β-hemolytic Streptococcal Infection at a Private Ear-nose-throat Clinic
    Yoshifumi Takahashi
    2012 Volume 105 Issue 2 Pages 145-152
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.145
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    We report 644 cases—411 cases in subjects aged 14 or under—of Group A β-hemolytic streptococcal infection. All children showed pharyngeal redness and “strawberry” tongue and were diagnosed with positive data from rapid strep testing. Subject number is peaked at the age 3, while fixed-point pediatrics observation peaked at age 5. The positive ratio of those reporting coughs exceeded that without coughs especially at age 5 or under. Fever, a significant complaint, affected the positive ratio at age 15 or over. Despite a chief complaint by 57 infected children of “ear pain”, 39 (68%) showed no signs of otitis media.
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  • A Case of Extra-abdominal Desmoid Neck Tumor
    Yujiro Fukuda, Shunsuke Tarumoto, Shinpei Nagato, Kenji Takeno, Hirosh ...
    2012 Volume 105 Issue 2 Pages 153-158
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.153
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    Desmoid tumor, a benign fibrous tumor of the connective tissue of the skeletal muscles, fascia, and tendon membranes, tends to recur locally despite being pathologically benign tumor so-called “clinically malignant”.
    We report a case of frontal neck desmoid tumor. A 37-year-old man reporting frontal cervical pain was seen based on a cervical tumor diagnosis. Cervical ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography showed a clear round, relatively benign tumor necessitating resection based on a preoperative diagnosis of cervical schwannoma. The tumor consisted histologically of uniform, spindle cells and collagen growth with no noticeable division. Cellular atypia was scarce. Cells and collagen fibers immunostained negative for S-100 and CD34 and positive for α-SMA, β-catenin staining, confirmed extra-abdominal desmoid tumor.
    Postoperative treatment was not done due to complete tumor resection without apparent recurrence.
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  • Hoarseness, Articulation Disorder and Hearing Impairment in Subjects with Hypothyroidism
    —Two Cases Hypothyroidism without Struma—
    Hideo Shigemi, Yuichi Yoshida, Katsuhiro Tanaka, Masashi Suzuki
    2012 Volume 105 Issue 2 Pages 159-165
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.159
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    Thyroid hormones target cardiovascular, neuromuscular, digestive, and metabolic systems, meaning that hypothyroidism may cause a wide variety of symptoms. Hypothyroidism is usually characterized by struma and myxedema. The absence of struma, however, may cause hypothyroidism to be mistaken for other organ disorders or normal aging-associated change.
    We report 2 cases of hypothyroidism without struma. Case 1 was a 76-year-old man seen for postnasal drip and ear stuffiness complicated by myocardial infarction, kidney dysfunction, and abnormally high CK. Case 2 was an 83-year-old man seen for prolonged dizziness, who also had heart failure and generalized edema. Neither patients responded well to a treatment and showed deteriorating truncal ataxia, increasing body weight, bradykinesia, bradyarthria, hoarseness, and impaired hearing. Case 2, also had edematous glottal change.
    Although no struma was seen, thyroid hormone levels were measured to determine the cause of hoarseness, showing high TSH and low fT3 and fT4 level. Case 1 was diagnosed with primary hypothyroidism, and Case 2 with secondary hypothyroidism.
    Hormonal therapy induced improvements in impaired hearing, previously considered a sign of aging, and in bradykinesia, truncal ataxia, and hoarseness. Hoarseness and bradyarthria were relieved regardless of glottal edema. Internal complications were also markedly alleviated. In case 1, impaired hearing worsened again after the mean stopped taking vitamin B12, but improved again when vitamin B12 was restarted.
    Articulation disorder in hypothyroidism presumably involves neuropathy and affecting from speech center to articulatory organs, including the glottis. Impaired hearing also presumably is caused by the same neuropathy depending on the vitamin B12 level.
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Original articles
  • Effect of Ramelteon (Agonist of Melatonin) on Tinnitus
    Harumi Arao
    2012 Volume 105 Issue 2 Pages 167-176
    Published: 2012
    Released on J-STAGE: February 01, 2012
    DOIhttps://doi.org/10.5631/jibirin.105.167
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    Ramelteon is a melatonin receptor agonist. Melatonin, a neurohormone secreted by the pineal gland at night, helps regulate the sleep-wake cycle, although tinnitus disturbs sleep. To evaluate ramelteon in treating subjective tinnitus, we administered it internally to 42 subjects not sufficient effectively aided by usual internal treatment. Subjects took 8.0 mg of ramelteon, nightly for 2 weeks or more. We evaluated results, using a visual analog scale (VAS) of the standardized, 1993 Tinnitus Study Group tinnitus test, the tinnitus handicap inventory (THI) for 25 subjects and symptom changes in all 42 subjects. Of the 42 (88.1%), 37 could take ramelteon. Of these 37 (64.9%), 24 improved subjectively, after taking ramelteon.
    In 7 subjects with Meniere’s disease (MD), 6 improved, possibly from MD melatonin deficiency12). Mean VAS and THI decreased significantly between weeks 0 and 4-16 in Wilcoxon’s signed rank test, after taking ramelteon.
    Ramelteon thus appears to be useful in treating subjective tinnitus, and subjects with MD are most likely to benefit from ramelteon treatment.
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Technical notes
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