Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
Volume 105, Issue 6
Displaying 1-17 of 17 articles from this issue
Editorial
  • Kensei Naito
    2012 Volume 105 Issue 6 Pages 499-508
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    Rhinomanometry, usually expressed as nasal resistance, is one of the useful methods for evaluating nasal patency objectively. International and Japanese standardization committees have held discussions in order to establish the beneficial methods, equipment, expressions, valuable evaluating points, and so on. In Japan, the current recommended Japanese standard involves active anterior rhinomanometry with a nasal nozzle, devices authorized by the JIS, measurement in the sitting position, 15 min. rest before measurement, and employing nasal resistance at ΔP100Pa, and has revealed the average value for nasal resistance in Japanese normal adults as 0.25 Pa/cm3/s. The relationship between obstructive sleep apnea and nasal patency, the averaged value of nasal resistance in children, the standardized provocation methods and evaluation, the relationship between rhinomanometry and acoustic rhinometry, and, objective and subjective nasal patency are important themes for either international and Japanese subjects. Furthermore the diverse application of rhinomanometry can be anticipated.
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Clinical color photographs
Original articles
  • Toshiro Kawano, Junichi Ishitoya, Mariko Hirama, Yukiko Yamashita, Ryo ...
    2012 Volume 105 Issue 6 Pages 513-520
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    It would appear that the result of treatment of sudden hearing loss remains unsatisfactory. In particular, it is difficult to treat patients with sudden hearing loss after failure of treatment with systemic steroids. The purpose of this study was to assess the effect of intratympanic steroid (IT-S). On the other hand, systemic steroids are the only proven drugs. Therefore, ethically, we could not simply compare IT-S with intravenous steroid (IV-S) therapy. Conventionally, we have treated sudden hearing loss patients after failure of systemic steroid therapy with both IV-S and hyperbaric oxygen (HBO), as the secondary modality. In a recent study, it has been suggested that IT-S obtained better hearing improvement in sudden hearing loss, and had few systemic side effects. We examined the effect of IT-S by adding it to the combined therapy with IV-S and HBO. Retrospectively, we clinically examined the effect of the combined therapy with IV-S and HBO (A group) for 10 subjects—5 men and 5 women (median age: 57 years) with sudden hearing loss after failure of systemic steroid therapy between September, 2009 and July, 2010. Prospectively, we also examined clinically the effect of triple combined therapy with IV-S and HBO and IT-S (B group) for 10 subjects—7 men and 3 women (median age: 57 years) with sudden hearing loss after failure of systemic steroid therapy between August, 2010 and April, 2011. In the A group, 4 patients (40%) demonstrated mild recovery, while no change was noted in 6 patients (60%). In the B group, 3 patients (30%) recovered completely, mild recovery was seen in 5 patients (50%), and the remaining 2 patients (20%) showed no change. There was a significant difference (P<0.05) between the A group (IV-S and HBO) and the B group (IV-S and HBO, IT-S). All 3 patients with complete recovery in the B group were treated within 14 days from the first onset.
    We concluded that the triple combined therapy with IV-S and HBO, IT-S (B group) gave better hearing improvement than the double combined therapy with IV-S and HBO (A group). Therefore, IT-S could be effective for the sudden hearing loss patients after failure of systemic steroid therapy. Our results further suggested that early IT-S therapy for sudden hearing loss after failure of systemic steroid could be effective as a secondary therapy.
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  • Kazuhiko Takeuchi, Hiroshi Sakaida, Satoko Usui, Sawako Masuda
    2012 Volume 105 Issue 6 Pages 521-526
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    Primary ciliary dyskinesia (PCD) is a hereditary disorder with structural and functional impairment of the cilia of the whole body. PCD is characterized by chronic sinusitis, bronchiectasis, male infertility, and ectopic pregnancy due to impaired ciliary motility. The prevalence of PCD is estimated at 1 in 20,000 live births. Cases with situs inversus are termed “Kartagener’s syndrome” and usually these diagnoses are not difficult to make. However, in cases without situs inversus, the diagnosis can be very difficult. As such, it is most likely that PCD without situs inversus is underdiagnosed at the present time. It is reported that the majority of the patients had seen physicians more than 50 times before the diagnosis was made at an average age of 10.9 years. Although the pathogenesis of the disease is well understood, data regarding the otological features of this disease are limited. In order to elucidate the otological features of PCD, we analyzed the clinical features of middle ear diseases in five patients with PCD seen during the past five years. The ages ranged from 8 to 34 years. Basically, they all had otitis media with varying degrees of severity of effusion. The middle ear diseases were intractable in children and were mild but persistent in adults. The eardrums of the adult patients showed a slight degree of retraction. The average hearing level of better hearing ears was 21.3 dB, which suggests that the hearing loss is not severe in PCD. The awareness of this disease should be raised among ENT physicians. Knowledge of these otological features may lead to the early detection of the disease.
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  • Masato Takiwaki, Hisakazu Kato, Masami Yanagida, Miyoko Yanagida, Keis ...
    2012 Volume 105 Issue 6 Pages 527-531
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    We describe two cases of burn caused by the operating microscope illumination system during a tympanoplasty. Cumulative risk factors such as strong light intensity, a short working distance, and dryness of the irradiated area induced irreversible tissue injury on the circumferential skin.
    Although only a few reports have referred to this kind of iatrogenic injury, in the interest of patient safety even during routine medical procedures, we believe that recognition of all potential risks is an essential prerequisite for the prevention of iatrogenic events.
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  • Hiromi Nagano, Yoshiko Hayamizu, Junichiro Ohori, Yuichi Kurono
    2012 Volume 105 Issue 6 Pages 533-536
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    Almost all choanal polyps originate from the maxillary sinus and a choanal polyp (CP) originating from the inferior nasal concha (INC) is a rare entity.
    A 56-year-old man presented to the ENT service with a one-month history of nasal mucus. On endoscopic examination, a polypoid mass completely obliterated the right nasal cavity and the middle nasal concha was normal. A computed tomography (CT) scan showed a soft-tissue opacity that filled the right inferior nasal concha without any sinus invasion and bony destruction. An endoscopic polypectomy was performed under local anesthesia and it was observed that the polyp originated from the right INC.
    Histological analysis (H and E) showed that it was covered by squamous epithelium with pseudostratified respiratory epithelium and glandular epithelium remnants. As mentioned above, it was diagnosed as CP.
    About two months after the operation, the INC endoscopic findings were normal.
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  • Yuzuru Ninoyu, Koichiro Yoshimoto, Shigeyuki Mukudai, Takeshi Nishio, ...
    2012 Volume 105 Issue 6 Pages 537-541
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    Inverted papillomas are benign sinonasal tumors, however they are often associated with carcinomas mostly squamous cell carcinoma. We present a rare case of an inverted papilloma associated with an adenocarcinoma. A 57-year-old woman was seen for a left nasal obstruction due to a sinonasal tumor which a biopsy revealed as an inverted papilloma. Endoscopic sinus surgery (ESS) was performed, which revealed histologically that it was in fact adenocarcinoma in situ. In the 4-month follow-up after the procedure, early recurrence was detected and revision ESS was performed. The postoperative histology revealed that it was an inverted papilloma with no malignancy. Thereafter, in a 12-month follow-up, no recurrence has been seen.
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  • Toshinori Iwagaki, Makiko Ohashi, Youhei Yamaguchi
    2012 Volume 105 Issue 6 Pages 543-548
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    We report on a case of endogenous endophthalmitis with meningitis caused by rhinosinusitis. A 45-year-old male, who had complained severe headachs and nausea, was diagnosed as having meningitis with sepsis, caused by rhinosinusitis and started treatment in hospital. He had initially bilateral ophthalmodynia and gradual deterioration of visual acuity, diagnosed as endogenous pneumococcul endophthalmitis. While on intravenous and intraophthalmic antibiotic medication, his visual acuity was totally lost. Bacterial endophthalmitis progresses rapidly and frequently causes blindness. It is recommended that vitreous antibiotics injection and vitrectomy with rapid correct diagnosis are essential for a good visual prognosis.
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  • Kaori Kase, Takeshi Kusunoki, Noritsugu Ono, Katsuhisa Ikeda
    2012 Volume 105 Issue 6 Pages 549-557
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    Our hospital surgically treated 788 cases with paranasal inflammatory diseases between 2004 and 2009. Twenty-six of 788 cases (3.3%) were diagnosed as having fungal rhinosinusitis with bacterial and histopathological examinations and were reviewed in the present study. Our cases were classified as fungal ball (22 cases), invasive paranasal aspergillosis (1 case) and allergic fungal rhinosinusitis (3 cases). All of 22 cases with fungal ball treated with endoscopic sinus surgery showed good progress without recurrence. In 21 of the 22 patients, aspergillus was identified. In the past history, from only 6 cases of the 22 cases, steroids were administered in 4 patients, with 1 patient each having diabtes and renel failure. The other cases (16 cases) were not immunocompromised and so, we should keep the possibility of mycosis in mind as infections of sinusitis without immunocompromised body. A patient with invasive paranasal aspergillosis had orbital apex syndrome. Endoscopic sinus surgery combined with an antifungal drug (voriconazol) could improve the orbital pain, but not the loss vision in the left eye. Because orbital apex syndrome due to mycosis is associated with the possibility of brain aneurysm and infarction by thrombophlebitis after treatment, we should follow up with MRI and MRA. We experienced 3 cases with allergic fungal rhinosinusitis. All cases showed eosinophlic mucin and fungus in the parasinus effusion.
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  • Yoshimitsu Saito, Shoji Watanabe, Shigeru Kasugai, Mitsuhiro Mukaide, ...
    2012 Volume 105 Issue 6 Pages 559-566
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    We experienced two cases of epidermoid cysts, which were 60-90 mm in diameter with intracystic fat balls inside. The cysts were located in the floor of the oral cavity. A 31-year old male (case 1) suffered from difficulty of swallowing and deviation of the tongue toward the posterior wall of the oropharynx because of the giant cyst. MRI showed a giant cyst of more than 90 mm with a low intensity area in T1 and a high intensity area in T2, involving the spherical structures, in the sublingual space. A 25-year old female (case 2) suffered from the swelling of the floor of the oral cavity and difficulty in breathing when she lay down in the supine position. MRI showed similar findings, compared to case 1. The histopathological diagnosis in both patients was an epidermoid cyst which was treated with surgery. It has been reported that the epidermoid cyst, the dermoid cyst and the teratoid cyst usually occur in the anus and the ovary. It is unusual to find epidermoid and dermoid cysts in the floor of the mouth. When it comes to the surgery, there are two ways to remove the tumor, based on its location. The intraoral approach is chosen for tumors located in the rostral to the suprahyoid muscles. The other is the extraoral approach (skin incision) for the tumor on the muscles. However, the standard method of the surgery for those giant tumors has not been established. The extraoral approach was chosen for the giant cysts in the present study, to avoid leaving any relic of the cyst wall. Recurrence has not been observed for 6 months after the surgery.
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  • Tomoyasu Tachibana, Yuya Ogawara, Yuko Matsuyama, Iku Abe, Soichiro Ha ...
    2012 Volume 105 Issue 6 Pages 567-570
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    Pneumoparotitis is rare. We report a case of pneumoparotitis in a 7-year-old boy that was related to subcutaneous emphysema. The boy reported left cheek swelling. Computed tomography (CT) showed expanding subcutaneous emphysema, and crepitation was heard in the left parotid region. A detailed interview revealed his “inflatable mouth” habit, which we diagnosed as pneumoparotitis We advised him to avoid increasing intraoral pressure and administered antibiotics to help prevent infection. Symptoms were alleviated within a few days. We concluded that pneumoparotitis could be diagnosed by detailed interview, in addition to radiological evaluation and palpation. We also suggest counseling as one of the treatments advised for subjects suffering from recurrent symptoms.
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  • Mie Shimatani, Jiro Udaka, Yoshimitsu Shimatani, Izumi Chida, Aki Shim ...
    2012 Volume 105 Issue 6 Pages 571-575
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    We report on a 79-year-old woman complaining of progressive dysphagia as an initial symptom of tetanus. Endoscopic and videofluoroscopic examination of her swallowing process showed dysphagea with food retention in the pyriform sinus, probably because of spasm of cricopharyngeal muscles due to tetanus. The patient was cured with tetanus antitoxin and antibiotics without any sequelae. Tetanus must be considered in the differential diagnosis of progressive dysphagia in spite of the lack of any history of injury.
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  • —Relation with Esophageal Diseases—
    Kengo Ichihara, Masahiko Higashikawa, Miki Maeda, Kazuho Utsunomiya, T ...
    2012 Volume 105 Issue 6 Pages 577-580
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    We report herein on two cases of multiple laryngeal cysts located on the lingual surface of the epiglottis, the aryepiglottic folds and the arytenoids. Esophagogastroscopy revealed gastro-esophageal reflux disease (GERD) in one case, and progressive esophageal cancer in the other case. We speculated that cases with multiple laryngeal cysts might have functional disorders of the esophagus.
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  • Tomonori Sugiyama, Mamika Araki, Kohei Fukukita, Tomohito Fuke, Takash ...
    2012 Volume 105 Issue 6 Pages 581-585
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    We experienced 2 cases with spinal metastasis from thyroid carcinoma who underwent spinal decompression. The 2 cases included a 57-year old male who had complete paralysis of the lower extremities caused by metastasis from a thyroid anaplastic carcinoma. In this case curative therapy for the thyroid carcinoma gave transient post operative improvement after the decompression. The other case was a 56-year old male with papillary carcinoma who underwent curative surgery. Complete paralysis of the lower extremities due to the spinal metastasis from thyroid carcinoma was suddenly observed. Immediate decompressin of the spine and irradiation were performed, and he could walk by himself.
    Though the indication of spinal decompression for paralysis due to metastatic carcinoma should be decided according to the Prognosis evaluation system, we should consider spinal decompression to improve ADL aggressively.
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Original articles
  • —Common Anatomical Pattern of the Thyroglossal Duct and Rationale Behind the Operative Concept—
    Minoru Horisawa, Akihide Tanano
    2012 Volume 105 Issue 6 Pages 587-598
    Published: 2012
    Released on J-STAGE: June 01, 2012
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    The Sistrunk operation for thyroglossal duct cyst (TGDC) is widely accepted as the method with the fewest recurrences. His operative concept is that all or as much as possible of the thyroglossal duct (TGD) should be removed. We already clarified the common anatomical pattern of the thyroglossal duct based on the following pathological studies. From the pathological study of specimens provided by Sistrunk operations in 81 cases in 1989-2010, we clarified the histological specificity and three-dimensional structure of the TGD. Thyroglossal duct remnants near the foramen cecum were also studied in 20 autopsy cases. The common anatomical pattern of the TGD is as follows. The cyst is usually located caudal to the hyoid bone mostly at the midline. The duct extends upwards from the cyst ventral to the hyoid bone, with many or a few branches and secretory glands. These ducts or branches merge into a single duct at the level of the cranial portion of the hyoid bone. However, as it leaves the hyoid bone and approaches the foramen cecum, many branches spread out from a single duct, which communicate with many secretory glands. Those spreading branches merge again into a single duct that continues to the foramen cecum. The epithelium of the TGD in the branched duct in tongue is usually ciliated epithelium that efficiently accelerates the secreted mucous flow to the foramen cecum. The TGD epithelium around the hyoid bone and below the hyoid bone usually does not have cilia, however, and is usually squamous or has defects. Secreted mucous thus stagnates below the hyoid bone level and a cyst or mass can easily develop. From the pathological and clinical studies of recurred cases, the suspected causes of recurrence included the following: 1) preoperative infection, 2) multiple TGD branches in the tongue, and 3) an unusually ectopic mucous gland draining into the main duct of TGD in cases with multiple recurrence.
    The proposed operative concept is that poorly drained anatomic part (the hyoid and below the hyoid level) should be excised with the Sistrunk procedure using a shallow core out and 95-97% cases of TGDC will be cured with this procedure. When recurrence is encountered, the cause of recurrence must be multiple lingual branches of the TGD. In the second operation, total secreted mucous should decreased with a Sistrunk procedure using a deeper and wider core out. In a rare case, when the ectopic mucous gland is found to be the cause of multiple recurrences, it should be surgically excised.
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