Rhinomanometry and acoustic rhinometry are useful tools for the objective assessment of nasal patency. Nasal patency during breathing is required as one of the measures of respiratory function because difficulty in nasal breathing is affected by any decrease in respiratory function. The nasal mucosa automatically changes depending on many different factors. The phenomenon of the nasal cycle is important in the understanding of the pathophysiology of nasal disease. Pollen allergy patients showed a dynamic change in their nasal cycle in the pollen season. Nasal cycle changes have also been shown during sleep and the duration of cycle was longer than in the daytime. Furthermore, the nasal cycle may correlate with the sleep cycle. The challenge test is important to evaluate nasal patency in patients with nasal disease. Malm introduced guidelines regarding a challenge test for the antigens, histamine and methacoline. These tests showed the reactivity of the nasal mucosa. Nasal patency also changes with exercise. The nasal mucosa was found to be particularly more swollen in patients with allergic rhinitis, so called exercise-induced nasal obstruction. Silvers also defined these changes as exercise-induced allergies. Exercise-induced nasal obstruction was not observed after management with steroids and anti-histamines. The symptom of nasal obstruction will decrease when medication is administered for allergic rhinitis. In conclusion, objective assessment is important to decide the proper plan to treat nasal disease.
Traumatic perforation of the tympanic membrane caused by hot water is a rare entity. We report herein on a 65-year-old male who accidentally poured hot water over his head, and suffered from a second-degree burn on his left face, chest, and upper arm. He recognized left hearing loss (HL) and otorrhea, and was found in an ENT clinic to have severe stenosis of the external auditory canal (EAC). He was referred to our department three weeks after the injury. On examinations, swelling of the EAC, total perforations of the eardrum and mixed HL were demonstrated in his left ear. Ear wicks were applied to prevent EAC re-stenosis. Antibiotic eardrops were also used, but his otorrhea persisted for 9 months after the injury. Fourteen months after the injury, when the middle ear infection disappeared, we performed tympanoplasty. The post-operative course was uneventful. The perforation had closed and his hearing had improved 17 months after the surgery. A burn of the tympanic membrane is often accompanied by repeated bacterial infections and an extensive burn of EAC, and therefore the prognosis of a tympanoplasty is not necessarily good. Although otorrhea repeats or persists for a long period, it is recommended that we consider surgical treatment only after confirmation of the resolution of the EAC and middle ear infections.
Malignant tumors of the minor salivary glands are very rare and most cases occur in the oral cavity, e.g., the palate, tongue, cheek and lip. We report herein on an extremely rare case of carcinoma ex pleomorphic adenoma arising in the fossa of Rosenmuller. An 83-year-old man, who had consulted another clinic with a complaint of hemosputum, was referred to our hospital because of the presence of a nasopharyngeal tumor. The tumor was resected via a transnasal endoscopic procedure without any major complications. The tumor was found to have arisen in the fossa of Rosenmuller and extended to superior lateral side behind the Eustachian tube cartilage. Histological examination showed that the main part of the tumor consisted of a pleomorphic adenoma, however, capsular invasion, nuclear atypia and mitosis were observed in a limited area where the MIB-1 index was high. We diagnosed the lesion as a carcinoma ex pleomorphic adenoma. We did not perform any postoperative therapy, because the area containing malignancy was far from the surgical margin and the patient was rather elderly. Three years and 10 months after the surgery, he remains in follow-up and has not shown any recurrence of the tumor.
The saccular cyst is one of the classifications of laryngeal cysts as described by De Santo. We report herein on one case of congenital laryngeal cyst treated with the transoral endoscopic approach. A 7-month-old girl visited our hospital in whom stridor in the night had occurred from two weeks postnatally. Flexible fiberoptic laryngoscopy was performed, which revealed a submucosal swelling of the left laryngeal ventricle to the pyriform sinus. A magnetic resonance imaging (MRI) scan of the neck confirmed a cystic mass and was considered to be a saccular cyst. During the observation period, the stridor did not improve, and the cyst volume gradually increased from the MRI findings. At the age of eighteen months, endoscopic marsupialisation was therefore performed. After the operation, the stridor improved immediately, and there has been no obvious recurrence for three months to date. Reports on saccular cysts are not uncommon in the foreign literature, but are especially rare in Japan. As treatment options for a laryngeal saccular cyst, the transoral endoscopic approach and extra-laryngeal approach have been reported. We found that the endoscopic transoral approach is minimally invasive, and appropriate as a choice for first time treatment especially in infants.
Multiple myelomas arise from neoplastic plasma cells growing in the bone marrow, plasmacytomas arise from neoplastic plasma cells growing in the bone except the bone marrow, or the soft tissues, and plasmacytic leukemia arises from plasma cells growing in the peripheral blood. Neoplastic plasma cells localized within the soft tissue are particularly called extramedullary plasmacytomas. The exramedullary plasmacytoma often arises in the head and neck. There are some reports on extramedullary plasmacytomas arising from the nasal cavity, the paranasal sinus, the pharynx, and the larynx, while it is a very rare case in which multiple myeloma involves the larynx and the trachea. A 72-year-old woman consulted the department of otorhinolaryngology in NHO Kure Medical Center complaining of hoarseness. She had been treated for multiple myelomas for two years previously at the department of hematology in our hospital. An angiogenic-like tumor almost obstructed the larynx and an emergency tracheotomy was performed. The subsequent biopsy revealed the tumor was a plasmacytoma. The patient received radiotherapy (50Gy) on the larynx. The tumor size was almost unchanged just after the end of the radiotherapy whereas the tumor had completely disappeared a month after the radiation. Another lesion arose from the trachea a year after the treatment of the larynx. Radiotherapy (50Gy) was performed on the tracheal lesion as well. The patient is currently surviving without any recurrences in either the larynx or the trachea.
We herein review the clinico-pathological features of 36 patients who received surgery for primary hyperparathyroidism in our hospital between October 1997 and August 2010. Among the 36 cases, there were 8 males and 28 females with ages ranging from 21 to 79 yr (average: 56.1 yr). In a retrospective review, we studied the presenting symptoms, results of the blood examination including serum ionized calcium and intact-PTH, preoperative diagnosis of localization, operation method, histopathologic diagnosis, results of surgery and any complications. From the 36 cases we reviewed, 23 cases (63.8%) were asymptomatic and hypercalcemia was detected. The values of preoperative serum calcium and intact-PTH were high in all cases. Cervical echography, CT, MRI, and 99mTc-MIBI scintigraphy were performed as the preoperative imaging, and a high probability diagnosis of the location of the tumor was possible. As for the surgical approach, a unilateral parathyroidectomy was performed in all patients. The postoperative pathological diagnosis in all cases was a benign lesion, with the majority (66.7%) comprising adenomas. After the surgery, the values of postoperative serum calcium and intact-PTH were normalized in almost all cases, but recurrences were found in two cases. No laryngeal nerve injury was seen as a postoperative complication. The appropriate surgical approach has conventionally been determined by a histopathological diagnosis, but we have determined the surgical approach by the number of tumescent glandular lesions and the localization of the tumor. It is necessary to choose an appropriate surgical approach prior to the operation to avoid the risk of postoperative recurrence and complications.
Metastasis of a tumor to the tonsil is a rare event. We report herein on a case of tonsillar metastasis from small cell lung cancer. A 70-year-old woman had been in our hospital for treatment of her lung cancer. She complained of pharyngalgia, and was referred to our division for examination. The right palatine tonsil was swelling, rubescent and covered with pus plugs. She was treated with antibiotics on the basis of having acute tonsillitis. The swollen right palatine tonsil reduced in size for a while, but enlarged again, and was partially ulcerated. She was afraid to undergo any biopsy, so a right tonsillectomy was done under general anesthesia. The histopathological examination resulted in the diagnosis of a metastatic tonsillar tumor from lung cancer (small cell carcinoma). Intravenous chemotherapy was performed, but ineffective. She died due to progression of the primary lesion and other metastasizing lesions (right adrenal gland, and abdominal lymph nodes) 5 months after the diagnosis of tonsillar metastasis.
Esophageal duplication is a rare congenital anomaly that occurs anywhere along the alimentary tract from the mouth, down to the anus and the nearby organs. We report herein on a patient with esophageal duplication accompanied with stridor, in whom an imaging study was useful. A 4-month-old boy was referred to our hospital with stridor, for which medical treatment had not shown any effect. We performed laryngeal endoscopy and ultrasonography, and computed tomography (CT). Laryngeal endoscopy showed the larynx biased to the right. Ultrasonography indicated the muscular rim sign. CT displayed a tumor (3×3×2cm) near the esophagus, and the trachea was displaced by the mass. Surgical excision of the tumor was perfomed, because esophageal duplication was suspected based on the examinations. The pathological diagnosis showed esophageal duplication. When a case of stridor is not cured by medical treatment, neoplastic lesion should be considered, and it is necessary to perform an imaging study.
Our Department is responsible for medical treatment in the Tokyo metropolitan area and Izu-Ogasawara islands. One hundred fifty nine referred patients from the medical institution of Izu-Ogasawara islands in the last five years were investigated based on their medical records. Thirty two patients a year visited our department, consisting of 66 females and 93 males aged 1 to 90 years with a mean of 56.4 years. Complications of lifestyle-related disease such as hypertension and diabetes mellitus were recognized in 43% and ear diseases were more frequent. Four cases (3%) were transported by emergency, which comprised 2 cases of acute epiglottitis, one case of severe massive epistaxis and one case of acute tonsillitis. Twenty seven cases (17%) were hospitalized immediately and 23 cases needed surgical treatments, comprising 4 tympanoplasties, 3 adenotonsillectomies, 3 tonsillectomies, 3 endoscopic sinus surgeries and 2 parotidectomies.
Subacute thyroiditis is a nonsuppurative inflammatory disease whose treatment differs from that of acute suppurative thyroiditis. We report herein on a case diagnosed as subacute thyroiditis in which a deep cervical abscess developed as a result of overdosing with a steroid hormone agent. The patient was a 55-year-old male whose chief complaint was anterior neck swelling. Based on sonography findings and blood sampling results, a diagnosis of subacute thyroiditis was made and a steroid hormone agent was administered. Though the symptoms were initially relieved, when the drug was withdrawn, they worsened again. The patient himself was an internist and based on his own judgment increased the dosage of the steroid hormone agent. On the 14th day following the initial examination, he was reexamined due to worsening of the neck swelling and respiratory discomfort. CT showed that a deep cervical abscess had developed and an emergency surgical intervention was conducted to drain it. Thus, despite a diagnosis of subacute thyroiditis, the possibility of acute suppurative thyroiditis should be kept in mind and appropriate action taken in view of the clinical course.
Following Menière’s report of a peculiar type of deafness accompanied with manifold symptoms such as tinnitus, vertigo, nausea and unstable gait, countless nomenclatures evolved from both the otologists and neurologists. These included as follows; “Peculiar type of the lesion in the inner ear”, “Aural lesion of Menière’s type”, “Apoplectic type of hearing loss” and “vertigo ab aure loesa”, just to mention a few. It was Simon Duplay who recognized the aural lesion of Menière as a nosological entity and termed it “Menière’s disease” in 1872, but his definition was acute labyrinthitis which corresponds to Menière’s disease without the firm evidence of labyrinthitis. Thereafter the terms, “Vertigo of Menière”, “Menière’s symptoms”, “Symtom complex of Menière”, “Idiopathic type of Menière’s disease”, “Secondary type of Menière’s disease”, and “Menière’s syndrome” followed with supplementary comments. At the end of the 19th century, Menière’s disease tended to be divided into two groups; Menière’s disease in the narrow sense and Menière’s syndrome in the wider and broader sense.