Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 106, Issue 3
Displaying 1-17 of 17 articles from this issue
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Editorial
  • Powered Endoscopic Ear Surgery
    Seiji Kakehata, Tomoo Watanabe, Tsukasa Ito
    2013 Volume 106 Issue 3 Pages 187-199
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.187
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    The surgical goals for cholesteatomas are to remove diseased tissue, to make a dry “safe” ear, to preserve normal anatomy, and to improve hearing. However, the rates of recurrent and residual cholesteatoma have been reported to be very high. To prevent residual cholesteatoma, hidden area control is necessary. To prevent recurrent cholesteatoma, restoring ventilation and mastoid preservation are also important. Recently, transcanal endoscopic ear surgery, TEES (Transcanal Endoscopic Ear Surgery), has been introduced for cholesteatoma surgery. TEES enables hidden area control, restoration of ventilation, and mastoid preservation. In TEES, the pathologies extending to the retrotympanum are treated under direct endoscopic visualization. An anterior ventilation route is made by removing the tensor fold in addition to the posterior route via the isthmus. The indication for TEES has been limited to cholesteatomas within the attic, because transcanal atticotomy has been performed mainly with a curette. To extend the indication for TEES, we currently use powered instruments such as the Ultrasonic Surgical System and High-Speed Curved Bur, instead of the standard drills. Endoscopic retrograde mastoidectomy is achieved up to antrotomy by the use of powered instruments. With this procedure, removal of the bony canal wall is minimum. Endoscopic retrograde mastoidectomies require much less removal of the bony canal wall, which permits preservation of mucosa in the antrum. TEES with powered instruments has proved to be less invasive, secure and safe, and is a more functional procedure for cholesteatoma surgery.
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Original articles
  • Role of Arteriosclerosis in Development of and Recovery from Sudden Deafness and Therapeutic Effects of Lipo-PGE1
    Eiji Kondo, Ikuji Kawata, Tsukasa Takaishi, Ritsuko Abe, Yoji Hori, Ma ...
    2013 Volume 106 Issue 3 Pages 203-206
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.203
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    In order to clarify the role of arteriosclerosis in the development of and recovery from sudden deafness, we evaluated arteriosclerosis in patients with sudden deafness, using pulse wave velocity (PWV) as a marker. Arteriosclerosis was observed in 69% of the sudden deafness patients and the initial hearing level in the patients with arteriosclerosis was worse than those without arteriosclerosis. After treatment with a steroid and lipid microsphere-incorporated prostaglandin E1 (lipo-PGE1), the recovery rate of the patients with arteriosclerosis was significantly lower than those without arteriosclerosis. These findings suggest that arteriosclerosis is an exacerbating condition and a poor prognostic factor in patients with sudden deafness. On the other hand, PWV in the patients with arteriosclerosis who recovered tended to decrease after the treatment, suggesting that the circulation-improving effect of lipo-PGE1 may contribute to the recovery of the hearing loss related to arteriosclerosis.
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  • A Case of a Nasopalatine Duct Cyst Surgically Opened to the Bilateral Nasal Cavity
    Kazuhiko Minami, Susumu Sakamoto, Kazunari Nishimura, Kazuyuki Ichimar ...
    2013 Volume 106 Issue 3 Pages 207-212
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.207
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    The nasopalatine duct cyst is one of the nonodontogenic epithelial cysts and it arises from the epithelial remnants of the nasopalatine duct of the fetus. It occurs in approximately 2% of all maxillary cysts.
    A 44-year-old man presented with asymptomatic swelling of the hard palate. Nasal endoscopy showed the elevation of the floor of the nasal cavities. CT and MRI images confirmed these findings, revealing a midline cystic mass of the maxilla, extending superiorly along the nasal septum and the floor of the nasal cavity, with a maximum diameter of 2.8 cm. The cyst was endoscopically opened to the bilateral nasal cavity under general anesthesia. The patient had no postoperative complications and showed no evidence of either stenosis of the opening or infection in the cavity at 6 months after surgery.
    Few cases of the dilation of the cyst to the nasal cavity have been reported, but this technique is familiar to otolaryngologists and considered as an effective treatment.
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  • A Case of Invasive Fungal Sphenoiditis with Nasal Septal Abscess
    Seiichiro Makihara, Ayako Takeuchi, Miki Yamamoto, Kazunori Senoo, Sei ...
    2013 Volume 106 Issue 3 Pages 213-220
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.213
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    We report a case of invasive fungal sphenoiditis with nasal septal abscess. We drained the septal abscess and performed endoscopic transnasal sphenoidotomy. The patient suffered from permanent saddle deformity of the nasal dorsum. Bacteriological cultures of the septal abscess fluid revealed Aspergillus flavus. Therapy with voriconazole failed because of resistance of the fungus, however, successful control of the symptoms was finally obtained by therapy with micafungin and itraconazole based on the minimum inhibitory concentration data.
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  • A Clinical Study on 58 Cases of Submandibular Gland Tumors
    Noriko Kobayashi, Akira Shimizu, Kouichi Kitamura, Hiroyuki Ito, Mamor ...
    2013 Volume 106 Issue 3 Pages 221-227
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.221
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    The present study analyzed 58 patients with submandibular gland tumors treated from April 1988 to March 2008 at the Department of Otorhinolaryngology of Tokyo Medical University Hospital. Forty six tumors were benign and were all pleomorphic adenoma. Twelve tumors were malignant. Six of the malignant tumors were adenoid cystic carcinoma.
    The two patients with the malignant tumors had tenderness as a clinical sign. Even if the tumor was small, we should regard tenderness as a malignant sign.
    Surgical complications were found in 36.2%, comprising facial nerve paralysis, dysgeusia and numbness of the tongue. Facial nerve paralysis which developed in the benign tumors was temporary. Permanent paralysis was noted in 33.3% in the malignant tumors.
    Some of the tumors with low malignancy recurred or developed distant metastasis. Our findings suggest that we cannot control even low malignancy tumors with surgery alone and we need strict follow-up after surgery.
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  • Three Cases of Tetanus Presenting with Dysphagia
    Atsuo Takeichi, Hidetaka Iwasaki, Hironori Akizuki, Ryo Kanamura, Nori ...
    2013 Volume 106 Issue 3 Pages 229-233
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.229
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    We report three patients with tetanus who complained of dysphagia. All cases showed trismus, however, physical, serological and endoscopic examinations revealed not abnormalities. Under the diagnosis of tetanus, intravenous penicillin was administered to all three cases, which resulted in the disappearance of trismus, although one case showed a brief episode of generalized convulsion. The diagnosis of tetanus should be suspected in patients complaining of dysphagia who are found to have trismus, but no accompanying endoscopic findings.
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  • A Clinical Study on 83 Cases of Snoring in Children
    Takafumi Yamano, Satoru Ohba, Toshifumi Sakata
    2013 Volume 106 Issue 3 Pages 235-240
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.235
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    We performed an analysis of the characteristics of and tendency towards snoring in children, using lateral X-ray imaging of the head following examination of cephalometric roentgenography and a clinical examination. As for surgical indications, based on our experience, we suggest that treatment such as tonsillectomy or adenotomy has been effective for pediatric patients complaining of snoring and sleep breathing disorders. We found that cephalometric analysis was not useful for children although it is useful for adults.
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  • A Case of Mycosis Fungoides in the Larynx and Pharynx
    Masashi Okazaki, Takanari Goto, Kazuhiro Kawaguchi, Yutaka Suzuki
    2013 Volume 106 Issue 3 Pages 241-245
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.241
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    Mycosis fungoides (MF) is the most common type of cutaneous malignant T-cell lymphoma, but reports of MF in the head and neck region are rare. We report herein on a case we experienced in which MF invaded the larynx and pharynx.
    An 80-year-old man, who was seeing his dermatologist, visited a local hospital complaining of dysphagia, where a lesion in the epiglottis on the right aryepiglottic folds was discovered, and the patient was referred to our hospital for further examination. A biopsy of the area of interest confirmed the presence of MF and the patient was immediately sent for radiation therapy. Three months thereafter, an elevated MF lesion appeared on the posterior part of the tongue, so the patient underwent additional radiation therapy of the entire pharynx. Since no recurrence was seen 12 months after the end of the treatment regimen in our department, radiotherapy for potentially malignant lesions of the larynx and pharynx is suggested as a valid approach.
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  • A Case of Malignant Carotid Body Tumor
    Akiko Wakatsuki, Akira Nishikado, Shinpei Ichihara, Koutetsu Lee, Ryo ...
    2013 Volume 106 Issue 3 Pages 247-252
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.247
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    Paraganglioma represent vascular neoplastic tumors that arise from chemoreceptors located in the wall of blood vessels or are associated with specific nerves. The site of origin defines the name given to these tumors, and they most commonly occur at the carotid bifurcation where they are known as carotid body tumors (CBT). A malignant form of CBT, malignant CBT is uncommon. We report herein on a case of malignant CBT in a 70-year-old woman. The patient complained of a lateral cervical mass on the right side four years previously. The tumor had become gradually larger and tender. Enhanced CT scan and carotid angiography revealed a vascular-rich tumor of the right carotid bifurcation. Fine-needle aspiration biopsy of the mass showed variation in nuclear size. A resection was performed after vascular embolization. Histopathologically, the tumor cells were positive for chromogranin A, synaptophysin and CD56. Scattered sustentacular cells were positive for S-100 protein. Moreover the specimens showed vessel invasion and extracapsular tumor invasion. This case was diagnosed as malignant CBT taking both the clinical findings and the histopathological sides into consideration. The patient had no problem after the operation. Observation of the patient’s progress is due to be performed carefully in the future.
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  • A Case of Laryngeal Closure for Dysphagia Following Percutaneous Dilatational Tracheostomy
    Takayuki Ota, Koichiro Nishiyama, Kazuo Matsui, Kouichi Kure, Yoshihik ...
    2013 Volume 106 Issue 3 Pages 253-260
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.253
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    In recent years, there are many reports about percutaneous dilatational tracheostomy (PDT). This procedure has been reported as being simple to perform and has less complications. However, we experienced a case in which a tracheostoma stenosis and granulation hyperplasia occurred due to PDT, and dysphagia occurred because of the defective laryngeal elevation.
    A 79 years old woman presented with disturbance of consciousness due to a subarachnoid hemorrhage and PDT was performed at an intensive care unit. Following the procedure she was quadriplegic with dysphagia and had to continue rehabilitation. Because of the dysphagia and difficulty in the management of the tracheotomy tube, she was referred to us.
    We selected laryngeal closure as preventive surgery against aspiration, and obtained a good result.
    PDT complications have also been reported in several studies.
    As the procedure is performed blindly, the tube may not be placed medially in the trachea or it may happen to break tracheal cartilages. When particularly long-term breathing management is necessary, we think that surgical tracheotomy associated with very few occurrences of tracheostoma stenosis and granulation hyperplasia is desirable.
    In addition, the operation that we performed was useful because it was hard to make a diastasis and it was easy to make a permanent tracheal stoma. In those patients with a tracheostoma and dysphagia, we would like to recommend a laryngeal closure operation.
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  • A Case of Intratracheal Ectopic Thyroid
    Morimasa Kitamura, Shigeru Hirano, Ichiro Tateya, Shinpei Kada, Seiji ...
    2013 Volume 106 Issue 3 Pages 261-265
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.261
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    Intratracheal ectopic thyroid tissue is a rare cause of upper respiratory obstruction. The first symptom may be a wheeze, so it can be mistaken for asthma.
    A 45-year-old female was admitted to our hospital with gradually progressive dyspnea over a period of 1 year. CT scan showed a tumor in the tracheal lumen subglottically with about 90% narrowing. The patient underwent bronchoscopy which demonstrated a broad-based, smooth, round and submucosal mass from the left posterolateral tracheal wall. A biopsy was deferred because the tumor demonstrated hypervascularity. A tracheostomy was performed, and a biopsy was undertaken via an open tracheal approach under general anesthesia. Histopathology confirmed benign thyroid tissue. The tumor was diagnosed as intratracheal ectopic thyroid and resected from trachea. The patient has done well for 2 years after surgery.
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  • Two Cases of Deep Neck Infection in Rheumatoid Arthritis Patients
    Masami Nakajima, Masami Osaki, Osamu Hida, Mutsuko Hara, Eikichi Tokun ...
    2013 Volume 106 Issue 3 Pages 267-272
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.267
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    Patients with rheumatoid arthritis (RA) have a tendency towards an increased incidence of oral disease, and the use of steroids or immunosuppressive drug to treat RA exacerbates their infections and, sometimes even causes serious infections. We present two cases of deep neck infection in RA patients who had a long history of RA treatment. In both patients septic shock occurred with serious early stage infection, however there were remarkable differences between the patients regarding their treatment periods and complications. The patient who underwent steroid therapy at the early stage of their infection had a particularly shorter treatment period and milder complications. It would appear from our limited results that steroid therapy is essential for immunosuppressed patients, such as our two cases, when serious infections occur.
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  • Three Cases of Tuberculosis in the Neck
    Ai Kawamoto, Masaki Ogura, Yukio Katori
    2013 Volume 106 Issue 3 Pages 273-277
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.273
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    We report herein on three cases of tuberculosis in the neck region experienced during a recent 1-year period. Two cases started with lymphadenopathy and the other started with subcutaneous abscess. Examinations and diagnosis for the tuberculosis were delayed for several weeks, because neither respiratory symptoms nor past and family histories for the tuberculosis were seen in any of the cases. In the examinations to make a diagnosis of tuberculosis, QuantiFERON® TB-2G (QFT) was effective in all three cases. After the diagnosis, all cases were treated with combination chemotherapy of four anti-tuberculosis drugs and the clinical symptoms gradually decreased. Bearing tuberculosis in mind is important in patients with extended lymphadenopathy and infectious regions in the neck.
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Original articles
  • The Immunomodulatory Effects of Garenoxacin on Interleukin-8 Produced by Human Tonsillar Lymphocytes with Lipopolysaccharide Stimulation
    Masaki Hayashi, Muneki Hotomi, Noboru Yamanaka
    2013 Volume 106 Issue 3 Pages 279-284
    Published: 2013
    Released on J-STAGE: March 01, 2013
    DOIhttps://doi.org/10.5631/jibirin.106.279
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    It has been reported that macrolides and some quinolones have an immunomodulatory effect and show synergy in their antimicrobial activity. Garenoxacin (GRNX), a recently developed fluoroquinolone, has been reported to show strong antimicrobial activity against respiratory pathogens such as Streptococcus pneumoniae and Haemophilus influenzae and high treatment efficacy for acute infectious diseases of the upper and lower respiratory tracts. To study the immunomodulatory effects of GRNX, we investigated its influence on interleukin-8 (IL-8), one of the products of proinflammatory cytokines, in human tonsillar lymphocytes stimulated with lipopolysaccharides (LPS). Palatine tonsils were obtained from patients with recurrent tonsillitis (n=12) and with hypertrophic tonsils (n=8). The tonsillar lymphocytes were stimulated with LPS (25 μg/ml) and were incubated with GRNX (5, 10, 15, 30 μg/ml) for 48 hours. IL-8 production of the treated lymphocytes was then measured with an ELISA. The IL-8 production of tonsillar lymphocytes was significantly suppressed by GRNX in the recurrent tonsillitis group, but not in the hypertrophic tonsil group. In conclusion, it is strongly suggested that GRNX has immunomodulatory effects on tonsillar lymphocytes with repeated episodes of infection through the suppression of IL-8 production. Thus GRNX has synergistic anti-inflammatory effects with its anti-bacterial properties, which is a favorable characteristic in the treatment of upper respiratory tract infections.
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Technical notes
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