The vestibulo-ocular reflex (VOR) generates smooth eye movements that compensate for head movements to ensure gaze stabilization during head rotation. The VOR is under adaptive control and corrects VOR performance when a visual-vestibular mismatch arises during head movement. During normal visual-vestibular interactions, cooperation between the VOR and vision results in the stabilization of retinal images. Adaptive VOR recalibration occurs when a visual-vestibular mismatch arises through the manipulation of visual feedback during head movement. In consideration of the importance of VOR in gaze stabilization, it has been predicted that when the VOR is lost, patients may become severely disabled by retinal image movements during head movements. The vestibular center uses substitutes such as visual and somatosensory information to compensate for lost vestibular signals. In this article, we report the results of our current studies investigating the contribution of somatosensory signals to the VOR. In the 1st experiment, we examined the effect of rotational stimulation to the shoulder joint on the VOR. In the 2nd experiment, we examined the plasticity of the VOR using vestibular-somatosensory interactions and the effect of adaptive plasticity on the VOR by somatosensory stimulation using alternative pressure stimulation on the outer side of both upper arms for 20 seconds. Based on our results, we suggest that somatosensory input represents a useful additional input for developing vestibular compensation in patients with peripheral vestibular disorders, such as vestibular neuronitis and Meniere’s disease.
We report herein on 5 cases of the transient type of apogeotropic direction-changing positional nystagmus. The pathophysiological mechanism behind this disorder is thought to be a canalolithiasis with the debris within the anterior part of the horizontal semicircular canal of an affected ear. In our cases, however, a transformation from an apogeotropic direction-changing positional nystagmus into a geotropic one was not observed before nystagmus completely disappeared. We therefore speculate that the free floating otoconia was located in the ampulla region on the utricle (vestibular) side. Therefore, rolling (yaw rotation) and FPP (Forced Prolonged Position) are considered to be an effective maneuver.
A 65-year-old man working near metallic fences during a thunderstorm was struck by lightning. He lost consciousness and experienced a dermal burn on the right side of his body (10% total body surface area). Even though he did not complain about any hearing problems after the event, we found that his tympanic membrane was ruptured. After 34 days, the perforation of the tympanic membrane spontaneously healed without any further problems. Otologic problems tend to be missed because of the priority given to other critical emergency problems. Lightning could cause many issues such as auditory problems, vestibular disorders and facial paralysis, so it is important to recognize that a patient who is struck by lightning should undergo a complete otolaryngological evaluation right away.
Laser surgery of the inferior turbinate has been considered a simple and effective surgical treatment with a low complication rate and has been used widely by many ENT surgeons including those in private clinics throughout Japan. In the present study, we assessed the clinical efficacy of carbon dioxide laser treatment in a private clinic. Treatments were performed on an outpatient basis in up to three consecutive sessions under local anesthesia. The outcome was evaluated with daily nasal symptom reports and patient interviews according to the Practical Guidelines for the Management of Allergic Rhinitis in Japan, 2009. Six months after treatment, almost all the nasal symptoms and total severity had remarkably improved in most patients. We also examined unsuccessful cases of laser surgery and discussed our results. Laser surgery of the inferior turbinate is a minor surgical procedure with high efficacy and minimal postoperative morbidity. More cases and a longer follow-up are necessary to provide longer-term results.
We encountered 2 patients who were tentatively diagnosed as having intestinal Behcet’s disease during treatment for refractory oral/pharyngeal ulcers, and 1 patient with Crohn’s disease. Case 1 was an 83-year-old male. Among the primary symptoms of Behcet’s disease, recurrent ulcers of the oral mucosa and vulval ulcer were observed. As an accessory symptom, digestive lesions were detected. A tentative diagnosis of intestinal Behcet’s disease was made according to the diagnostic criteria established by the Ministry of Health, Labour and Welfare. Case 2 was an 81-year-old female. Emergency surgery for two perforations in the small intestine was performed, but the patient died. Among primary symptoms of Behcet’s disease, recurrent ulcers of the oral mucosa was noted. As an accessory symptom, digestive lesions were detected, leading to a tentative diagnosis of intestinal Behcet’s disease. Case 3 was a 22-year-old male. Endoscopy of the large intestine revealed digestive lesions and stones, suggesting Crohn’s disease. In all patients, the initial symptoms were oral/pharyngeal ulcers, and digestive lesions appeared. The maximum interval from onset until diagnosis was 8 months. Intestinal Behcet’s and Crohn’s diseases are difficult to differentiate from oral/pharyngeal mucosal lesions. Endoscopy of the digestive tract may be useful.
Children with Down Syndrome (DS) have many predisposing factors for the obstructive sleep apnea syndrome (OSAS), and removal of the tonsils and adenoids is the first-line treatment of airway obstruction and sleep apnea in children with DS. On the other hand, it is known that despite tonsillectomy and adenoidectomy, obstructive sleep apnea persists in 30-50% of children with DS. We investigate herein 4 patients who underwent tonsillectomy and adenoidectomy between January 2008 and December 2010. To evaluate the causes of OSAS in children with DS, we performed a comparative study of the degree of tonsillar hypertrophy, hypertrophy of adenoids, macroglossia, body weight, obesity, body mass index, oxygen saturation, apnea hypopnea index, period of operation, and the Mallampati test. Snoring and apnea improved in 2 cases (50%) after the operation, but OSAS remained in two cases (50%). Persistent sleep apnea in children with DS has multiple causes which include macroglossia, glossoptosis, enlarged lingual tonsils, hypopharyngeal collapse, and central sleep apnea. It is important to identify and characterize these potential causes.
Autoinflammatory diseases are characterized by seemingly unprovoked episodes of inflammation, without high-titer autoantibodies or antigen-spcific T cells. The periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a non-hereditary autoinflammatory syndrome characterized by periodic episodes of these conditions. It usually manifests itself in early childhood, especially before 5 years of age, and lasts several years. Its etiology is unknown, but in a recent study, the efficacy of tonsillectomy was suggested in the PFAPA syndrome. In one of our cases, a 4-year-old boy diagnosed clinically with the PFAPA syndrome, tonsillectomy proved effective. The tonsil is deeply associated with the etiology of autoinflammatory disorders in PFAPA syndrome. These data suggest the possibility that PFAPA may be a new member of the tonsillar focal diseases.
The Actinomyces, a resident flora in the oral cavity, can form a mass in the head and neck region that is often difficult to distinguish from a malignant tumor. This report describes a case of actinomycosis in a 65-year-old man who underwent concurrent chemoradiotherapy, left cervical lymph node dissection, laryngopharyngoesophagectomy, and esophageal reconstruction with the pectoralis major muscle for treatment of hypopharyngeal carcinoma. He subsequently developed a suspicious mass at the pharyngeal stump that was difficult to distinguish from recurrent carcinoma. After two biopsies, treatment with a penicillin antibiotic, and strict follow-up, the mass disappeared 38 weeks after the start of antibiotic treatment. Antibiotic treatment was subsequently discontinued and no recurrence has been detected to date.
Anaplastic thyroid carcinoma is a rare and lethal human malignancy. In this paper, we report on a case of a 55-year-old man who had undergone radiation therapy on the cervical region for malignant lymphoma at 14 years of age, and had been consulting our hospital for 19 years. He underwent a left hemithyroidectomy for papillary thyroid carcinoma at the age of 35, and 11 years after that a total thyroidectomy was performed for cervical nodal disease. After the operation he underwent radioiodine therapy twice. Five years after radiotherapy, anaplastic carcinomas arose in the left cervix and the cranium. Soon after complete resections of the tumors, systemic metastases were detected with FDG-PET. Finally, 11 months after the operation, he died in our palliative care unit at the age of 55 due to frequent bleeding from a palatal carcinoma. A review of the literature showed that the age at which the tumor arose, namely the peak of the patient’s life, was earlier than was usually reported. The survival time of 11 months observed in our patient was more than that generally observed in patients with anaplastic carcinoma.
Primary ciliary dyskinesia (PCD) is a rare, autosomal recessive disease with abnormalities of the ciliary structure and function, which causes impaired mucociliary clearance. Patients with PCD present with rhinitis, sinusitis, otitis media with effusion, recurrent lower respiratory tract infections, and/or bronchiectasis. Approximately half of PCD patients have situs inversus totalis, called Kartagener’s syndrome. The absence of clinical or laboratory signs makes PCD difficult to be diagnosed. However, it is important to recognize this disease in order to make the correct diagnosis so as to start appropriate therapy for the respiratory tract infections and to minimise lung damage. Early diagnosis and effective treatment result in prevention of PCD progression. The diagnosis of PCD has relied on analysis of ciliary ultrastructure anomalies with electron microscopy. However, taking biopsy specimens from the conchal mucosa or bronchus mucosa is not easy for general doctors. Therefore, the diagnosis of PCD is often delayed or missed or made incorrectly. In two of the three patients with PCD presented herein, we obtained biopsy specimens from the inferior turbinate mucosa under local anesthesia. Consequently, the patients were diagnosed as having PCD. Another patient who had been diagnosed as having Kartagener’s syndrome had pneumonia, and we performed a tracheostomy. In this article, we emphasize the role of the otolaryngologist in the diagnosis and treatment of PCD.
Impalement injuries of the head and neck are extremely rare. We report herein on a 62-year-old man with an impalement injury in the head and neck region from the branch of a tree. He fell into a ditch and a tree branch penetrated through his left cheek to the posterior region of his neck. Contrast enhanced CT showed that it had penetrated through the parotid gland and passed near the retromandibular vein. The tree stick was successfully removed under general anesthesia without cervical incision. Although a salivary fistula occurred temporally after removal, no other sequela was observed. Preoperative contrast enhanced CT is useful to prevent complications in removal of foreign bodies in the parotid gland.
We report herein on an impalement injury in a 76-year-old woman caused by a wooden chair accessory that penetrated through her neck into the oral cavity. The penetrating object had already been removed when the patient was brought to our clinic. Enhanced CT showed emphysema from the retropharyngeal space to the right lateral neck, but there was no damage to major vessels or submandibular gland. Under general anesthesia, the wound was debrided. After the operation, the patient received administration of antibiotics. On day 12 after the surgery a videofluorographic study showed no leakage of the wound, and she started feeding orally. The postoperative course was good and the patient was discharged 18 days after surgery without any complications.
Fluticasone furoate (FF) is a potent topical glucocorticoid for the treatment of allergic rhinitis (AR). We studied the effect of FF on subjects with seasonal allergic rhinitis using an allergen challenge chamber (ACC). The investigation was conducted in 35 patients suffering from Japanese cedar pollinosis through a randomized parallel-group trial. We compared the nasal and ocular symptom scores between the control subjects and the treatment group. There were no statistical differences in background factors between the two groups. The aim of this study was to assess the efficacy of FF in the ACC. FF showed consistent attenuation of AR symptoms. A seven-day treatment course of intranasal FF given once-daily before the allergen exposure caused a statistically-significant reduction of some objective symptoms of AR including associated eye findings. In regard to subjective responses to eye manifestations, however, statistical significance for the treatment-control comparison was not be attained. The positive effects obtained by this study suggested that FF could be efficacious as a once daily steroid before the pollen allergy season. This means that FF could also be used for the initial drug of choice for the treatment of AR resulting from pollinosis along with oral anti-allergic agents.
Thyroid oxyphilic cell adenoma, which is also called oxyphilic cell tumor, Hurthle cell tumor or eosinophilic cell tumor, is follicular adenoma. It is diagnosed when oxyphilic cells comprise more than 75％ of a lesion. Thyroid oxyphilic cell adenoma has been reported to comprise from 1.5％ to 10％ of all thyroid adenomas. There are varied clinical feature and malignancy, and both treatment and prognosis are unclear. We report herein on a case of oxyphilic cell adenoma which was diagnosed by chance during the examination of invasive thymoma and was resected via a thyroid lobectomy.