The objective methods currently available to evaluate nasal obstruction are rhinomanometry and acoustic rhinometry. The aim of the present study was to carry out numerical simulations of airflows in the nasal cavity using three-dimensionally reconstructed images of the nasal cavity of patients obtained from CT data. As the first step, the effectiveness of flow computations using simple models of the nasal cavity was investigated. Two-dimensional acrylic resin nasal cavity models were constructed. In vitro experiments (water-flow experiment) and computer simulations of airflow patterns were then conducted. Air was used as the working fluid, the Reynolds number was calculated, and therefore the flow was assumed to be laminar. The flows were visualized by particle image velocimetry. Differences in the airflow pattern depended on the presence or absence of the middle and inferior turbinates in both the in vitro experiments and computational simulations. In both experimental and computational models without nasal turbinates, the fluid entered from the anterior aperture into the nasal cavity, after which a whirl was generated in the nasal cavity due to inspiration. There was consequently a flow found going forward in the lower portion of the nasal cavity. During expiration, a whirl was generated in the reverse direction, after which airflow turned backward in the lower portion of the nasal cavity. In both models with the turbinates, no large whirl, but a few tiny vortices and small reverse flows were generated during inspiration and expiration. These results may indicate that the turbinates play an important role in decreasing whirl and reverse flow in the nasal cavity and securing smooth and sufficient ventilation. Results in experimental and computational models were very similar. Therefore, computation was considered a reliable and useful method to simulate airflow in the nasal cavity and to investigate the nasal cavity anatomically.
A 32-year-old woman was admitted for acute vertigo with posterior cervical pain. It was suspected that an inner ear disorder was causing the vertigo because the patient had no neurological symptoms other than left-beating nystagmus and difficulty in standing, and computed tomography (CT) of the brain showed no abnormality. However she was diagnosed as having Wallenberg syndrome, because magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed a vertebral artery dissection, which can cause posterior cervical pain. Although vertigo is often caused by an inner ear disease, a cerebrovascular disease should be considered in the differential diagnosis of vertigo, even in a case of a young adult. In many cases, patients with cerebrovascular disease have some neurological symptoms, but some of them have minimal symptoms, especially at the initial visit. When the diagnosis is uncertain, MRI and MRA are useful.
We report herein on a case of reimplantation of a cochlear implant (CI) necessitated by cholesteatoma formation. Although the cholesteatoma had partly invaded the tympanic sinus, the round window niche, and the cochlea, a canal wall down mastoidectomy and expansion of the cochleostomy were useful to remove the cholesteatoma completely. In the replacement with a CI24RECA model we were able to reinsert all electrodes into the cochlea without resistance, and then the results of the neural response telemetry (NRT) were entirely positive. There were no postoperative complications. The postoperative speech perception improved compared with the preoperative findings. About a month after the operation, the patient suffered from otitis media with effusion, but it was cured without puncture and ventilation tube placement in a few weeks. At present there has been no reccurence. In agreement with previous reports, we think that CI reimplantation is an effective and relatively safe procedure.
We analyzed 203 children with ages ranging from 0-14 yr. (134 children visited our clinic complaining of ear pain and/or ear fullness. Sixty-nine children visited with acute upper respiratory infection and showed ear redness and/or fluid collection in their tympanic cavities.). One hundred and forty-nine of them showed redness of pharynx, and strawberry tongue, and then were tested with a rapid strep test. One hundred and twenty-four children were proved to be infected by group A β-hemolytic streptococcus (GABS). We should pay attention if patients with otitis media are suffering from GABS at the time when GABS is prevalent. Forty children positive for the rapid strep test showed no signs of otitis media, even though they complained of ear pain and/or ear fullness. One hundred and fifty-nine children with apparent symptom in their tympanic membrane and/or tympanic cavity were classified according to the severity due to the “Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media (AOM) in Children”. Infection with GABS did not significantly affect the severity of otitis media. The effect of AMPC and/or CDTR-PI on their otitis media showed no significant difference between patients with and without GABS.
Only a few cases of malignant melanoma of the middle ear have been reported in the literature to date. We report herein on a case of malignant melanoma in a 76 years old female with right facial palsy and hearing loss in her right ear. An otoscopic examination revealed a black right tympanic membrane. Computed tomography imaging showed a dense mass of soft tissue, filling the right tympanum and the right mastoid cavity, and invading the middle skull base. The diagnosis of malignant melanoma was confirmed on excisional biopsy of the tumor in the right mastoid cavity. We used a CyberKnife system as a palliative procedure, because the disease was considered as being inoperable. The treatment achieved stable disease (SD) status for 6 months. After 6 months metastases were detected in her sacral bone and liver. Although the patient died 11 months after the first examination, she suffered from nothing more than facial palsy and hearing loss until she died. Our case indicates that CyberKnife therapy could be feasible for controlling a patient’s QOL concomitantly with treating malignant melanoma of the middle ear.
Objectives: To assess the efficacy of myringotomy for mild or severe acute otitis media cases conducted in our department and examine search backgrounds of these cases. Methods: We studied 72 cases (117 ears) in which we carried out a myringotomy. Results: The following results were obtained. 1. The frequency of detection of PISP in this study was greater than that in a 2007 National surveillance. 2. The treatment of mild acute otitis media cases with high dose AMPC, high dose CFPN-PI or AMPC/CVA (14:1) was effective. As a result, the cases of myringotomy in our department decreased from 44 cases in 2010 to 14 cases in 2011. 3. The efficacy rate 3 weeks after myringotomy was 91.7%, which is higher than that of other reports. On the other hand, the recurrence rate was 40.3%, which required treatments.
Langerhans cell histiocytosis (LCH) involves the proliferation and accumulation of Langerhans cells at various sites and presents with various symptoms, depending on the organ or organs invaded. A 2-year-old boy with LCH was treated at our hospital. Fever, head rash, bilateral chronic otorrhea unresponsive to antibiotics, and left exophthalmos were observed at our first examination. The CT scan showed destruction of the skull bone, zygomatic bone and vertebrae, and masses within these lesions. No bony defect was detectable in the middle ear, but a mass was present in the external auditory meatus. Skull X-rays revealed characteristic “punched-out” lesions. We confirmed the diagnosis of LCH with a biopsy of the head mass and the external auditory meatus mass. Immunohistology revealed positive staining of the lesional cells with CD1a and Langerin (CD207). The final diagnosis was multisystem LCH (MS-LCH). The child was placed on the chemotherapeutic regimen recommended by the Histiocyte Society.
Renal cell carcinoma (RCC) occasionally metastasizes to a variety of regions including bone and liver, but nasal and paranasal sinal metastases are rare. No standard treatment currently exists, because of the small number of cases, so treatment varies for each patient. Sorafenib is a novel small molecular inhibitor of several kinases for malignancy, especially for RCC and hepatocellular carcinoma. We report herein on a case of nasal and paranasal metastatic RCC treated with VEGF targeted therapy (sorafenib) and radiotherapy.
Despite the concept of eosinophilic sinusitis becoming accepted widely in recent years, the diagnostic criteria remain unclear and definitive diagnosis requires histological proof of eosinophilic infiltration. Since it is not feasible for private otolaryngologists to sample tissue from deep within the paranasal sinuses, we examined if there might be another useful methods to establish the diagnosis of eosinophilic sinusitis before commencing treatment. In 43 cases of sinusitis (17 cases of eosinophilic sinusitis and 26 cases of non-eosinophilic sinusitis) of adult-onset, bilateral multiple polyps, and smell disturbance, we found significantly increased numbers of circulating eosinophils, high E/M values, and a high incidence of a prominence of the ethmoidal sinus on plain X-rays. The sensitivity, specificity, and accuracy of a blood eosinophil count of greater than 462 and prominence of the ethmoidal sinus on a plain x-ray of the sinuses for the diagnosis of eosinophilic sinusitis were 69.2%, 100%, and 88.2%, respectively. On the basis of these results, we propose that private otolaryngologists can also diagnose eosinophilic sinusitis based on history and medical examination, blood tests, and plain radiographs of the sinuses.
We report herein on a case of laryngocele with recurrent infection. A 48-year-old male complained of hoarseness and swelling of the left side of his neck. The endoscopic and CT scan examinations demonstrated the combined type of laryngocele that had expanded through the thyrohyoid membrane and had swollen up both medially and laterally in a dumbbell-like shape. To avoid the risk of laryngeal stenosis with the enlarged laryngocele infected by bacteria, in addition to intravenous infusion of an anti-bacterial drug, purulent discharge was drained from the infected laryngocele with a puncture needle. Because infection of the laryngocele was recurrent, it was surgically removed via an external neck approach under general anesthesia without any prophylactic tracheotomy. The laryngocele may be translated from a saccular cyst that had developed after the obstruction of communication between the laryngeal ventricle and the laryngeal saccule.
We report a rare case of papillary carcinoma of the thyroglossal duct. A 30-year-old woman visited our hospital with the chief complaint of a mass in the anterior neck. Although a cyst of the thyroglossal duct was suspected on physical examination, imaging examinations, including ultrasound, CT, and MRI revealed a solid pattern of the tumor mass. Fine needle aspiration cytology revealed malignant cells of papillary carcinoma origin. Surgical resection of the tumor mass along with a part of the hyoid bone was performed. Papillary carcinoma of the thyroglossal duct was confirmed by histopathological examination. Papillary carcinoma originating from the thyroglossal duct is relatively rare. However, it is important to keep the possibility of carcinoma of the thyroglossal duct in mind.
At the otorhinolaryngology out-patient clinic of our hospital, from April 2011 to March 2012, voice therapy was performed based on a simple method of voice training which placed great importance on the abdominal type of respiration. Eight cases with vocal fold nodules, 6 cases with vocal fold polyps and 6 cases with laryngeal granulomas underwent our method of voice training. The results are summarized as follows. From the 8 cases with vocal fold nodules who followed our method of voice training, disappearance was seen within 3 months in 7 cases and reduction in 1 case. In 5 of 6 cases with vocal fold polyps and 3 of 6 cases with laryngeal granulomas, reduction or disappearance was seen. Voice therapy is recognized as the first choice for treatment of vocal fold nodules. These results suggested that our method of voice training could be useful for some cases of vocal fold polyps and laryngeal granulomas, in addition to vocal fold nodules.
We encountered a case of a cervical and mediastinal hematoma after a stellate ganglion block (SGB) which had been performed on a 64-year-old man with trigeminal herpetic pain. Thirty minutes after the first SGB, he noticed a swelling on his neck, which worsened gradually. Computed tomography revealed a hematoma extending in the retropharyngeal space from the cervical to the mediastinal area. We removed the hematoma via a transcervical approach and performed a tracheostomy. He underwent decannulation 5 days after the operation, and was discharged from hospital 16 days postoperatively. A cervical and mediastinal hematoma occurring after an SGB is a rare complication, but it causes airway obstruction and necessitates emergency airway management.
Recently, octreotide has been reported to be effective in the treatment of some cases of chylothorax and chylous peritoneal effusion. However, there are few reports on the use of octreotide in the fields of otorhinolaryngology and head-and-neck surgery. Herein, we present a case in which octreotide treatment was found to be beneficial to arrest chylous fluid leakage following neck dissection. A 59-year-old woman with thyroid cancer and neck lymph node metastasis underwent total thyroidectomy with bilateral conservative D3a neck dissection. During the operation, the thoracic duct was cut and the tissue surrounding the chylous leakage was sutured and ligated. The patient was started on a low-fat diet on the third postoperative day (POD), and immediately, a large quantity of chylous fluid was found to drain out of the drainage tube. Intermittent subcutaneous administration of octreotide at a dose of 100 μg twice a day was started on the fourth POD. The chylous leakage from the drainage tube started to decrease noticeably from the day after the start of octreotide administration, almost stopping completely on the seventh POD. On the 12th POD, oral intake was resumed, however, no chylous fluid leakage was detected. The patient was discharged from the hospital on the 24th POD. Thus, octreotide appears to be extremely effective for controlling chylous leakage after operation, and treatment with octreotide should be considered before attempting any surgical intervention.