耳鼻咽喉科臨床
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
106 巻, 6 号
選択された号の論文の16件中1~16を表示しています
論説
  • 藤枝 重治, 坂下 雅文, 意元 義政
    2013 年 106 巻 6 号 p. 477-484
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    Chronic rhinosinusitis (CRS) is an extremely common disease in Japan. The standard therapeutic strategies for CRS have been low-grade macrolide therapy and endonasal endoscopic sinus surgery (ESS). Recently a new subtype of CRS has been increasing in Japan. CRS of this subtype which is classified by as eosinophilic chronic rhinosinusitis (ECRS), shows less response to standard therapy and a higher tendency for recurrence. Strong eosinophil infiltration can be found in nasal polyps of ECRS patients.
    We conducted a retrospective study in 12 universities to ascertain the diagnostic characteristics of ECRS and to establish clinical diagnostic criteria to distinguish ECRS from CRS. In all, 3,014 patients with CRS who underwent an ESS procedure during the 3 years from 2007 to 2010 were enrolled in this study. Patients were clinically diagnosed as having CRS by their respective ENT medical doctors. We collected clinical data and analyzed the data using statistical methods. Eight hundred and thirty two patients (28%) were diagnosed as having ECRS. We found a significantly high rate of bilateral lesions, nasal polyps, viscous rhinorrhea, olfactory disturbance, and olfactory cleft closure in ECRS. In CT findings, the ethmoid sinus shadow was significantly strong in ECRS patients. As for comorbidity, several diseases (brochial asthma, allergic rhinitis, aspirin-induced asthma and drug allergy) showed a significantly high rate together with ECRS. We calculated the odds ratio and clinical score for ECRS using a multiple classification analysis. Seven items (age of onset, bilateral region, ethmoid shadow, nasal polyps, olfactory cleft closure, drug allergy and percentage of eosinophils in blood) were chosen, because ENT doctors are able to check these easily. We can total up the individual score for every patient to make a diagnosis. Based on these criteria, we can diagnose ECRS if the total score is greater than 5. Now we are revising these criteria.
カラー図説
臨床
  • 大門 康子, 樋口 仁美, 山野 貴史, 中川 尚志
    2013 年 106 巻 6 号 p. 489-494
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    We investigated the length of hospital stay of 256 patients who underwent otologic surgeries after introduction of the in-house protocol (group A) at the Department of Otorhinolaryngology & Head and Neck Surgery of Fukuoka University Hospital from September 2007 to August 2010, and compared it with that of 110 patients who underwent similar surgeries from January 2005 to August 2007, prior to the introduction of the protocol (group B). The average length of hospital stay of patients of group A who underwent Canal Wall Down Tympanomastoidectomy was significantly shorter than that of group B who underwent the same surgery. However, for patients who underwent conductive system reconstruction without eardrum repair, much slighter benefit was derived from use of the protocol in terms of reducing the length of hospital stay. These findings suggest that the protocol is selectively useful for reducing the overall length of hospital stay, but may require revisions for some types of surgical procedures.
  • 若島 純一
    2013 年 106 巻 6 号 p. 495-503
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    We studied 186 ears in 109 children aged 0-12 years with otitis media with effusion (OME) and recurrent acute otitis media who underwent the insertion of a short-term ventilation tube (Shepard Grommet tube) at Tomakomai ENT clinic between 2008 and 2011. The average age at the time of insertion was 3.3 years, and general anesthesia was required for 2 out of 302 ventilation tube insertions. The tubes were removed after an average of 227 days. Sequelae from indwelling tubes included otorrhea (18.2%), and obstruction (12.9%). No perforation, adhesion and cholesteatoma was occurred after tube extraction. In children aged 2 or over, the recurrence rate of OME requiring a second ventilation tube insertion was significantly higher in the group without chronic sinusitis during intubation than in the group with chronic sinusitis. The cure rate for otitis media was significantly higher in the group intubated for 5 months or longer, compared with the group intubated for less than 5 months.
  • 下郡 博明, 菅原 一真, 山下 裕司
    2013 年 106 巻 6 号 p. 505-508
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    We report two pediatric cases of suspected congenital cholesteatoma which the lesions spontaneously disappeared during the follow-up period. In case 1, a 3-year-old boy was examined by his local otolaryngologist because of an ear wax plug. In case 2, a 4-year-old girl was examined by her local otolaryngologist because of acute otitis media. In each case, a small whitish mass was found behind the ipsilateral anterior-superior-quadrant of the tympanic membrane, and the cases were referred to our hospital for further investigation. The children did not exhibit hearing loss or bone destruction in the middle ear. In both cases, the whitish mass gradually decreased in size during the follow-up period and disappeared under otomicroscopic examination. On the temporal bone CT images, a soft tissue mass anterior to the manubrium of the malleus also gradually decreased in size and disappeared. Based on these two cases, a “wait and watch” approach should be considered for patients with congenital cholesteatoma who do not exhibit hearing loss or bone destruction in the middle ear.
  • 増田 理佐, 加藤 明子, 大淵 豊明, 寳地 信介, 橋田 光一, 武永 芙美子, 鈴木 秀明
    2013 年 106 巻 6 号 p. 509-513
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    Endolympathic sac tumor is a rare temporal bone neoplasm, and is considered to be a low-grade adenocarcinoma. Despite its slow growth and low incidence of association with distant metastasis, this tumor often shows aggressive local bone destruction. Herein, we report a rare case.
    A 52-year-old man with Down syndrome presented with a 6-month history of hemifacial palsy. The initial examination revealed left-sided complete facial nerve palsy. Analysis of the auditory brain stem response indicated deafness on the affected side. The patient had no vertigo or nystagmus. Computed tomography revealed a well-defined osteolytic soft tissue lesion in the left petrous bone. The lesion was seen as a high intensity on both T1- and T2-weighted magnetic resonance images, and showed heterogeneous gadolinium enhancement. The labyrinth was destroyed, and the internal acoustic meatus was indistinguishable. Under a tentative diagnosis of cholesterol glanuloma, transmastoid biopsy was performed. The histopathological diagnosis was endolymphatic sac tumor. The patient eventually underwent removal of the tumor via a trans-middle cranial fossa approach following preoperative arterial embolization. His postoperative clinical course was uneventful, and he was discharged 19 days after the surgery. Although the facial nerve palsy or hearing loss did not recover, no evidence of tumor recurrence has been seen over a postoperative follow-up period of 32 months. A bibliographic review of the clinical/histopathological characteristics, diagnosis and treatement of endolymphatic sac tumor is presented.
  • 篠 美紀, 古田 厚子, 小松崎 敏光, 浜崎 泰佑, 滝口 修平, 野垣 岳稔, 鈴木 美雪, 山田 良宣, 門倉 義幸, 小林 一女, ...
    2013 年 106 巻 6 号 p. 515-519
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    The aim of this study is to analyze clinical features of young patients with olfactory disorders. The number of pediatric patients with olfactory dysfunction is low, and only a few studies have examined the characteristics of such patients and evaluated the results of their treatment. In this study, we compared the clinical characteristics of olfactory dysfunction in young and adult patients.
    Patients 19 years of age or younger who consulted the Department of Otorhinolaryngology at Showa University Hospital from 2000 to 2009 complaining of olfactory disorders, were investigated retrospectively. Olfactory functions were examined based on T&T olfactometry.
    A total of 39 patients were identified. The mean age was 14.5 years. Twenty-one patients were male and 18 patients were female. The common causes of olfactory disorders were congenital dysosmia (28.2%), chronic rhinosinusitis (20.5%) and dysosmia after head trauma (17.9%). The average recognition threshold was 4.91 and the average detection threshold was 4.37 in T&T olfactometry. After treatment, re-examinations were performed in 17 patients. The average recognition threshold was 4.04 and the average detection threshold was 2.54. Five patients showed improvement of olfactory functions, but 12 patients showed no improvement.
    Young patients with olfactory dysfunction represented only 1.7% of all patients who visited the Special Outpatient Clinic for Olfactory Dysfunction. Compared with adult patients, young patients more frequently had congenital or post-traumatic olfactory dysfunction, and less frequently had post-common cold and no drug-induced olfactory dysfunction.
    The improvement rate of olfactory dysfunction was 39.1% in young patients and young patients with olfactory dysfunction due to sinusitis showed the highest rate of improvement. No significant difference in the improvement rate was observed between the young and adult patients.
    It was difficult to perceive olfactory dysfunction in young children, and their parents tended to notice it and bring their children to the outpatient clinic.
  • 谷山 岳司, 杉山 智宣, 荒木 真美佳, 福喜多 晃平, 山田 弘之, 畠山 好央, 小山 真司, 細井 裕司
    2013 年 106 巻 6 号 p. 521-524
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    Between 2001 and 2010, we treated 34 cases of paranasal sinus cysts with orbital symptoms. The subjects were 20 men and 14 women, aged 15 to 88 years (mean: 60.5 years). The paranasal sinus cysts were located in the frontal sinus in 15 cases, anterior ethmoid sinus in 12 cases, posterior ethmoid sinus in 8 cases, sphenoid sinus in 5 cases, and maxillary sinus in 2 cases. The symptoms included diplopia (9 cases), exophthalmos (8 cases), eyelid swelling (7 cases), visual disturbance (5 cases), orbital pain (4 cases), orbital discomfort (2 cases), and epiphora (2 cases). The cysts were postoperative in 24 cases and primary in 8 cases. Most patients tended to visit departments other than the department of otolaryngology, with only 5 patients initially visiting the department of otolaryngology. While the symptoms improved in 32 cases, little improvement was seen in 2 cases. Both of these latter symptoms 2 cases presented with visual disturbance. Therefore, early diagnosis and prompt treatment are essential for cases presenting with visual disturbance, as the symptoms may not respond satisfactorily to treatment if the treatment is delayed. Therefore, it is important for doctors in departments other than the department of otolaryngology also to be aware about this condition.
  • 齊藤 雄, 小川 恭生, 稲垣 太郎, 清水 雅明, 渡嘉敷 邦彦, 鈴木 衞
    2013 年 106 巻 6 号 p. 525-530
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    A 70-year-old man was referred to our hospital with the chief complaint of painful and intractable erosions of the oral mucosa. We performed radiation therapy for tongue cancer in March 2000. Then, in February 2001, neck dissection was performed for left cervical lymphadenopathy. No recurrence of the tumor was noted thereafter. In June 2011, the patient visited a nearby hospital with some bleeding sores in the mouth. As no improvement was noted with the usual treatment, oral bacterial pharyngitis was suspected and the patient was referred to our hospital. After admission, we performed biopsy suspecting recurrence of squamous cell carcinoma, however, no evidence of cancer recurrence was detected. Thereafter, skin biopsy and the test for anti-desmoglein antibody confirmed the diagnosis of pemphigus vulgaris. Patients with pemphigus vulgaris can present with mucosal lesions as the only initial symptom. For refractory oral, pharyngeal and laryngeal lesions, it is important to bear in mind the possibility of pemphigus vulgaris in the differential diagnosis. The test for anti-desmoglein antibody is highly specific, and useful as a minimally invasive test for the diagnosis and treatment of pemphigus vulgaris. Our present case exemplifies the usefulness of this test.
  • 小上 真史, 土橋 重貴, 森山 智美, 横山 道明
    2013 年 106 巻 6 号 p. 531-536
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    A retrospective study was conducted to evaluate the clinical outcomes of 59 patients with laryngeal cancer treated at our department between 2001 and 2012 using our institution’s treatment protocol. The mean age of the patients, comprising 56 males and 3 females, was 70 years.
    According to the TNM staging system, 39 cases (66.1%) were classified as having early-stage disease, and 20 (33.9%) as having advanced-stage disease. The treatment for early T stage laryngeal cancer at our insititution is radiation therapy at a total radiation dose of 60Gy. The patients with advanced-stage disease are treated by total laryngectomy with preoperative and postoperative radiation. The 5-year overall survival rate was 82.2% overall, being 92.4%, 100%, 72.9%, and 0% in patients with stage I, II, III, and IV disease, respectively. The disease-specific 5-year survival rate was 88.2% overall, being 100%, 83.3%, and 0% in patients with stage I/II, III, and IV disease, respectively. The preservation rate of the larynx was 85.3% in the T1 cases, but substantially lower (45.5%) in the T2 cases.
    According to these results, our treatment protocol needs to be improved, particularly for patients with T2 and stage IV disease. Because the preservation rate of the larynx in the T2 cases was lower, we plan to introduce a new protocol involving the use of S-1 instead of 5-FU to improve the preservation rate of the larynx, or increase the total dose of radiation. Furthermore, we propose to add adjuvant systemic chemotherapy to the stage IV treatment protocol to improve the survival rate, because the high rate of distant metastasis was the main reason for the unsatisfactory results in patients with stage IV disease.
  • 児玉 晴香, 熊井 良彦, 伊勢 桃子, 湯本 英二
    2013 年 106 巻 6 号 p. 537-541
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    Although the presence of a non-recurrent inferior laryngeal nerve (NRILN) is rare, surgeons occasionally encounter this anomaly during thyroid and parathyroid surgery. It is usually due to anomalous nerve and blood vessel development from the embryonic branchial arches.
    We recently encountered two patients with NRILN. One represented type 1 branching from the vagus trunk at the level of the inferior thyroid artery, and the other, type 2 branching at the level of the superior pole of the thyroid gland.
    Avoiding injury to the inferior laryngeal nerve is a major consideration during thyroid and parathyroid surgery. Because in most cases, including our two cases, NRILNs are associated with anomalous origin of the right subclavian artery from the aortic arch, this anomaly can be predicted by imaging procedures. Therefore, surgeons must pay careful attention to the preoperative examination findings in order to reduce the risk of injury of this nerve.
  • 朝日 淳仁, 片田 彰博, 原渕 保明
    2013 年 106 巻 6 号 p. 543-548
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    We recently encountered a case of laryngeal amyloidosis. The patient was a 58-year-old man who presented with the complaint of stridor. Fiberoptic laryngoscopy revealed yellow smooth-surfaced tumors in the left arytenoid and in the subglottis. The biopsy findings were consistent with amyloidosis. The mass in the arytenoid was treated by laryngomicrosurgery, and the mass in the subglottis was treated by endoscopic surgery with tracheostomy. There have been no remarkable signs of recurrence since the surgeries.
  • 川畠 雅樹, 吉福 孝介, 永野 広海, 黒野 祐一
    2013 年 106 巻 6 号 p. 549-555
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    Amyloidosis comprises a diverse group of disorders characterized by the deposion of amyloid protein in various organs and extracellular tissues. Clinically, it has been classified into systemic and localized forms. Amyloidoma, a very uncommon presentation of amyloidosis, could be defined as a solitary localized tumor-like deposit of amyloid in the absence of systemic amyloidosis. We present a case report of amyloidoma of the neck in an 83-year old man with laryngeal carcinoma. Localized deposits of amyloid occurring throughout the upper aerodigestive tract have been described, but such deposits have rarely been reported in the soft tissues of the neck.
    On physical examination, an immobile and elastic hard mass was palpable in the neck. A CT of the neck region revealed a poorly enhancing mass in the right submandibular region. On MRI, the mass was visualized as a hypointensity on both T1 and T2-weighted images. 18FDG PET-CT revealed a high FDG uptake in the mass, with a maximum standardized uptake value (SUVmax) of 5.9. The mass was surgically removed. Histopathological examination revealed AL amyloidosis. Systemic amyloidosis was excluded by several examinations. The patient was still disease-free at the 12-month follow-up.
  • 岡本 伊作
    2013 年 106 巻 6 号 p. 557-564
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    The pleura is the most common site of solitary fibrous tumors (SFTs), while such tumors are relatively rare in the head and neck region. This report documents two cases with SFTs developing in the parapharyngeal space. In total, 76 patients with tumors of the parapharyngeal space were operated on under general anesthesia between 2005 and 2012 at the Department of Head and Neck Oncology and Surgery, International University of Health and Welfare. SFT accounted for 2.6% of the cases (2 patients).
    The two patients were a 77-year-old man and a 57-year-old woman. Their conditions were diagnosed as SFTs based on postoperative immunohistological test results showing the lesions to be positive for CD34, bcl-2, and vimentin and negative for S-100. Only 11 cases with SFT in the parapharyngeal space have been reported in the literature, to date. Hence, SFT is an extremely rare disease.
機器
  • 重野 浩一郎
    2013 年 106 巻 6 号 p. 565-569
    発行日: 2013年
    公開日: 2013/06/01
    ジャーナル 認証あり
    We examined efficient cleaning methods for steel instruments, i.e., aural speculum, nasal speculum, tongue depressor and forceps, and whether the use of any of these methods could skip cleaning instruments by hand at an otolaryngology outpatient clinic. The steel instruments that were used in the outpatient area and instruments contaminated with blood were cleaned either by hand, dipping in detergent, in a desk top washer-disinfector, or using an ultrasonic device. Before and after the cleaning, the remaining protein was measured by the Coomassie brilliant blue method. There were no significant differences in the residual amount of protein among the cleaning methods. The amount of residual protein was up to 60 μg per instrument. Except for those cleaned by hand, the amount of residual protein was below 30 μg per instrument for more than 90% of the instruments. Thus, steel instruments used at an otolaryngology outpatient clinic can be washed effectively by dipping them in detergent containing an enzyme cleaner, with no need for cleaning by hand. Instruments contaminated with blood can be expected to be cleaned securely and safely by both dipping in detergent containing an enzyme cleaner and ultrasonic cleaning.
研修ノート
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