Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 107, Issue 1
Displaying 1-14 of 14 articles from this issue
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Clinical color photographs
Original articles
  • Usefulness of Streptococcus pneumoniae Antigen Detection Kit for the Management of Acute Otitis Media
    Noboru Yamanaka, Rinya Sugita, Yutaka Fujimaki, Yosuke Kamide, Yoshifu ...
    2014 Volume 107 Issue 1 Pages 7-14
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.7
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    A multi-center study was conducted in 8 otolaryngological clinics in Japan to obtain the clinical usefulness of Streptococcus pneumoniae antigen detection kit for the management of acute otitis media (AOM). Children with acute otitis media who visited the clinics in this group study were categorized in terms of severity based on the Clinical Practice Guidelines for Pediatric Acute Otitis Media (2009 Edition), and patients with moderate or severe AOM were given diagnostic tests with S. pneumoniae kit (HS kit). The treatment strategy was decided by each clinic in accordance with its clinic-specific criteria. Study results from clinics that made decisions based on the current treatment guidelines (non-HS group) and in reference to the test kit results (HS group) were stratified and post analysis was performed. The usefulness of the HS kit was evaluated based on the rate of concordance with cultivation tests, the clinical course and the impression of the attending doctors regarding the usefulness. The performance of the kit in comparison to cultivation tests showed a sensitivity of 78.2% and specificity of 89.9%. The results demonstrated that in 127 of 155 subjects (81.9%) the HS kit was “extremely useful” or “useful” in identifying the infecting organism, selecting appropriate antibacterial agents, or in giving the information to explain to patients’ guardians about the management of AOM. In HS kit-positive cases, the HS group and non-HS group judged that the kits were “extremely useful” or “useful” in 97% and in 90%, respectively. On the study of reasons on judging the HS kit as useful, the HS group indicated that the kit was useful in identifying the infecting organism, selecting appropriate antibacterial agents, and in giving the information to explain to patients’ guardians about the management of AOM. On the other hand, the non-HS group considered the kit as useful mainly in identifying the infecting organism.
    Based on these results, the implementation of a rapid diagnostic method using S. pneumoniae kit was confirmed as highly useful for the management of AOM.
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  • A Case of Recurrent Cerebrospinal Fluid-Middle Ear Effusion Caused by Habitual Valsalva’s Maneuver
    Haruo Hirakawa, Yasuyuki Nishi, Taisuke Watanabe, Makoto Tada, Takahir ...
    2014 Volume 107 Issue 1 Pages 15-24
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.15
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    We report herein on a case of recurrent cerebrospinal fluid (CSF) from the different bony defects of the tegmen of the middle ear caused by habitual Valsalva’s maneuver at about a seven-year interval. A 47-year-old man consulted the otorhinolaryngological department of the NHO Kure Medical Center complaining of left ear fullness. Three weeks before he had caught a cold and had repeated Valsalva’s maneuver to reduce the ear fullness. Two weeks previously he recognized watery rhinorrhea just after he heard sound of air in the left ear. A week previously he had consulted an ENT clinic and middle ear effusion of the left ear was discovered. The patient was referred to our department as possibly having recurrent CSF-middle ear effusion, for he had had a past history of CSF-middle ear effusion about 7 years previously. At that time the first surgery was performed to treat the CSF. The surgery revealed a bony defect in the mastoid tegmen and the defect had been closed with cortical bone, bone paste, and periosteum. Three weeks after the consultation the second surgery was performed. The surgery revealed another bony defect in the epitympanic tegmen and no defect in the mastoid tegmen. The defect was closed in the same way as the first surgery. Detailed questioning revealed that the patient had had a habit of performing Valsalva’s maneuver before the first onset. We suspect that continual or intermittent positive pressure to the middle ear due to habitual Valsalva’s maneuver may cause the thinning or the disappearance of the bony wall of the middle ear.
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  • A Study on Ventilation Tube Therapy for Chronic Otitis Media with Effusion in Children
    Takafumi Yamano, Toshifumi Sakata, Takashi Nakagawa
    2014 Volume 107 Issue 1 Pages 25-29
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.25
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    Objectives: To perform ventilation tube therapy for chronic otitis media with effusion in children, to investigate how the incidences of recurrence and tympanic membrane perforation varied with duration of placement, and to determine the most appropriate duration of placement.
    Methods: Using a questionnaire survey in clinics after follow-up, we studied 119 ears 74 children with chronic otitis media with effusion, undergoing ventilation tube therapy between January 2007 and December 2012.
    Results: The duration of tympanostomy tube placement was 444 days on average, and recurrence was seen in 5 cases. There was no significant difference in the rate of improvement between patients undergoing adenoidectomy and with no adenoidectomy.
    Conclusion: It was thought that 500 days or more were desirable for tube placement and that an adenoidectomy should be undertaken concomitantly wherever possible. A future study should be designed to examine the long term effect. Our results suggested that a high risk of the recurrence was associated with congenital anomaly or retraction within one year after the insertion.
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  • A Case of Hemangiopericytoma of the Oropharynx
    Nimpei Yamaguchi, Kenichi Kaneko, Haruo Takahashi, Naoe Kinoshita
    2014 Volume 107 Issue 1 Pages 31-36
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.31
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    Hemangiopericytomas (HPCs) are a rare vascular tumor arising from mesenchymal cells. We herein describe a 26-year-old man with an oropharyngeal HPC, who had a 3-month history of dysglossia and noticed a painless mass in the oropharynx. Contrast enhanced CT demonstrated an oropharyngeal tumor with a high vascularity. Preoperative biopsy of the tumor was insufficient because the tumor had high vascularity. The patient underwent transoral removal of the mass after embolization and sclerosing therapy. Postoperative diagnosis was an HPC. Eleven months have passed from the operation without any signs of either local recurrence or distant metastasis.
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  • A Case of Malignant Lymphoma Suspected as Peritoneal Metastasis from Laryngeal Carcinoma
    Kenichi Mori, Masami Ohnishi, Hiroki Takahashi, Yuzuru Sakaida
    2014 Volume 107 Issue 1 Pages 37-42
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.37
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    We report herein on a rare case of double primary malignant tumors composed of squamous cell carcinoma of the larynx and malignant lymphoma. The patient was a 60-year-old man with the chief complaints of swelling on the right side of his neck and hoarseness. Endoscopic examination demonstrated a massive tumor on the right supraglottic tissue. The accumulation of fluorodeoxyglucose was seen in the larynx, the cervical lymph nodes, the spleen, and the intraperitoneal lymph nodes. Supraglottic squamous cell carcinoma of the larynx (T4aN2bM1) was histologically diagnosed. As a treatment, chemotherapy was first performed. From the second course after inception of the administration, the intraperitoneal metastatic lesion almost disappeared on PET-CT, and furthermore, after the third course concurrent chemoradiotherapy was administered. As a result, the right supuraglottic tumor had completely disappeared. However, an intraperitoneal lymph node had developed. The patient underwent laparotomy, and investigation of the biopsy revealed an intraperitoneal tumor. The histopathological diagnosis was diffuse large B-cell lymphoma. The patient was treated with R-CHOP. There was no recurrence of laryngeal carcinoma observed for 9 months until he died of malignant lymphoma.
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  • A Case of Mumps with Acute Laryngeal Edema
    Taiji Kawasaki, Koichiro Wasano, Noriomi Suzuki, Yoshihiro Watanabe
    2014 Volume 107 Issue 1 Pages 43-46
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.43
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    We report herein on a case of mumps associated with laryngeal edema. The patient was an 18-year-old man who was referred by a nearby doctor with complaints of dyspnea and swelling of the submandibular and parotid glands. We suspected that the patient was suffering from mumps associated with laryngeal edema. The patient was hospitalized and started on treatment with intravenous steroids. Because the laryngeal edema did not improve with this treatment approach, a tracheostomy was performed. The diagnosis of mumps was confirmed by the elevated serum antibody titers. There have been about 15 reports of mumps associated with laryngeal edema especially from Japan. It is essential to examine the airway by laryngoscopy in case of mumps with swelling of the submandibular and parotid glands.
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  • A Case of Posterior Reversible Encephalopathy Syndrome due to Hypercalcemia as a Complication of an Endstage Oral Cancer
    Hirotaka Shinomiya
    2014 Volume 107 Issue 1 Pages 47-51
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.47
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    Posterior reversible encephalopathy syndrome (PRES) was first codified as a single named syndrome in a 1996 case series by Hinchey et al. PRES was described as a clinical syndrome of insidious onset of headache, confusion, visual changes and seizures, which was associated with neuroimaging findings of posterior cerebral white matter edema. Hypertensive disorders, renal disease and immunosuppressive therapies so on are risk factors for this disorder. There are few reports of PRES caused by hypercalcemia. We report herein on a rare case of PRES in normotensive patient with hypercalcemia as a complication of an endstage oral cancer.
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  • A Case of Triple Collision Malignancies in Cervical Lymph Nodes
    Hiroyuki Harada, Shogo Shinohara, Keizo Fujiwara, Masahiro Kikuchi, Yu ...
    2014 Volume 107 Issue 1 Pages 53-58
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.53
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    Collision tumors are rare entities that consist of multiple neoplasms of distinct origin found in a single anatomic location. Several papers have mentioned collision tumors with two different malignancies in the head and neck. We report herein on a case with triple collision tumors in pathological neck dissection-lymph nodes. A 58-year-old male underwent a total laryngectomy and bilateral neck dissection under the diagnosis of supraglottic squamous cell carcinoma cT4aN2cM0. The dissection of the central compartment (level VI) with subtotal thyroidectomy was simultaneously undertaken due to the subglottic extension of the primary tumor. Histopathological examination revealed metastases of papillary thyroid carcinoma in the right lymph nodes, level III to V, in the left at level II, III and VI as well as metastases of squamous cell carcinomas in the right and left at level III and level II, respectively. Moreover small lymphocytic lymphoma cells were found to have infiltrated the lymph nodes bilaterally at level II to IV. Histology of the right level III, specimen revealed that these 3 kinds of tumor had collided in one lymph node. Multiple micropapillary carcinomas (4 mm maximum diameter) were also detected in the resected thyroid specimen. After the pathological report, we reviewed the preoperative FDG-PET/CT and found that only the existence of SCC showed an high accumulation of FDG on PET/CT. Considering the prognoses of each malignancy, postoperative radiation for squamous cell carcinoma was performed because lymphovascular invasions were pathologically seen at the primary site. It was decided to place the thyroid cancer and small lymphocytic lymphoma under observation without additional therapeutic intervention because the former was considered to be an incidental microcarcinoma and the latter was an indolent type lymphoma.
    To our knowledge, this is the first reported case of triple collision tumors in one cervical lymph node.
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  • A Case of Branchiogenic Carcinoma
    Toshiya Kimura, Tohru Sogami, Akifumi Mizukoshi, Tsunehisa Ohno, Hisan ...
    2014 Volume 107 Issue 1 Pages 59-63
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.59
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    A case of branchiogenic carcinoma is reported herein. The patient was a 59-year-old female who noticed a mass on the left neck and visited our hospital. CT and echography revealed a cystic lesion, and PET disclosed multiple abnormal accumulations on the bilateral cervical lymph nodes and pharynx. First of all, we suspected the tumor as being a malignant lymphoma or metastatic carcinoma. We resected the tumor under general anesthesia for biopsy. The histopathological diagnosis was squamous cell carcinoma arising from a branchiogenic cyst. We examined the whole body and added the biopsies of the epipharynx, palatine and lingual tonsils which revealed no malignancy and no other primary lesions existed. The tumor was therefore diagnosed as a branchiogenic carcinoma. Bilateral radical neck dissection, and postoperative chemotherapy and radiotherapy were performed. The patient has survived until the time of writing for 30 months without recurrence.
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  • A Case of Branchio-oto-renal Syndrome
    Takashi Masui, Katsunari Yane, Yoshinori Nakai, Ichiro Ota, Hiroshi Ho ...
    2014 Volume 107 Issue 1 Pages 65-69
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.65
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    Branchio-oto-renal (BOR) syndrome is an autosomal dominant disorder with branchial anomalies: ear malformation, hearing loss, cervical fistula, and renal anomalies.
    We experienced a case of BOR syndrome. A 16-year-old female had bilateral preauricular pits, bilateral hearing loss, left cervical fistula, and right renal aplasia. Computed tomography revealed inner ear anomalies with cochlear hypoplasia and an enlarged internal auditory meatus. We treated left cervical fistula only in this case. As the rate of improvement in hearing loss by surgical treatment such as tympanoplasty is not necessarily high, we should decide the indication for surgery carefully.
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  • A Case of Tracheotomy in a Patient with Pena-Shokeir Syndrome Type I
    Saeko Yoshida, Shigetaka Moriai, Tetsuji Wada, Naoki Kanai
    2014 Volume 107 Issue 1 Pages 71-75
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.71
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    Pena-Shokeir syndrome type I is an uncommon disease first reported by Pena & Shokeir in 1974. This disease is characterized by congenital multiple arthrogryposis, characteristic facial anomalies, and pulmonary hypoplasia. Respiratory failure is the main reason for death, usually in the early postnatal period, of patients with this syndrome.
    We report herein on a case of a 4-month-old girl with Pena-Shokeir syndrome type I who underwent a tracheotomy. Since it was very hard to extend her neck, we performed the tracheotomy by modifying her body position and using a specialized tracheal cannula. She has remained clinically asymptomatic for a year following the tracheotomy.
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Technical notes
Medical essays
  • Reactions after Menière’s Report in the 19th Century
    —Part 6. Historical Reviews for the Pathogeneses of Menière’s Disease. Part one—
    Toshitaka Iinuma
    2014 Volume 107 Issue 1 Pages 79-82
    Published: 2014
    Released on J-STAGE: January 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.79
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    The various theories concerning the pathogeneses of Menière’s disease were reviewed in 19th Century bibliographies. The following are discussed in Part one: 1. External canal origin including thermal stimulation by cold and warm water, pressure in the canal; 2. Tympanic cavity and the origin of mucosal lesions including catarrhal changes of the mucosa, lesions including ossicular chains and around the oval and round windows; 3. Tubal stenosis; 4. Hemorrhage in the labyrinth; 5. Labyrinthitis; 6. Disorders of the vascular nerves of the labyrinth including the stellate ganglion.
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