Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 107, Issue 2
Displaying 1-15 of 15 articles from this issue
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Editorial
  • Indication and Limitation of Concurrent Chemoradiotherapy for Squamous Cell Carcinoma of the Hypopharynx
    Takahide Taguchi, Nobuhiko Oridate
    2014 Volume 107 Issue 2 Pages 85-92
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.85
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    We reviewed our experiences with concurrent chemoradiotherapy (CCRT) treatment for patients with resectable squamous cell carcinoma (SCC) of the hypopharynx and considered the indication of CCRT for this disease. The survival rates of stage I–II hypopharyngeal SCC patients treated with radiotherapy alone were reported to be adequate. CCRT may be applied to improve the laryngeal preservation rate for stage II disease. We reported that the chemotherapy regimen and the N staging could predict the treatment outcomes of patients with advanced stage. The indication of CCRT was able to be determined by these factors. A functioning larynx could be preserved in most of the patients with hypopharyngeal SCC treated with CCRT according to our previous reports on the evaluation of laryngeal functions after CCRT.
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Original articles
  • A Clinical Survey of Pediatric Patients with Dizziness/Vertigo at a Neuro-otological Clinic
    Naoki Saka, Shigeto Ota, Toru Seo, Masafumi Sakagami
    2014 Volume 107 Issue 2 Pages 97-101
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.97
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    We investigated the clinical characteristics of 63 patients aged under 15 years who visited the neuro-otological clinic in Hyogo College of Medicine over the last 10 years. These patients accounted for 1.9% of all patients during the period, and there were 31 boys and 32 girls. The predominant diagnosis was orthostatic dysregulation in 12 patients (19.0%), psychogenic vertigo in 8 patients (12.7%), and Ménière’s disease in 5 patients (7.9%). The ratio of diseases with a peripheral origin was lower in children than in adults. Thirty-four patients (54.0%) were referred from other otorhinolaryngology clinics and 12 patients (19.0%) from mainly pediatric clinics. Abnormal results were found in 29.3% of patients on pure tone audiometry and 26.2% on caloric testing. These results suggest that both examinations were useful and should be performed in pediatric patients.
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  • A Study on Recurrence of Middle Ear Cholesteatoma after a Canal Wall Down Tympanoplasty with Soft-wall Reconstruction
    Yasuhiro Tanaka, Tsuyoshi Yoshimura, Ayako Masuda, Hisashi Kessoku, Sa ...
    2014 Volume 107 Issue 2 Pages 103-110
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.103
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    We performed revision tympanoplasty on 10 patients with recurrent cholesteatoma in the past two years between May 2011 and April 2013. Four of 10 patients with recurrent cholesteatoma were operated on using a canal wall down tympanoplasty with soft-wall reconstruction as the initial surgery. We report herein on two representative cases of recurrent cholesteatoma in whom a canal wall down tympanoplasty with soft-wall reconstruction was initially performed. In the first case, an 11-year-old female child had repeated mucopurulent otorrhea from her left ear one year after the second planned staged tympanoplasty. The canal wall down tympanoplasty with soft-wall reconstruction was performed as second surgery. Otoscopic finding revealed recurrent cholesteatoma from the attic to a part of the mastoid cavity, protruding through the scutum and posterior wall defect. CT of the temporal bone showed soft tissue from the attic to the mastoid cavity with a bone defect of scutum and posterior canal wall. We diagnosed recurrent cholesteatoma after the canal wall down tympanoplasty with soft-wall reconstruction, and performed revision surgery. In the second case, a 10-year-old male child was suffering from purulent otorrhea from his right ear approximately one year after a canal wall down tympanoplasty with soft-wall reconstruction. Otoscopic finding revealed recurrent cholesteatoma that had eroded the scutum to invade the attic. The bone defect extended from the attic to more than half of the posterior canal wall. CT showed soft tissue from the attic to the mastoid cavity with a balloon-like retraction of the posterior canal wall. Finally we performed revision surgery for a recurrent cholesteatoma which had occurred after soft-wall reconstruction of the posterior canal wall. We consider that the soft-wall reconstruction for the purpose of simplifying the surgical procedure should be avoided. We had better preserve the posterior canal wall as much as possible when operating on children. Furthermore, when operating on children the long-term prognoses must always be considered.
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  • A Case of Solitary Fibrous Tumor in the Nasal Cavity Resected via Endoscopic Surgery
    Kayoko Hattori, Takeshi Morita, Nobuya Fujiki, Kosaku Yamada, Takatosh ...
    2014 Volume 107 Issue 2 Pages 111-115
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.111
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    The solitary fibrous tumor (SFT) is a rare neoplastic entity which typically originates from the pleura and other serosal tissues, and infrequently arises in the head and neck region. A 26-year-old female, who complained of nasal obstruction, was referred to us for a tumor in the left nasal cavity. A contrast-enhanced computed tomography scan showed a heterogeneously enhanced mass. The pathological findings of this hemorrhagic tumor on the first biopsy were compatible with a nasal polyp; however, the specimen on re-biopsy revealed a spindle cell neoplasm which was immunohistologically positive for CD34 and bcl-2, leading to the diagnosis of SFT. The tumor was endoscopically resected, the pathologic finding of which was identical to the preoperative diagnosis. The patient showed no evidence of recurrence four years after the operation. Immunohistological staining is essential for the diagnosis of SFT, as HE staining alone is insufficient to differentiate it from other tumors.
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  • A Case of Intraorbital Abscess in the Upper-lateral Part of the Orbit Following Acute Sinusitis
    Hiroshi Hyakusoku, Yasuhiro Arai, Tatsu Kuwahara, Kae Sawakuma, Daisuk ...
    2014 Volume 107 Issue 2 Pages 117-120
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.117
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    Orbital infection mainly develops as a complication of sinusitis, and often disturbs the functions of the eye by raising orbital pressure due to abscess formation. We herein report on a case of an intraorbital abscess in the upper-lateral part of the orbit following acute sinusitis. At presentation, the sinusitis itself had already been improved and the abscess did not have contact with frontal or the ethmoid sinuses. A quick and correct diagnosis of sinusitis followed by orbital infection is essential. An urgent surgical drainage along with an adequate use of antibiotics is required to preserve the eyesight.
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  • A Case of Rapid Growing Frontal Sinus Cysts after Endoscopic Sinus Surgery for Eosinophilic Chronic Sinusitis
    Hiroyuki Harada, Shogo Shinohara, Yuji Kanazawa, Keizo Fujiwara, Masah ...
    2014 Volume 107 Issue 2 Pages 121-126
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.121
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    Postoperative sinus cysts are known to be slow growing and it normally takes 15 to 25 years for them to become symptomatic. We report herein on an extraordinary case with frontal sinus cysts developing and ballooning intracranially 1 year after endoscopic sinus surgery. A 26-year-old male underwent bilateral endoscopic sinus surgery under the diagnosis of eosinophilic chronic sinusitis. The postoperative follow up CT in 5 months revealed recurrent polyps in the nasal cavity and thickened mucosa in every sinus, as a nature of eosinophilic chronic sinusitis. One year postoperatively, CT and MRI imaging showed that large bilateral frontal sinus cysts had eroded the posterior wall of the frontal sinuses, widely extended into the anterior cranial fossa and compressed the left frontal lobe. Interestingly, the patient did not complain of any symptoms, central nervous system deficits, headaches or head heaviness though the cysts developed in the rather short period of seven months. In order to widely open the cysts and to observe the condition of the frontal sinus, we employed a modified Lothrop procedure with small extranasal control holes. The content of the cysts was a serous and clear effusion and differed from the known content of postoperative cysts which is ordinary a dark color mucous with high viscosity. The patient has not demonstrated any relapse of his frontal sinus cysts for 1 year and 8 months after the surgery. Our case is an extremely rare condition of frontal sinus cysts because of the speed of their development, the extraordinary contents of the cysts and the lack of symptoms. To the best of our knowledge, and despite an extensive search, no other such a case has ever been reported in the literature. The mechanisms of the development of these cysts are unknown but supposed to be partially due to the cause of the sinusitis itself, eosinophil infiltration.
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  • The Use of the Electrotome and Operating Microscope in Tonsillectomy
    Ray Motohashi, Kiyoaki Tsukahara, Kazuhiro Nakamura, Minoru Endo, Hiro ...
    2014 Volume 107 Issue 2 Pages 127-131
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.127
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    Tonsillectomy is a basic surgical procedure commonly carried out at many institutions. The most conventional procedure includes the palatine arch incision, the tonsillar capsule separation and tonsil removal using a snare. However, different institutions adopt various refinements in the procedure. Also, with advances in medical instruments, electrosurgical devices and other types of hot-knife are now used in addition to cold-knives such as scalpels and other knives used for incision. Under the current situation, instruction to residents is sometimes hampered due to the narrowness of the surgical view because it is not easy for residents and consultants to share the same view. It is also difficult for the consultant to check the residents’ work in detail. As refinements adopted at our institution, we use a hot-knife to suppress hemorrhage and an Angle Wider to ensure an adequate view and to protect the corners of the mouth. We also use an operating microscope so that the consultant and resident may have the same surgical view for easy and accurate instruction. In the present study, we compared the cold-knife and hot-knife procedures in tonsillectomies conducted by residents in their first year of training in our department. The refinement of the procedure adopted by our institution allowed easy instruction, decreased operation time, suppressed hemorrhage and reduced hospitalization days.
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  • A Case of Hypoglossal Schwannoma in the Submandibular Space
    Takafumi Nagatomo, Keiichi Ichimura
    2014 Volume 107 Issue 2 Pages 133-139
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.133
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    Hypoglossal schwannomas are extremely rare tumors especially in the submandibular space. They are sometimes difficult to diagnose as schwannomas before surgery. A 42-year-old male presented with a painless submandibular swelling. After various examinations, we diagnosed the swelling as a pleomorphic adenoma originating in the submandibular gland. Surgical excision was planned. During the operation, the tumor was proved to be of hypoglossal nerve origin. We performed subcapsular tumor resection with mild postoperative nerve paralysis. The patient was observed for 6 months. Hypoglossal dysfunction gradually improved. Schwannoma is a rare tumor but should be considered as one of the conditions in differential diagnosis of any masses located in the submandibular space.
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  • A Case of Descending Necrotizing Mediastinitis Treated with Continuous Saline Irrigation with a Pleated Drain
    Hitoshi Shono, Takahiro Azuma, Kazunori Sekine, Koji Abe, Koichi Tamur ...
    2014 Volume 107 Issue 2 Pages 141-145
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.141
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    Descending necrotizing mediastinitis (DNM) requires an early and aggressive surgical approach. We report herein on a case of DNM in which continuous saline irrigation with a pleated drain was found to be useful. A 71-year-old man presented with a sore throat and a peritonsillar abscess, CT imaging showed that an abscess with gas had spread widely over the mediastinum. The pus culture showed Streptococcus milleri group, and anaerobic bacteria were not identified in this case, The CT imaging findings on the other hand revealed suspected anaerobic infection and so the conditions in this case had caused serious mixed infection. We performed aggressive therapies such as cervicomediastinal and transthoracic drainage combined with broad-spectrum antimicrobial therapy, but the abscess was not cleared. We therefore added transcervical continuous saline irrigation with a pleated drain. The patient responded well to this treatment and was discharged on the 62nd postoperative day. We found that continuous saline irrigation with a pleated drain was useful in this case.
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  • A Suspected Case of Lemierre’s Syndrome with Neck Abscess
    Ippei Kishimoto, Masahiro Kikuchi, Shogo Shinohara, Keizo Fujiwara, Yu ...
    2014 Volume 107 Issue 2 Pages 147-152
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.147
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    We report a suspected case of Lemierre’s syndrome with a neck abscess. A 27-year-old man without any significant past medical history visited our hospital with a complaint of right neck pain which had lasted for three days. His tonsils were mildly infected and the uvula was shifted a bit toward the left side. He complained about severe pain in his right neck, which is not usually seen in cases of tonsillitis or peritonsillitis. He was treated with intravenous antibiotics for four days, however, his symptoms did not improve, and contrast-enhanced CT and MRI were performed. These images revealed the existence of a right parapharyngeal abscess and fresh thrombus in the right internal jugular vein extending into the lateral sinus. These findings suggested Lemierre’s syndrome, but there was no abnormality on chest CT. Therefore, he was diagnosed as being suspected as having Lemierre’s syndrome. After intraoral incisional drainage of the parapharyngeal abscess, his symptoms disappeared rapidly. Bacterial culture of the pus in the abscess showed growth of Fusobacterium necrophorum. Anticoagulant therapy with heparin and warfarin was also started and continued after discharge. On the 43rd day from onset of symptoms, remarkable reduction of thrombus was observed on the follow-up MRI. In this case, enhanced MRI was more useful than enhanced CT for detecting the presence of thrombus and confirming the extension of the thrombus. In examining patients with a peritonsillar abscess and severe neck pain, it is important to take Lemierre’s syndrome into consideration because the disease may sometimes be life threatening if overlooked.
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Original articles
  • Clinical Usefulness of Nerve Integrity Monitoring (NIM) for the Removal of Upper Neck Neurinomas
    Yuh Baba, Takanori Nishiyama, Keisuke Yoshihama
    2014 Volume 107 Issue 2 Pages 153-158
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.153
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    Findings of previous studies have shown that the identification of the responsible nerve when removing a parapharyngeal space neurinoma and the preservation of nerve functions are difficult. These processes are however crucial for both surgeons and patients during parapharyngeal space neurinoma surgery.
    The Nerve Integrity Monitoring System (NIM-Response® 3.0-, Medtronic, USA) has been recognized as a useful tool for surgery of parotid and thyroid glands, and for detecting and preserving the facial nerve and recurrent laryngeal nerve or superior laryngeal nerve.
    In the present study, we used the NIM system in the treatment of 3 cases of parapharyngeal space neurinomas. Two vagal neurinomas were successfully removed and the vagal nerve function was preserved by an intracapsular resection of the neurinoma using the NIM system, and one sympathetic neurinoma was resected for the contamination of the nerve in the tumor: the sympathetic nerve was repaired with a greater auricular neuronal graft. The NIM system showed good results in identifying the responsible nerve and assisting with preserving the functions of both the responsible and surrounding nerves in these 3 parapharyngeal space neurinoma surgeries.
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Original articles
  • The Difference between the Analgesic and Antipyretic Effects of Lornoxicam
    Nobusuke Hohchi, Shoji Ikezaki, Kei Imazato, Toshiaki Sanka, Asuka Yam ...
    2014 Volume 107 Issue 2 Pages 159-163
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.159
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    Lornoxicam is a non-selective cyclooxygenase inhibitor that exhibits strong analgesic and anti-inflammatory effects but a weak antipyretic effect in rat models. We studied the analgesic and antipyretic effects of lornoxicam on postoperative pain and fever.
    Forty-three patients who underwent surgery under general anesthesia in our department between August 2011 and September 2012 were enrolled in the study, comprising 27 males and 16 females ranging in age from 15 to 74 years with an average age of 44.8 years. The operative procedures were endoscopic sinus surgery in 32 patients, tonsillectomy in 10 patients and an adenotomy in one patient. The patients were administered of lornoxicam 8 mg when they felt postsurgical pain. The pain intensity was evaluated with the Wong-Baker FACES Pain Rating Scale (0=no pain, 5=most intense). The pain intensity and body temperature were checked immediately before and 1 h after medication. Body temperature was also checked before surgery.
    Lornoxicam was administered once in 43 patients, twice in 24 patients, and three times in 15 patients (82 times overall). The pain intensity was significantly reduced after administration (2.6→1.0 overall, P<0.001). Body temperature before medication was significantly higher than that before surgery (36.5°C vs. 36.9°C overall, P<0.001), but did not differ from that after medication (36.9°C vs. 36.8°C overall, P=0.584). The results were the same when the first, second and third administrations were analyzed separately. These results indicate that lornoxicam inhibits pain without affecting body temperature. We conclude that lornoxicam is an ideal analgesic that does not prevent pyrexia, one of the early signs of infections and postoperative complications.
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Technical notes
Medical essays
  • Reactions after Menière’s Report in the 19th Century
    —Part 7. Historical Reviews for the Pathogeneses of Menière’s Disease. Part Two (end)—
    Toshitaka Iinuma
    2014 Volume 107 Issue 2 Pages 167-170
    Published: 2014
    Released on J-STAGE: February 01, 2014
    DOIhttps://doi.org/10.5631/jibirin.107.167
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    The theories concerning the pathogeneses of Menière’s disease are reviewed, continuing from Part one. From the six groups of theories, the first three are introduced in Part one. Introduced in part two are: 4. Origins from appendages of the labyrinth; 5. Origins from the cranial nerves and/or brain; 6. Others such as hysteria, epilepsy and temperament.
    Gruber (1895) suggested that Menière’s disease originated from the disturbance of endolymph or of its secretion. Gradenigo (1893) introduced the mechanism of recurrent attacks by means of a gradual increase of ampullar stimulation by lesions in the mucosa of the middle ear. Among the countless theories, these two are worthy of serious consideration.
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