The human amniotic membrane (HAM) is a tissue of fetal origin and consists of a single epithelial layer, a thick basement membrane and an avascular mesenchyme. Due to their characteristics of being nonantigenic, adhering well to wounds, promoting epithelization and decreasing infection, HAMs have been widely used clinically for membranous allografts such as in the ophthalmologic and dermatologic fields. In surgery of the ear, HAMs were first used in radical mastoidectomies as a lining for the mastoid cavity. The hyperdry HAM, newly dried AM processed using far-infrared rays and microwaves, and then sterilized with gamma-ray irradiation, is a safe and easy-to-use biological material for a variety of clinical applications. This study investigates the usefulness of hyperdry HAM as a substitute for temporal fascia in otology.
In this study, we report on a patient who had superior canal dehiscence and was treated by resurfacing the defect via the transmastoid approach. An 80-year-old male patient had the chief complaint of vertigo when he touched his left porus acusticus externus. As leftward nystagmus was induced by change in middle ear pressure and the existence of superior canal dehiscence was confirmed with computed tomographic scans (CT) of the temporal bones, we suspected an idiopathic labyrinthine fistula similar to the superior canal dehiscence syndrome (SCDS). At first, he was treated with medication, but as his vertigo was getting worse, he underwent surgery. A wide mastoidectomy was performed identifying the middle fossa dura. The superior semicircular canal was exposed together with the angle between the superior semicircular canal and the middle fossa bone. A bone pate was insinuated down the dehiscent canal. After the operation, no nystagmus was induced by change in the middle ear pressure and the patient did not feel any vertigo. When we anticipate the possibility of a transmastoid approach to a defect of superior canal based on preoperative CT findings, we should select this approach because the approach can avoid the more invasive middle fossa craniotomy.
There have been recent reports that autoimmune inner ear disease (AIED) has been found in some cases of refractory hearing loss such as idiopathic bilateral sensorineural hearing loss. McCabe first reported that patients with AIED responded to immunosuppressive therapy. Corticosteroid therapy alone is effective in the early phase of AIED, but becomes ineffective in a repeated series and immunosuppressive therapy is recommended in such cases. We experienced a case of idiopathic bilateral sensorineural hearing loss in which corticosteroid therapy was not effective after the recurrence and immunosuppressive therapy was applied, although the presence of the inner ear autoantibodies was not tested. In this case, the immunosuppressive therapy seemed effective for preventing the progression of the hearing loss and for improving the speech discrimination scores. This therapeutic strategy may be indicated in some cases of idiopathic bilateral sensorineural hearing loss which have proved refractory to corticosteroid therapy.
We evaluated whether an outcome could be predicted using a scoring system 3 days after initiating drug administration in the treatment of acute otitis media (AOM). On the post-marketing clinical research of tebipenem pivoxil, we evaluated the associations among the scores at the initiation of drug administration, the variation of the scores from the baseline to 2-4 days afterward, and the judgment of the attending physician (cure/failure) within 3 days after completion or cancellation of the dosage. Compared to patients in whom simple AOM was cured (cure group), the redness scores of the eardrum were significantly higher (P=0.003) at the first visit, a smaller change of the severity scores (P=0.049) and a larger increase of the otorrhea scores were noted (P=0.049) in patients in whom simple AOM was not cured (failure group). In patients with recurrent/persistent otitis media, a tendency similar to that found in simple AOM was observed. According to the variations of the scores for severity or for the tympanic membrane, the patients were classified as having Effectiveness Index (EI) A (decrease of scores >50%) and EI-B (decrease of scores <50%); thus, all patients in the failure group were classified as EI-B. These results suggest that the clinical response to antibiotic therapy for AOM can be predicted to some extent based on whether the patient is EI-A or EI-B at 2-4 days after initiating drug administration. Specifically, the results allowed a change in the treatment method: after measuring the score at 2-4 days after initiating drug administration, patients classified as EI-A would continue to receive the same treatment, whereas in those classified as EI-B a change in the antimicrobial agent should be considered. In other words, the decision of effectiveness based on the variations of the scores was useful to determine the treatment strategy for patients with AOM.
When the ear canal often gets exposed to cold water, it leads to the formation of a state called external auditory canal exostoses. This condition is known as surfer’s ear because it is commonly seen among surfers. We experienced seven cases of surfer’s ear from March 2008 to October 2012. All these patients were males with more than 15 years’ experience of surfing. These patients consistently complained of having ear-fullness and hearing loss. In all of these cases, a surgical approach was adopted and performed. The posterior ear incision with a trans-canal approach was chosen for all the cases.It might appear to be difficult to approach an anterior elevated exostoses in the wall of the external auditory canal via this approach, but drilling the external auditory canal in a conical shape from the posterior wall could enlarge the access very appropriately. The method provides a wide field of view and enough space for surgical techniques; therefore it could decrease the risk of sensory hearing loss due to surgical damage.
The post surgical results of the canal formation demonstrated successful enlargement with a good shape in all the cases we have experienced.
We investigated the test results from 73 patients who were diagnosed based on the Japanese revised criteria for the diagnosis of Sjögren’s syndrome (SjS). When a patient showed 2 positive results, he was diagnosed as having SjS. Twenty-six of 73 patients were definitively diagnosed as having SjS. Eleven patients had one positive test result only. Thirty-six had three negative results. The histopathologic test was performed on 11 patients, and all 11 had positive results. The oral test was performed on 23 patients, and positive results were obtained for 18. The ocular test was performed on 15 patients, and positive results were detected in 9. The serologic test was performed on 26 patients, and 14 patients showed positive results. In the combinations of the serologic test and the oral test, 9 patients were diagnosed as having SjS. In the combinations of the oral test and the histopathologic test, 7 patients were positively diagnosed. In the serologic test and the ocular test, 4 were positively diagnosed. In the ocular test and the histopathologic test, 3 were positively diagnosed. In the oral test and the ocular test, 2 were positively diagnosed. In the serologic test and the histopathologic test, 1 patient was positively diagnosed. When the patient showed a positive result on the first serologic test, one of the residual tests certainly showed a positive result. This study suggested a patient was definitively diagnosed as having SjS when the first serologic test showed a positive result. The predictive value positive (PVP) of the serologic test and the histopathologic test were both 100%. The PVP of the ocular test was 81.8% and that of the oral test was 66.7%. The PVP of the oral test was statistically different from that of the serologic and histopathologic tests. Our results strongly suggest that the diagnostic capability using the serologic test and the histopathologic test were superior to the oral test.
We report herein on a case of hemangioma of the hypopharynx. A 72-year-old male was referred to our department with a tumor of the hypopharynx, discovered on gastrofiberoscopy. We diagnosed this tumor as a hemangioma. Excising hemangiomas carries the risk of severe bleeding, so photocoagulation with a KTP laser was performed for this patient. The tumor disappeared following photocoagulation with the KTP laser, and our results suggested that the KTP laser could be effective for the treatment of hemangiomas in the hypopharynx. Manufacture of this laser was however stopped in Japan in 2008, therefore some consideration is required to find an alternative system to the KTP laser.
IgG4-related inflammatory diseases, including autoimmune pancreatitis and Mikulicz syndrome, have become known to physicians as new clinical entities, especially over the past few years. We would like to present a case of IgG4-related oropharyngolaryngitis. We encountered a case with a severe and intractable inflammation distributed exclusively in the hypopharynx and laryngeal surface of the epiglottis. The patient did not spontaneously recover and the disease was resistant to antibiotics and NSAIDs that were administered for 4 weeks. Frequent fiberscope inspections and punch biopsies failed to provide a diagnosis, and were followed by a detailed examination under laryngomicrosurgery, with multiple tissue samplings under general anesthesia. The samples revealed proliferative, non-malignant inflammatory lesions and the pathology showed IgG4-related symptoms; indicated by all of the criteria including blood and local IgG4 elevation being met.Symptoms were quickly suppressed by a week of steroid infusion drips, followed by a gradual tapering of oral steroids in accordance with a regimen for autoimmune pancreatitis. For many years, ENT physicians have often used corticosteroids empirically for atypical pharyngitis, but usage of steroids on conditions with uncertain criteria has always been criticized.This is, as far as we know, the first report of oropharyngolaryngitis to be associated with IgG4-related symptoms. The case is thought-provoking in that some of those recurrent atypical oropharyngolaryngitis cases might be explained in accordance with this information. Moreover, the results suggest that the serum IgG4 level might be a predictive marker for the requirement of corticosteroids administration.
Actinomycosis is an inflammatory disease by the Actinomyces Sp. which is an anaerobic bacterium with a Gram-positive bacillus. The Actinomyces is an intraoral indigenous bacterium, and it is has been reported that actinomycosis often develops within the head and neck region, but reports on epiglottal actinomycosis are rare. We therefore report herein on one case of epiglottis actinomycosis which we experienced. A 49-year-old man was suffering from pharyngalgia. The patient apparently consulted a nearby otorhinolaryngologist for a diagnosis regarding the symptoms of a common cold. He was referred to our hospital, where on arrival he was found to have hoarseness, but without dyspnea. Laryngoscopy revealed significant swelling of the epiglottis and we judged that immediate hospitalization was necessary. After hospitalization, no change was seen in either the epiglottal swelling or the inflammatory reaction, and we first considered that a neoplastic change had occurred in the epiglottis following hospitalization. Having failed to reach a diagnosis following CT, MRI and PET/CT imaging, we performed a biopsy of the epiglottis under the general anesthesia. The result of the pathological examination revealed granulation tissue of the epiglottis caused by actinomycosis. We started oral treatment with AMPC(1500mg/day). The patient recovered on the 140th day after starting treatment. In the examination of any epiglottal tumor actinomycosis should be considered in the differential diagnosis.
The thyroid gland is usually located in the anterior neck region between the second and fourth tracheal cartilages. An ectopic thyroid refers to the presence of thyroid tissue in other locations. Its reported prevalence is 1 per 100,000–300,000people and 1 per 4,000–8,000 patients with thyroid diseases.
This report describes the case of a 51-year-old woman with an ectopic thyroid in the form of a large mass on the base of the tongue with repeated hematemesis. To reduce the bleeding, embolization of the main feeding artery was performed before surgical intervention. As a result, the surgery was successfully performed via the intraoral approach without much bleeding. Thus, embolization before surgical treatment for an ectopic thyroid on the base of the tongue was demonstrated to be an effective therapeutic strategy.
The basaloid cell carcinoma is a rare variant of squamous cell carcinoma, that was recognized by the World Health Organization (WHO) in 1991. The prognosis is remarkably poor because of distant metastasis, but an effective therapy has not yet been established. Basaloid cell carcinoma of the hypopharynx is uncommon and only limited studies have been reported in the literature. We present herein on a case of basaloid cell carcinoma which occurred in the hypopharynx.
Menière showed much interest in the relationship between vertigo and migraine in his Translator’s additions in Kramer’s textbook of otology (1848). In Menière’s report of 1861, he declared that migraines originated from lesions of the semicircular canals. Based upon the four bibliographies comprising theses by Voury (1874), Morisset (1878), Bertrand (1874) and Woakes’s paper (1878), a total of 67 cases of Menière’s disease was collected. Among these 67cases, 13 cases including headache and heavy sensation of the head were noted amounting to 19% of all. Another 9eminent textbooks of otology such as Tröltsch (1868), Gellé (1885), Politzer (1893), Ménière (1895, son of Menière) and others referred neither to migraine nor headache. It seems, at least in the 19th century, the connection of migraine in Menière’s disease was not clearly comprehended. The major monographs on migraine were reviewed as to migraines related to vertigo. Vertigo played a minor role as an occasional prodromal sign. Mène’s textbook on otology (1860) was introduced since Menière gave priority to Mène as having noted coexistence of vertigo with migraine.