Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 108, Issue 10
Displaying 1-13 of 13 articles from this issue
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Editorial
  • Eosinophilic Otitis Media: Basic Research and Clinical Manifestations
    Atsushi Matsubara
    2015 Volume 108 Issue 10 Pages 737-744
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.737
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    Intractable otitis media associated with bronchial asthma was first reported at the annual meeting of the Japan Otological Society held in 1992, and was named eosinophilic otitis media (EOM) by Dr. S. Matsutani in 1995. The most common characteristics of this disease is the presence of eosinophil-dominant highly viscous middle ear effusion. EOM is well-known to be associated with a high risk of hearing loss, and some cases have even been reported to develop deafness. Therefore, it is important to diagnose EOM early and provide appropriate treatment to ensure preserved hearing.
    The pathological characteristics of EOM have been gradually revealed by both clinical research and basic research over the last two decades. Here, we report the clinical manifestations of EOM, and the data of basic research in the middle ear of human subjects and in inner ear specimens of an animal model constructed by us recently.
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Original articles
  • A Study on 102 Inpatients with Idiopathic Sudden Sensorineural Hearing Loss
    Masashi Osano, Yukihiro Hiraga
    2015 Volume 108 Issue 10 Pages 749-753
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.749
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    One hundred two inpatients with idiopathic sudden sensorineural hearing loss (ISSHL) treated primarily in our hospital between January 2008 and March 2014 were studied clinico-statistically. Our principal therapy adopted for ISSHL included a series of glucocorticoids, methylprednisolone sodium succinate, or prednisolone sodium succinate.
    The treatment results were as follows; the cure, improvement, and effective ratios were 32.4%, 54.9%, and 76.5%, respectively. According to the grades for initial hearing levels, the cure ratios were not statistically different. The ratios differed based on the types of audiogram, especially for the deaf or completely deaf types; however, no cured cases were identified. Patients >64 years of age at the first presentation had significantly lower ratios than patients <64 years of age. In addition, patients complaining of vertigo had significantly lower ratios than those without vertigo. Amongst the patients with diabetes mellitus (DM), the cure ratio was not significantly different from patients without DM because insulin was administered immediately after admission. There were no significant differences in the efficacies of the different types of glucocorticoids in the treatment of ISSHL, thus we decided to administer prednisolone sodium succinate because of the lower cost, as analyzed with a clinical pathway. Stellate ganglion block (SGB) therapy did not contribute to the therapy for ISSHL, but in patients with less than grade 3 ISSHL, the, effectiveness was significant.
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  • Blind Sac Closure of the External Ear Canal in Cochlear Implant Surgery
    Hideaki Kato, Miyako Hatano, Hisashi Sugimoto, Kenichi Nakamura, Mari ...
    2015 Volume 108 Issue 10 Pages 755-761
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.755
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    Care must be taken to identify cochleovestibular malformations and facial nerve anomalies in the patients undergoing cochlear implantation (CI). Canal wall down mastoidectomy gives excellent visibility and access during surgery in difficult temporal bone anatomy. We present herein on a case of CI surgery where cochleovestibular malformations existed, and adequate surgical access for implantation was obtained using canal wall down mastoidectomy with blind sac closure of the external ear canal. Indications for performing canal wall down mastoidectomy+CI surgery are as follows: chronic otitis media with persistent otorrhea, presence of a radical cavity/canal wall down open mastoid technique, cochlear ossification/obliteration, inner ear malformations and/or facial nerve anomaly, fracture of temporal bone with inner ear involvement and unfavorable anatomic conditions for posterior tympanotomy. In cases with chronic otitis media and persistent inflammation, canal wall down and complete mastoidectomy are mandatory to eradicate infected middle ear mucosa. Contraindications are as follows: Only one absolute contraindication is when electroacoustic stimulation with EAS-CI system is to be used. A relative contraindication is cases with active infection of the middle ear or cavity. The procedure can be staged. At the first stage, complete mastoidectomy with total eradication of the infection has to be performed. Canal wall down mastoidectomy with blind sac closure of the external ear canal combined with CI is a good procedure required in specific situations as mentioned above.
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  • A Case of Superficial Siderosis of the Central Nervous System Treated Successfully with Cochlear Implantation
    Yurika Kawaguchi, Mitsuhiro Aoki, Shigeaki Tanahashi, Bunya Kuze, Keis ...
    2015 Volume 108 Issue 10 Pages 763-766
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.763
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    Superficial siderosis of the central nervous system (CNS) is a progressive disease of the CNS associated with persistent or chronic subarachnoid hemorrhage. The classic symptoms are bilateral sensorineural hearing loss, cerebellar ataxia and myelopathy. Sensorineural hearing loss is a particularly important symptom which occurs early in the disease and ultimately affects 95% of cases. The failure site associated with hearing loss due to the disease is retrocochlear, and peripheral or both of them coexist. However, the detailed mechanism is not known. We describe herein a 57-year-old woman with superficial siderosis who underwent cochlear implantation for bilateral profound hearing loss. The performance score on the word recognition test was 72%. However, the speech perception started to worsen at 18 months after the operation. Prolonged follow-up may be therefore required to evaluate the benefit of cochlear implantation for profound hearing loss associated with superficial siderosis.
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  • Effect of Glutamine Supplementation on Chemoradiotherapy-induced Mucositis in Patients with Head and Neck Cancer
    Tatsuya Fujii, Kazunori Matsuda, Katsushi Miyazaki, Noriaki Takeda
    2015 Volume 108 Issue 10 Pages 767-773
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.767
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    In head and neck cancer, almost all patients treated with chemoradiotherapy suffer from oral mucositis. But, a standard treatment for chemoradiotherapy-induced oral mucositis has not been established. It is considered that the creation of reactive oxygen species (ROS) caused by radiation and anticancer drugs is related to the mechanism that causes oral mucositis. Recently, it was reported that glutamine, an antioxidant, can reduce oral mucositis induced by chemoradiotherapy. Therefore, in the present study we examined the effects of glutamine supplementation on oral mucositis in head and neck cancer patients receiving chemoradiotherapy. Of the patients with head and neck cancer who received chemoradiotherapy or radiotherapy, we compared 6 patients receiving glutamine supplementation and 7 patients not receiving it. The patients receiving glutamine supplementation showed a reduction in the grade of oral mucositis with grade 4 never being reached, and both intake and the type of food were maintained. There was a significant elevation of the C-reactive protein (CRP) score in patients not receiving glutamine supplementation compared with those who received it (2.43 vs. 0.77, P<0.05). This result suggested that glutamine supplementation had therapeutic effects on oral mucositis induced by chemoradiotherapy.
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  • A Case of Adult T-cell Leukemia-lymphoma (Acute Type) Occurring from the Pterygopalatine Fossa to the Sphenoid Sinus
    Hiromi Nagano, Yumi Miyamoto, Tomohiro Jimura, Hiroyuki Iuchi, Yuichi ...
    2015 Volume 108 Issue 10 Pages 775-781
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.775
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    Adult T-cell leukemia (ATL) is leukemia whose symptoms are shown owing to an adult-T-cell-leukemia virus (human T-cell leukemia virus type I: HTLV-1).
    A 74-year-old woman presented to the ENT service with a two-month history of a starange feeling in her face. On endoscopic examination, a tumorous lesion was observed in the nasopharynx. CT and MRI showed the inversional region in the pterygopalatine fossa to the sphenoid sinus. A positron emission tomography/computed tomography (PET/CT) scan showed accumulation in the same area with a 10.8 standardized uptake value (SUV). Histological analysis showed variant cell, which stained positivity for CD3, CD4, and CD25, and negatively CD8, CD20 and CD79a.
    Taking those findings together, we diagnosed the patient as having the acute type of ATL.
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  • Two Cases of Acute Thyroid Swelling After Fine-needle Aspiration Biopsy
    Satoshi Chikano, Masashi Kurokawa, Seijirou Yamada, Hiroshi Kajikawa, ...
    2015 Volume 108 Issue 10 Pages 783-790
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.783
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    Thyroid fine-needle aspiration biopsy (FNAB) is a simple, cost-effective and minimally traumatic technique for the diagnosis of thyroid nodules. We report on two cases of acute thyroid swelling after FNAB. In both cases, within two hours after completion of the procedure, the entire thyroid gland enlarged rapidly. Ultrasound showed diffuse swelling of the entire thyroid gland with a heterogeneous appearance. There were no signs of bleeding or airway obstruction. The next morning a repeat US showed that the thyroid had returned to its normal size.
    It has been demonstrated that nerve fibers storing neuropeptides such as vasoactive intestinal peptide, substance P, cholecystokinin, neuropeptide Y, peptide histidine isoleucine, galanin, and calcitonin gene-­related peptide (CGRP) exist in the thyroid.
    The clinical and ultrasound data support the hypothesis of capillary leakage as the underlying mechanism, possibly evoked by neuropeptide release.
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  • A Study on 35 Patients with Mediastinal Goiter
    Ryohei Fujiwara, Shinya Uchino, Shiro Noguchi, Kosuke Hayamizu, Mutsuk ...
    2015 Volume 108 Issue 10 Pages 791-799
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.791
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    Mediastinal goiter means the presence of a goiter within the mediastinum or the thoracic cavity and is also called intrathoracic or substernal goiter. However, its terminology and definition have not been standardized. Katlic et al. defined mediastinal goiter as a thyroid tumor existing continuously or discontinuously in the mediastinum, with not less than 50% of the tumor always being within the mediastinum. This condition is treated with surgery. The tumor can often be removed when it is approached via a collar incision in the cervical region, but sternotomy is sometimes needed. The present study investigated patients who underwent thyroid surgery during the recent 10-year period, and those who were treated surgically after being diagnosed as having mediastinal goiter based on the above definition were reviewed.
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  • Efficacy of Concurrent Chemoradiotherapy on N1 Neck Nodal Disease Defined Using PET-CT
    —Is Neck Dissection Warranted?—
    Yukihiro Hiraga, Masashi Osano
    2015 Volume 108 Issue 10 Pages 801-805
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.801
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    In the present study, we analyzed the impact of concurrent chemoradiotherapy (CCRT) statistically and reappraised the necessity of neck dissection (ND) in 32 cases of head and neck squamous cell carcinoma with N1 nodal disease.
    At our hospital, between 1989 and 2005, we encountered 21 cases of N1 nodal disease in which the N-stage was not defined using PET-CT; the 3-year neck control ratio in these patients who were primarily treated by induction chemotherapy (ICT) followed by irradiation with ND or definitive irradiation alone, was 71%. On the other hand, between 2006 and 2014, we encountered 11 cases of N1 disease in which the N-stage was strictly defined using PET-CT; the 3-year neck control ratio in these patients treated by pre-operative CCRT followed by ND or definitive CCRT, was 100%. The difference between the two groups was statistically significant.
    Furthermore, histopathological examination of the dissected lymph nodes from the patients treated by pre-operative CCRT revealed no evidence of residual disease.
    Consequently, definitive CCRT without ND, if feasible, is a promising therapeutic strategy for N1 neck nodal disease, and although close follow-up with a “watch-and-see policy” and frequent examinations by FDG-PET are necessary.
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  • A Case of Tracheal Diverticulum Suspected to be a Mediastinal Abscess
    Hirohito Satoh, Takashi Matsuzuka, Makoto Kano, Koichi Omori
    2015 Volume 108 Issue 10 Pages 807-812
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.807
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    Tracheal diverticula are relatively rare among tracheobronchial anomalies and are categorized pathologically as congenital or acquired. The majority of tracheal diverticula are asymptomatic. They are usually discovered incidentally. In cases of symptomatic tracheal diverticula, the symptoms are usually pain and blood-stained sputum caused by infection, dysphagia and so on. Conservative treatments such as antibiotics, mucolytic agents and physiotherapy are usually chosen. Surgery is indicated in patients in whom conservative treatment has been unsuccessful.
    A patient in our hospital had a cervical tracheal diverticulum suspected of being a mediastinal abscess. After the infection was conservatively treated with antibiotics, surgery was performed. The patient was a 54 year-old woman who complained of anterior chest pain for two days. She had similar pain for five years each time she had a cold. A CT scan revealed a right posterior paratracheal region of low density with a high density area. The lesion was suspected to be a mediastinal abscess. The patient was referred to our hospital. Four years previously at our hospital, a CT scan had demonstrated an air-filled lesion in the same region. It was thought that the tracheal diverticulum had become infected and an abscess had formed. The infection was cured conservatively with antibiotics. However, because the diverticulum had acquired an infection a number of times through the years, the probability that it might become infected again was very high. Surgical removal of the diverticulum was therefore decided on. Pathologically, the specimen was lined with simple ciliated epithelium, and had no cartilage. It was regarded as an acquired diverticulum.
    The surgical approach to diverticula varies according to the location. Because our case was an extrathoracic diverticulum, we chose a cervical incision and were able to resect it. A CT scan after surgery revealed no abnormal lesion, and anterior chest pain has been non-recurrent. It was thought that the surgery was effective.
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  • Two Cases of Tetanus without Visible Injury
    Toru Ishikawa, Mizuno Sakai, Masatsugu Tashiro, Satoshi Takei, Takekat ...
    2015 Volume 108 Issue 10 Pages 813-816
    Published: 2015
    Released on J-STAGE: October 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.813
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    Tetanus is a serious infection caused by the neurotoxin which is produced by Clostridium tetani. Its symptoms may progress rapidly and sometimes can be fatal, so we have to make a diagnosis and treat early. To make a diagnosis, the detection of the bacterium is important, but it is rarely possible. In many cases, we identify tetanus mostly from the history of injury and the symptoms. We report herein on two cases of tetanus without injury. The first case, a 78-year-old woman who had undergone a left submandibular glandectomy and had hypoglossal nerve paralysis, visited us with the chief complaint of dysphagia. She developed laryngospasm four days later and a tracheotomy was required. We diagnosed tetanus in the third stage, and we transferred her to a tertiary medical facility. The other case, a 68-year-old woman visited us with the chief complaints of dysphagia, neck pain, and trismus. We started treatment, and she was cured.
    We have to bear in mind that there are a few cases of tetanus in which the patients have no visible injury.
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