Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 108, Issue 11
Displaying 1-11 of 11 articles from this issue
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Editorial
  • Classification and Treatment of Psychiatric Disease-associated Dizziness
    Arata Horii
    2015 Volume 108 Issue 11 Pages 821-827
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.821
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    The behavioral subcommittee of International Classification of Vestibular Disorders (ICVD for Barany Society) identified eight psychiatric disorders that cause vestibular symptoms and one disorder at the interface of neuro-otology and psychiatry. Basically, anxiety and depressive disorders are the two major psychiatric disorders that cause vestibular symptoms. Both are the primary disorders that cause episodic and chronic dizziness and they are also disorders secondary to organic vestibular diseases which are responsible for episodic or chronic dizziness. Vestibular health anxiety, which is categorized as somatoform disorders, has characteristic features such as excessive seeking for reassurance about vestibular symptoms. Persistent Postural and Perceptual Dizziness (PPPD) is a newly defined inclusive term that is a synonym encompassing the previously-termed Phobic Postural Vertigo (PPV), Chronic Subjective Dizziness (CSD), Space Motion Discomfort (SMD), and Visual Vertigo (VV). The characteristic symptom of PPPD is chronic dizziness that is related to posture (severe when upright) and is exacerbated by active or passive motion, complex visual stimuli, or by performance of small-field, precision visual activities such as using a computer. PPPD patients sometimes have comorbid anxiety and depression. In all cases except for vestibular health anxiety, treatment for anxiety and depression with minor tranquilizers or SSRIs is effective for both vestibular and psychiatric symptoms. In treating dizzy patients, careful investigation of psychiatric disorders is important especially in the case of secondary psychiatric comorbidities since clinicians often treat only for vestibular disorders. In our study, SSRIs were exclusively effective for chronic dizziness patients with highly anxious and depressive patients with or without organic vestibular diseases (Horii A et al. 2004, 2007). A simple interview using the Hospital Anxiety and Depression Scale (HADS) is useful to judge the existence or absence of psychiatric comorbidities.
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Original articles
  • Middle Turbinate-septal Suture in Endoscopic Sinus Surgery
    Kohei Kawamoto, Shigeki Kawamura, Mikiya Asako, Koichi Tomoda
    2015 Volume 108 Issue 11 Pages 831-838
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.831
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    Endoscopic sinus surgery (ESS) has now become the standard treatment for medically refractory chronic sinusitis. The most frequently occurring complication is lateralization of the middle turbinate and synechia formation in the middle meatus, which increases the risk of recurrence of the sinusitis and may necessitate a revision surgery. Several methods have been reported so far to prevent synechia formation, and we used the septum stitch, which is a semiautomatic suturing device for suturing the nasal septum. At the end of the surgery, the middle turbinate was sutured to the nasal septum, thereafter, post operative lateralization of the middle turbinate and synechia formation were assessed 3 months after the surgery. No synechia formation was seen in 64.9% of the cases and 91% of the cases needed no extra treatment. The synechia formation was mostly seen in the upper part of the middle meatus. Middle turbinate-septal suturing medialization is effective for preventing lateralization of the middle turbinate and synechia formation after ESS.
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  • A Case of Spindle Cell Carcinoma of the Hypopharynx
    Teppei Kaminota, Hiroyuki Yamada, Naohito Hato
    2015 Volume 108 Issue 11 Pages 839-843
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.839
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    Spindle cell carcinoma is a rare tumor that contains both a conventional epithelial squamous component and a sarcomatous spindle cell component. Here, we report a rare case of spindle cell carcinoma of the hypopharynx. The patient was a 49-year-old woman who visited our hospital complaining of discomfort in the throat. A pedunculated tumor originating from the left piriform sinus was observed. Contrast-enhanced CT and T1-weighted MR images showed a well-demarcated mass with heterogeneous enhancement and a pedunculated mass adjacent to the left piriform sinus. A biopsy led to the diagnosis of an undifferentiated pleomorphic sarcoma. A partial pharyngectomy and left neck dissection were performed. The pathologic diagnosis was consistent with spindle cell carcinoma. Pathologically, the surgical margins were negative, and cervical lymph node metastasis was not observed. No signs of recurrence were observed at a 26-month follow-up examination.
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  • A Case of Desmoid Tumor Arising in the Anterior Scalene Muscles
    Hiromi Nagano, Hiroyuki Iuchi, Masaki Kawabata, Yuichi Kurono
    2015 Volume 108 Issue 11 Pages 845-850
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.845
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    Desmoid tumor are benign fibrous tumors that can occur in the connective tissue of skeletal muscles, fascia, and tendon membranes. These tumors tend to recur locally despite being pathologically benign, and are regarded as being “clinically malignant”.
    We report a case with a desmoid tumor that occurred in the anterior scalene muscles. A 39-year-old man visited our ENT facility complaining of a left neck pain and swelling of the neck appearing 4–5 years earlier. Computed tomography (CT) and magnetic resonance imaging (MRI) showed an inversional region in the anterior scalene muscles. A positron emission tomography/computed tomography (PET/CT) scan showed an accumulation in the same area with a standardized uptake value (SUV) of 3.3. A histological analysis revealed spindle cells, which stained positive for β-catenin and α-SMA in the nuclei and negativity for desmin, CD34, bcl-2 and S-100.
    Accordingly, the patient was diagnosed as having a desmoid tumor.
    Here, we describe the clinical course of this case and provide a review of the literature.
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  • Two Cases of Papillary Cystadenocarcinoma of the Root of the Tongue
    Takeshi Mohri, Tomonori Terada, Nobuhiro Uwa, Kosuke Sagawa, Akihiro T ...
    2015 Volume 108 Issue 11 Pages 851-858
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.851
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    Papillary cystadenocarcinoma is a salivary gland tumor that was classified as a subtype of adenocarcinoma by the World Health Organization (WHO) in 1991. It is histologically characterized by papillary growth with a cyst-like structure. The incidence is extremely low, with this tumor accounting for less than 0.2% of all salivary gland tumors. We report our experience of two patients with papillary cystadenocarcinoma, the tumor originating from a small salivary gland in the first case and from the sublingual gland in the second, with a review of the literature.
    Patient 1 was a 73-year-old woman who presented with a cyst-like tumor at the base of the tongue. Biopsy led to the diagnosis of papillary cystadenocarcinoma, and tumor resection was performed by the suprahyoid approach under general anesthesia. Histopathology of the resected specimen revealed the diagnosis of papillary cystadenocarcinoma of low-grade malignancy originating from a small salivary gland. Until now, 4 years since treatment by surgery, the patient has shown no evidence of relapse. Patient 2 was a 67-year-old woman who was diagnosed as having papillary cystadenocarcinoma and underwent tumorectomy by the suprahyoid approach and manipulation from the oral cavity. The pathological diagnosis was papillary cystadenocarcinoma of high-grade malignancy originating from the sublingual gland. Because the resection line allowed for only a close margin, postoperative radiation therapy (60 Gy/30 Fr) was administered. Thereafter, the patient developed repeated recurrences, and despite salvage surgery, she died 4 years and 3 months after the initial surgery.
    Although papillary cystadenocarcinoma shows slow growth and benign tumor-like features, in some cases, the tumor is classified as being of high-grade malignancy relapses occur, therefore, treatment should be selected with due consideration given to the possibility of relapse and metastasis.
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  • A Case of Metastatic Hepatocellular Carcinoma of the Nasal Septum
    Tatsuya Fujii, Yoshiaki Kitamura, Ryo Kanamura, Hiroki Onishi, Aki Shi ...
    2015 Volume 108 Issue 11 Pages 859-863
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.859
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    Metastatic hepatocellular carcinoma in the sinonasal region is rare. We report the case of an 85-year-old man who presented to us with a history of recurrent nasal bleeding. A reddish and hemorrhagic tumor was found in the right nasal septum. Histopathological examination of a biopsy specimen of the tumor revealed metastatic hepatocellular carcinoma. The patient had been diagnosed as having hepatocellular carcinoma many years ago and received multiple sessions of transcatheter arterial chemoembolization. Computed tomography and magnetic resonance imaging showed a slightly enhancing soft-tissue mass measuring 10 mm in diameter in the right nasal septum. We resected the metastatic hepatocellular carcinoma in the right nasal septum by endoscopic surgery under local anesthesia to control the recurrent nasal bleeding, and this treatment improved the quality of life of the patient. The postoperative course was uneventful, and until now, eight months since the surgery, the patient has shown no evidence of recurrence.
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  • A Case of Lymphangioma of the Palatine Tonsil in an Adult
    Takatoshi Furukawa, Teruaki Nagase, Shinya Ogata, Haruka Shoji, Shuich ...
    2015 Volume 108 Issue 11 Pages 865-869
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.865
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    Cervical lymphangioma usually occurs in children as a soft tumor, but lymphangioma of the palatine tonsil is an extremely rare lesion that presents as a tonsillar outgrowth. We report herein on our rare experience with a 30 years old female patient with lymphangioma of the palatine tonsil. She presented with a foreign body sensation and a nonproductive cough from two years previously. Her tonsillar lymphangioma was treated by wide surgical excision with a tonsillectomy. Recurrence of tonsillar lymphangioma has not been detected to date at 8 months after surgery. We present herein the course of this case with several references to previous literature.
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  • A Case of Amebic Dysentery During Concurrent Chemoradiotherapy for Hypopharyngeal Cancer
    Yojiro Kawamura, Yuko Shimotatara, Taisuke Nakamura, Yoichi Ikenoya, N ...
    2015 Volume 108 Issue 11 Pages 871-876
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.871
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    We report a case of amebic dysentery during combination chemoradiotherapy for hypopharyngeal cancer. The patient was a 52-year-old man with suspected hypopharyngeal cancer who was referred by his local physician after presenting with pharyngeal pain. The results of detailed investigations, including CT, showed hypopharyngeal cancer (T2N0M0), and the patient was admitted for simultaneous radiotherapy and S-1 plus nedaplatin (hereafter, SN therapy). On hospital day 36 (on day 6 after the second course of SN was started), 10 episodes of mucous, bloody stools and diarrhea were observed on the same day, accompanied by a left lower abdominal pain. We performed a lower gastrointestinal endoscopy that revealed aphthous ulcers from the ascending colon to the lower rectum. The biopsy showed numerous trophozoites consuming red blood cells, leading to a diagnosis of amebic dysentery. The patient was given oral metronidazole (1 g/day) for 10 days, and the symptoms improved. After treatment, a lower gastrointestinal endoscopy showed that the ulceration had disappeared and that the mucosa appeared normal. In this case, we believe that amebic dysentery occurred because of the patient’s background of decreased immune function caused by the administration of chemotherapy and steroids. Mucous, bloody stools and diarrhea during chemotherapy should lead to concerns not only of an adverse chemotherapy event causing gastrointestinal mucosal edema and ulceration, but also of an opportunistic infection and amebic dysentery. In the present case, early diagnosis by a skilled doctor was an important factor; the disease might have become more severe if the diagnosis had not been reached. For this reason, obtaining a sufficient history as well as performing a lower gastrointestinal endoscopy and biopsy are important for early diagnosis.
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Original articles
  • Treatment with Salcoat® Nasal Spray for Nasal Polyps Associated with Allergic Rhinitis
    Masakazu Kawai, Nobuo Ohta
    2015 Volume 108 Issue 11 Pages 877-882
    Published: 2015
    Released on J-STAGE: November 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.877
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    Beclometasone (product name: Salcoat®) for oral spray is a powder formulation containing a large amount of a mucosal-adhesive base material (hydroxypropyl cellulose: HPC), which allows the drug to be retained longer at the local site. When the product is sprayed on the affected site with a dedicated small sprayer (pubriser®), the HPC gelates by absorbing moisture on the mucosal surface and adheres to the mucosa. As a result, it remains at the affected site for a prolonged period of time and thereby also releases the active ingredient (steroid) locally for a prolonged period of time.
    Treatment with Salcoat® nasal spray (one puff in each nostril, twice daily) was given to 10 patients with nasal polyps associated with allergic rhinitis who showed no improvement with conservative treatment for one year or longer. Subjective improvement in the feeling of nasal congestion was observed in 7 cases and the nasal polyps shrank in 5 cases.
    Treatment with Salcoat® was prematurely discontinued in one patient because nasal congestion occurred immediately after the formulation was sprayed, due to gelation of the drug. None of the patients showed any signs of mycosis.
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Technical notes
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