Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 108, Issue 2
Displaying 1-13 of 13 articles from this issue
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Editorial
  • Fat Injection Laryngoplasty for a Patient with Unilateral Vocal Fold Paralysis
    Hirohito Umeno
    2015 Volume 108 Issue 2 Pages 81-91
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.81
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    Medicalization thyroplasty type I (MT) is the standard management for glottal insufficiencies without a level difference during phonation, regardless of the severity of the glottal gap. On the other hand, fat injection laryngoplasty (FIL) is considered to be an alternative treatment for patients with small gaps. However, FIL with a quantity of adipose tissue has been used to treat the arytenoid cartilage of the paralyzed side, even in patients with severe glottal gaps. Based on this, FIL and MT were thought to be a good indication for a patient with unilateral vocal fold paralysis who has no vertical level difference between the two vocal folds during phonation. The vocal function after both surgeries was investigated using vocal examination. As a result, all parameters significantly improved in both groups after surgery. In particular, there was a significant difference in the postoperative acoustic analyses. However, the aerodynamic analysis after FIL improved more significantly in comparison to that after MT because of the respiratory handicap. We found that MT and FIL provided almost the same effectiveness, and that both surgeries were reliable in improving the vocal function in patients with vocal cord paralysis. The structure consisting of a unilocular cell, containing a single droplet of lipid, surrounded by a meshwork of delicate reticular fiber is one of the reasons why autologous fat has viscous properties similar to those of human lamina propria. Autologous fat was not damaged by our harvesting and microinjection method.
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Original articles
  • A Case of Perilymph Fistula Following Eustachian Tube Insufflation
    Kazuki Sugizaki, Tetsuo Ikezono, Susumu Shindo, Han Matsuda, Yasuhiro ...
    2015 Volume 108 Issue 2 Pages 95-100
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.95
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    Introduction: The perilymph fistula (PLF) has been described as a rare complication of eustachian tube insufflation (ETI). We report a case of PLF induced by ETI with a catheter, in which the definitive diagnosis was made using the Cochlin-tomoprotein (CTP) detection test.
    Case Presentation: A 66-year-old male patient had been undergoing ETI for treatment of recurrent otitis media with effusion in a local clinic. Immediately after ETI, he experienced otalgia and dizziness. Dizziness persisted for three months and remained incurable despite conservative treatment, and the patient was subsequently referred to our clinic. He had left-sided mixed hearing loss, as well as nystagmus in the head positioning, positional, and head-shaking tests. We suspected barotraumatic PLF, and the CTP testing yielded positive results. We performed PLF repair surgery, and the vestibular symptoms gradually improved from the day after surgery.
    Conclusion: A positive result for the CTP detection test is one of the diagnostic criteria for definitive PLF, and in this case, facilitated determination of the treatment strategy, which comprised surgery that effectively relieved the patient’s intractable dizziness. Therefore, the CTP detection test is useful for diagnosis and determination of a treatment strategy in such cases.
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  • Three Cases of Myeloperoxidase-Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (MPO-ANCA)-positive Otitis Media with ANCA-associated Vasculitis
    Tomohisa Kato, Takao Ogawa, Hideaki Kouzaki, Takeshi Shimizu
    2015 Volume 108 Issue 2 Pages 101-108
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.101
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    We report three cases of myeloperoxidase-perinuclear anti-neutrophil cytoplasmic antibodies (MPO-ANCA)-positive otitis media with ANCA associated vasculitis (OMAAV). Case 1 was a 75-year-old female. She had right hearing loss and kidney involvement. Treatment with oral prednisolone was initiated and the MPO-ANCA titers decreased. Sensorineural hearing loss remained. Case 2 was a 77-year-old male. He had bilateral hearing loss and lung involvement. Treatment with oral prednisolone and oral cyclophosphamide was initiated. Serum MPO-ANCA became negative, and both hearing loss and lung involvement improved. However, serum PR3-ANCA became positive and he developed myelitis. Case 3 was a 71-year-old male. He had bilateral hearing loss but no other sites of involvement, such as lung and kidney. Treatment with oral prednisolone and oral cyclophosphamide was initiated. The MPO-ANCA titers became negative. He recovered from his hearing loss, however, he developed multiple cranial nerve palsy.
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  • A Case of Nasal Glomangiopericytoma Resected under Endoscope
    Mizuo Umakoshi, Hiromi Nagano, Yuichi Kurono
    2015 Volume 108 Issue 2 Pages 109-113
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.109
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    Glomangiopericytomas (sinonasal-type hemangiopericytomas) are a rare tumor entity deriving from pericytes. Less than 0.5% of hemangiopericytomas occur in the nasal cavity and are characterised by a rather benign nature with low tendency for metastasis.
    A 69-year-old man presented with epistaxis. Endoscopic and radiographic examination revealed a bilateral mass involving the nasal cavity and paranasal sinuses. Histopathological features were consistent with a glomangiopericytoma. Immunohistochemically, the tumor cells were positive for vimentin and α-smooth muscle antigen. Complete endoscopic resection with free margins was achieved without embolization.
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  • A Case of Hereditary Hemorrhagic Telangiectasia Exacerbated Due to Heart Failure
    Hirofumi Sei, Taro Takagi, Masahiro Okada, Hirotaka Takahashi, Naohito ...
    2015 Volume 108 Issue 2 Pages 115-119
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.115
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    Hereditary hemorrhagic telangiectasia (HHT) is an uncommon disease characterized by the presence of abnormal telangiectasia and arteriovenous malformations that cause recurrent episodes of epistaxis. In case of recurrent epistaxis, the management of bleeding could be difficult in HHT patients. Systemic complication, such as arteriovenous shunt in lung and liver, can also occur in the clinical course. Once a systemic complication occurs, epistaxis can be severe and uncontrollable.
    We experienced a female patient with HHT which was complicated with infective endocarditis. Though several hemorrhages were treated with argon plasma coagulation (APC), her epistaxis did not improve. After an aortic valve replacement was performed for infective endocarditis, the incidence of recurrent bleeding was reduced. It was considered that heart failure due to infective endocarditis caused the intractable nose bleeding. These clinical findings suggested that the management of systemic complications are most probably important for the control of recurrent epistaxis in HHT patients.
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  • A Pediatric Case of a Button Battery Nasal Foreign Body
    Noriko Taniguchi, Takaki Inui, Tatsuro Kuriyama, Kengo Ichihara, Koute ...
    2015 Volume 108 Issue 2 Pages 121-125
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.121
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    We report a case of a button battery as a nasal foreign body in a 3-year-old male child. An otolaryngologist at another hospital removed the foreign body, however, the child was referred to our hospital the following day with severe damage of the nasal mucosa. We carried out endoscopic nasal surgery under general anesthesia; the damaged tissue was removed and the nasal cavity was flushed copiously with distilled water. At 4 months since this procedure, the child remains asymptomatic.
    Button batteries as nasal foreign bodies can lead to clinical complications such as nasal septal perforation, atrophic rhinitis, anterior nasal atresia, etc., which can persist or develop several months after removal of the foreign body. These batteries can cause damage both through physical pressure and electrical and alkali burns. The alkaline component of the cell cathode may persist submucosally, to cause chronic damage for several months even after removal. In conclusion, to avoid permanent damage, it is important not only to remove the foreign body promptly, but also to treat or remove any tissues that have been chemically damaged.
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  • A Case of Sphenoidal Sinus Mucocele with Orbital-apex Syndrome
    Takatoshi Furukawa, Nobuo Ohta, Tomoo Watanabe, Tsukasa Ito, Yusuke Su ...
    2015 Volume 108 Issue 2 Pages 127-132
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.127
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    When the eye socket is damaged for various reasons, the oculomotor nerve, the trochlear nerve, the abducens nerve, the first trigeminal nerve branch and the optic nerve can be damaged, and the orbital-apex syndrome is exhibited. Reported causes for this include external injury, leukemia, cancer, mycosis and Hodgkin’s disease, and reports of orbital-apex syndrome due to sphenoidal sinus cysts are rare. We report herein on our rare experience with a 73 years old male patient in whom a sphenoidal sinus cyst caused orbital-apex syndrome. His visual function was highly inhibited. Endoscopic sinus surgery on day 8 enabled improvement in the visual function. We present herein the course of this case with several references to previous literature.
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  • A Case of a Retropharyngeal Abscess Associated with Pyogenic Cervical Osteomyelitis and a Spinal Epidural Abscess
    Keiko Ohno, Yurika Kimura
    2015 Volume 108 Issue 2 Pages 133-138
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.133
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    Advances in antibiotic therapy have reduced the incidence of retropharyngeal abscesses. However, the morbidity and mortality rate are high in immune-compromised patients or when diagnosis and treatment are delayed. In the present report, we describe a rare case of a retropharyngeal abscess associated with pyogenic cervical osteomyelitis and a spinal epidural abscess. An 83-year-old man presented to the emergency department of our hospital with disorder of consciousness (Japan coma scale I-2), weakness of the limbs, and a 4-day history of neck pain. Laboratory blood tests revealed a high white blood cell count and C-reactive protein level, and marked hyperglycemia. Thereafter, he was admitted to the internal medicine department with a diagnosis of hyperosmolar hyperglycemia syndrome and a bacterial infection of an unidentified focus. Cerebrospinal fluid examination performed on hospital day 2 indicated aseptic meningitis. Computed tomography performed on hospital day 3 showed a retropharyngeal abscess, after which he was referred to our otolaryngology department. Posterior pharyngeal wall swelling and airway obstruction were observed. Therefore, we performed an emergency tracheotomy and trans-oral incision and drainage of the retropharyngeal abscess. Blood, urine, and pus cultures indicated positive results for Group B Streptococcus. Magnetic resonance imaging performed on hospital day 6 demonstrated pyogenic osteomyelitis and a spinal epidural abscess. We continued conservative antibiotic therapy after consultation with the orthopedics department. However, upper limbs paralysis was noted on hospital day 17. The patient was diagnosed as having myelopathy and an epidural abscess, and he underwent an emergency laminectomy (C2–6). After the surgery, the upper limb paralysis improved. Based on the literature and our experience, we believe that although rare, spinal epidural abscesses are a critical complication that could result in a severe decline in neurologic function or death if diagnosis and treatment are delayed.
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  • A Case of Maxillary Sinus Small Cell Carcinoma Treated with CPT-11 and CBDCA Concurrently Combined with Radiation
    Yuri Ueda, Yasuo Ogawa, Akira Shimizu, Hiroyuki Ito, Mamoru Suzuki
    2015 Volume 108 Issue 2 Pages 139-144
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.139
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    Objective: Extrapulmonary small cell carcinoma (EPSCC) is a cancer with a poor prognosis. The treatment of EPSCC has not been established because of its rarity. We encountered a case of EPSCC involving the maxillary sinus, which had been treated with irinotecan (CPT-11), carboplatin (CBDCA) and radiotherapy.
    Case report: A-79-year-old woman visited our clinic with bloody rhinorrhea and nasal obstruction. Physical examination revealed a rough nasal polyp in the left nasal cavity. CT scans revealed a soft tissue shadow in the left maxillary sinus. Endoscopic sinus surgery was performed. The nasal polyp was pathologically diagnosed as a small cell carcinoma. There was no evidence of metastasis, and the tumor was staged as maxillary cancer, T2N0M0. Chemotherapy with CPT-11 combined with CBDCA and radiotherapy (total 50 Gy) were started. After 3 cycles, the chemotherapy was discontinued due to severe anemia. The CT scan at this time demonstrated no signs of tumor progression. The disease has remained stable with no recurrence for 3 year and 6 months.
    Discussion: Recently, some articles about extensive-disease small cell lung carcinoma have shown that the IP therapy comprising CPT-11 combined with platinum, is more effective than the EP therapy comprising etoposide and platinum. However, for limited-disease small cell lung cancer, the IP therapy combined with thoracic radiotherapy is not indicated in general, due to its severe toxicity such as radiation pneumonitis. However, for EPSCC, the IP therapy with radiotherapy can possibly be performed more safely, because radiation for EPSCC does not target the lungs. In the present case, no severe side effect developed except for anemia, suggesting the usefulness of the IP therapy combined with radiotherapy for EPSCC.
    Conclusion: We present herein on a case of EPSCC treated with chemoradiotherapy with CPT-11 and CBDCA. Tumor growth has been controlled for the period of 3 year and 6 months.
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  • A Study on 13 Cases of Bone and Soft Tissue Sarcomas in the Head and Neck
    Shinya Agena, Takayuki Uehara, Yukashi Yamashita, Sen Matayoshi, Masah ...
    2015 Volume 108 Issue 2 Pages 145-152
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.145
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    Since bone and soft tissue sarcomas arising from the head and neck region are very rare, the standard treatment protocol has yet to be established. In the present study, 13 cases with bone and soft tissue sarcomas treated from 2007 to 2014 were analyzed. The mean period from initial visit to final pathological diagnosis was approximately 3 weeks, and 38.5% of the cases needed several biopsies for an accurate diagnosis. Death occurred early for those cases in which more than 40 days was needed to obtain the histological diagnosis. The 3-year overall survival in 13 cases was 35.2%. As the cause of death was uncontrolled local lesion, the locoregional control was more important than distant metastasis control for the prognosis. Tumor location, TNM stage, and histological grade affected the prognosis of the sarcomas. Radiation therapy including heavy ion and proton beam radiotherapy was not so effective as the primary treatment, as was the case with salvage treatment of sarcomas in the head and neck. Although the primary treatment of sarcomas was surgical treatment with an adequate margin, an efficient treatment protocol should be established to obtain a better prognosis.
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  • A Case of Intracapsular Carcinoma Ex Pleomorphic Adenoma of the Parapharyngeal Space with Cervical Lymph Node Metastasis
    Kohei Yamahara, Juichi Ito, Yohei Kumabe, Shinzo Tanaka, Yasuyuki Hira ...
    2015 Volume 108 Issue 2 Pages 153-159
    Published: 2015
    Released on J-STAGE: February 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.153
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    Carcinoma ex pleomorphic adenoma is a rare aggressive malignant carcinoma developing in a pre-­exisiting pleomorphic adenoma. Capsular invasion has an oppressive prognosis. On the other hand, intracapsular carcinoma ex pleomorphic adenoma is known to have a benign clinical behavior. We report a rare case of intracapsular carcinoma ex pleomorphic adenoma of a minor salivary gland in the parapharyngeal space revealed by prior cervical lymph node metastasis. A 35-year-old male presented with a month-long history of progressive enlargement of the left cervical mass. We performed a biopsy of the mass and the diagnosis of a metastatic adenocarcinoma of undetermined origin was made. To detect the primary tumor, several investigations were performed using various diagnostic modalities. We found a tumor in the left parapharyngeal space. But, unlike the metastatic cervical lymph node, this tumor showed neither FDG uptake nor enhancement on either CT or MRI. These imaging findings did not favor this tumor as the primary site. We were unable to confirm that the tumor in the parapharyngeal space was the primary carcinoma. We performed a left modified radical neck dissection, removal of the tumor in the parapharyngeal space and hemithyroidectomy of the left lobe. Histological examination revealed that the tumor in the parapharyngeal space was carcinoma ex pleomorphic adenoma. We diagnosed it as the primary carcinoma. Despite the absence of capsular invasion, this case featured high-grade malignancy with cervical lymph metastasis.
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