Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 108, Issue 5
Displaying 1-13 of 13 articles from this issue
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Editorial
  • The Existing State of Surgically Implanted Hearing Devices
    Satoshi Iwasaki
    2015 Volume 108 Issue 5 Pages 327-334
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.327
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    Remarkable advances have been made in the field of cochlear implantation, especially the new trends of hearing and structure preservation. Electric acoustic stimulation (EAS) is becoming a standard procedure worldwide and has improved the quality of life of patients with a ski-slope type audiogram, while Vibrant Soundbridge (VSB) and Bone Conductive Implant are also becoming available as hearing implants for the hearing-impaired population. We present the current information about hearing implants in Japan. Advances in the development of new atraumatic concepts of electrode design as well as in surgical techniques have enabled structure preservation after cochlear implantation, and EAS is a new trend for patients with residual hearing at lower frequencies, that became eligible for coverage by the national health insurance in Japan in 2014. The VSB is an active middle ear implant that was developed for the treatment of sensorineural hearing loss. Stimulation of the cochlea by coupling the small electromagnetic element called the floating mass transducer (FMT) to the round window membrane was a promising second alternative for the treatment of conductive or mixed hearing loss. A multicenter clinical study for VSB with a round window approach was conducted in Japan in 2014. Bone conductive implants allow direct transmission to the bone of the skull, and Baha is a semi-implantable percutaneous BC hearing device. A multicenter clinical study with 9 participant institutions was conducted in Japan between 2006 and 2009 to compare the efficacy of Baha with that of conventional hearing aids. Baha became eligible for coverage by the national health insurance in 2013. Several types of bone conductive implants have been developed and may be used in Japan in the near future.
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Original articles
  • Analysis of Type I Tympanoplasty Versus Simple Underlay Myringoplasty for Tympanic Membrane Perforation
    Ryo Suzuki, Shinichi Sato, Kazuyuki Ichimaru, Tomoyuki Haji, Juichi It ...
    2015 Volume 108 Issue 5 Pages 339-345
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.339
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    The postoperative results of type I tympanoplasty performed for 150 cases of tympanic membrane perforation and simple underlay myringoplasty performed for 46 cases of tympanic membrane perforation were analyzed comparatively in this study.
    The final tympanic closure rate in the patients treated by type I tympanoplasty was 90.7%, and favorable hearing results were obtained in 92.1%. The final tympanic closure rate in the patients treated by myringoplasty was 82.6%, although the rate tended to decrease as the size of the perforation increased. The haring results were favorable.
    To achieve the high closure rate, it is important to monitor the status of the tympanic membrane and ensure adequate postoperative care as necessary.
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  • A Case of Surgical Treatment of Juvenile Angiofibroma in the Pterygopalatine Fossa with Endoscopic Transmaxillary Surgery Combined with Endoscopic Intranasal Surgery
    Keiichi Miyashita, Junichiro Ohori, Yuichi Kurono
    2015 Volume 108 Issue 5 Pages 347-352
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.347
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    Juvenile angiofibroma (JAF) is a benign tumor that arises from the sphenopalatine foramen in adolescent males. It accounts for about 0.05% of all head and neck tumors. JAF manifests with a triad of symptoms, including nasal obstruction, epipharyngeal mass lesion, and recurrent epistaxis. Since this tumor frequently invades the surrounding tissues, causing bony destruction, it is not easy to treat the condition surgically without damaging the oropharyngeal function or aesthetics. Herein, we report the case of an 11-year-old boy with JAF who was successfully treated by endoscopic surgery via the transmaxillary approach combined with endoscopic intranasal surgery. Based on this experience, the advantages and disadvantages of the procedure are discussed.
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  • Endoscopic Sinus Surgery for a Patient of Chronic Rhinosinusitis with Severe Skull Deformation and Motor and Intellectual Disabilities
    Yosuke Nakamura, Hiromi Takeuchi, Kei Fukushima, Rie Morizane, Hiroya ...
    2015 Volume 108 Issue 5 Pages 353-358
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.353
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    Chronic rhinosinusitisis a commonly encountered disease in the field of otolaryngology, and with the advances in therapeutic technologies, cure has been achieved in many cases. However, in patients with a handicap, the standard drugs cannot be administered and the technically complex endoscopic sinus surgery (ESS) cannot be performed on account of medical and/or social reasons in some cases. Use of a navigation system lends useful support for ESS in cases with marked anatomic modifications. We present a case of navigation-guided ESS in a patient of chronic rhinosinusitis with severe skull deformation and motor and intellectual disabilities.
    The patient was a 20-year-old man who had undergone brain surgery for traumatic intracranial hemorrhage at the age of 10 months. He was subsequently left with the sequelae of epilepsy, spasticity limb palsy, and serious motor development deficits, and had scoliosis, cervical retroflexion, and flattening of the left side of the face with growth.
    He was hospitalized at our institution in the department of pediatric neurology for acute respiratory failure. He had a history of rhinorrhea and postnasal drip, and was referred to our hospital because CT revealed advanced pansinusitis on both sides. As conservative medical management was considered to be potentially insufficient, surgery was scheduled. Use of the navigation system helped in making the approach route safer and avoiding dangerous manipulation in the area of anatomic deformity. Although the patient developed mycoplasma pneumonia and recurrence during the first postoperative year, both resolved with conservative medical treatment for one month. Subsequently, these problems did not recur and the postoperative progress was good.
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  • A Study on 5 Cases of Elevated Serum IgG4
    Yukiko Yamashita, Junichi Ishitoya, Yasunori Sakuma, Nobuhiko Oridate
    2015 Volume 108 Issue 5 Pages 359-365
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.359
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    IgG4-related disease is a syndrome characterized by hyper-IgG4 gamma-globulinemia and infiltration of tissues by IgG4+plasma cells. Although glucocorticoid therapy can improve both the symptoms and serum IgG4 concentrations, differential diagnosis from other similar disorders is necessary. We report the cases of 5 patients who presented with swelling of the salivary glands and elevated serum IgG4 concentrations, and were suspected as having IgG4-related disease. Of the 5 patients, 2 were histopathologically diagnosed as having IgG4-related disease, the diagnosis remained unclear due to a lack of biopsy findings in 2 patients, and the remaining 1 patient was diagnosed as having malignant lymphoma after follow-up for 3 years. To obtain a definitive diagnosis, histopathological examination may have to be performed several times.
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  • Four Cases of Fish-bone Foreign Bodies Requiring General Anesthesia for Removal
    Hiroki Takeda, Masako Masuda, Eiji Yumoto
    2015 Volume 108 Issue 5 Pages 367-373
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.367
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    Fish bone foreign bodies in the pharynx are common and can usually be removed on an outpatient basis. However, fish bones in the larynx or the extraluminal digestive tract are rare. We treated four cases in which a fish bone foreign body was found in the larynx or the extraluminal digestive tract. In the first case, a fish bone was found at the larynx (subglottis) in a 2-year-old boy. The second case was a fish bone in the retropharyngeal region which had migrated into the submucosal layer in a 74-year-old man. The third case was a 74-year-old woman with a fish bone puncturing the thyroid gland, resulting in a chronically progressing neck abscess. The forth case was a 61-year-old woman with a fish bone completely lodged in the thyroid gland. The post-operative course was uneventful in all cases. Computed tomography (CT) images were effective for making the diagnoses.
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  • Two Cases of Spindle Cell Carcinoma of the Head and Neck
    Chiaki Suzuki, Satoshi Ohno, Shinji Takebayashi, Akiyoshi Yasumoto, Sa ...
    2015 Volume 108 Issue 5 Pages 375-380
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.375
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    We report two cases of spindle cell carcinoma (SpCC), one of the maxillary sinus and another of the larynx. SpCC is extremely rare in the head and neck region, especially in the paranasal sinuses. It has been reported that the larynx, oral cavity, and pharynx are the sites of predilection of this cancer in the head and neck.
    Case 1 (66-year-old, male) was initially diagnosed as having squamous cell carcinoma (SCC) of the maxillary sinus (cT4aN2cM0). An extensive operation was performed via a lateral rhinotomy approach, with reconstruction performed after induction chemotherapy. Histopathological examination of the resected specimen revealed the diagnosis of SpCC. Case 2 (66-year-old, male) with SCC of the larynx (cT1bN0M0) was administered radiation therapy at 66 Gy. However, the tumor recurred locally two years after completion of the radiation therapy, and cordectomy was performed. However, a local recurrence was detected again after two years, and finally SpCC was diagnosed and total laryngectomy was performed. Both patients are doing well until date, without any evidence of local recurrence or distant metastasis.
    SpCC is defined as a biomorphic carcinoma that contains both squamous cell and spindle cell components. Therefore, it is sometimes misdiagnosed as SCC in small biopsies. However, it is reported as a highly aggressive tumor with a poor prognosis, therefore, biopsies of adequate depth and size are recommended for precise diagnosis of SpCC.
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  • A Study on Patients with Suspected Schwannoma of the Neck
    Yojiro Kawamura, Toshikazu Shimane, Taisuke Nakamura, Yuko Shimotatara ...
    2015 Volume 108 Issue 5 Pages 381-388
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.381
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    In this study, we examined the possibility of definitive diagnosis of schwannoma prior to surgery in patients admitted to our hospital between April 2009 and December 2013. There were 37 cases of suspected schwannoma, of which 11 cases were finally diagnosed as not having schwannoma. Of these 11, 5 cases were diagnosed preoperatively as not having schwannoma and 5 were diagnosed intraoperatively as not having a schwannoma; in the remaining 1 case, the diagnosis was made postoperatively. The results revealed determination of the following as important for the differential diagnosis: clinical course (rate of growth of the tumor), tumor mobility (pain and hardness), MRI findings (tumor location and shape, and presence/absence of contrast enhancement), ultrasound findings (tumor blood vessel distribution), and findings on fine-needle aspiration cytology. If all of these fundamental findings are reconfirmed during the initial examination of referred patients, we believe that a definitive diagnosis may be made in many cases.
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  • A Case of Myoepithelial Carcinoma of the Parotid Gland
    Kenji Hosono, Homare Akahane, Tadao Okayasu, Hiroki Ooyama
    2015 Volume 108 Issue 5 Pages 389-395
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.389
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    Myoepithelial carcinoma of the salivary gland is a rarely occurring tumor. We report a case of myoepithelial carcinoma of the parotid gland. A 66-year-old male visited our hospital with a left parotid mass. CT revealed a mass measuring 5.0×4.0 cm in size in the left parotid gland. Aspiration biopsy of the mass was indeterminate. Partial resection of the left parotid gland was performed under the diagnosis of suspected parotid gland carcinoma (cT4aN0M0). Then, surgery to remove the enlarged regional swollen lymph nodes was performed at the same time. Histopathological examination of the surgical specimen showed proliferating atypical spindle-shaped cells. Immunohistochemical study revealed positive staining of the carcinoma cells for cytokeratin, vimentin, and S-100 protein, and slightly positive staining for p53, p63 and MIB-1 (Ki-67). Histopathologically, the resected tumor was diagnosed as myoepithelial carcinoma (pT4aN2b). Since we judged it as a high-grade carcinoma, post-operative radiation therapy was administered at 60 Gy. Eight months later, the patient was found to have multiple metastases in the lung. The lung metastases did not show any response to PF (cisplatin, 5FU) therapy. We therefore started treatment with TS-1 (120 mg/body) to maintain a good QOL of the patient. He developed adverse events 8 months later, therefore, the treatment was switched to UFT (300 mg/body). Finally, the patient died 2 years and 9 months after the operation without local recurrence.
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  • Two Cases in which Critical Bone Marrow Suppression was Caused in the First Course of TS-1 Treatment
    Akihiro Takaoka, Tomonori Terada, Nobuhiro Uwa, Takeshi Mohri, Kota Ki ...
    2015 Volume 108 Issue 5 Pages 397-402
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.397
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    We report herein on two cases in which critical bone marrow suppression was caused in the first course of TS-1 treatment.
    A 79-year-old man with hypopharyngeal cancer of the right piriform fossa (cT2N0M0) underwent an operation with larynx-preserving partial pharyngectomy at our institution.
    Two months later, a neoplastic lesion was observed in the posterior wall from the oropharynx to the hypopharynx. It was diagnosed by biopsy as a squamous cell carcinoma, and was considered as a local recurrence. The salvage operation was planned. Oral administration of TS-1 (70 mg/m2/day) was started for the purpose of induction chemotherapy under hospitalization. However, serious bone marrow suppression happened on the 13th day. The patient developed multiple organ failure, and died two days later. On the basis of result of the autopsy, the sepsis following agranulocytosis was considered to be the cause of death.
    A 70-year-old-man with hypopharyngeal cancer of the right piriform sinus (cT4aN2bM0) underwent operation with a total laryngopharyngectomy. Multiple pulmonary metastasis and right cervical lymph node recurrence occurred 8 months postoperatively. Oral administration of TS-1 (74 mg/m2/day) was started. After a 2-week course of the TS-1, we had planned a break for one week.
    However, a feeling of general malaise developed and the patient suddenly visited the hospital on the 5th day of the wash out period. A blood test revealed remarkable bone marrow suppression, and multiple organ failure occurred with sepsis. The patient was admitted of intensive care units for multidisciplinary treatments.
    These two cases suggest that, even if a normally-accepted dose of TS-1 is given, severe bone marrow suppression may occur. Therefore strict and thorough observation is believed necessary in any such cases involving TS-1 treatment.
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Original articles
  • Clinical Efficacy of Single 2 g Dose of Azithromycin for the Treatment of Acute Pharyngotonsillitis and Acute Rhinosinusitis
    Shin Takei, Noboru Yamanaka, Muneki Hotomi, Takaaki Kimura, Kiyonori K ...
    2015 Volume 108 Issue 5 Pages 403-414
    Published: 2015
    Released on J-STAGE: May 01, 2015
    DOIhttps://doi.org/10.5631/jibirin.108.403
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    We investigated the efficacy of a novel single 2 g dose of azithromycin for the treatment of adult patients diagnosed as having acute pharyngotonsillitis or acute rhinosinusitis. Eighty-eight cases with acute pharyngotonsillitis and 174 cases with acute rhinosinusitis were included in the multicenter single group non-blinded clinical trial from Oct 29, 2010 to Mar 30, 2012. This study was approved by the Institutional Review Board of the Ethical Committee of Wakayama Medical University.
    We assessed the severity of disease by using the scoring system based on symptoms and local findings. Clinical efficacy rates at 4 days after the treatment were as follows; “Complete response” in 54 cases (62.1%), “Efficacy A” in 22 cases (25.3%), “Efficacy B” in 10 cases (11.5%), and “Ineffective” in 1 case (1.1%) in acute pharyngotonsillitis and “Complete response” in 54 cases (32.1%), “Efficacy A” in 38 cases (22.6%), “Efficacy B” in 59 cases (35.1%), “Ineffective” in 13 cases (7.7%), and “Aggravation” in 4 cases (2.4%) in acute rhinosinusitis. The eradication rates of pathogens at 4 days after the treatment were 85.7% in acute pharyngotonsillitis and 50.8% in acute rhinosinusitis.
    Among patients categorized as “Complete response” or “Efficacy A” at 4 days after the treatment, all cases in acute pharyngotonsillitis were involved in “Complete response” at 8 days after the treatment, and 88.1% of acute rhinosinusitis were involved in “Complete response” or “Efficacy A”.
    These results show the high efficacy of single 2 g dose of azithromycin in treating adult acute pharyngotonsillitis and acute rhinosinusitis. Data clearly indicated the usefulness of the clinical scoring system: from which a score at 4 days after the treatment may predict the prognosis of acute infectious disease, and be helpful for decision making on antimicrobial treatments.
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Technical notes
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