Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 109, Issue 5
Displaying 1-12 of 12 articles from this issue
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Editorial
  • Poor Prognostic Factors in Patients with Chronic Rhinosinusitis after Endoscopic Sinus Surgery
    Mamoru Yoshikawa
    2016 Volume 109 Issue 5 Pages 291-297
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.291
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    Chronic rhinosinusitis (CRS) is a commonly encountered chronic disease that is treated with medications (e.g., corticosteroids or macrolides) and by endoscopic sinus surgery. Although there has been an increase in the cure rate of CRS recently following the introduction of these treatments, a substantial number of patients still have a poor prognosis. Nasal polyps immediately recur after surgery in cases of CRS that present with severe eosinophilic infiltration. We refer to CRS with eosinophilic infiltration as eosinophilic CRS (ECRS). CRS is known to have a multifactorial etiology. Even with the best ESS technique, the clinical course of the disease after the surgery can be challenging on account of several factors, including the postoperative management and the type and the extent of the disease, which may contribute to the natural course of the disease and the surgical outcomes. It has been reported that nasal polyps and asthma are linked by shared inflammation of the entire airway mucosa, and particularly by increased eosinophil infiltration of the mucosa. In addition, mucosal eosinophilia is frequently associated with more severe disease and with recurrence of polyps after surgery. Furthermore, CRS patients with aspirin-intolerant asthma often have particularly severe asthma that is associated with rhinorrhea and recurrent nasal polyps. These findings suggest that concomitant asthma may contribute to the pathophysiology of CRS. Our study revealed that women with CRS have a poorer prognosis than men with CRS. Future studies are needed to elucidate the mechanisms that drive the gender-related difference in disease severity, paving the way for the development of personalized treatments for CRS based on the gender of the patient.
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Original articles
  • A Case of Leptomeningeal Carcinomatosis with Progressive Sensorineural Hearing Loss and Facial Paralysis on Both Sides
    Hiroshi Okuda, Masato Takiwaki, Keiichi Izuhara, Yoichi Yokota, Hiromi ...
    2016 Volume 109 Issue 5 Pages 301-305
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.301
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    Leptomeningeal carcinomatosis is often associated with acoustic nerve and facial nerve involvement, similar to the case in acoustic nerve tumors, hence, distinction between the two is often difficult. We report a patient of leptomeningeal carcinomatosis who was initially treated as a case of acoustic nerve tumor (AT), but was diagnosed after several months during follow-up as a case of leptomeningeal carcinomatosis. An 82-year old man with bone metastases from lung cancer visited us with the complaint of difficulty in hearing on the left side. Soon thereafter, he developed difficulty in moving the left side of the face. Based on the findings of MRI, we assumed the diagnosis of AT and began to treat the patient with steroids. However, the symptoms began to get worse and started to spread to the opposite side. A cerebrospinal fluid examination revealed the presence of atypical cells. Based on this finding, we diagnosed the patient as having leptomeningeal carcinomatosis.
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  • Use of a Ceramic Ossicular Prosthesis for Lateralized Tympanic Membrane Developing Postoperatively
    Kiichiro Shinkawa, Manami Shinkawa, Hidenaga Yamamoto, Yang Tao, Maya ...
    2016 Volume 109 Issue 5 Pages 307-311
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.307
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    Ceramic ossicular replacement prostheses have been used for more than 30 years in Japan. The use of these prostheses was limited to certain institutions. Recently, artificial materials, mainly titanium, have come to be used more commonly in Europe and the USA. In Japan also, these new types of prostheses are frequently used to reconstruct the ossicular chain. These prostheses are effective as long ceramics for type IV tympanoplasty and lateralized tympanic membranes. However, there are issues with the surgical method employed to return the lateralized tympanic membrane to its physiological position. In many patients, the tympanic membrane returns to its previous lateralized location after the surgery, resulting in recurrent lateralization. Due to this phenomenon, no desirable amelioration of hearing is observed in some patients. We have reported improvements in hearing with the use of a long ceramic without changing the location of the tympanic membrane. However, there are still patients with extremely lateralized tympanic membranes for whom even the use of the long ceramics proves ineffective for reconstruction of the ossicular chain.
    We observed a patient with an extremely lateralized tympanic membrane, which was in such an advanced state, that a finger could easily touch the tympanic membrane through the external ear. We reported a case in which implantation of both P- and T-type ceramics, which were securely stuck to each other with medical Aron-Alpha, into the area between the lateralized tympanic membrane and the stapes improved hearing.
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  • A Study on Secondary Acquired Cholesteatoma
    Tsuyoshi Umehara, Kazuo Matsui, Katsura Hakamada, Goro Oshima, Katsuyo ...
    2016 Volume 109 Issue 5 Pages 313-319
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.313
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    This study was designed to analyze the clinical features of patients who underwent surgery in Seirei Hamamatsu General Hospital for secondary acquired cholesteatoma (SAC). The subjects were 19 patients (19 ears) who underwent surgery for SAC in our hospital from 2001 to 2013. We investigated the age distribution and sex in SAC compared with primary cholesteatoma. There were 6 males (31.6%) and 13 females (68.4%), with a mean age of 55.9 (±19.8) years. SAC had high incidence in elder women compared with primary cholesteatoma. However, in only 2 cases, SAC was seen in children who had a history of insertion of a tympanic ventilation tube. We indicated the history of surgery as one of risk factors of SAC. Based on the site and pattern of invasion of the tympanic membrane (TM) epidermis, the cholesteatoma was classified into two types. The types were the perforation type where the epidermis invaded from the edge of the perforation, and the malleus manubrium type where the epidermis invaded from around the malleus manubrium to the promontory. The TM perforation was smaller in size in the perforation type compared with the malleus manubrium type. The extent of cholesteatoma invasion and destruction of the surrounding tissues were severe in the malleus manubrium type. The canal wall down tympanoplasty with a canal reconstruction procedure was adopted in all cases. The postoperative hearing improvement rate was 83.3% in the perforation type and 88.9% in the malleus manubrium type. There were no cases of recurrence of the cholesteatoma. The pathogenesis of SAC still remains unknown, which is clearly different from that of other types of cholesteatoma, so it is important to elucidate the mechanisms.
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  • A Case of Actinomycosis of the Maxillary Sinus Secondary to Foreign Bodies
    Shigetoshi Yoda, Hisaki Fukushima, Tamotsu Harada
    2016 Volume 109 Issue 5 Pages 321-326
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.321
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    We report a case of actinomycosis of the maxillary sinus secondary to foreign bodies. A 49-year-old woman was referred to our hospital for maxillary sinusitis with foreign bodies. A plain x-ray and CT showed evidence of left maxillary sinusitis with linear radiopaque shadows. We therefore performed endoscopic sinus surgery, and fungus-like lesions and foreign bodies were removed from the maxillary sinus. The removed foreign bodies were identified as pieces of the root canal filling agent called gutta-percha point. Histopathological examination revealed the presence of actinomyces. We thought that the foreign bodies were accidentally inserted into the maxillary sinus during dental treatment. The patient had a good postoperative course and has been followed up for 18 months after the surgery. In a patient presenting with radiologic evidence of unilateral paranasal sinusitis, actinomycotic sinusitis as well as fungal sinusitis should be suspected. In most cases of foreign bodies in the maxillary sinus, the foreign body is dental material. It is important to perform a detailed medical examination and to consult a dentist.
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  • A Case of an Elongated Styloid Process Resected with Navigation Guide
    Ayako Suzuki, Shunsuke Miyamoto, Meijin Nakayama, Makito Okamoto
    2016 Volume 109 Issue 5 Pages 327-331
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.327
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    We carried out successful resection of an elongated styloid process under the guideance of a navigation system. A 58-year-old man presented to us with a 2-year history of an annoying sensation in the throat, otalgia, and left-sided headache. A head CT revealed elongated styloid processes (35 mm in length) on both side. We attempted treatment by navigation-guided transoral resection under general anesthesia.
    Left tonsillectomy was performed first. The tip of the styloid process was not palpable through the tonsillar fossa wound, whereas it was easily identifiable by the navigation system. The process was resected to a length of 5 mm. The patient’s symptoms began to improve soon after the resection and resolved completely by 14 days after the surgery.
    The advantages of the transoral approach are the limited invasiveness and avoidance of a scar in the neck. The disadvantage is the difficulty of identifying the tip of the styloid process due to the anatomical complexity in the field of surgery. We confirmed that the use of a navigation system is useful to locate the target process with minimal navigation errors.
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  • Two Cases of Nasal and Paranasal Verrucous Carcinoma
    Yousuke Takemoto, Yoshinobu Hirose, Yousuke Okinaka, Takefumi Mikuriya ...
    2016 Volume 109 Issue 5 Pages 333-342
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.333
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    Verrucous carcinoma originating from various sites has been reported since Ackerman first reported an intraoral case in 1948. Histologically, the tumor is composed of atypical low squamous epithelium showing papillary growth, with strong cornification; in regard to the differentiation grade, the tumor is a subtype of well differentiated squamous cell carcinoma. There are scarce reports from foreign countries of verrucous carcinoma arising in the rhinosinus. Extensive resection is necessary, but it is said to be generally associated with a good prognosis. There are many reports recommending against the use of radiotherapy as the treatment modality of first choice, because local control is insufficient and radiotherapy is associated with a high risk of anaplastic transformation of the tumor.
    We encountered two cases of verrucous carcinoma of the rhinosinus. Case 1 was a 44-year-old woman with verrucous carcinoma of the left frontal sinus, complicated by a brain abscess. Case 2 was a 78-year-old woman with verrucous carcinoma (T4aN0M0 Stage IVa) of the left nasal cavity, who was treated by radiation plus cetuximab therapy. This verrucous carcinoma showed strong EGFR expression, therefore, cetuximab was effective. There is a case following fatal course in verrucous carcinoma, and it is necessary to pay attention.
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  • A Case of External Jugular Venous Aneurysm
    Tetsuro Kobayashi, Takashi Matsuzuka, Shuji Yokoyama, Yukio Nomoto, Mi ...
    2016 Volume 109 Issue 5 Pages 343-347
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.343
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    We herein on report a case of a resected thrombosed venous aneurysm in the external jugular vein of an 81-year-old woman who noticed swelling of a soft mass with no pain in the left side of her neck. Physical and computed tomography findings did not suggest a thrombosed venous aneurysm. However, at a 3-month follow-up, the woman complained of pain in the mass, and magnetic resonance imaging and ultrasonography findings suggested a thrombosed venous aneurysm. Complete surgical resection under general anesthesia was performed successfully with no complications. Histopathologically, the aneurysm had thrombosed. The postoperative course has remained uneventful. We consider a thrombosed venous aneurysm in the external jugular vein merits aggressive surgical indications. Even if a venous a neurysm is not thrombosed at the time of its identification, regular follow-up is important, taking the possibility of thrombus formation occurring in the future.
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Original articles
  • Histopathological Investigation of Nuclear Y-box Binding Protein-1 Expression in Salivary Gland Carcinoma
    Hiroyuki Mihashi
    2016 Volume 109 Issue 5 Pages 349-359
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.349
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    Histopathological diagnosis of salivary gland carcinoma is relatively difficult because of the low frequency and variety of histopathological types of this cancer. There is at present no effective immunohistochemically identifiable prognostic marker in cases of salivary gland carcinoma. Since nuclear expression of Y-box binding protein-1 (YB-1) is known to be correlated with the tumor aggressiveness and poor prognosis in various types of cancers, this study was aimed at investigating the relationship between the expression of YB-1 and other relevant proteins (androgen receptor (AR), epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor type 2 (HER2)) and the histopathological grade, clinical parameters and prognostic factors in patients with salivary gland carcinoma.
    Immunohistochemistry was performed to evaluate the expression of YB-1, AR, EGFR and HER2 proteins in 66 cases of salivary gland carcinoma. The histopathological types included salivary duct carcinoma (n=37), mucoepidermoid carcinoma (n=24) and adenocarcinoma not otherwise specified (NOS) (n=5).
    The expression rate of YB-1 protein was 83.7% in salivary duct carcinoma and 80% in adenocarcinoma NOS. The expression of YB-1 and HER2 were correlated with the presence of lymph node and distant metastasis (p<0.05). AR expression was correlated with the presence of lymph node metastasis (p<0.05). Using univariate survival analysis, YB-1 and HER2 expressions were identified as being correlated with the overall and disease-free survival rates (p<0.05). Furthermore AR expression was identified as being correlated with the disease-free survival rate (p<0.05).
    Nuclear expression of YB-1 in salivary gland carcinomas appears to be useful for the histopathological diagnosis of malignancy. Into the clinical significance of immunohistochemistry for AR and HER2 expressions, nuclear YB-1 expression appears to be a prognostic factor in cases of salivary gland carcinoma.
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Original articles
  • A Nystagmus and Head-position Recording System Using a USB Infrared Camera and a Motion Sensor Device
    Tatsuaki Kuroda, Kazuhiro Kuroda
    2016 Volume 109 Issue 5 Pages 361-367
    Published: 2016
    Released on J-STAGE: May 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.361
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    In a nystagmus test under an infrared camera, nystagmus images are not only observed on monitors but also stored in video devices, etc. When they are saved as video images, it is very important to find a way to record the information of the head positions on the video.
    We developed a videonystagmography system with head-position recording embedded in it: a USB infrared camera and a motion sensor device are attached to a pair of goggles made by a 3D printer and then the goggles are connected to a computer with a USB cable: the data generated by the sensor create head animation which is correlated with the nystagmus images using the software that we developed.
    Herein we report on the system in our clinic which is much lighter in weight and significantly more portable than the existing head-position recording system produced by medical equipment manufacturers because no power supply is required if it is used with a portable computer.
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Technical notes
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