Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 109, Issue 6
Displaying 1-13 of 13 articles from this issue
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Editorial
  • Oropharyngeal Cancer and HPV
    Hisayuki Kato, Kensei Naito
    2016 Volume 109 Issue 6 Pages 371-381
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.371
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    At present, there are no high-impact biomarkers for deciding the course of treatment in patients with head and neck cancer. While smoking and alcohol abuse are among the most common risk factors for head and neck cancer, in the last decade, the human papillomavirus (HPV) has also been implicated in oropharyngeal carcinogenesis. HPV-related oropharyngeal cancer (OPC) is reported to be associated with a better prognosis and lower relapse rate, with increased sensitivity to both radiotherapy and chemotherapy, than HPV-unrelated OPC. However, it is mentioned in the NCCN guideline that the results of HPV testing should not change management decisions in patients with head and neck cancer, except in the context of a clinical trial. Several phase III clinical trials are currently underway to determine whether treatment can be de-intensified by replacing cisplatin with cetuximab in patients diagnosed as having HPV-related OPC. We present an overview of the current state of HPV as a biomarker of HPV-related OPC.
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Original articles
  • Three Cases of Aberrant Internal Carotid Arteries in the Middle Ear
    Yui Suematsu, Yoshihiro Noguchi, Yurika Kimura, Yoshiyuki Kawashima
    2016 Volume 109 Issue 6 Pages 385-391
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.385
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    The internal carotid artery (ICA) that runs laterally to the lateral aspect of the vestibule is defined as an aberrant ICA. Aberrant ICAs in the middle ear are relatively rare, however, it is important for otolaryngologists to recognize the entity, since common procedures, such as myringotomy, can lead to serious complications. We report herein on three cases with an aberrant ICA in the middle ear.
    In Case 1, a 49-year-old female presenting with hearing loss (HL) and pulsatile tinnitus (PT) in her left ear was referred to our hospital with an initial diagnosis of a glomus tumor. Otoscopic examination revealed a reddish pulsatile mass behind the anteroinferior quadrant (AIQ) of the tympanic membrane (TM). A pure-tone audiogram showed bilateral mild mixed HL. In Case 2, a 64-year-old male presented to our hospital with PT in his right ear. Otoscopic examination revealed a reddish mass behind the AIQ of the TM. Her audiogram showed sloping sensorineural HL in the right ear, which was considered to be presbycusis. In Case 3, a 31-year-old female presenting with bilateral HL and PT in her left ear was referred to our hospital. Otoscopic examination revealed a reddish pulsatile mass behind the AIQ of the TM. Her audiogram showed bilateral mixed HL. An auditory brainstem response test and Bekesy audiogram indicated the presence of functional deafness. In all cases, computed tomography (CT) scans of the temporal bone showed characteristic findings of an aberrant ICA: 1) absence of the vertical carotid canal; 2) enlargement of the inferior tympanic canaliculus; 3) an aberrant course of the artery through the hypotympanum and 4) dehiscence of the carotid plate through which the artery enters the horizontal carotid canal.
    A careful otoscopic examination should be performed to evaluate patients with PT. CT scans of the temporal bone can provide a definitive diagnosis of an aberrant ICA in the middle ear.
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  • A Case of Foreign Body in the Ethmoid Sinus Diagnosed Nine Years after the Dental Implant Surgery
    Shizuka Takaishi, Ryo Kanamura, Chisa Fujimoto, Koichi Tamura, Koji Ab ...
    2016 Volume 109 Issue 6 Pages 393-397
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.393
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    Dental implant surgery is carried out in edentulous patients to fix the denture on the foundation of a dental implant body embedded in the maxilla. This procedure has become popular over the last 20 years, and one of the complications is the intrusion of the dental implant body into the paranasal sinuses.
    Herein, we report the case of a 64-year-old man in whom a dental implant body was found in the ethmoid sinus nine years after the dental implant surgery. The patient complained of discomfort in the right cheek and ipsilateral purulent rhinorrhea. CT revealed a shadow extending from the maxillary sinus to the ethmoid sinus on the right side, representing the dental implant body in the right ethmoid sinus. It is believed that the dental implant body which was fixed on the maxilla had intruded into the maxillary sinus and remained there for a long period, and then advanced into the ethmoid sinus due to chronic sinusitis. Finally, the dental implant body was removed by endoscopic sinus surgery.
    It is thought that dental implant interventions will increase in the future, and ENT surgeons need to increase their awareness to prevent complications related to these interventions.
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  • An Elderly Case with an Arteriovenous Malformation in the Neck Region Requiring Suture to Control Bleeding at the Base of the Tongue
    Takahiro Kimura, Kazuhiko Nario, Ichiro Ota, Toshiaki Yamanaka, Tadash ...
    2016 Volume 109 Issue 6 Pages 399-403
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.399
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    Arteriovenous malformations (AVMs) in the head and neck region pose therapeutic challenges. We report the case of an elderly patient in whom bleeding from an AVM at the base of the tongue was controlled by a figure-of-eight suture.
    An 87-year-old woman suffering from pain in her mandible and oral bleeding was referred to the oral surgery department. She was diagnosed as having AVM based on the findings of enhanced computed tomography. The bleeding subsided without treatment.
    Eight months later, the patient developed recurrent re-bleeding from the oral cavity and was referred to our department. She presented with expanded blood vessels in her mandible, neck and oral cavity. Endoscopy revealed exposed vessels at the base of the tongue. The vessels were considered to be the cause of the bleeding. The bleeding again subsided spontaneously. However, 6 days later, the patient suddenly vomited large amounts of blood. She was transported by ambulance to our hospital. Angiography showed that the AVM was supported by the bilateral facial and lingual arteries. We decided against interventional therapy as we could not advance the catheter through the meandering blood vessels. Eventually, the bleeding subsided spontaneously and the patient was discharged.
    However, 25 days after her first visit to our department, the bleeding recurred. We decided to undertake surgical intervention in the operation room under general anesthesia. The bleeding point was grasped by mosquito forceps and was occluded with a figure-of-eight suture using 3-0 PDS II® under endoscopic guidance. Tracheotomy was performed to prevent suffocation in the event of a large amount of oral re-bleeding. Fortunately, no persistent bleeding or angiogenesis was noted. At three months after the operation, the hemoglobin value remains normal.
    Under limited circumstances, suture hemostasis (finger-of-eight suture) is useful in the treatment of bleeding from an AVM in the head and neck region.
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  • A Case of Subacute Pharyngo-laryngeal Swelling after Accidental Ingestion of Dimethylammonium Chloride
    Hironori Akizuki, Hidetaka Iwasaki, Noriaki Takeda
    2016 Volume 109 Issue 6 Pages 405-409
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.405
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    An 88-year-old woman put dodecyl dimethylammonium chloride (quaternary ammonium salt) in her mouth by accident. She spat it out immediately without swallowing, but thereafter, she developed severe oral pain. Twelve hours later, she also developed dyspnea and visited our hospital. At that time, laryngoscopy revealed severe pharyngo-laryngeal swelling with erosion of the oro-pharyngo-laryngeal mucosa. Emergent tracheotomy was performed. After two weeks, a repeat laryngoscopy revealed improvement of the pharyngo-laryngeal swelling. The patient eventually recovered completely without any complications. We report the progression of the pharyngo-laryngeal swelling as examined by laryngoscopy.
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  • A Case of Riedel’s Thyroiditis
    Takuya Sasaki, Kan Kishibe, Tatsuya Hayashi, Yasuaki Harabuchi
    2016 Volume 109 Issue 6 Pages 411-417
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.411
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    Riedel’s thyroiditis is a rare disease of unknown etiology, mainly affecting middle-aged to old females. The condition is characterized by an aggressive fibrosis partly or totally replacing the normal thyroid gland tissue. Herein, we report a case of Riedel’s thyroiditis. A 62-year-old woman presented to us with a mass on the left side of the neck and was admitted to the hospital. On palpation, the mass, 40 mm in diameter, was found to be very hard in consistency and not freely mobile. CT revealed a large mass lesion in the left lobe of the thyroid. At operation, the mass was very hard to palpation and adherent to the trachea and esophagus. Histopathological examination revealed fibrous invasion of the connective tissue and organs surrounding the thyroid gland, and based on the findings, we made the diagnosis of Riedel’s thyroiditis. After surgery, the patient has had an uneventful clinical course.
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  • A Case of Anaplastic Thyroid Carcinoma Responded to the Chemotherapy with Carboplatin and Paclitaxel
    Ryo Ikoma, Mariko Kobayashi, Nobuhiko Oridate
    2016 Volume 109 Issue 6 Pages 419-424
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.419
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    Anaplastic thyroid carcinoma (ATC) represents only 1–2% of all thyroid malignancies, but it carries an extremely poor prognosis. The reported median survival time is 3–9 months, and very few ATC patients survive for more than 1 year after the diagnosis. We encountered an 82-year-old female patient diagnosed as having ATC who survived for 13 months. Right hemithyroidectomy with D1 dissection was undertaken 9 days after the patient presented to us. The histopathological diagnosis was ATC, T4bN0. Radiation therapy to the whole neck was administered. Because metastasis to the lung was detected four weeks after the surgery, the patient received chemotherapy with monthly CBDCA and weekly PTX. Although partial response was observed, the chemotherapy was discontinued due to the development of myelosuppression. The patient died of respiratory failure 13 months after the surgery. Effective therapeutic mesures for ATC are needed.
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  • Five Cases of Adenoid Cystic Carcinoma of the External Ear Canal
    Masao Noda, Hisashi Sugimoto, Miyako Hatano, Makoto Ito, Tomokazu Yosh ...
    2016 Volume 109 Issue 6 Pages 425-432
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.425
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    Among head and neck tumors, adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) is very rare. However, this disease needs to be treated early and completely because of its characteristics, including its tendency to recur locally, its location near important organs, its low sensitivity to radiation, etc.
    We evaluated the data of 5 patients with ACC of the EAC who were treated surgically between 2009 and 2015.
    The average age was 60.2 years, and 4 of the patients were male. At the first examination, 80% complained of having suffered from otalgia for more than a year. In 4 cases, the tumor stage according to the TNM classification was T4 and the histopathological grade according to Szanto’s classification was grade 2 or 3. In 3 cases, we performed lateral temporal bone resection; the surgical margin was positive in two of these cases and negative in one case. On the other hand, in 2 cases, we performed expanded extraction, including parotidectomy, and obtained negative surgical margins in both.
    Considering the results, early differential diagnosis from inflammation is needed, and expanded extraction with a safety margin should be considered for radical treatment.
    Age and comorbidity should be considered while determining the therapeutic strategy and effective perioperative treatment also needs to be established in the future.
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  • A Case of Severe Subcutaneous and Mediastinal Emphysema after Tracheotomy
    Kaho Momiyama, Atsuko Maki, Koichi Kano, Makito Okamoto
    2016 Volume 109 Issue 6 Pages 433-437
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.433
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    A 36-year-old man who presented with the chief complaint of sore throat was diagnosed as having laryngeal edema due to acute tonsillitis. Emergency tracheotomy was performed to establish an airway, and antibiotic therapy was prescribed with bed rest. Emphysema was observed just after the operation because the patient had a very strong cough reflex, and a subsequent chest x-ray confirmed the presence of air around the greater pectoral muscles and expansion of the mediastinum. A few days later, the laryngeal edema and the subcutaneous emphysema improved, and the tracheal cannula was removed. However, the emphysema recurred in spite of continued treatment, gradually spreading out from his face to the chest. The chest circumference increased to 129 cm, therefore, we reinserted the tracheal cannula to prevent air from penetrating into the subcutaneous tissues. On the 29th postoperative day, a CT scan revealed disappearance of the mediastinal emphysema without relapse.
    Although tracheotomy for upper airway obstruction caused by acute inflammatory diseases is one of the most basic procedures for otolaryngologists, it is crucial for otolaryngologists to bear in mind the possibility of occurrence of severe complications when performing tracheotomy.
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Original articles
  • Comparison of Music Perception between Hearing-aid Modes in Normal Subjects and Subjects with Hearing Impairment
    Masayo Kamei, Hiroaki Sato, Youko Odashima
    2016 Volume 109 Issue 6 Pages 439-444
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.439
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    The aim of this study was to evaluate the differences in music perception in subjects with hearing aids depending on the mode in which the hearing-aid was set. In all, 11 subjects with normal hearing and 6 with hearing impairment were enrolled in this study. The hearing aid was set in two modes: a mode beneficial for speech perception (mode A), and a mode beneficial for music perception (mode B). Perception of music and the speech intelligibility through the hearing aid was examined in the subjects with normal hearing. Subjects with hearing impairment were tested for their music perception with their own hearing aids set in the usual mode.
    In the subjects with normal hearing, the perception of music was more positive with the hearing aid set in mode B as compared to that set in mode A. Factor analysis revealed high regression factor scores for “beautiful and powerful” in mode B, while the average score for speech intelligibility was significantly decreased in this mode. On the other hand, in subjects with hearing impairment, music perception was better in bilateral long term hearing-aid users than in subjects who scarcely used hearing aids.
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Original articles
  • Maobushisaishinto for Watery Rhinorrhea in Geriatric Patients
    Takaaki Kimura
    2016 Volume 109 Issue 6 Pages 445-448
    Published: 2016
    Released on J-STAGE: June 01, 2016
    DOIhttps://doi.org/10.5631/jibirin.109.445
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    Geriatric patients often exhibit watery rhinorrhea with rapid temperature changes or during intake of meals. The condition, sometimes called “old man’s drip,” is frequently resistant to treatment.
    We prescribed Maobushisaishinto to 19 geriatric patients with watery rhinorrhea not associated with sneezing or nasal obstruction who consulted our clinic, and the preparation proved effective in 84% of the cases. Taking into consideration the age of the patients and presence of underlying diseases, we varied the number of daily doses from one to three times. Good effect was obtained even in patients receiving once-daily administration in the morning.
    Maobushisaishinto is thought to be one of the useful treatments for watery rhinorrhea in geriatric patients.
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