Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
Volume 109, Issue 7
Displaying 1-12 of 12 articles from this issue
Editorial
  • Yoshimasa Tsuchiya, Hiromi Ueda
    2016 Volume 109 Issue 7 Pages 453-460
    Published: 2016
    Released on J-STAGE: July 01, 2016
    JOURNAL RESTRICTED ACCESS
    Congenital cholesteatomas (CCs) are white mass lesions in the middle ear arising from keratinizing squamous epithelium behind the intact tympanic membrane. CCs are characterized by invasive growth and osteolytic activity. The pathogenesis of CCs is unclear. CCs are estimated to account for 1–5% of all middle ear cholesteatomas. Along with improvement of office-based tools used for otologic examinations (i.e., otomicroscopy, lightening, and photodocumentation), detection of CCs among otolaryngologists and pediatricians has increased in recent years. To date, no conservative treatment for CCs has proven to be effective, except for treatment of secondary infection. The only effective treatment for CCs is therefore surgery. CCs are some surgical techniques, for example, intact canal wall mastoidectomy and canal wall down mastoidectomy using microscopy, and transcanal endoscopic ear surgery. Postoperative issues related to the effects of deafness and recurrence can have social, educational, and behavioral consequences.
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Clinical color photographs
Original articles
  • Eriko Yanagi, Masaaki Kouchi, Nobuaki Miyahara
    2016 Volume 109 Issue 7 Pages 465-468
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    Herein, we report the case of a 75-year-old woman diagnosed as having the neurovascular compression syndrome associated with intermittent hemifacial spasm and simultaneous tinnitus.
    Magnetic resonance imaging of the head revealed compression of the left seventh and eighth cranial nerves by an expanded vertebral artery, and based on these findings, the diagnosis of neurovascular compression syndrome was made. The left hemifacial spasm was induced by compression of the seventh cranial nerve. The patient did not complain of vertigo or hearing loss, but exhibited tinnitus with mimetic words on the left side, suggesting that the tinnitus was induced by abnormal contraction of the stapedial muscle as a result of stimulation of the stapedius nerve, a branch of the seventh cranial nerve.
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  • Kentaro Ohashi, Hajime Sano, Makito Okamoto
    2016 Volume 109 Issue 7 Pages 469-473
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    The large vestibular aqueduct syndrome is a congenital disease characterized by inner ear malformation. The major symptom of this disease is difficulty in hearing and dizziness. According to a previous study, the hearing level gradually became worse with head trauma or strenuous exercise. However, several cases, hearing deterioration was not associated with any obvious events. There are few reports of long-term observation of cases of large vestibular aqueduct syndrome. We diagnosed 10 cases of this disease at our hospital and were able to follow up 3 of these cases for over ten years. The aim of this study was to investigate the clinical symptoms, especially by healing study and to discuss the characteristics of this disease by long-term observation.
    As results, the cases with repeated and acute decreas in hearing level were not induced head trauma. The hearing level in most cases decreased gradually during the long-term observation, even though it recovered each time with acute medications.
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  • Ryouta Mihashi, Yoshihisa Ueda, Hiroyuki Kamimura, Kei Nagata, Shun-ic ...
    2016 Volume 109 Issue 7 Pages 475-481
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    Herein, we report the results of clinical evaluation and surgical treatment of a case of glomus tympanicum tumor. The patient was a 63-year-old woman who presented with a 2-year history of pulsatile tinnitus. Otoscopic examination revealed a reddish and pulsatile mass in the tympanic cavity, and the tumor was diagnosed as a glomus tympanicum tumor based on the otoscopic, CT and MRI findings. Preoperative embolization was performed, followed by complete resection of the tumor via a transcanal approach. On preoperative angiography, the inferior tympanic artery was identified as the lone feeding artery, and this artery was occluded with PVA embolization material. There were no complications after the preoperative embolization procedure, and the pulsatile tinnitus disappeared immediately after the embolization. The amount of bleeding was slight.
    Electron-microscopic examination of the resected specimen revealed the presence of neuroendocrine vesicles in the tumor tissue suggestive of catecholamine production by the tumor.
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  • Ayako Kinoshita, Tsunemasa Aiba, Tomoaki Nakano, Gou Uemura
    2016 Volume 109 Issue 7 Pages 483-486
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    The occurrence of benign tumors in the external auditory canal is relatively rare. Whereas reports concerning tumors such as nevus cell nevus, osteomas, papillomas, hemangiomas and adenomas can be noted, there are few reports on pleomorphic adenomas of the external auditory canal in Japan.
    We have experienced one case of pleomorphic adenoma of the external auditory canal. A 42-year-old male visited our hospital with a two-year history of left ear hearing loss. We identified a mass occupying the left external auditory canal consisting of an elastic tumor. Following excision of the tumor under general anesthesia, it was pathologically diagnosed as a ceruminal gland pleomorphic adenoma.
    Pleomorphic adenomas of the external auditory canal have a better prognosis than those of parotid origin, but the possibility also exists that a malignant tumor from the parotid has developed in the external auditory canal. We considered that the first treatment of choice should be an operation.
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  • Satoshi Hara, Shin Ito, Takuo Haruyama, Asami Ito, Takamoto Suzuki, Hi ...
    2016 Volume 109 Issue 7 Pages 487-492
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    Recently, the mortality rate from intracranial complications secondary to bacterial infection of the paranasal sinuses has decreased, because of the availability of effective antibiotic treatment. However, the complications of acute bacterial rhinosinusitis still pose a potentially life-threatening problem. Long-term antibiotic therapy together with prompt endoscopic surgery is considered suitable for the treatment of this disease. Herein, we report the case of a patient who developed intracranial complications secondary to acute rhinosinusitis.
    An 18-year-old male complained of nasal obstruction and purulent nasal discharge. About one month later, he presented at the neurological department with severe frontal headache, high fever and nausea, and was suspected as having acute meningitis. He was immediately hospitalized and treated with antibiotics. Nine days later, the patient developed paresis and sensory disturbance of the left lower extremity. Because computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of paranasal sinus opacification and a subdural soft-density lesion, the patient was referred to the Department of Otolaryngology of our hospital. Endoscopic sinus surgery with surgical drainage of the subdural abscess was performed.
    After the surgical procedure, the headache, paresis and sensory disturbance of the left lower extremity resolved completely. However, 43 days later, lower right quadrantanopsia was observed, and CT revealed recurrence of the abscess in the occipital region. Surgical drainage of the subdural abscess was performed again. After administration of a long course of antibiotics again, the patient was discharged 55 days postoperatively.
    We encountered a case of subdural abscess complicating sinusitis. Both the subdural abscess and sinusitis improved with aggressive antibiotic and surgical treatment, while the neurosurgery department confirmed that there were no signs of neurologic deficits.
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  • Shintaro Sueyoshi, Fumihide Rikimaru, Yuichiro Higaki, Muneyuki Masuda
    2016 Volume 109 Issue 7 Pages 493-499
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    Extramedullary plasmacytomas are rare plasma cell tumors that occur mainly in the head and neck region. We report a case of extramedullary plasmacytoma of the parotid gland. A 32-year-old woman presented to us with the chief complaint of swelling of the right mandibular region. Physical examination and MRI revealed a mass lesion measuring 25×15 mm in the right parotid gland and an enlarged right retropharyngeal node. Fine needle aspiration cytology of the main mass showed the presence of some severely atypical, plasma cell-like cells. For the purpose of definitive diagnosis, a right superficial parotidectomy with preservation of the facial nerve was performed. Histopathological examination of the resected specimen revealed the diagnosis of extramedullary plasmacytoma. Immunohistological studies revealed positive staining of the tumor cells for IgG and the kappa chain of immunoglobulin. There were no abnormalities of the serum immunoglobulin level or serum and urinary protein levels, and no abnormal findings on bone marrow biopsy. Postoperative radiation therapy (intensity modulated radiation therapy: IMRT) was administered at a total dose of 50 Gy to the right parotid gland and retropharyngeal lymph node. According to the literature, extramedullary plasmacytoma often transforms to multiple myeloma after several years or even several decades. Therefore, long-term strict observation after treatment is needed.
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  • Yasuhiro Kise, Hiroki Koizumi, Jun-ichi Ohkubo, Nobusuke Hohchi, Shoko ...
    2016 Volume 109 Issue 7 Pages 501-506
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    Nasopharyngeal cancer is generally difficult to diagnose at an early stage because it is anatomically hard to access, often asymptomatic, and apt to metastasize. We retrospectively analyzed the date of 19 freshly diagnosed cases of nasopharyngeal cancer who were treated at our department between 2001 and 2013. The patients consisted of 15 males and 4 females, and ranged in age from 17 to 77 years, with an average of 62.6 years.
    Our treatment protocol was as follows: For stage I/II cancers: hyperfractionated radiotherapy (1.2 Gy×2/day) to a total of 72 Gy, with concurrent daily carboplatin (25 mg/m2); for stage III/IV cancers: 1–2 courses of induction chemotherapy (docetaxel 60 mg/m2 (day 1), cisplatin 60 mg/m2 (day 1), and 5-fluorouracil 600 mg/m2 (days 1–5)), followed by concurrent chemoradiotherapy as for the stage I/II cancers. Patients with remnant primary tumor received additional radiotherapy with a cyberknife. Patients with remnant disease in the cervical lymph nodes underwent neck dissection if/when they showed complete response of the primary tumor without distant metastasis.
    The subdivision of the primary tumor was the posterosuperior wall in 11 patients (58%) and lateral wall in 8 patients (42%). Two patients had stage I disease, 3 patients had stage II disease, 6 patients had stage III disease, and 8 had stage IV disease. The overall 5-year crude and disease-specific survival rates determined by the Kaplan-Meier method were 49.8% and 69.2%, respectively. The 5-year crude and disease-specific survival rates in each stage were 100%/100% (crude/disease-specific) in patients with stage I disease, 33.3%/50.0% in patients with stage II disease, 50.0%/100% in patients with stage III disease, and 31.3%/46.9% in patients with stage IV disease.
    The survival rate could be improved by early detection of cancers and altering the treatment protocol for advanced cancers.
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  • Yuri Nomura, Maria Masuda, Yukiko Iino
    2016 Volume 109 Issue 7 Pages 507-510
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    A 52-day-old infant with bilateral cervical fistulae originating from the second branchial apparatus was admitted because of left cervical swelling and fever. Computed tomography revealed findings suggestive of infection of the left cervical fistula, and the patient was treated by incision and drainage and administration of intravenous antibiotics. The swelling of the neck subsided by 7 days after the start of treatment and the patient was discharged from the hospital. However, the infection recurred repeatedly, and incision and drainage was performed a total of three times. Frequent incision and drainage to treat cervical fistula infections in infants has been rarely reported. Although general anesthesia in infancy should ideally be avoided, surgery should be considered in infants with frequent infection of cervical fistulae.
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  • Yoshihiro Akazawa, Shigeru Kasugai, Masahiko Fukasawa, Koshi Mikami, M ...
    2016 Volume 109 Issue 7 Pages 511-517
    Published: 2016
    Released on J-STAGE: July 01, 2016
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    Cetuximab plus radiotherapy has been shown to be a useful treatment for locoregionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). At our institute, we have begun to use cetuximab plus radiotherapy for LA-SCCHN in August 2013. In this paper, we report the adverse events of cetuximab plus radiotherapy and the countermeasures adopted by us at our institute. We applied this treatment regimen for 15 patients. The site of the primary lesion were as follows; oropharynx (3 cases), hypopharynx (8 cases), larynx (3 cases), and unknown (1 case). The distribution of the disease stage was as follows; Stage II (5 cases), Stage IVA (8 cases), and Stage IVB (1 case). The treatment was administered in accordance with the protocol in the Bonner trial. The treatment completion rate in the initial period of observation was 66.7%, while the rate improved in the latter part of the observation period. Presumably, the rate improved in the latter part of the treatment period because we adopted measures for management of the adverse effects of radiation dermatitis and oral mucositis. No serious infusion reactions were observed. We observed grade 3 radiation dermatitis in 6 cases, oral mucositis in 5 cases and grade 4 interstitial pneumonia in 1 case. The patients with interstitial pneumonia recovered with steroid pulse therapy, however, the radiation therapy had to be discontinued. Cetuximab plus radiotherapy is a very useful treatment method for squamous cell carcinoma of the head and neck, however, it is associated with a high risk of serious adverse events. Thus, patients should be carefully selected for cetuximab plus radiotherapy.
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