Two main factors are considered to be involved in the pathogenesis of sinusitis: anatomical abnormalities of the human paranasal sinuses, and factors predisposing to inflammation. Inflammation is usually induced by bacterial infections, virus infections or allergic diseases, influenced by the patient and environmental backgrounds. The major causes of inflammation in Japan used to be bacterial and virus infections, manifesting as typical purulent chronic sinusitis. In recent decades, however, eosinophilic chronic rhinosinusitis (ECRS) has come to be identified as the main cause of sinusitis, and it is known to be refractory to treatment.
Several pathogenetic mechanisms underlying eosinophilic inflammation have been proposed until date, including a possible relation with protease production from Alternaria, super-antigens released from Staphylococcus aureus, local allergic inflammation, and autoimmune responses, including overproduction of IgG4. Gastric acid reflux has also been reported as another cause of persistent sinus inflammation. So far, the correlation between chronic sinusitis and gastric acid reflux has mainly been pointed out from several epidemiological surveys. Some of the suggested mechanisms underlying the development of sinusitis secondary to gastric acid reflux are direct injury of the nasal epithelial cells by the gastric acid contents, Helicobacter pylori colonization or infection of the nasal mucosa, and factors related to vagus nerve reflexes. A series of our studies had revealed that gastric acid stimulation induced interleukin-33 production in the nasal mucosa. A relatively higher prevalence of Helicobacter pylori colonization of the ethmoid sinus mucosa has been reported in chronic sinusitis patients. The clinical effectiveness of anti-reflux therapy using proton pomp inhibitors has also been reported in some of these cases. These results imply the existence of a possible relation between gastric acid reflux and the occurrence of chronic sinusitis. Results of further studies are awaited to obtain a consensus on the causal association between chronic sinusitis and gastric acid reflux.
Congenital hemophilia is well known, but acquired hemophilia caused by autoimmune disorder is rare. We treated a 76-year-old woman with a hematoma in her soft palate and hypopharynx. The patient visited the hospital complaining of dysphagia and was found to have a hematoma in the throat. As a hematoma in this position can be extremely risky, we performed tracheostomy and obtained a biopsy specimen from the palate. The biopsy revealed no evidence of tumor, but blood examination revealed a coagulation disorder; the patient also had a large hematoma in her right buttock. On the basis of these findings, we diagnosed the patient as having acquired hemophilia A and started her on treatment with coagulation factor VIII. As enough response was not seen to this treatment, we added prednisolone and cyclophosphamide. With this treatment, the hematomas gradually resolved and we could close her tracheal stoma. Patients with acquired hemophilia are prone to repeated and severe bleeding, and severe bleeding or hematoma in the throat carries the risk of suffocation. Therefore, we should consider the possibility of hemophilia if severe hematoma formation is seen in the elderly.
Spontaneous tonsillar hemorrhage (STH) is a rare occurrence, and mainly occurs as a complication of acute tonsillitis. We report a case of peritonsillar abscess accompanied by STH. The patient presented with oral hemorrhage and dyspnea. Computed tomography revealed air density around the tonsils on both sides. In this case, the tonsillar bleeding did not need any intervention, and the peritonsillar abscess was successfully treated by incision and drainage and antibiotic plus steroid administration. STH should be managed by appropriate control of bleeding and prompt treatment of the tonsillar inflammation.
Cases of laryngeal foreign bodies are rarely encountered in clinical practice, and the appropriate management strategy needs to be carefully considered in each case. We encountered a pediatric patient with a laryngeal foreign body and report this case herein, together with a review of the relevant literature. The patient was a 10-month-old boy. His family noticed an abnormal breathing sound and visited a nearby doctor. As a preliminary examination revealed a foreign body under the glottis, the infant was transferred to the emergency room of our hospital. At arrival at our hospital, he was fully consious, and had no hoarseness or cough. Fiberoptic laryngoscopic examination confirmed the presence of the foreign body under the glottis, therefore, we carried out urgent surgery for removal of the foreign body on the same day, under general anesthesia and oxygen supplementation via a face mask. A Jackson’s direct laryngoscope, and a foreign body forceps for a bronchoscope made by STORZ were used for the foreign body removal. The foreign body was a star-shaped plastic toy, about 1 cm in diameter. Edema of the subglottis was expected, therefore, endotracheal intubation was performed after the foreign body removal. Extubation could be performed on day 5 after the surgery. Based on the management strategy adopted for our case and previous reports, we examined the type of anesthesia, method of extraction and need for tracheotomy in patients with a laryngeal foreign body, and we summarize the management of cases of laryngeal foreign body.
We report a rare case of bilateral pleomorphic adenoma of the parapharyngeal spaces. A 45-year-old male patient was referred to Tenri Hospital with a slowly growing mass in the right parotid region. Contrast-enhanced MRI revealed large, hypervascular masses in the parapharyngeal spaces of both sides. Fine needle aspiration cytology from the right-sided lesion showed no evidence of malignancy, however we could not confirm the diagnosis.
After selective embolization of the major feeding vessels, the tumors of either side were enucleated via the cervical approach. The patient developed no significant complications that could be potentially problematic clinically, including facial paralysis or dysphagia. Histopathologically, all the tumor lesions were diagnosed as pleomorphic adenoma. Bilateral pleomorphic adenoma of the parapharyngeal spaces is extremely rare and has been scarcely reported in the literature.
Thyroid tissue in the cervical lymph nodes without a history of malignant thyroid tumor is rarely encountered, and when detected, it is usually interpreted as ectopic thyroid tissue. We report a case in which thyroid tissue was found in numerous cervical lymph nodes. Thyroid cancer and cervical lymph node metastasis were suspected and hemithyroidectomy with neck dissection was performed. No histopathological evidence of malignancy was found in either the excised thyroid gland or lymph nodes.
Finally, we diagnosed the case as adenomatous goiter with metastasis to the cervical lymph nodes.
We believe that the patient needs to be closely followed up for any evidence of malignancy, and that if the patient develops further lymphadenopathy, etc., in addition to neck dissection, it would also be necessary to consider completion total thyroidectomy and iodine therapy.
In recent years, chemotherapy has become important for the treatment of head and neck cancer. Hepatitis B virus (HBV) reactivation is a serious complication of chemotherapy, which can lead to fulminant liver failure and even death.
We report the case of a 70-year-old man with oropharyngeal carcinoma and skin metastasis.
He was administered an antiviral agent for the prevention of HBV reactivation during chemotherapy. His HBV-DNA level was undetectable during palliative biochemotherapy and concurrent chemoradiotherapy (CCRT).
However, subsequently, during chemotherapy with TS-1, his HBV-DNA level increased because of his poor adherence to the antiviral medication. After his antiviral treatment was switched from entecavir to tenofovir, his HBV-DNA level became undetectable again. Finally, he died of his primary disease 27 months after his first visit to our hospital. We would like to underscore the importance of consulting with hepatologists for antiviral drug therapy for the prevention of HBV reaction.
In conclusion, otolaryngologists should be aware that antiviral therapy for prophylaxis is required in hepatitis B surface antigen (HBsAg)-positive patients and that HBV reactivation can occur even in HBsAg-negative patients.
A 29-year-old male was admitted to our hospital with persistent high fever. Examination revealed painful swollen cervical lymph nodes. Laboratory tests revealed bicytopenia, coagulopathy, and elevated serum lactate dehydrogenase and ferritin levels. Bone marrow aspiration revealed hemophagocytosis; therefore, the patient was diagnosed as having hemophagocytic syndrome (HPS). Findings of fine-needle aspiration biopsy suggested the diagnosis of malignant lymphoma. On day 6 after admission, progression of bicytopenia was observed. Laboratory examination revealed a white blood cell count of 1600/μl and platelet count of 5000/μl. Lymph node biopsy was performed to identify the cause of the HPS, and histopathological examination revealed features consistent with subacute necrotizing lymphadenitis (SNL), also known as Kikuchi-Fujimoto disease (KFD). Steroid pulse therapy was initiated for HPS on the same day as the lymph node biopsy. The patient’s clinical symptoms resolved within 2 weeks. Although the prognosis of KFD is generally good, with resolution within approximately 1–3 months with symptomatic treatment, KFD can occasionally be fatal. We encountered a rare case of KFD that was complicated by HPS. This case highlights the need to bear in mind the diagnosis of KFD as one of the causes of HPS and that lymph node biopsy should be rapidly performed in patients in poor general condition.
Sarcopenia, defined as low muscle mass and low muscle strength, is known as a predictor of survival and as a risk factor for postoperative complications in patients with gastrointestinal cancer. However, the clinical significance of sarcopenia in patients with head and neck cancer has not yet been clarified. Bioelectrical impedance analysis (BIA) is a simple method for the measurement of skeletal muscle mass. In this study, we evaluated the skeletal muscle mass in 50 patients with head and neck cancer by BIA. Of the 50 patients, 25 (50.0%) were judged as having sarcopenia. The relationship between sarcopenia and the complications of chemoradiotherapy were analyzed. Significant differences in the frequency of renal function impairment (P=0.005) and radiation dermatitis (P=0.019) were recognized between the sarcopenia group and the non-sarcopenia group. In this study, we showed that sarcopenia occurs at a prevalence in head and neck cancer patients, and also that sarcopenia is associated with the risk of development of treatment complications in these patients.
Introduction: Papillary thyroid carcinoma has a relatively good prognosis among malignant tumors of the thyroid. Therefore, a “wait and see” strategy is often adopted for patients micropapillary thyroid carcinoma. On the other hand, papillary thyroid carcinoma patients with N1b or M1 disease are known to show a poor prognosis. Here, we investigated the differences in the characteristics between papillary thyroid microcarcinoma patients with and without N1b metastatic nodes/distant metastases, in order to identify the risk factors for metastasis.
Method: The retrospective study was performed in patients with thyroid microcarcinoma who were treated at the Kobe City Medical Center General Hospital from 2007 to 2017. The characteristics of the patients with thyroid microcarcinoma who were classified as having N1b or M1 disease (high-risk group) were compared with those of patients with the same cancer classified as having N0, N1a, M0 disease (low-risk group).
Result: A total of 65 patients were enrolled in this study, and 12 were classified into the high-risk group, and 53 were classified into the low-risk group. The proportion of males was significantly higher in the high-risk group than in the low-risk group. There were no statistically significant differences in the distribution of the sites of the tumors, the ultrasonographic findings, or the frequency of the presence of multiple carcinomas. Although three patients died due to other causes, there were no patients who died due to the papillary thyroid carcinoma.
Conclusion: No significant predictors for classifying papillary thyroid microcarcinoma patients into the high-risk group were identified in this study. However, our findings suggested that male patients with papillary thyroid microcarcinoma require more careful follow-up as compared to female patients with this cancer.