PURPOSE: The hearing level and cognitive function were examined in 174 elderly persons admitted to a nursing care facility using the Auditory Checker (JB electronics.inc, Japan). The Auditory Checker is a screening tool that can evaluate pure-tone hearing level up to 1000 Hz and speech discrimination and sentence understanding; the results are expressed in terms of the auditory cognitive score. The baseline score and the score after one year were compared using a statistical approach. The background factors of the subjects, such as the age, sex, degree of disability, and MMSE-J scores were also evaluated by statistical methods.
RESULTS: The results revealed a significant positive correlation between the auditory cognitive score and the MMSE-J score. Factors such as the age, gender, degree of need for long-term care, presence/absence of brain disease, etc., had no significant influence on the auditory perception.
CONCLUSION: It was useful for the functional screening of hearing acuity and cognitive function in case that had the hearing loss conducted prior to cognito-psycho test batteries. It is useful to conduct functional screening of the hearing acuity and cognitive functions prior to administration of cognito-psycho test batteries in patients with hearing loss. The Auditory Checker is useful for evaluating the hearing ability and auditory perception of elderly people who need long-term care. When evaluating hearing-impaired elderly people whose cognitive function is significantly reduced, it is useful to use the MMSE-J, Barthel Index, motivation score, etc. (VI) It is also desirable to use internationally recognized test batteries. An outline of the test batteries and their application method are outlined. It is an urgent need to establish a screening system for hearing and auditory perception in elderly people.
There have been few reported cases of parasitic infestation of the external auditory canal. We report a case of parasitic tick infestation of the external auditory canal. A 61-year-old female patient visited our hospital after she was bit in the ear by a tick. We sprayed 8% lidocaine and removed it with the mouthparts intact. We identified the tick as Amblyomma testudinarium. In recent years, a tick-mediated infectious disease characterized by severe fever and thrombocytopenia syndrome (SFTS) has drawn attention due to the high mortality rate. We believe that not only local treatment of the bite, but also strict follow-up of the patient’s overall condition is important.
Although epistaxis is a common problem during pregnancy, severe epistaxis necessitating surgical management is rare. Herein, we report 2 cases of severe epistaxis in the absence of any underlying risk factors for hemorrhage during pregnancy.
The first case, a 41-year-old female in the 12th week of pregnancy presented with severe epistaxis of sudden onset. As conventional management failed to control the epistaxis, we performed electrocauterization of the mucosa lining the nasal septum and sphenopalatine foramen under local anesthesia. The epistaxis was successfully controlled by this procedure, and her subsequent pregnancy and delivery were uneventful.
The second case, a 36-year-old woman who was 24 weeks pregnant presented with profuse epistaxis. The epistaxis was not controlled by the insertion of a gauze packing into the nasal cavity and posterior packing with a balloon catheter. Therefore, we performed electrocauterization of the area supplied by the sphenopalatine artery and anterior ethmoidal artery under general anesthesia. The epistaxis was successfully controlled by this surgery, and the woman went on to deliver a healthy baby.
The management options for severe epistaxis should be carefully selected during pregnancy. Early involvement of gynecologists and anesthesiologists is crucial in these cases. We report the management of these cases and present a review of the literature on severe epistaxis during pregnancy.
A 63-year-old woman visited a neighborhood ENT doctor with an approximately 6-month history of blocked nose on the left side. The ENT doctor referred her to our hospital with suspicion of a lesion in the nasopharynx. Nasal endoscopic examination at our hospital revealed a yellow-white to dark-red sessile polypoid lesion with a smooth surface in the left nasopharynx as the cause of the left nasal obstruction.
Contrast-enhanced CT showed absence of any bone destruction associated with the tumor of the left nasopharynx. MRI examination with contrast injection showed possible infiltration of the surrounding soft tissue by the tumor. On PET/CT examination, the maximum SUV was 3.7, and no evidence of metastasis to the cervical lymph nodes or distant metastasis was recognized. The initial biopsy revealed the possibility of hemangiopericytoma, and a second biopsy was performed, which also failed to reveal a definitive diagnosis. Therefore, we performed a third biopsy under local anesthesia to obtain a definitive diagnosis, which confirmed the diagnosis of pleomorphic adenoma. The tumor was resected by nasal endoscopic sinus surgery under general anesthesia 3 weeks after the last biopsy. With the preoperative diagnosis of plemorphic adenoma, the tumor was resected with a sufficient margin owing to the possibility of infiltration of the surrounding soft tissues by the tumor and extracapsular invasion. At present, 3 years after the surgery, the patient remains under follow-up and has shown no evidence of any recurrence of the tumor.
Organized hematoma is defined as a benign tumor containing blood and blood clots. Organized hematomas may be mistaken for malignant tumors, both clinically and radiologically. Correct preoperative diagnosis is important for determining the appropriate therapeutic plan, because organized hematomas are curable by simple surgical resection using a transnasal endoscope.
We report here the case of an 84-year-old woman who presented with the chief complaints of nasal obstruction and cheek swelling on the right side. The pre-contrast computed tomograpy (CT) images before surgery showed a large, expansive soft tissue mass in the right maxillary sinus, with destruction of the bony walls of the maxillary sinus, which prompted us to take measures to rule out the possibility of malignancy. On magnetic resonance imaging (MRI), on the other hand, several masses, well demarcated from the surrounding structures and showing heterogeneous signal intensities were observed on all of the T1-weighted, T2-weighted and Gd-DTPA-enhanced images. In addition, a dark peripheral rim surrounding the lesion was well demonstrated on T2-weighted images, reflecting hemosiderin deposition. Furthermore, the mucous membrane lining the maxillary sinus mucosa was normal and well-enhanced by Gd-DTPA. These MRI findings were consistent with the diagnosis of an organized hematoma. Therefore, we performed endoscopic surgery under the pre-surgical diagnosis of organized hematoma to provide relief from the symptoms and make a definitive diagnosis. At first, a biopsy of the mass was performed with intraoperative rapid diagnosis, which yielded the diagnosis of a benign nasal polyp. Then, all the lesions were safely removed by transnasal endoscopy. The final pathological diagnosis was organized hematoma.
Organized hematomas are relatively rare, however, they could be mistaken for malignant lesions. Therefore, it is important for physicians to be aware of the characteristic MRI findings of organized hematomas, so that inappropriate invasive surgery can be avoided.
Adenomatoid odontogenic tumors are uncommon benign odontogenic lesions.
We treated a 29-year-old pregnant woman with an adenomatoid odontogenic tumor in her left molars. She visited the otolaryngology hospital complaining of left nasal obstruction. Because she was pregnant at that time, a CT was obtained after delivery, which revealed the tumor with many small calcifications in her left maxillary sinus, and the tumor included an impacted tooth. She visited our hospital for operation. First, we performed endoscopic biopsy which revealed the diagnosis of adenomatoid odontogenic tumor. We resected the tumor by making incisions in the canine fossa. Histopathological examination of the resected tumor confirmed the diagnosis of adenomatoid odontogenic tumor. Until now, three years after the surgery, she has shown no evidence of recurrence.
Primary mucinous adenocarcinoma of the salivary glands is a very uncommon tumor and accounts for about 0.1% of all salivary gland tumors. They are characterized by the presence of large pools of extracellular mucin. We report a case of mucinous adenocarcinoma of the hard palate.
A 77-year-old woman presented with a 3-month history of bloody sputum. On physical examination, she showed a submucosal tumor and formation of a small fistula on the posterior aspect of the hard palate on the left side, and discharge of bloody mucus from the fistula.
Computed tomography and magnetic resonance imaging revealed a tumor measuring 2 cm in size with a cystic part in the center and thinning of the hard palate. Biopsy revealed the diagnosis of canalicular adenoma. Initially, the patient did not provide consent for surgery, but since the bloody sputum persisted and a tendency towards increase in the size of the tumor was observed, transoral tumor resection was performed 13 months after the initial examination with the consent of the patient. Microscopically, a cystic lesion containing mucus was found in the vicinity of the minor salivary glands, the cyst wall showed papillary and tubular hyperplasia of the mucous tumor cells with nuclear atypia, and extracapsular invasion was observed; based on the findings, the tumor was diagnosed as mucinous adenocarcinoma of a minor salivary gland. Since the resection margin was positive, partial resection of the left upper jaw including the stump was additionally performed, but no residual tumor was observed. As of 6 months after the additional operation, there was no evidence of recurrence and metastasis.
Mucinous adenocarcinomas are classified as low-grade malignancies and grow slowly in size, as in our case, and are sometimes difficult to distinguish from benign tumors. On the other hand, some reports describe aggressive behaviors of these tumors, such as rapid increase in size, relapse and distant metastasis, and it is necessary to follow-up these patients carefully.
Chemoradiotherapy has become the standard treatment for head and neck squamous cell carcinomas. In this study, we compared the patient background, treatment efficacy, and adverse events between patients treated with two regimens, namely, cisplatin-based chemoradiotherapy (CRT) and cetuximab-based bioradiotherapy (BRT).
Data of a total of 27 patients (17 patients treated with CRT and 10 patients treated with BRT) with advanced oropharyngeal carcinoma were retrospectively reviewed. The BRT group showed a higher mean age, greater degree of renal function impairment, lower hemoglobin level, lower serum albumin level, and a lower lymphocyte count as compared to the CRT group. The 1-year overall survival and disease-free survival rates of the CRT versus BRT group were 93.8% versus 68.6% (p=0.060) and 60.2% versus 57.1% (p=0.776), respectively. The incidence rates of Grade ≥ 3 radiation dermatitis and pharyngeal mucositis were higher in the BRT group as compared to the CRT group. Moreover, all patients of the BRT group showed Grade ≥ 2 hypoalbuminemia.
Our results suggest that the poorer nutritional status and poorer clinical condition of the patients of the BRT group adversely affected the treatment outcome as well as adverse effects in this group, suggesting that selection between the two treatment options should be carefully considered according to individual patients’ conditions.
Thyroglossal duct cyst is an anterior neck mass that arises from the remnants of the thyroglossal duct in the embryonic period and is generally known as a benign cystic mass. However, in rare cases, these cystic tumors show malignant transformation. We report a case of cervical lymph node metastasis in a case of thyroglossal duct remnant carcinoma. The patient was a 54-year-old woman who presented with an 8-year history of an anterior neck mass. At the first examination, ultrasonography revealed a solid mass measuring 13 mm in diameter. She had not returned for a follow-up thereafter, however, the tumor had gradually increased in size over the last two years, and she visited our hospital again. The tumor had increased in size to 35×35×45 mm. CT and MRI imaging revealed a large cystic mass with enhancing solid areas within the mass and two enlarged lymph nodes in the left inferior neck. Preoperative fine-needle aspiration cytology from the anterior neck mass was classified as group V and we made a diagnosis of papillary carcinoma. Excision of the tumor with selective neck dissection on the left side was performed, and until now, 19 months since the surgery, there has been no sign of recurrence. There have been few reports of cervical lymph node metastasis from thyroglossal duct remnant carcinoma, and only 4 cases have been confirmed in Japan. We compared the findings in our case with those in these previously reported cases.
Malignant lymphoma of the thyroid is rare, accounting for only about 2–3% of all malignant thyroid tumors. Individuals with this cancer sometimes present with dyspnea caused by rapid growth of the tumor within a short period, therefore, airway management is of importance in these patients. Differential diagnosis between malignant lymphoma and anaplastic carcinoma (which presents with similar symptoms) is difficult, and a definitive diagnosis requires biopsy.
We report a case of malignant lymphoma of the thyroid with swelling of the hypopharyngeal wall. The patient was an 81-year-old Japanese male who presented with a history of dyspnea and sore throat. CT showed a thyroid tumor and hypopharyngeal wall swelling, and since we considered that both emergency airway management and immediate diagnosis were mandatory, we performed a tracheotomy and biopsy on the same day. The final diagnosis was diffuse large B-cell lymphoma (DLBCL). The tumor was reduced by chemoradiation therapy. In many cases, the airway obstruction improves after treatment. In cases of thyroid tumor presenting with airway obstruction, in which the possibility of a malignant lymphoma of the thyroid would be strongly considered, the airway management of first choice should be tracheal intubation.