耳鼻咽喉科臨床
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
112 巻, 3 号
選択された号の論文の11件中1~11を表示しています
論説
  • 大久保 公裕
    2019 年 112 巻 3 号 p. 137-142
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    Allergen immunotherapy, including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), has been evaluated as an effective and tolerable treatment for allergic rhinitis. Nowadays SLIT is widely employed for pollinosis in Japan, although its use in children and elderly patients is still restricted. Ipropose to conduct an analysis and confirm the efficacy and tolerability of this treatment modality in these age groups.

    Moreover I introduced allergen immunotherapies in near future, monophosphoryl lipid A conjugated allergen immunotherapy, lysosomal associated membrane protein immunotherapy, and non-specific immunotherapy, anti-IgE immunotherapy. Allergen immunotherapy has the prospect of possibly becoming a curative treatment for allergic rhinitis.

カラー図説
臨床
  • 冨岡 亮太, 太田 陽子, 白井 杏湖, 河野 淳, 塚原 清彰
    2019 年 112 巻 3 号 p. 147-150
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    Cochlear implant is used for treating severe hearing loss in those who receive insufficient benefit from hearing aids. It was first commercialized at Melbourne University in 1977. With the switch to the multi-channel type, the ability of cochlear implants to restore hearing loss has improved even further. In addition, the effectiveness of binaural cochlear implants has recently been reported. However, such problems as infection due to the implant, as it is a foreign body, electrode migration, facial nerve paralysis and electrode abnormalities, may occur. According to a report by Ikeya, postoperative complications occurred in about 8.7% of cases and reoperation was necessary in about 3% of cases. Elsewhere, the most frequent complication, accounting for around 40%, was infection due to skin flaps. Infection occurred in 28 of 267 pediatric patients (under 20 years of age) who underwent cochlear implant surgery from 2000 to 2015 at our department. The causative organism was methicillin-resistant Staphylococcus aureus (MRSA) in 8 cases, Staphylococcus aureus in 7 cases, Corynebacterium sp. in 7 cases, Corynebacterium in 6 cases, coagulase-negative staphylococci (CNS) in 6 cases, Staphylococcus epidermidis in 2 cases, Moraxella sp. in 1 case, Pseudomonas aeruginosa in 1 case, and Candida parapsilosis in 1 case (including duplicate infections). Among the 8 cases with MRSA infection, 6 cases required removal of the cochlea. Other infections included cases of multiple infections (31 cases), including 2 of the 7 cases with Staphylococcus aureus infection and 1 of the 6 cases with corynebacterial infection. These results suggest that MRSA infection in cochlear implant wearers necessitates reoperation at a high rate. Herein, we present two representative cases of MRSA infection in detail and a retrospective review of 8 cases of MRSA infection encountered at our hospital.

  • 松見 文晶, 野本 幸男
    2019 年 112 巻 3 号 p. 151-156
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    Transmastoid decompression of the facial nerve is considered for patients with severe peripheral facial nerve paralysis. Early decompression is thought to salvage facial nerve fibers from showing progression to Wallerian degeneration, and to be more beneficial than decompression after a delay.

    We performed transmastoid decompression of the facial nerve for 14 patients with severe Bell’s palsy, Ramsay Hunt syndrome, and zoster sine herpete within 14 days of the onset. All the patients had poor facial motor function and ≥90% degeneration of the facial nerve fibers according to electroneurography before the surgery. The operation in all the cases were performed by the senior author F. Matsumi and the facial nerve was decompressed from the geniculate ganglion to the stylomastoid foramen. We performed a retrospective chart review. Ten patients (71%) exhibited good recovery (House-Brackmann grade I or II) at the final visit postoperatively. The mean postoperative loss of hearing at 500, 1000, 2000 Hz was 0.2 dB.

    Early transmastoid decompression of the facial nerve in patients with Bell’s palsy, Ramsay Hunt syndrome, zoster sine herpete which generally have poor neurophysiological prognoses, could provide a chance for good facial nerve restoration.

  • 加藤 智久, 清水 猛史
    2019 年 112 巻 3 号 p. 157-163
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    We report herein on a case of sebaceous lymphadenoma arising from the parotid gland. A 53-year-old woman presented with a five-year history of progressive and painless swelling in the right parotid region. Magnetic resonance imaging (MRI) displayed a well-circumscribed lesion within the right parotid gland. Fine-needle aspiration cytology was performed with ultrasound guidance, and the tumor was diagnosed as a suspected adenoid cystic carcinoma. The parotid tumor was removed with a superficial parotidectomy and pathological examination revealed a sebaceous lymphadenoma. The postoperative course was uneventful, with no signs of recurrence for 8 months after the operation.

    Sebaceous lymphadenoma of the parotid gland is extremely rare, and only 51 cases have been reported, including our case. The clinical characteristics of sebaceous lymphadenoma are discussed.

  • 鈴木 貴博, 東海林 史, 野口 直哉, 角田 梨紗子, 太田 伸男
    2019 年 112 巻 3 号 p. 165-171
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    Background: S-shaped incision (SI), which provides excellent surgical access to the parotid gland, is conventionally used for parotid surgery, but it leaves a visible scar in the neck, producing esthetic problems, especially in young persons. As an alternative, therefore, the facelift incision (FLI), which leaves an inconspicuous neck scar, is often considered. The objective of this study was to compare the tumor characteristics and surgical outcomes between patients who received these two incisions for parotid surgery.

    Materials and methods: In this retrospective study, we analyzed the data of 69 patients with benign parotid diseases who had undergone parotidectomy at our hospital over the past 1 year 9 months. The FLI was mainly applied for relatively small, benign lesions located in the superficial lobe posteriorly or in the tail of the parotid gland.

    Result: Of the 69 patients, 55 patients received the SI (SI group) and 14 received the FLI (FLI group). The median tumor size in the SI group was larger than that in the FLI group, with a significant difference between the two groups (35 mm and 22 mm, respectively; P=0.04). The frequency of deep-lobe location was not significantly different between the two groups (SI vs. FLI: 22% vs. 14%; P=0.72). The average operating time by the same surgeon was 134 min in the SI group (n=46) and 139 min in the FLI group (n=14), without significant difference (P=0.73). Postoperative facial nerve palsy was observed in 6 patients (10.9%) in the SI group, but none of the patients in the FLI group. One patient with diabetes mellitus in the FLI group showed postoperative ischemia at the distal end of the flap in the retroauricular region, which left a hypertrophic scar. There were no significant differences in the frequencies of other complications such as salivary leakage or Frey’s syndrome between the FLI group and the SI group.

    Conclusion: Facelift incision is a safe and aesthetically superior approach for benign parotid disease.

  • 川口 壽比古, 深堀 光緒子, 栗田 卓, 千年 俊一, 梅野 博仁
    2019 年 112 巻 3 号 p. 173-180
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    We report herein on three cases of laryngeal saccular cyst with a review of the relevant literature. All three patients were female. Two were 68 years old, and the third was 78. Their chief complaint was hoarseness. Laryngoscopic findings revealed submucosal swelling protruding into the laryngeal ventricle in the anterior position. Endoscopic resections were performed and the cysts were pathologically diagnosed as laryngeal saccular cysts. The patients remained recurrence-free at follow-up.

    The laryngeal saccular cyst was described by De Santo and these lesions are mainly classified as the anterior or lateral type. In Japan, laryngeal saccular cysts are relatively rare, and only 28 cases have been reported (19 were the lateral type, 2 were unknown and 7 were the anterior type, as were the cases in the present study). Previous reports have recommended complete removal for both types. In addition, the endoscopic approach is recommended for cysts under 30 mm in diameter that remain in the larynx.

    In cases of laryngeal cyst, we should consider the possibility of a saccular cyst and complete removal should be performed except in cases of an occluded airway. In addition, the endoscopic approach should be considered depending on the size and the locus of the lesion to reduce the invasiveness of the operation.

  • 平賀 幸弘, 森山 元大
    2019 年 112 巻 3 号 p. 181-188
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    The necessity of planned neck dissection (PND) after definitive concurrent chemoradiotherapy (CCRT) is still controversial, because of the rapid progression of image-guided surveillance for advanced nodal disease using PET-CT. But definitive CCRT with PND has been reported to be associated with severe long-term adverse effects.

    At our hospital, since 2006, we have been treating head and neck squamous cell cancer patients with N2 nodal disease by ND after preoperative CCRT administered at a median dose of 46 Gy. The reduced-dose CCRT was aimed at avoiding severe adverse events while preserving the efficacy.

    In this study, 34 cases with stage IVA head and neck squamous cell cancer patients (including 16 cases of hypopharyngeal carcinoma, 11 of oropharyngeal carcinoma, and 7 of laryngeal carcinoma) were enrolled, and the efficacy of our therapeutic paradigm was analyzed, along with evaluation of the necessity of preoperative CCRT followed by ND.

    The results were as follows: the 3-year disease-specific survival rate (DSS) was 86%, the 3-year cervical recurrence-free rate was 90%, and the rate of finding pathological nests of viable cancer cells in the dissected lymph nodes was 47%. In regard to the stage of nodal disease, 0% had N2a disease, 50% had N2b disease, and 46% had N2c disease. The rates in the hypopharyngeal or laryngeal carcinoma patients were higher than those in the oropharyngeal carcinoma patients.

    Furthermore, the 3-year DSS in the group without viable cancer cells in the dissected lymph nodes was found to be significantly higher than that in the group with viable cells in the dissected lymph nodes. There were no cases with any severe adverse events, such as cases needing permanent tracheostomy or gastrostomy. The data did not show any inferiority as compared to previous reports, although it is noteworthy that viable cancer cells could be identified in 47% of the dissected lymph nodes.

    To conclude, our recommended therapeutic approach for N2 neck nodal disease in patients with head and neck squamous cell cancer would still be comprehensive preoperative CCRT with reduced-dose irradiation followed by adequate ND.

  • 岩澤 敬, 野本 剛輝, 小川 恭生, 近藤 貴仁, 矢富 正徳, 塚原 清彰
    2019 年 112 巻 3 号 p. 189-193
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    Rhabdomyomas are a very rare benign tumor. We report herein on a case of rhabdomyoma arising from the thyroarytenoid muscle. A 73-year-old man visited our hospital with the chief complaint of hoarseness. Laryngoscopy showed a smooth swelling of the left vocal cord. No other abnormalities, including recurrent nerve paralysis, were observed. In imaging examinations, CT revealed a lesion involving two subsites from the supraglottic to the glottic regions in coronal sections, and MRI showed paraglottic space invasion, whereas the thyroid cartilage was preserved; and malignancy was suspected. We performed a laryngomicrosurgery under general anesthesia to make a diagnosis by biopsy. A rapid intraoperative diagnosis of the biopsied tissues revealed a benign tumor, and a diagnosis of rhabdomyoma was made based on the permanent pathologic findings. While growth of rhabdomyomas is slow and rarely causes problems, dyspnea and airway narrowing may develop due to tumor progression in some cases. Our patient was an elderly individual and had no difficulty breathing or desire to improve his hoarseness, so we took a wait-and-see approach. He has been followed up on an outpatient basis for 21 months since his first visit, with good progress. In this report, we describe the course of this patient along with a review of literature.

二次出版
  • 木村 俊哉, 三浦 誠, 暁 久美子, 山田 光一郎, 本多 啓吾, 林 泰之, 谷上 由城, 中平 真衣, 池田 浩己
    2019 年 112 巻 3 号 p. 195-200
    発行日: 2019年
    公開日: 2019/03/01
    ジャーナル 認証あり

    A fall accident is an event that is associated with many disadvantages. In our hospital, 5,259 fall cases have been reported over the last 7 years according to our incident reports, and account for 16.5% of all incident reports. We conducted a detailed examination of 120 of these fall cases at the department of otorhinolaryngology. Most of all, “before and after excretion” is a common reason for falls in all departments. In the field of otolaryngology, “use of drugs” and “walking disorder” are frequently encountered reasons for a fall. Calculation of age-specific fall rates revealed two peaks: around 0 years old and after 80 years old. It is suggested that a fall is associated with a reduced ability for maintaining the standing position. A correlation has been reported between the fall rate and the average length of hospitalization.

    Both the length of hospitalization of 12.3 days and fall rate of 1.97 among the cases seen at the department of otorhinolaryngology are lower than that in other fields, on average. In the patients seen at the department of otorhinolaryngology, the fall rate rises significantly as the length of hospitalization increases. In the department of otorhinolaryngology, the fall rate of the malignancy group is high (2.91), irrespective of the treatment regimens. Each of the three items, “14 hospitalization days or more”, “65 years old or older” and, “malignancy” contribute to falls in patients seen at the department of otorhinolaryngology, and multivariate analysis revealed a particularly strong contribution of the previous 2 items. In elderly patients with expected long-term hospitalization, it is necessary to proactively attempt risk reduction; we first make all patients aware of the risk of long-term hospitalization at the first examination, and divide length of stay into multiple times. We review the assessment score after re-examining the “disease severity” and “performance status” as risk factors for falls, and want to realize more efficient measures for preventing falls in the future.

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