耳鼻咽喉科臨床
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
112 巻, 5 号
選択された号の論文の12件中1~12を表示しています
論説
  • 梅野 博仁, 千年 俊一, 小野 剛治, 三橋 亮太, 佐藤 公則
    2019 年 112 巻 5 号 p. 277-284
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    Recently, with the advances in diagnostic endoscopy techniques, the rate of diagnosis of early-stage hypopharyngeal cancer has been increasing. Treatment outcomes have also improved because of advances in the techniques of transoral mucosal resection. We investigated the treatment outcomes of 60 cases of locally confined early hypopharyngeal cancer who were treated by TLM at our institution. The overall 5-year cause-specific survival of the patients was 88%; the rates for patients with stage I, II, III and IV disease were 95%, 92%, 60% and 54%, respectively. However, there were no patients with primary death. The 5-year local control rates in patients with T1, T2 and T3 disease were 93%, 89% and 50%, respectively. The 5-year laryngeal preservation rate in patients with T1, T2 and T3 disease were 96%, 93% and 75%, respectively.

    The efficacy of neoadjuvant chemotherapy (NAC) followed by TLM was investigated in 8 patients, including 1 patient with T1 disease, 3 patients with T2 disease, and 4 patients with T3 disease. None of the patients, except for one patient with T3 disease, had local recurrence. There is a possibility that the indication for NAC can be extended to patients with locally advanced hypopharyngeal cancer potentially suitable for TLM.

    Some importance of the histoanatomical characteristics of the hypopharynx was recognized. Microscopic magnification images at the supraglottic level have revealed two kinds of elevator muscles of the pharynx in the posterolateral hypopharyngeal wall, whereas the stylopharyngeus and palatopharyngeus run longitudinally inside the inferior constrictor muscle. The stylopharyngeus and palatopharyngeus are clearly delineated by fasciae. The anterolateral hypopharyngeal wall between the superior horn and the lamina of the thyroid cartilage has no muscle layer. The superior laryngeal artery and vein and internal branch of the superior laryngeal nerve pass between these structures en route to the larynx. The pharyngeal branch of the vagus nerve and a branch of the superior thyroid artery are seen outside of the inferior constrictor in the posterolateral hypopharyngeal wall. A precise understanding of the histoanatomical characteristics of the hypopharynx is expected to be helpful for successful performance of TLM by surgeons, with decreased morbidity rates and improved rates of laryngeal preservation, by preventing unnecessary tissue damage.

カラー図説
臨床
  • 市川 晴之, 金谷 健史, 太田 亮, 岸部 幹, 片田 彰博, 原渕 保明
    2019 年 112 巻 5 号 p. 289-293
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    The opsoclonus-myoclonus syndrome (OMS) is characterized by subacute onset of opsoclonus, a disorder associated with saccadic eye movements causing involuntary, chaotic saccades that occur in all directions in combination with myoclonus of the neck and trunk and sign of cerebellar ataxia, especially related to the inability to stand and walk.

    We report herein on a 11-year-old boy complaining of nausea, dizziness and inability of locomotion. One week before visiting our hospital, he had had a fever with a cold. Serological examination certified his fever was due to Mycoplasma pneumoniae infection. Intravenous corticosteroids pulse therapy was very effective and his opsoclonus and inability to stand and walk disappeared.

    On diagnosis of OMS and evaluation of the steroid pulse therapy, a neurotological examination (ex. foam posturography) was very useful.

  • 赤井 亮, 白井 杏湖, 河野 淳, 太田 陽子, 冨岡 亮太, 塚原 清彰
    2019 年 112 巻 5 号 p. 295-301
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    Although cholesteatoma is a rare complication of cochlear implantation, special attention to the possibility of this complications needs to be paid especially in cases with breach of the canal wall. A female patient with congenital hearing loss received her first cochlear implantation by the canal wall down procedure at the age of three at another hospital. She visited our hospital for the first time at the age of 11 years. CT examinaton revealed a lack of full insertion, and it was difficult to improve programming due to facial nerve stimulation. Nine years after the first implantation, we performed a repeat cochlear implantation by canal wall reconstruction. Three years after the second surgery, cholesteatoma developed in relation to the posterior wall of the external ear canal with the exposure of the electrode array to the canal. A third cochlear implantation with cholesteatoma removal was required three years after the second surgery. Seven years after the third surgery, the cholesteatoma recurred at the same place, with gradual worsening of speech recognition, and the patient needed a fourth cochlear implantation.

    The standard approach for cochlear implantation is the transmastoid and posterior tympanotomy approach. Sometimes, the transcanal approach needs to be selected to obtain sufficient working space for cochleostomy, however, breaching of the canal wall or the canal wall down procedure with canal reconstruction is associated with an increased risk of formation of cholesteatoma. Appropriate canal reconstruction is necessary to prevent secondary cholesteatoma formation. Surgeons should understand the potential risk of cholesteatoma formation as a long-term complication in patients with cochlear implant (CI).

    The patient had never used a hearing aid for the other ear since the first cochlear implantation. If she had had bilateral CIs or a hearing aid on the other side, cochlear implantation on the other side could have been chosen. Bilateral cochlear implantation is important to keep open the possibility in future, especially in children.

  • 石田 航太郎, 細川 誠二, 橋本 雄一, 峯田 周幸
    2019 年 112 巻 5 号 p. 303-307
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    Duane retraction syndrome (DRS) is a congenital eye-movement disorder that shows limited outward gaze, retraction of the eye and partial closure of the eyelid on gazing inwards. There are additional symptoms such as inferior rolling disturbances and up and down deviation (upshoot, downshoot) when gazing inwards. The cause of DRS is presumed to be associated with the absence of the abduction nerve and abnormal innervation of the oculomotor nerve. Various combined malformations have been reported in DRS, but there are few reports of inner ear malformations. We report herein on a case of DRS with inner ear malformations.

    A 55-year-old man had been suffering from repeated vertigo attacks. He had right hearing loss and diplopia from childhood. The examination in our hospital showed bilateral limited outward gaze, partial closure of eyelid on gazing inwards, horizontal pendulum like nystagmus on gazing left and right, and right superior sensory hearing loss. Temporal bone target CT and MRI revealed hypoplasty of the right semicircular canal and right cochlear malformation of the incomplete partition type I, and aplasia of the left semicircular canal. In addition, the bilateral vestibule was a common cavity and the left cochlea was normal. Thus, we diagnosed DRS and bilateral inner ear malformation.

  • 川島 貴之, 日尾 祥子
    2019 年 112 巻 5 号 p. 309-313
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    We report a rare case of Ramsay Hunt syndrome in a patient with herpes zoster affecting the contralateral trigeminal nerve. A 69-year-old woman presented with a history of having become aware of a painful rash on the left forehead since 4 days prior to her first visit to our otolaryngology department. Three days later, she was referred to our dermatology department and was diagnosed as having ophthalmic zoster. In the evening on the same day, she noticed that she could not drink liquids through a straw. At her first visit, examination revealed painful redness in the right external ear and external auditory canal. Right facial palsy was also seen, with a score of 12 on the Yanagihara facial nerve grading system. In the audiogram, while there was no significant difference between the two sides, the hearing threshold of 8 kHz on the right side was 15 dB worse than that on the left side. Stapedial reflexes were positive on both sides. In the electric taste tests, the thresholds in the right chorda tympani nerve and greater petrosal nerve regions were outside the scale, whereas those in the right and left glossopharyngeal nerve regions were within the normal range. From her first visit, she was begun on intravenous hydrocortisone treatment, with gradual tapering of the dose from 500 mg daily, for 14 days. Antiviral drug was also administered. ENoG performed on day 10 after the initial visit was 65%. The prognosis was anticipated to be good. By day 22 after the initial visit, the redness of the right auricle disappeared, and by day 27, the facial nerve paralysis also resolved. The test for virus antibody (EIA) performed on day 13 after the initial visit revealed a significant increase in the VZV IgG titer. As the mechanism of onset in this case, transmission through the cerebrospinal fluid or simultaneous reactivation of latent VZV in the ganglion of the opposite side was speculated.

  • 佐藤 公則
    2019 年 112 巻 5 号 p. 315-321
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    Recently, dental implant therapy has been routinely undertaken at many dental hospitals and institutions. Consequently, complications associated with dental implant treatment have also increased.

    There is no consensus on the management of bone prosthetic materials displaced into the maxillary sinus following maxillary sinus augmentation surgery (maxillary sinus floor elevation) for a dental implant.

    When the displacement of bone prosthetic material into the maxillary sinus occurs, first of all, closure of the perforation between the oral cavity and maxillary sinus should be performed to prevent infection. Next, antibacterial therapy should be administered in conjunction with ventilation and drainage of the maxillary sinus. After the procedure, the bone prosthetic materials displaced into the maxillary sinus will, in most cases, be drained out of the maxillary sinus via the natural ostium.

    When intractable maxillary sinusitis occurs following the initial treatment as mentioned above, endoscopic sinus surgery is indicated.

    Management of bone prosthetic materials displaced into the maxillary sinus should be performed based on the pathophysiological conditions of the maxillary sinus.

  • 櫻井 みずき, 中島 恭子, 町田 純帆, 平戸 純子, 近松 一朗
    2019 年 112 巻 5 号 p. 323-328
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    Paget’s disease is a rare type of breast cancer characterized by the proliferation of large cells with clear cytoplasm in the epidermis. Paget’s disease occurring in regions other than the breast, such as in the external genitalia and/or perianal region, is known as extramammary Paget’s disease. Herein, we present the case of a 77-year-old man with extramammary Paget’s disease of the larynx. The patient was referred to our hospital with a mass on the right side of the neck. Endoscopic examination of the larynx showed a smooth mass covered by intact mucosa involving the right aryepiglottic fold. Biopsy of the laryngeal tumor led to the diagnosis of extramammary Paget’s disease. Radiotherapy was administered at a total dose of 66 Gy, in view of the patient’s age, likelihood of complications, and requirement of larynx-preservation. Following radiotherapy, the laryngeal tumor and the cervical lymph node metastasis disappeared and the patient remains alive, more than 2 years after the treatment. Aside from surgery, radiotherapy may also be an effective treatment option for ectopic extramammary Paget’s disease of the larynx.

  • 髙橋 洋城, 大西 将美, 坂井田 譲, 森 健一
    2019 年 112 巻 5 号 p. 329-333
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    The patient was a 42-year-old woman with Bloom syndrome and a history of malignant lymphoma, who presented with left central facial nerve paralysis.

    Examination revealed deafness, and obstruction of the left external auditory meatus. CT revealed a soft tissue shadow with destruction of the left apex in the petrous area, and cholesteatoma was suspected. It was Bloom syndrome and considered the merger of the malignant tumor and photographed PET-CT, and a tumor with the accumulation of FDG was indicated at parapharyngeal space. Since it was considered difficult to perform radical excision, a craniotomy operation was performed together with neuro surgeon team of our hospital. A frozen-section examination revealed the diagnosis of squamous cell carcinoma.

    Bloom syndrome is a hereditary autosomal recessive disease characterized by a distinctive facial appearance, low body weight, immunodeficiency, primary amenorrhea, sunlight-hypersensitive erythema. In addition, it is known even that I have a high cancer-causing percentage to be associated with a high incidence of cancer.

  • 大久保 由布, 大淵 豊明, 竹内 頌子, 河口 倫太郎, 若杉 哲郎, 鈴木 秀明
    2019 年 112 巻 5 号 p. 335-338
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    We report a rare case of adenoid cystic carcinoma (ACC) arising from the external auditory canal (EAC), which was preoperatively misdiagnosed as pleomorphic adenoma. A 69-year-old woman presented with a 10-year history of left-sided hearing loss and repeated episodes of otorrhea. Her left EAC showed marked swelling over the entire circumference, with severe mixed hearing loss. Computed tomography revealed a soft-tissue shadow filling left EAC without bone destruction and an intact middle ear cavity. Histopathological examination of a biopsy specimen revealed the diagnosis of pleomorphic adenoma, and transcanal tumor resection was performed. However, histopathological examination of the surgical specimen revealed the diagnosis of ACC, clinical stage T2N0M0. The patient then underwent lateral temporal bone resection, followed by intensity-modulated radiotherapy. Her post-treatment course has remained uneventful over the 27 months from the start of treatment, with no evidence of recurrence. It is important to be aware of the necessity of several repeat histopathological examinations if the biopsy sample reveals a rare diagnosis.

二次出版
  • 原 亜希子, 荒木 康智, 川野 健二, 黄川田 徹
    2019 年 112 巻 5 号 p. 339-344
    発行日: 2019年
    公開日: 2019/05/01
    ジャーナル 認証あり

    Pediatric allergic rhinitis is a disease characterized by paroxysmal sneezing, runny nose, and nasal obstruction. In addition, there can be mental/psychological problems, but these aspects have not been precisely clarified. We investigated the psychological characteristics of children with severe pediatric allergic rhinitis. The subjects were 40 children with drug-resistant severe pediatric allergic rhinitis. Personality diagnostic tests were conducted using the TS-type infant/child character diagnostic test method. Compared with normal children, children with severe allergic rhinitis had more emotional instability (i.e., lack of confidence in daily life and strained tension), a greater lack of self-control (i.e., outrageous anger induced by immature control of emotions and a lack of self-suppression), and more dependency (i.e., a lack of independence from parents and surrounding people, and a lack of desirable social development during childhood). Instability at home was also observed. These results suggested that severe allergic rhinitis affected mental and personality traits of children. Therefore, it might be important to take these mental/psychological problems into consideration while considering the medical treatment of these patients.

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