Practica Oto-Rhino-Laryngologica

Degree of Malignancy Related to Extirpation of Hypopharyngeal Carcinoma

Yasushi Murakami

1989 Volume 82 Issue 12 Pages 1677-1689
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1677

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The results of treatment of hypopharyngeal carcinoma are not yet satisfactory, although some improved combinations of radical surgery plus chemo- and radio-therapy have been reported. Thorough analysis of the oncological characteristics and biological behavior must be performed to obtain better results in each patient.
In addition to histopathological evaluation of tissue differentiation, more detailed examination of biopsied specimens by immunohistochemical techniques using monoclonal antibodies to determine the degree of single cell keratinization and the labelling index of proliferating cells that may be closely related to the intensity of submucosal spread of carcinoma. The results of such studies should provide information on the margin of safety advisable for resection of this carcinoma.
Studies on the basic oncology of hypopharyngeal carcinoma which are currently done in my department are described.

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A Coincidence of Tuberculous Otitis Media and Epipharyngeal Tuberculosis

[in Japanese], [in Japanese]

1989 Volume 82 Issue 12 Pages 1684-1685
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1684

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Clinical and Neurological Features of Cerebellar Hemorrhage

Takeshi Kubo, Izumi Koizuka, Yoshiharu Sakata, Takayuki Shiraishi, Tor ...

1989 Volume 82 Issue 12 Pages 1687-1692
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1687

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Five patients with primary Cerebellar hemorrhage recovered about one month after the onset, without any surgical treatment. CT showed bleeding in and around the dentate nucleus in three patients and in the ventral vermis in two. All five had spinning vertigo or giddiness and vomiting, but cerebellar signs and other neurological symptoms were not common. Eye movement tests such as eye tracking, gaze nystagmus, positional nystagmus, optokinetic and caloric tests, suggested the possibility of central vestibular lesions. However, oto-neurological examinations alone could not provide the exact diagnosis.

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Anterior Inferior Cerebellar Artery Syndrome and “Internal Auditory Artery Syndrome”

Meiho Nakayama, Shigeru Inafuku, Mizuyo Honi, Isao Takimoto

1989 Volume 82 Issue 12 Pages 1693-1700
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1693

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Four patients with anterior inferior cerebellar artery (AICA) syndrome were studied radiologically and neurotologically. Saccadic pursuit in the eye tracking test (ETT) showed dysmetria in two patients, smooth pursuit of ETT showed saccadic patterns in three, and the optokinetic pattern test showed central-type disturbances in three. In all four angiography showed defects of AICA on the diseased side. Two patients had central nystagmus and internal auditory disturbances without cerebellar symptoms. The disorder in these two patients should be called “internal auditory artery (IAA) syndrome” to differentiate it from AICA syndrome.
Although AICA syndrome was recognized during the 1930's, it was rarely reported until the 1970's. During the last twenty years, radiological and neurotological studies have made remarkable advances, and AICA syndrome has been clarified. In our present study, we found that special attention should be given to the diagnosis of hearing loss with vertigo; however, diagnosis of some AICA syndrome cases (especially IAA syndrome) can be complicated by peripheral diseases, and so the examination of nystagmus should be performed carefully.

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Acute Sensorineural Hearing Disturbance With Vertigo Caused by Circulatory Insufficiency of Anterior and Posterior Inferior Cerebellar Arteries; A Case Report

Yasushi Kukuminato, Hideaki Shirasaki, Fumiaki Shido, Akikatsu Kataura ...

1989 Volume 82 Issue 12 Pages 1701-1706
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1701

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A 77-year-old male complained of acute left hearing disturbance with vertigo. A diagnosis of circulatory insufficiency of the left anterior inferior cerebellar artery (AICA) and the posterior inferior cerebellar artery (PICA) was made from the results of examinations and the clinical course.
Otoneurological examination showed profound sensorineural hearing disturbance and spontaneous horizontal and rotatory nystagmus toward the right in both eyes indicating left peripheral vestibular dysfunction.
Vertebral angiography showed occlusion of the basilar artery leading to circulatory insufficiency of the left AICA and PICA.
After conservative treatment, the hearing disturbance and vertigo were reduced as the blood flow increased in the left AICA and PICA.
Although sensorineural hearing disturbance with vertigo of sudden onset is usually diagnosed as sudden deafness in clinical practice, RICA and PICA circulation should be assessed for a precise diagnosis.

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Clinical Analysis of Dizziness in Patients with Congenital Nystagmus

Kazutoyo Kobayashi, Noboru Yamanaka, Akikatsu Kataura

1989 Volume 82 Issue 12 Pages 1707-1712
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1707

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Congenital nystagmus is usually noted at birth or during childhood and is present throughout life. Congenital nystagmus in itself is not a disease which causes dizziness.
However, when it is present coincidentally with certain other diseases, it may give rise to dizziness which cause difficulty in diagnosis.
We examined 14 patients with congenital nystagmus who complained of dizziness. Eight patients had orthostatic dysregulation and four had peripheral vestibular dysfunction which was associated with canal paresis and/or sensorineural hearing loss.
More studies are needed to clarify the mechanism of dizziness in patients with congenital nystagmus.

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Cervicovestibural Syndrome Originating in an Anomaly of the Left Vertebral Artery

-A Case of Right Aortic Arch-

Eiji Fukushi, Jiro Hozawa, Fumiaki Fujiwara, Tetsuya Nishimura, Atsush ...

1989 Volume 82 Issue 12 Pages 1713-1718
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1713

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A 54-year-old man complained of paroxysmal vertigo when his head turned to the right or left.
Counter-clockwise rotatory nystagmus, accompanied by a turning sensation, was provoked transiently when the headhung low and was turned to the right or left. However, the results of other neuro-otological tests were almost normal.
Digital subtraction angiography revealed reversal of the aortic arch and kinking of the left vertebral artery. “Cervicovestibular syndrome” was suspected, and perivascular sympathectomy of the left vertebral artery was performed.
After the removal of a tight adhesion between the left vertebral artery and the anterior scalenus muscle, paroxysmal positional vertigo disappeared and nystagmus was greatly improved. The operative results suggest that the origin of the paroxysmal positional vertigo was constrictive ischemia of the left vertebral artery caused by a mechanical compression of the scalenus anterior muscle when the head was turned and irritation of the perivascular sympathetic nerve-plexus.

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Vestibulo-Spinal Reflex Observed in Postures of Figure-Skating

-Role of the Semicircular Canal in Circular Movements-

Shinsuke Ito, Shuichi Odahara, Katsuya Yamaguchi, Minoru Hirano

1989 Volume 82 Issue 12 Pages 1719-1725
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1719

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The relationship between the direction of rotation and the leg supporting the body in figure-skating was thought to be based on the cristo-spinal reflex. Skaters stand or jump with the leg of the same side as the rotation when turning around a vertical axis. This suggests that the movement of endolymphatic fluid towards the ampulla of the ipsilateral horizontal semicircular canal as the direction of rotation exerts a facilitatory action on the extensor neurons. On the other hand, they land on the ice with the opposite leg after turning in the air. This can be interpreted as a phenomenon similar to postrotatory nystagmus; that is, the ampullopetal flow takes place in the semicircular canal opposite to the rotation after cessation of turning, resulting in activation of this canal.

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Audiometry Results after Tympanoplasty with and without Mastoidectomy

Masaru Aoyagi, Toshihisa Suzuki, Mika Yoshida, Yo Kimura, Yutaka Suzuk ...

1989 Volume 82 Issue 12 Pages 1727-1734
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1727

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Postoperative hearing was investigated in 383 ears after tympanoplasty performed during the period from 1976 to 1988, especially with the intention of analyzing the influence of mastoidectomy on postoperative inner ear disorders.
At speech frequency ranges, postoperative hearing test results were satisfactory in 95% of ears after type I tympanoplasty without mastoidectomy, and in 74% of ears after types I, III and IV tympanoplasty with mastoidectomy.
Mastoidectomy, posterior and anterior tympanotomy were performed only with the air drill from 1976-4985. From 1986 to 1988, an operative procedure just around the ossicles was performed carefully with small gouges after mastoidectomy with an air drill. Although the postoperative hearing results were almost the same with and without mastoidectomy with respect to speech frequencies from 1976 to 1985, hearing thresholds at high frequency ranges were impaired in many ears after mastoidectomy. However, after a change in the mastoidectomy technique (1986-1988), hearing impairment was rarely observed at high frequency ranges in the ears after mastoidectomy.
The results suggest that mastoidectomy with an air drill should be performed very carefully and small gouges should be used more frequently to prevent inner ear disorders by careless use of the air drill.

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Fragment of Bomb Removed after 40 Years; A Case Report

Hideki Saito, Shouzo Kawamura, Ginichiro Ichikawa, Masahiko Nishiya, T ...

1989 Volume 82 Issue 12 Pages 1735-1738
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1735

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A foreign body located in the right postauricular area was removed 40 years after a shrapnel injury in 1943. The patient visited our clinic complaining of pain behind his right ear. X-ray examination showed a dense foreign body located extracranially adjacent to the S. C. M.
Under general anesthesia an iron fragment was removed.

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Nasal T-Cell Lymphoma Associated with Double Gammopathy; A Case Report

Koichi Omori, Hisayoshi Kojima, Mitsuharu Nonomura, Myojo Kanaji, Shin ...

1989 Volume 82 Issue 12 Pages 1739-1744
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1739

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Nasal T-cell lymphoma associated with double gammopathy (IgG and IgA) was found in a 78-year-old man with a necrotic tumor in his right nasal cavity. He was treated with radiotherapy and CVP chemotherapy but the lymphoma relapsed in his left nasal cavity 1 year later. He was treated again with the same therapy and is now alive and tumor-free.
Two serum M-components (IgG and IgA) were detected through his clinical course. To our knowledge, this is the first report of T-cell lymphoma associated with double gammopathy. The significance of M-components in T-cell lymphocytic proliferation remains unclear, but it may be that the M-components appear because of the inappropriate regulation of the T-B immune-response system in the presence of T-cell lymphoma.
Histology in this case is also noteworthy. The first nasal tumor showed granulation and necrotic tissue with plasma cell infiltration; it was diagnosed as non-Hodgkin diffuse lymphoma, mixed type, by surface marker analysis. This indicates that immunohistochemical study is indispensable for the diagnosis of nasal non-healing granuloma with necrosis.

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Long Term Prognosis of Hoarseness in School-Children

Eiji Yumoto, Hiroshi Okamura

1989 Volume 82 Issue 12 Pages 1745-1749
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1745

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Laryngeal pathology, which causes so-called school-age hoarseness, includes swelling and nodules of the vocal folds. The authors followed eight children with swollen vocal folds, 27 with nodules and nine whose nodules had been removed microsurgically. All these children received vocal hygiene therapy. Two of the eight children with swollen vocal folds recovered and two others developed vocal fold nodules. The other four had fluctuating hoarseness. Nineteen of the 27 with nodules recovered and four others developed swollen vocal folds. The other four remained unchanged. Vocal hygiene therapy seemed helpful because 11 of the 19 recovered within two months. Five of the nine who had been operated on had an uneventful course; the vocal folds became swollen again in the other four. Vocal fold nodules recurred in one of these four children with swollen vocal folds.

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Usefulness of Ultra-Sound Sonography of the Thyroid Gland for Abnormal Sensation in the Throat

Soichi Motoyama, Yasuo Uesugi, Akira Ikeda, Atushi Sakakura, Kazuo Mak ...

1989 Volume 82 Issue 12 Pages 1751-1756
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1751

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Ultra-sound sonography of the thyroid gland was used to examine 58 patients with abnormal sensation in the throat. There were abnormal ultrasound findings in five patients, two with chronic thyroiditis and one with papillary adenocarcinoma.
This evidence indicated that in some cases of abnormal sensation in the throat, but without abnormal findings in the neck on physical examination, thyroid disease might be present. Since ultra-sound sonography is simple, noninvasive and reproducible, this procedure can be used as a diagnotic tool for the detection of thyroid abnormalities in these patients.

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Histological Immunohistochemical Examination of the Hyaline Vascular Type of Castleman's Lymphoma

Hideaki Naganuma, Akihisa Segawa, Koitiro Nisiyama, Satosi Yosio, Maki ...

1989 Volume 82 Issue 12 Pages 1757-1765
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1757

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In 1954 Castleman described a special type of lymphoma which consisted of hyperplasia of the lymph nodes in the mediastinum. It is now called Castleman's lymphoma which may be of two types histologically: a plasma cell type and a hyalinvascular type. Their clinical course is some what different. The origin of the tumor is still a matter of speculation. For example, the origin of the hyalin-vascular type has been thought to be: a tumor originating in the thymus, hyperplasia of lymph nodes due to vasculitis, a hamartoma of the lymph node, etc.
This paper discribes a patient with neck tumor, diagnosed histologically as Castleman's lymphoma of the hyalin-vascular type. The histological architecture was identified by optical and electron microscopic procedures and by the following immunohistochemical techniques: studies with antikeratin antibodies, UCHL-1 antibodies, MB-1 antibodies and antigen antibodies related to the eighth factor. Epithelial reticulum cells originating from the thymus and the distribution of vascular endothelium in the tumor were investigated.
It was assumed by following reasons that the tumor of our case is a hamartoma of lymph node which showed the abnormal proliferation in the paracortical area. 1. The tissue contained a mount of small lymph-follicles. 2. The wide intrafollicular tissue contained lymph cells of T type. 3. The most of vessels had a character of postcapillary venules. 4. The postcapillary venules passed through the lymph follicles.

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Application of Digital Fluorography to Pharyngo-Esophagography

Hiroshi Okarnura, Shoko Inaki, Toshihiro Mori

1989 Volume 82 Issue 12 Pages 1767-1771
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1767

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The authors devised a new system of pharyngo-esophagography using a digital fluorography to correct the aspect ratio of video-recorded images and to copy those on a sheet film. When the video-image recorded under conventional fluoroscopy is reproduced on an ordinary video-monitor, the image is deteriorated horizontally due to the difference of the aspect ratios. The video-image was fed into a digital fluorograph apparatus at the speed of 30 frames per second, and an image processer was used to transform the aspect ratio of 1 to 1 to that of 3 to 4. With this procedure, the correct image could be reproduced on the video-monitor. Moreover, the video-images stored in the image memory of a digital fluorograph apparatus were converted to a multi-format camera system and were copied on a sheet film as sequential pictures. Qualitative and quantitative assessments of deglutition were feasible with the present system.

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Changes in the Ciliary Interconnections of Stereocilia in the Organ of Corti after Acoustic Overstimulation

Masaya Takumida, Isao Nishida, Masafumi Nikaido, Katsuhiro Hirakawa, Y ...

1989 Volume 82 Issue 12 Pages 1773-1778
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1773

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Changes in the glycocalyx structure and ciliary interconnections of the organ of Corti were demonstrated after acoustic overstimulation. A special high resolution scanning electron microscope and a tannic acid-osmium staining technique giving an almost three-dimensional view were used for this demonstration. Guinea pigs were exposed to a 3.85kHz pure tone at an intensity of 120dB for 22.5min. It was possible to observe the early changes of the ciliary interconnections of the hair cell stereocilia. The first detectable change was a disarrangement of the cilia with a loosening of the interconnections. The ciliary membrane had an abnormally smooth appearance. The tip links connecting the tips of the stereocilia to their neighbours were also affected showing elongation or even disappearance. The fine granules which cover the tips of the tallest stereocilia of outer hair cells were also decreased. These findings suggest that acoustic overstimulation probably affects carbohydrate metabolism which induces a regeneration of ciliary interconnections resulting in a disarrangement and detachment of cilia. The tip links, which appeared to be involved in sensory cell transduction, seem also to be affected by acoustic overstimulation.

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Morphological and Histochemical Observation of Human Levator Muscles

Shinobu Yamaguchi, Masaya Takumida, Tatsuzo Taira, Michiaki Hiramoto

1989 Volume 82 Issue 12 Pages 1779-1784
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1779

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The morphological and histochemical characteristics of the levator muscles were investigated in patients with velopharyngeal insufficiency. Muscle samples were obtained from 2 patients with cleft palate (CP), 2 with submucosal cleft palate (SMCP) and 2 with congenital velopharyngeal incompetence (CVPI). The muscles removed from the cleftside of CP, SMCP and CVPI revealed disturbed growth. Abnormal patterns of muscle fibers were noted in SMCP and CVPI. The proportions of muscle fiber types (red, white and intermediate) were similar in the non-cleftside of CP and CVPI, while on the cleftside of CP and SMCP there were reduced numbers of red fibers. The diameter of the red fibers in CVPI was significantly smaller than that in the other 3 types of disease. These findings may be closely related to the development of velopharyngeal insufficiency.

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Relationship between an Antibody to EBV-Determined Nuclear Antigen and an Antibody to Rheumatoid Arthritis Nuclear Antigen

Mitsuru Furukawa, Hideo Sakashita, Hajime Takeshita, Yasuyuki Kimura, ...

1989 Volume 82 Issue 12 Pages 1785-1790
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1785

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In order to characterize the antibodies to EBNA and RANA, autoantibody produced by lymphocytes transformed by Epstein-Barr virus, was tested in EBNA positive and negative epithelial cells by indirect-, and anticomplement immunofluorescent stains.
An antibody to rheumatoid arthritis nuclear antigen, RANA, was thought to be an antibody-complex consisting of antibodies to the EBV-determined nuclear antigen, EBNA, and autoantibodies to the cellular components of cultured cells on the basis of morphological observations on sera from EBV-seropositive healthy subjects and from a patient with rheumatoid arthritis.

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Effect of Sairei-to on the Ciliary Activity in the Middle Ear

Yusuke Esaki, Yoshihiro Ohashi, Hiroyuki Furuya, Yoshiharu Ohno, Yoshi ...

1989 Volume 82 Issue 12 Pages 1791-1795
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1791

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Sairei-to is clinically useful in the treatment of otitis media with effusion (OME). Recent experimental studies have demonstrated that ciliary activity in the middle ear close to the tympanic orifice plays an important role in the clearance of the tubotympanum. The present study was designed to clarify the effect of Sairei-to on the ciliary activity in the tubotympanum. The middle ear mucosa close to the tympanic orifice was sampled from guinea pigs (average weight: 200g), and the ciliary activity was measured photoelectrically in an RPMI 1640.
Then the medium was replaced with a medium containing various concentrations of Sairei-to or Sho-Saiko-to. Our results demonstrated that both drugs enhanced ciliary activity and that ciliary activity could not be reduced in the presence of a relatively high concentration of Sairei-to. In conclusion, Sairei-to enhances tubotympanic clearance, and the clinical use of this drug should be beneficial in the treatment of patients otitis media with effusion.

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Clinical Evaluation of Amlexanox in Patients with Perennial Allergic Rhinitis Refractory to Other Oral Antiallergic Medications

Hisashige Tsuji, Hideo Nameki, Yasuo Satoh, [in Japanese], [in Japanes ...

1989 Volume 82 Issue 12 Pages 1797-1808
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1797

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The clinical efficacy and safety of amlexanox, an oral antiallergic agent, were studied in 32 patients with perennial allergic rhinitis refractory to other oral antiallergics. A 50mg tablet of amlexanox was taken three times daily for four weeks.
1. The overall global improvement rate of amlexanox therapy was : five patients (17%) “markedly improved”, seven (23%) “moderately improved”, and six (20%) “fairly improved”.
2. The global usefulness rate was: “markedly useful” in six (17%), “moderately useful” in five (17%) and “fairly useful” in nine (30%).
3. Amlexanox relieved nasal obstruction and subjuctive nasal symptoms.
4. Mild rash, headache and itching occurred in three patients.
These adverse reactions disappeared without any additional treatment during the therapy, except in one patient with rash, which disappeared upon withdrawal of the drug.
The results indicate that amlexanox therapy is useful in patients with perennial allergic rhinitis refractory to other oral antiallergic medications.

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Therapeutic Effect of Neuzym® in Chronic Sinusitis Evaluated by Densitometry with the Copper-Step-Wedge System

Harumi Suzaki, Yasuya Nomura, Meijin Shu, [in Japanese], [in Japanese] ...

1989 Volume 82 Issue 12 Pages 1809-1820
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1809

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A multicenter study was undertaken in 12 institutions to determine the clinical effect of Neuzym® in patients with chronic sinusitis. The drug was administered for 8 weeks, and the changes in subjective symptoms and rhinoscopic and X-ray findings were determined. The improvement of the radio-opacity in the maxillary sinus was also objectively assessed by densitometry with the Copper-Step-Wedge System.
After 4 weeks of treatment 29.1% of the patients showed good or moderate general improvement and 84.3% showed slight, moderate or good improvement. After 8 weeks of treatment the figures were 39.7% and 85.7%, respectively. The subjective symptoms and rhinoscopic findings were better after 8 weeks than after 4 weeks of treatment.
The X-ray findings of the maxillary sinus, interpreted by gross inspection, showed slight improvement in 33.5% of the patients after 4 weeks of treatment and in 34.6% after 8 weeks. The radio-opacity of the maxillary sinus, as assessed by densitometry with the Copper-Step-Wedge System, showed a more favorable response than the gross X-ray findings: improvement in 49.4% of patients after 4 weeks and in 57.0% after 8 weeks of treatment. The difference between the two assessments may be accounted for by the higher precision of the Copper-Step-Wedge System. In a few cases, there were opposite assessments.
None of the patients had any side effects of Neuzym® therapy. Neuzym® was assessed to be very or moderately effective in 45.1% and very moderately or slightly effective in 86.3%. Thus, Neuzym® can be recommended for chronic sinusitis.

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Primary Cure for Congenital Auricular Deformity

-Polycast Stick Method-

[in Japanese]

1989 Volume 82 Issue 12 Pages 1822-1823
Published: December 01, 1989
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.82.1822

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