Practica Oto-Rhino-Laryngologica

Surgery of the Skull Base

-A Tutorial Note-

Minoru Hirano

1990 Volume 83 Issue 10 Pages 1475-1481
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1475

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Advances in surgery of the skull base have greatly benefited patients with neoplasms of this area which had been unresectable until recently. This paper describes the concept of surgery of the skull base, the surgical anatomy of the skull base and the techniques of craniofacial resection. An interdisciplinary team that consists of an otolaryngologist, a neurosurgeon and a plastic surgeon is essential for craniofacial resection. It should be emphasized that the skull base is now accessible surgically. Unfortunately, the number of otolaryngologists who perform surgery of the skull base seems to be limited in Japan. Otolaryngologists working in major medical centers are strongly encouraged to pay attention to surgery of the skull base.

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Laserthermia for Treating Tongue Cancer

[in Japanese]

1990 Volume 83 Issue 10 Pages 1482-1483
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1482

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Atypical Impairment of Fixation Suppression in a Patient with Unilateral Flocculus Lesion

Kanji Baba, Tetsuzo Inouye

1990 Volume 83 Issue 10 Pages 1485-1490
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1485

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Fixation suppression of caloric nystagmus was examined in a patient with a unilateral flocculus lesion demonstrated by NMR-CT. Visual suppression (Takemori & Cohen, 1974) of nystagmus to the side of the lesion was less than that to the contralateral side. However, this value may not be accurate because of mixed spontaneous pathological eye movements other than caloric nystagmus. The degree of fixation suppression (FS%=(1-F/D)×100) was calculated from the mean slow-phase velocity (F) of caloric nystagmus during fixation and the maximum slow-phase velocity (D) with eyes open in darkness. FS% of nystagmus to the contralateral side of the lesion was lower than that to the ipsilateral side; that is the reverse of the results of experimental flocculus destruction. The difference between FS% of nystagmus to the ipsilateral side of the lesion and that to the contralateral side is due mainly to the asymmetry of nystagmus during fixation. This may be in compensation for unilateral vestibular system lesions.

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Auditory Simulation of Cochlear Implant Using Mel Scale

Junji Sakakihara, Mariko Takeuchi, Hisayoshi Kojima, Iwao Honjo, Shuji ...

1990 Volume 83 Issue 10 Pages 1491-1496
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1491

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The nature of the voice sounds which cochlear implant (CI) patients “hear” is not well known. We input five Japanese vowels/u, o, a, e, i/into the CI, and recorded the exact time of discharge and position of active intracochlear electrodes. To simulate the vowels which CI patients hear, we digitally synthesized tone bursts of characteristic frequencies at stimulated portions, and arranged them according to the timing of stimulation on the time axis.
Next, we improved the quality of simulated vowels using formant shifting by the mel scale which represents a psychophysical relationship between perceptual pitch and actual frequency.
We evaluated the efficacy of this scale in two CI patients through a discrimination test among synthesized vowels which emulate mel scale shifting by activating appropriate electrodes.
Simulated vowels were like a “Donald Duck” voice, but distinguishable from each other to some extent after repetition. Mel scale shifting improved discrimination by normal subjects and also by CI patients. These results suggest that patients may hear more intelligibile vowels with the use of the mel scale.

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Meningioma in the Middle Ear; A Case Report

Kazunori Nishizaki, Ryusuke Saito, Makoto Kanatani, Tatsuo Hori

1990 Volume 83 Issue 10 Pages 1497-1501
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1497

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Meningioma involving the middle ear is very rare, but it can be either a primary tumor or an extension of an intracranial tumor. A 41-year-old female with middle ear meningioma treated surgically was followed for one year with no evidence of recurrence. A review of the literature on middle ear meningioma stresses, the following points:
1. The possibility of meningioma should be considered as well as more common disorders of that area whenever a tumor presents in the middle ear.
2. Electron microscopy may aid in the differentiation of meningioma from chemodectoma and schwannoma.
3. Because of the slow growth and insidious spread of meningioma within and around the temporal bone, follow-up CT scans should be performed periodically for at least 10 years to rule out residual disease and intracranial extension.

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Preoperative Determination of Attic Block

-Examined by Impedance Audiometry-

Fumio Ohno, Haruhiro Suzuki, Kenshi Katsuda

1990 Volume 83 Issue 10 Pages 1503-1509
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1503

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The usefulness of impedance audiometry in determining the presence of attic block was evaluated in 49 patients with chronic otitis media. At operation obstruction between the mastoid antrum and the mesotympanum was found in 22 ears, and no obstruction in 27 ears. The average impedance volume was 3.71ml in the ears without attic block, and 1.36ml in the ears with attic block. The significant differences were observed in impedance volume between the two groups (p<0.01). An impedance volume less than 1.4ml was considered to indicate attic block, while in ears without block the impedance volume was more than 2.0ml. A good correlation was found between the impedance volume and the size of the air-filled ear space in the group without attic block.

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External Ear Canal Tumors in Seven Patients

Nobuko Wanifuchi, Yoichi Ishizuka, Takao Yabe

1990 Volume 83 Issue 10 Pages 1511-1520
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1511

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Tumors in the external ear canal of 7 patients were diagnosed as a nevocellular nevus, a epidermoid cyst, a capillary hemangioma, a pyogenic granuloma, an eosinophilic granuloma in the temporal bone and two adenoid cystic carcinomas. The relevant literature on these tumors was reviewed. Some tumors invaded the external ear canal from surrounding tissue, such as eosinophilic granuloma, and others originated in the canal tissue. Computerized tomography of the temporal bone was useful in the location of external ear canal tumors in our study.

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Olfactory Neuroblastoma; A Case Report

Tohru Ogiwara, Rinya Sugita, Kazuhisa Ishi

1990 Volume 83 Issue 10 Pages 1521-1526
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1521

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It is said that olfactory neuroblastoma is an extremely rare carcinoma developing in the epithelium of the olfactory mucous membrane. In Japan its prognosis is poor.
We recently treated a 49-year-old male with olfactory neuroblastoma. Intracranial infiltration was demonstrated by detailed examinations. Patients with intracranial infiltration have an extremely poor prognosis.
We performed surgery, radiotherapy and chemotherapy (300mg of cis-diaminedichloroplatinum: CDDP).
The patient is still alive without recurrence more than 3 years after surgery.

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Rhabdomyosarcoma in the Nasal Cavity; A Case Report

Shinji Ohguro, Kohji Asakura, Shinya Sohma, Masaaki Ohsaka, Akikatsu K ...

1990 Volume 83 Issue 10 Pages 1527-1532
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1527

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Rhabdomyosarcoma is rare in the head and neck region. Although combinations of surgery, radiotherapy and chemotherapy have improved the survival rate in recent years, the prognosis for patients with rhabdomyosarcoma in the nasal cavity is still poor.
A 16-year-old male with alveolar type rhabdomyosarcoma originating in the right nasal cavity visited a hospital for the evaluation of rapidly growing right exophthalmos, nasal obstruction and bloody nasal secretion. Roentogenographic examination revealed a large right nasal mass with ipsilateral orbital and intracranial invasion. The first biopsy specimen from the nasal mass was pathologically suspected to be olfactory neuroblastoma.
He was treated first with radical surgery, combined with frontal craniotomy. The pathological diagnosis of the resected specimen was rhabdomyosarcoma after immunohistochemical and electronmicroscopic examinations. One month after the radical operation, the intracranial tumor recurred. During radiotherapy for the intracranial tumor, there was an abrupt onset of leucocytopenia and thrombocytopenia and pathological evidence of bone marrow invasion. Although the hematological and radiological abnormalities responded to combination chemotherapy with mitoxantrone, etoposide, cisplatinum and prednisolone, cytological abnormality of the spinal fluid continued. Extra high dose general treatment with methotrexate in combination with weekly intradural injection of methotrexate and steroid were only partially effective, and he died of respiratory failure due to brain stem involvement. Autopsy revealed no residual or metastastic lesions in the head and neck or other organs except for the central nervous system.

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Primary Lymphomas of the Nasal Cavity and Paranasal Sinuses; A Clinico-Pathological Study of 16 Cases

Akira Nagasawa, Koji Yajin, Isao Nishida, Nobuhiro Hamamura, Shuso Ari ...

1990 Volume 83 Issue 10 Pages 1533-1541
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1533

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Sixteen patients with extranodal lymphoma originating in the nasal and/or paranasal cavity were initially treated between 1975 and 1988 and have been followed for more than 12 months. In 11 patients the lymphoma was stage I, in 4 stage II and in one stage III. The majority were classified pathologically as T-cell types (81.2%) and high-grade lymphomas (68.8%) according to the Working Formulation. Three patients were treated with radiotherapy alone, and 8 received a combination of chemotherapy (VEMP or VEPA) and radiation. Two others were treated with chemotherapy alone. Local control by the initial treatment was fairly good. Eleven patients achieved a complete response (69%). The other 5 patients had high grade lymphomas with T-cell surface markers and showed a poor response. The 3-year survival rate of 9 patients with the tumor confined to the nasal cavity was 75%. The other 7 patients had involvement of the paranasal sinuses and failed to survive for 3 years. The overall 3-year survival rate was 45%. The ralatively low survival rate may be due to poor control of distant metastases. Better results might be achieved by more intense initial chemotherapy, such as MACOP-B or CHOP-B.

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Orbital Floor Reconstruction with Porus Hydroxyapatite Ceramics

Katsuya Kawai, Michiaki Hiramoto, Yohko Kuniyoshi, Masaki Sawada, Mayu ...

1990 Volume 83 Issue 10 Pages 1543-1548
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1543

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To treat bony defects following fracture of the orbital floor, autogenous bone or exogenous material has been used.
For an autogenous bone transplant (ex. pelvic bone or rib cartilage), it is difficult to obtain an adequate volume and shape. Silicon plates are frequently used as exogenous material, but there are various complications.
We are using porous hydroxyapatite ceramics (PHAC) to reconstruct orbital defects. PHAC has attracted special attention as a prosthetic inlay on account of its good biostability, biocompatibility, and bioactivity; it has been used successfully for the reconstruction of bony defects in recent years.
In order to obtain a natural curve, we prepared “PHAC for the orbital floor” by measuring the orbital floor.
It is a fan-shaped piece formed by dividing an empty cone (upper diameter of 20mm, lower diameter of 40mm, height 20mm, and thickness of 2mm) into three equal parts.
PHAC was shaped, adapted, and perforated with a diamond bar of “Torx” intraoperatively. Then it was fixed with Nylon, screw of mini-plate, or only inserted into the bony defect.
To date, we have used “PHAC for orbital floor” in 9 places in 7 patients. No changes were noted during of follow-up periods 10 to 30 months.
Thus, it seems to be useful for the reconstruction of bony defects.
We describe a representative case and experiments with its use.

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Middle Ear Diseases in Patients with Congenital Velopharyngeal Insufficiency

Kazunori Mori, Michio Kawano, Satoshi Ikegami, Iwao Honjo, Yasuyuki Is ...

1990 Volume 83 Issue 10 Pages 1549-1552
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1549

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To clarify the incidence of middle ear disease in patients with congenital velopharyngeal insufficiency (CVPI), we observed the shape of the velopharynx by a videofluorography and the movement of the lateral pharyngeal wall and soft palate with a flexible fxberscope. The findings of otoscopy, audiometry, and tympanometry were also recorded.
Otitis media with effusion was the most common findings. The shape of the velopharynx had no relation to the incidence of middle ear disease. On the other hand, middle ear diseases were uncommon in CVPI patients with a good mobility of the lateral pharyngeal wall and soft palate. It was thought that the mobility of the velopharyngeal muscles, such as a levator veli palatini, might have some effect on conditions in the middle ear.

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Sinusitis in Patients with Cleft Palate in Relation Allergy

Yasuyuki Ishikawa, Michio Kawano, Iwao Honjo

1990 Volume 83 Issue 10 Pages 1553-1557
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1553

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We examined if allergy is involved in the development of sinus infection in cleft palate patients. Furthermore, the rate of nasal polyps in these patients was also examined because nasal polyps have been reported to be closely related to allergy. Our subjects were 151 cleft palate patients with sinusitis, between 0 and 50 years old. The control group consisted of 406 non-cleft individuals with sinus infection, between 1 and 73 years old.
The rate of allergic history was significantly lower in cleft palate patients with sinusitis than in the normal control (p<0.01). Cases with positive eosinophils in nasal secretions were significantly fewer in the cleft population with sinusitis than in the normal control (p<0.01). No significant difference between the two groups was observed in the incidence of eosinophilia in blood. The rate of nasal polyps was markedly lower in the cleft group with sinus infection than in the normal control. In patients with cleft palate, allergy seemed to play a minor role in the development of sinus infection compared to the normal population.

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South American Blastomycosis; A Case Report

Tetsuyoshi Umeno, Kiminori Sato, Masayoshi Kage, Hiroshi Hachisuga

1990 Volume 83 Issue 10 Pages 1559-1564
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1559

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South American Blastomycosis with oral and pharyngeal mucosal disease and lymphnode swelling was diagnosed in a 47-year old male, who had lived in Brazil from 1962 to 1967. He complained of abnormal sensation of the oral cavity in February 1989 and more recently noticed a tumor of the oral mucosa. He visited our clinic on July 31. On admission, a granulomatous tumor with ulceration was seen at the retromolar lesion. Mucosa erosions were found in the soft and hard palates. Lymphnode swellings were observed bilaterally after admission. Histological examination revealed granulomatous infiltration with epithelioid and giant cells. Fungus spores were seen within giant cells and free in the infiltrate. Cultures revealed yeast cells in cross sections with the shape of a marine pilot's wheel. Histological examination and culture studies led to a diagnosis of South American Blastomycosis. Fluconazole treatment was very effective.
Imported infections are no longer rare. South American Blastomycosis should be considered in the differential diagnosis of oral and pharyngeal mucosal disease with lymphnode swelling.

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Primary Syphilis with Ulcer of the Lip; A Case Report

Hiroshi Orita, Satoshi Ogino, Morihiro Irifune, Tamotsu Harada, Yoshiy ...

1990 Volume 83 Issue 10 Pages 1565-1569
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1565

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As sexual habits are becoming more diversified, oral sex is increasingly frequent, so otorhinolaryngologists are seeing more cases of STD.
Our patient was a 25-year-old single male with the chief complaint of pain in the lower lip. The first diagnosis was stomatitis, but the lesion failed to improve.
Suspecting STD, we reexamined the patient. The serological tests for syphilis were positive, and penicillin was administered orally for 2 weeks. Notable improvement was achieved. The patient was questioned about the route of infection and confessed to engaging in kissing and fellatio.

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A Case of Castleman's Lymphoma of the Neck and Its Immunohistological Study

Masaji Lee, Tomoyuki Yoshida, Fumihisa Hiraide, Yoshiyuki Otsuka, Tada ...

1990 Volume 83 Issue 10 Pages 1571-1576
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1571

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Castleman's lymphoma was diagnosed of the neck in a 21-year-old female.
The patient complained of a gradually enlarging tumor on the left side of her neck. The preoperative diagnosis was lymphoid hyperplasia. The tumor was removed and identified histologically as a hyaline-vascular type of Castleman's lymphoma.
Immunohistological studies were performed to clarify the nature of the tumor. All elements of a lymphnode were present follicles, germinal centers, and intrafollicular spaces, plasma cells produced both κ and λ immunoglobulin. There was little evidence of inflammation and most of the lymphocytes were B cells. The tumor was therefore classified as a lymphoid hamartoma.

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Ectopic Gastric Mucosa in the Cervical Esophagus as a Cause of Abnormal Sensation in the Throat

Kenichi Nibu, Keiichi Ichimura, Kosuke Ishii, Osamu Ito, Toshihisa Mur ...

1990 Volume 83 Issue 10 Pages 1577-1581
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1577

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The endoscopic diagnosis of congenital ectopic gastric mucosa in the cervical esophagus has recently become possible.
However, symptoms have rarely been attributed to its presence.
We treated a 45-year-old woman with isolated ectopic gastric mucosa in the cervical esophagus who had complained an abnormal sensation in the throat for one year.
Physical examination was normal and her esophagogram was negative, but esophagoscopy revealed an area of reddish raised mucosa, about 5mm in diameter, arising from the antero-lateral wall of the cervical esophagus.
Histological examination of the biopsied specimen showed columnar epithelium consistent with gastric mucosa.
Since the endoscopic treatment, the patient has been asymptomatic without any medical treatment.
Ectopic gastric mucosa has the potentiality of malignant transformation to adenocarcinoma.
Therefore, endoscopic examination of the cervical esophagus is indicated in the evaluation of persistent abnormal sensation in the throat.

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Mediastinitis Caused by Esophagoscopy; A Report of Two Cases

Shigenori Matsubara, Hideo Miyata, Satoshi Sogano, Tomoo Suzuki

1990 Volume 83 Issue 10 Pages 1583-1589
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1583

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Two patients with mediastinitis caused by esophagoscopy were treated successfully. Case 1: the esophagus was injured during the insertion of a rigid esophagoscope for diagnostic purposes. Initial conservative treatment was not curative, and a mediastinal abscess developed and dyspnea occurred. Emergency surgery was required, and the patient recovered. Case 2: the esophagus was injured during the removal of a foreign body (dental prosthesis) through an esophagoscope. Surgery was performed immediately, and recovery was achieved without any complications.
We suggest that surgical treatment is indicated in all cases of mediastinitis caused by the use of an esophagoscope. Sufficient drainage of a mediastinal abscess is achieved by postoperative continuous suction and frequent cleaning.

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Establishment and Characteristics of a Cisplatin-Resistant KB Cell Line

Yoshiro Hori, Noriko Yamazaki, Yasuhiro Wada, Toshio Yamashita, Tadami ...

1990 Volume 83 Issue 10 Pages 1591-1598
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1591

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A KB cell line resistant to cisplatin (KB-rc cell) was established by exposing KB cells to gradually increasing doses of cisplatin in vitro.
The concentration of cisplatin required for 50% inhibition of cell proliferation of KB-rc cells was 1.0μg/ml, while that of KB cells was 0.5μg/ml.
The characteristics of KB-rc cells were compared with those of KB cells by flow cytometry. KB-rc cells had a cell cycle time of 23 hours, not significantly longer than that of KB cells. Studies of cell kinetics of KB-rc cells after the treatment with cisplatin show that the G₂M phase block on the 3rd day was inhibited and that G₀G₁ phase cells started to increase on the 5th day. Cisplatin resistance is related to the inhibition of G₂M phase block.

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Vasoactivity of Endothelin in Nasal Mucosa

Keiichi Ichimura, Wataru Okita, Toshiyoshi Tanaka

1990 Volume 83 Issue 10 Pages 1599-1604
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1599

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Using an in vitro bioassay technique, we examined the vasoactivity of endothelin-1 (ET), a new potent vasoconstrictor peptide released from endothelial cells, in nasal mucosa obtained from the canine septum and the human inferior turbinate. Cumulative addition of ET induced contractions in a concentration-dependent manner starting at a very low concentration. ET caused slow-onset and long-lasting contractions which were difficult to reverse even when the tissue was washed repeatedly. This contraction was not blocked by any of the known receptor antagonists tested, but was completely inhibited by pretreatment with the calcium channel blocker nifedipine. Removal of extracellular calcium ions abolished ET-induced contractions. ET enhanced exogenous noradrenaline (NA)-induced contractions, but did not affect endogenous NA-induced contractions produced by electric stimuli. It is postulated that since endotheliumderived substances, such as ET, show powerful vasoreactivity, endothelial cells may play an important role in the regulation of the vasomotor tone of nasal blood vessels, along with the autonomic neural mechanism.

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Effect of Lysozyme Chloride on Abnormal Sensation in the Throat

Mitsuharu Nonomura, Hideyuki Fukushima, Hisayoshi Kojima, Kazuhiko Sho ...

1990 Volume 83 Issue 10 Pages 1605-1609
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1605

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We treated 57 patients with abnormal sensation in the throat without inflammation on inspection. 34 patients were treated with lysozyme chloride (Acdeam®) commbined with minor tranquilizer (Group A) and 23 patients were treated with minor tranquilizer only (Group B). Use of only minor tranquilizer was effective for 43.5%, on the other hand, combined use of minor tranquilizer and lysozyme chloride (Acdeam®) was 73.5%. Statistical difference was found between Group A and Group B. Therefore, lysozyme chloride (Acdeam®) is effective for patients with abnormal sensation in the throat without inflammation on inspection, because they have surely occult inflammation in the upper respiratory organ.

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Combination Therapy with AZT, FOM, for Infections in the Field of Otorhinolaryngology

Kiyoshi Yonei, Takayo Yanagawa

1990 Volume 83 Issue 10 Pages 1611-1616
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1611

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Infections of the ears, nose and thsoat are caused by a variety of pathogens at different sites and under various pathological conditions. Therefore, treatment with one antibiotic agent is sometimes not effective. In this study we evaluated the clinical and bacteriological results of combination therapy with aztreonam (AZT) and fosfomycin (FOM) in 4g patients with an acute exacerbation of chronic otitis media, chronic sinusitis or chronic tonsillitis.
The clinical effectiveness was 80.4%. Of the 41 strains of bacteria isolated, disappeared, 6 decreased and 9 were unchanged after the treatmedt of AZT and FOM. No side effects were observed.

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Diagnosis of Facial Palsy

[in Japanese], [in Japanese]

1990 Volume 83 Issue 10 Pages 1618-1619
Published: October 01, 1990
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.83.1618

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