Practica Oto-Rhino-Laryngologica

Juvenile Nasopharyngeal Angiofibroma

Yasuo Harada, Katsuhiro Hirakawa

1991 Volume 84 Issue 12 Pages 1663-1671
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1663

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Juvenile nasopharyngeal angiofibroma (JNA) is a relatively rare, benign, highly vascular tumor that almost exclusively affects adolescent males. This tumor is not limited to the nasopharynx and usually extends into the nose, paranasal sinuses, pterygomaxillary fossa, temporal fossa, cranium et al. Computed tomography (CT) and magnetic resonance imaging (MRI) are of great use in defining the extent of the tumor, bony destruction, sinus involvement and other extensions. Good results have been reported in the treatment of JNA with either surgical resection or radiation therapy. In general, most authors favor surgical resection, saving radiation for tumors with extensive intracranial invasions. Hormone therapy, chemotherapy, and arterial embolization have been used as auxiliary techniques, but generally have not been employed as primary treatment modalities. CT, MRI and selective angiography are important in the meticulous treatment planning and careful follow up in the management of this tumor.

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Two Cases of Laryngeal Neurilemmoma

[in Japanese], [in Japanese]

1991 Volume 84 Issue 12 Pages 1672-1673
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1672

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A Report of Hereditary Mondini Type Inner Malformation

Yasushi Ohta, Hiroaki Funai, Bunji Tajima, Keiko Ogawa

1991 Volume 84 Issue 12 Pages 1675-1682
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1675

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High resolution computed tomography (HRCT) of the temporal bone has enabled us to diagnose inner ear anomalies easily. Otorhinolaryngologists will be able to diagnose Mondini type malformation more frequently. A 55-year-old female visited us because of hearing loss and vertigo. Pure tone audiograms revealed bilateral deafness. Bilateral Mondini type inner ear malformations were observed in the HRCT of the temporal bone. Her family history revealed that there were five women with severe hearing impairment. We perform temporal bone HRCT and audiograms on three women with impaired hearing and a woman with normal hearing in her family. Pure tone audiograms of three women revealed nearly bilateral deafness and temporal bone HRCT showed bilateral Mondini type inner malformations similar to one another. The CT of the woman with normal hearing showed completely normal findings. Autosomal dominant inheritance was suspected because of the family history.

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Treatment of Children with Otitis Media with Effusion (OME)

Iwao Honjo, Akihiko Fujita, Kyosuke Kurata

1991 Volume 84 Issue 12 Pages 1683-1689
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1683

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On the Basis of 205 answers from ENT doctors to questionaires on the treatment of otitis media with effusion (OME) in children, we attempted to evaluate these therapies from the view-points of pathogenesis of OME: eustachian tube dysfunction and upper respiratory inflammation.
For compensation of tubal dysfunction, air inflation of the tube, puncture of the drum, myringotomy and placement of tympanostomy tubes are performed. However, we should be aware that the duration of the effect of ventilating the middle ear cavity varies greatly depending on the method.
For improvement of upper respiratory inflammation, including the nose and eustachian tube, administration of antibiotics etc, and conservative treatment of rhinitis and paranasal sinusitis were frequently carried out. However, antibiotics have only a temporary effect on OME. On the other hand, treatment of paranasal sinusitis, which frequently accompanies OME in children, was found to be effective.
In general, we should take it into account that OME in children has the characteristic of spontaneous healing with increasing age. Therefore, in using the therapeutic methods mentioned above, we should select the proper one in relation to both the age of the child and the duration or severity of the OME.

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Office Closure Method for Perforated Tympanic Membrane Using Collagen Sheet

Toshio Yamashita, Yuji Tohyama, Tadashi Iwano, Chiyonori Ino, Mako Kat ...

1991 Volume 84 Issue 12 Pages 1691-1697
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1691

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A new closure method was carried out on 281 ears with sizable tympanic perforations caused by trauma or chronic otitis media. This method combines trichloracetic acid cautery and a collagen sheet patch. Closure was successful in 91.1% of perforations due to trauma and in 68.6% of those due to chronic otitis media. The treatment time averaged 6.7 weeks and 16.3 weeks, respectively. This method is thought to be useful, especially in ENT office practice because it is easy and relatively prompt.

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Peripheral Facial Nerve Palsy; A Statistical Study

Hiroyuki Kodama, Hiroshi Tsubota, Hideaki Shirawaki, Yasushi Kukuminat ...

1991 Volume 84 Issue 12 Pages 1699-1705
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1699

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A statistical analysis of the prognostic factors of peripheral facial nerve palsy was performed on 110 patients with Bell's palsy and 24 patients with Hunt's syndrome admitted to the Department of Neurotology at Nakamura Memorial Hospital from 1981 to 1989. The patients treated within 13 days after the onset got to be recovered significantly better than those treated after 14 days. The final recovery rate was significantly higher in patients with Bell's palsy than those with Hunt's syndrome. High evoked electro nerve potential and low nerve excitability differences were good prognostic signs in both disease. Steroid and acyclovir were significantly effective in the patients with Hunt's syndrome.

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Adenoid Cystic Carcinoma of External Auditory Canal; A Report of Two Cases

Yasuyuki Nishiyama, Toshiyuki Ono, Keigo Tatemoto, Yasushi Murakami

1991 Volume 84 Issue 12 Pages 1707-1713
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1707

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Two patients were treated surgically for adenoid cystic carcinoma of the external auditory canal. A 24-year-old woman complained of pain and preauricular swelling. The diagnosis was confirmed by biopsy of the posterior wall of the right external auditory canal. Histopathological study revealed typical tubular type of adenoid cystic carcinoma. She was treated primarily with en bloc resection of the external auditory canal, radical mastoidectomy, parotid gland extirpation and regional lymphnode resection for the purpose of complete surgical removal of the tumor. Thereafter, irradiation was done. The second patient was an 80-year-old man, who complained of earache. The diagnosis was confirmed by biopsy of the anterior wall of the left external auditory canal. Histopathological study revealed cribriform type of adenoid cystic carcinoma. He was treated only with en bloc resection of the external auditory canal because of his age and because his tumor was limited to the cartilagenous part of the external auditoryanal.

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Anterior Nasal Atresia; A Case Report

Kensei Naito, Masato Miwa, Takashi Suzuki, Ryuichi Kato, Shigenobu Iwa ...

1991 Volume 84 Issue 12 Pages 1715-1722
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1715

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In a 50-year-old housewife anterior nasal atresia was diagnosed and treated with surgical enlargement of the stenosis with a skin flap transplantation technique under local anesthesia.
She was able to breathe comfortably through the nose after the operation. Rhinomanometry, which is an objective evaluation of nasal patency, showed obvious reduction of nasal resistance to airflow after the surgical repair. The stenosis has not recurred during the approximately two years since the skin flap transplantation operation.
We reviewed the 49 reported cases of anterior nasal atresia in Japan, including our case, and discuss this rare condition.

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Nasal Allergy in Hakodate; A Clinical Study

Shiroh Maguchi, Tomohide Tabuchi

1991 Volume 84 Issue 12 Pages 1723-1728
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1723

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A clinical study was carried out on 202 patients with nasal allergic symptoms seen in the otolaryngological clinic of Hakodate Chuo Hospital from April 1989 to March 1990. The diagnosis was made through their history, number of eosinophiles in the peripheral blood and nasal secretions, intradermal skin tests, radioallergosorbent test (RAST) and nasal provocation test.
House dust and mites were the most frequent allergens, as has been reported in almost all clinics. With respect to pollinosis, the highest incidence of allergy was observed to artemisia in August and September, followed by allergy to orchard grass in June and July. Although Japanese cedar pollen has been reported to be airborne to this district, there were much fewer patients allergic to this pollen than on Honshu island.

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Nasal Leiomyoma; A Case Report

Tetsuro Saka, Masahiko Higashikawa, Motome Nakamura, Yuzo Yamamoto, Hi ...

1991 Volume 84 Issue 12 Pages 1729-1734
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1729

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We treated a 45-year-old woman who had complained of left nasal obstruction for three years. A spherical tumor was found in the nasopharyngeal space and was removed surgically under general anesthesia in our hospital. The 30×24×15 mm tumor arose from the end of the left middle turbinate. Histopathological examination revealed a vascular leiomyoma. It is relatively uncommon for leiomyomas to develop in the nasal and paranasal cavities. Only 36 such cases have been reported in Japan; ours is the 37th case.

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Penetration through the Upper Eyelid and into the Maxillary Sinus by a Piece of Bamboo; A Case Report

Masaru Toshima, Sho Hashimoto, Toshimitsu Kobayashi, Tomonori Takasaka

1991 Volume 84 Issue 12 Pages 1735-1739
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1735

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A piece of bamboo accidentally pierced the upper eyelid of a 40-year-old man. Computed tomography (CT) revealed a foreign body in the orbit and maxillary sinus. The maxillary sinus was explored five days after the injury. A piece of bamboo with a split end had traversed the bony orbital floor, and several fragments were found in the maxillary antrum. After removal of the foreign body, the patient recovered quickly with only a slight decrease in visual acuity.
In the Japanese literature this is the first case report of a wooden foreign body penetrating through the upper eyelid deep into the maxillary sinus.
It is important to suspect the existence of a foreign body and to evaluate the CT in detail, in such cases.

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Preoperative Histological Assessment of Salivary Gland Lesions by Biopty Biopsy Instrument

Kentaro Ochi, Toru Ohashi, Sadao Ogino, Hirohisa Yazaki, Noriko Kihara ...

1991 Volume 84 Issue 12 Pages 1741-1745
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1741

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Recently, a “Biopty-Gun” has been introduced as a simple method of needle biopsy. We assessed the clinical usefulness of this device in salivary gland lesions. Ten biopsies in the salivary gland were performed with 18-gauge needles in dispensary.
High-quality histopathologic specimens were obtained in all biopsies without complications, and diagnostic target tissue was obtained in all cases. The Biopty-Gun eliminated the disjointed movements of conventional needle biopsies, and none of the samples demonstrated significant crush artifacts or obscuring blood, problems that are commonly associated with the manual biopsy technique.
We believe this procedure offers a safer and more effective means of obtaining adequate tissue for histopathological assessment. With these distinct advantages, Biopty-Gun should be useful for salivary gland lesions.

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Three Cases of Carcinoma in Pleomorphic Adenoma of the Parapharyngeal Space

Tetsuya Ogata, Nobuya Yagi, Makoto Miura, Shogo Shinohara

1991 Volume 84 Issue 12 Pages 1747-1752
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1747

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Three cases of carcinoma in pleomorphic adenoma of the parapharyngeal space are reported. All cases were resected surgically through the lateral cervical approach. The histological diagnosis made at the time of transoral biopsy before operation in two cases was benign, but postoperative diagnosis was malignant. According to recent reports, cases of malignant parapharyngeal tumors are increasing.
If the tumor is suspected malignant, surgical resection should be performed immediately without transoral biopsy

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Ankyloglossia with Deviation of the Epiglottis and Larynx

-Symptoms and Respiratory Functions in Adults-

Susumu Mukai, Chikako Mukai, Kazuyuki Asaoka

1991 Volume 84 Issue 12 Pages 1753-1762
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1753

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We have treated 38 adults with ankyloglossia with deviation of the epiglottis and larynx.
1) The patients had type III occlusion of Angle's and had irregular teeth in the upper jaw.
2) The patients' chief complaints were shoulder stiffness, cold extremities, feeling of obstruction in the throat, insomnia, fatigue, snoring, irritated, dry skin, incorrect articulation and muscle cramps during physical activity, pregnancy and/or sleep.
3) Correction of the ankyloglossia and deviation of the epiglottis and larynx resulted in great relief of their chief complaints as well as their respiratory function.
4) In addition, patients said that they breathed more easily, could bite well, and that their joints could bend better. They also remarked that they were less angry.
However there were no significant changes in their incorrect articulations.

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Localization of Interleukin-1α, β in Cholesteatomatous Epithelium

Hiromu Kakiuchi, Takaaki Kimura, Akira Shibano, Yutaka Kato, Kazuya Ki ...

1991 Volume 84 Issue 12 Pages 1763-1768
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1763

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Interleukin-1 (IL-1) has been thought to be one of the essential cytokines mainly produced by macrophages. It has recently been reported that epidermal keratinocytes produce IL-1, and attention is being paid to local immune reactions mediated with this cytokine. IL-1 not only activates lymphocytes, but also acts as an osteoclast-activating factor. In this study, we used immunohistochemistry and immunoblotting on cholesteatomatous epithelium with anti-IL-1α antibody and anti-IL-1β antibody to evaluate the production of IL-1 by epithelial keratinocytes.
Highly concentrated IL-1α was found in the cholesteatomatous epithelium, especially in the basal cell layer. The intensity of IL-1β staining was weaker. In the immunoblotting study, the 31 kD band, intracellular immature IL-1 molecule, was identified besides 17 and 52 kD. These findings suggest that IL-1 is derived from cholesteatomatous keratinocytes. IL-1, mainly IL-1α, from the stimulated cholesteatomatous keratinocytes may be one of the important factors for the markedly increased bone resorption observed in cholesteatoma patients.

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Morphological Study of the Wounds Approximated with Nd: YAG Laser Irradiation

Hirofumi Nishizono

1991 Volume 84 Issue 12 Pages 1769-1782
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1769

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Ann experimental study was carried out using the Nd: YAG laser by approximating surgically cut skin wounds in guinea pigs. The wound healing condition was observed by scanning electron microscopically using a tissuemaceration method with an NaOH solution characterizing tissue collagen as well as HE staining for the paraffin specimen. Tensile strength of the wound tissue was measured. The study was carried out under intraperitoneal anethesia with Ketamine solution on the 7th, 21 th and 42th postoperative day and the findings compared with those obtained in the control animals the incised wounds of which was closed by the silk suture methods.
The incised skin wounds following laser approximation showed less scarring and faster healing than the conventional silk suture technique. The advantages of this new laser technique were follows; 1) uniformity, 2) low scar formation, 3) strong approximation, and 4) rapid wound healing.
This laser technique will be beneficial as a new procedure of skin suture in clinical practice.

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Treatment of Tinnitus with Tizanidine Hydrochloride

Shinsei Nishihara, Takayuki Shinohara, Kiyofumi Gyo, Naoaki Yanagihara ...

1991 Volume 84 Issue 12 Pages 1783-1788
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1783

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The clinical effects of tizanidine hydrochloride were evaluated in 58 patients with tinnitus. The subjective improvement rate was 60.0%. A better effect was obtained when the loudness of the tinnitus was more than 10 dB and when treatment was continued for over 4 weeks. Treatment with tizanidine hydrochloride alone was as effective as combined treatment with other drugs.
Shoulder stiffness improved in 47.5% of the patients and in these patients tinnitus responded better. Side effects were observed in 15.5%, but none were serious.

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Influence of Inhaled Broncasma Berna® Administered by Ultrasonic Nebulization on the Lower Respiratory Tracts of Rabbits

Kayoko Hanazawa, Yoichi Hatano, Eiko Ito, Yoshitaka Okamoto, Kiyoshi T ...

1991 Volume 84 Issue 12 Pages 1789-1798
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1789

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The influence of inhaled Broncasma Berna® on the lower airways was evaluated by histopathological examination. Thirtynine rabbits were divided into 9 groups (A-I). In group A, Broncasma Berna® (BB) solution was administered by ultrasonic nebulization twice a week for 4 weeks starting four weeks after immunization with BB and Freund's complete adjuvant (CFA). In group B, a steroid was inhaled along with BB in the same schedule as in group A. In group C, 0.9% saline solution (SS) was injected and inhaled. In group D, SS was inhaled after immunization with CFA and SS. Group A-D animals were sacrificed 24 hours after the last inhalation. Group E-H rabbits were sacrificed 1, 2, 4 or 12 weeks after the last inhalation, but otherwise the schedule was the same as in group A. Group I was the control group in which nothing was done for 24 weeks. The groups were compared histologically and immunologically. No change was observed during Ag challenge.
Typical pathological changes were macrophage infiltration and granulomatous proliferation resembling sarcoidosis in the alveoli. The degree of severity was A=E>D, F, G>B>H>C>I. The BB specific antibody in serum measured by ELISA was significant-ly higher in groups A, B, E, F, G and H than in I or the SS control groups. The Ab titer in BALF was higher in groups A, B and G. The elevated BALF IgG level correlated statistically well with the degree of granulomatous proliferation.

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Diagnosis of Dizziness

[in Japanese]

1991 Volume 84 Issue 12 Pages 1800-1801
Published: December 01, 1991
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.84.1800

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