Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 84, Issue 10
Displaying 1-22 of 22 articles from this issue
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  • Inner Ear Disorders
    -The Difference in Vulnerability between the Cochlea and the Vestibular Organ-
    Jiro Hozawa
    1991 Volume 84 Issue 10 Pages 1357-1364
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1357
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    The essential difference between cochlear damage and vestibular damage is discussed on the basis of the author's clinical experiences and animal experiments.
    i) Cochlear symptoms originate from the cochlea on the affected side. However, vestibular symptoms are caused by an functional imbalance of the vestibular organs on the affected side and the sound side.
    ii) In the disturbed process of the vestibular organ on the affected side, two different states could be observed: first, an irritative state, then a paralytic state. On the other hand, in cochlear damage there was only a paralytic state without any sign of initial irritation.
    Investigation of the differences above mentioned is very important to clarify the discrepancy of vestibulo-cochlear symptoms and inner ear pathology.
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  • Immuno-Therapy of Nasopharyngeal Carcinoma
    [in Japanese]
    1991 Volume 84 Issue 10 Pages 1366-1367
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1366
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  • Objective Tinnitus; A Report of Two Cases
    Chiaki Koide, Akio Imai, Akira Nagaba
    1991 Volume 84 Issue 10 Pages 1369-1374
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1369
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    A 9-year-old boy had click-like objective tinnitus generated by a voluntary palatal movement. No treatment was performed because the tinnitus was completely controllable. A 62-year-old woman complained of click-like objective tinnitus associated with expiration. The electromyogram revealed activity of the tensor veli palatini muscle associated with the tinnitus. Carbamazepine did not cure the tinnitus. Pterygoid hamulotomy stopped the tinnitus temporarily but it reappeared two weeks later.
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  • Abnormal Eye Movements in Fisher Syndrome
    Ken Kitamura, Masato Yagi, Naofumi Takueuchi, Jun Shimizu, Hiroyuki Sh ...
    1991 Volume 84 Issue 10 Pages 1375-1381
    Published: October 01, 1991
    Released on J-STAGE: December 12, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1375
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    In three patients with Fisher syndrome abnormal eye movements suggested the presence of supranuclear lesions.
    The first patient was a 59-year-old woman, and the second patient was a 37-year-old man. Both patients had preservation of Bell's phenomenon despite paralysis of voluntary upward gaze, an increase of the range of supraduction in the doll's eye maneuver, and downward nystagmus on gaze and positioning tests. In addition, ocular dysmetria was observed in the first and rebound nystagmus in the second patient. The third patient, a 56-year-old man, show ocular dysmetria and square wave jerks.
    In our patients, no central lesion was detected by either CT or MRI studies, although the abnormal eye movements mentioned above are consistent with a supranuclear lesion. These findings can't show definite location of the lesion in Fisher syndrome. However, ophthalmoplegia might result from both the peripheral and the supranuclear lesions.
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  • Barotraumatic Perilymphatic Fistula and Tympanometry in Lateral Position
    Sumiko Koyama, Kazuo Gotsu, Jin Okubo, Atsushi Komatsuzai
    1991 Volume 84 Issue 10 Pages 1383-1388
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1383
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    The presence of a perilymphatic fistula has been difficult to determine because of the lack of efficient and reliable testing methods. The condition is suspected on the basis of the history alone and is confirmed by surgery.
    Our previous studies have shown that when a patient with mild dysfunction of the eustachian tube lies on his side, the lower middle ear cavity pressure becomes markedly positive.
    It is important to differentiate perilymphatic fistula (PLF) from other inner ear disease, and the purpose of this study was to clarify by positional tympanometry mild dysfunction of the eustachian tube with barotraumatic PLF.
    Using the peak values of the tympanogram in the lateral position (TLP), we analyzed the changes in pressure of the lower tympanomastoid cavity in ears with PLF and in patients with sudden deafness.
    In patients with PLF, there was a significant increase in the internal pressure of the affected lower cavity, which rose to 81.0±4.4 mmH2O after 10 min (Nor. 27.7±16.8 mmH2O). On the other hand, in patients with sudden deafness, middle ear pressure was 24.13±8.00mmH2O after 10 min.
    These results suggest that when there is a strong possibility of barotraumatic PLF, we can utilize TLP for the diagnosis of PLF. Once there is a marked elevation of the affected ear cavity pressure in TLP, exploratory tympanotomy must be done immediately.
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  • Hydroxyapatite Ventilation Tube for the Treatment of Otitis Media with Effusion
    Sugata Takahashi, Yayoi Sato, Kouki Noto, Yuichi Nakano
    1991 Volume 84 Issue 10 Pages 1389-1392
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1389
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    Thirty-one patients with otitis media with effusion were treated with a ventilation tube made of hydroxyapatite, an inorganic component of bone. The shape of the tube is nearly same as the Grommet-type tube.
    The patients were followed from 1 to 12 months. The average time from intubation to extubation was 5.1 months. Only one patient had infection as a complication of intubation. The average hearing gain as a result of tube insertion was 16 dB.
    It was concluded that the hydroxyapatite tube would be a useful mid-term ventilation tube for the treatment of otitis media with effusion because of its satisfactory biocompatibility.
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  • Middle Ear Barotrauma during Hyperbaric Oxygenation
    Yoshikazu Igarashi, Yukio Watanabe, Kanemasa Mizukoshi
    1991 Volume 84 Issue 10 Pages 1393-1398
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1393
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    Middle ear barotrauma is a major side effect of hyperbaric oxygenation therapy (OHP) which may develop such clinical symptoms as otalgia and ear fullness.
    The purpose of this study is to observe patients with side effects during OHP and examine the factors predisposing to middle ear barotrauma.
    OHP was used in 94 patients (64 males and 30 females) at Shakaihoken Takaoka Hospital. Their subjective symptoms were correlated with sex, age, primary diseases and the incidence of middle ear barotrauma.
    In 12 patients with middle ear barotrauma, the incidence of eustachian tube stenosis, and of nasal and paranasal diseases were determined. Eustachian tube stenosis was evaluated by the measurement of opening pressure by catheter inflation. Nasal and paranasal diseases were evaluated by anterior rhinoscopy and plain X-rays.
    1. The incidence of middle ear barotrauma was 37.2%, higher in males (45.3%) than in females (20.0%).
    2. Aged patients and those with severe disease had a low incidence of middle ear barotrauma, but some of them might not have mentioned symptoms.
    3. In patients with middle ear barotrauma, a high incidence of nasal and paranasal diseases and a low incidence of eustachian tube stenosis were observed.
    These results suggest that otorhinolaryngological examinations should be performed in all patients treated with OHP. Treatment of nasal and paranasal diseases is important to prevent middle ear barotrauma.
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  • Middle Ear Diseases in Patients with Submucous Cleft Palate
    Kazunori Mori, Michio Kawano, Iwao Honjo, Yasuyuki Ishikawa, Yasuyuki ...
    1991 Volume 84 Issue 10 Pages 1399-1402
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1399
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    The association between middle ear disease and abnormal pathway of the levator veli palatini muscle was investigated by otological and endoscopic examination in patients with submucous clef palate (SMCP).
    The characteristics of middle ear diseases of SMCP patients were similar to those of cleft palate patients, suggesting that the morphology and function of the eustachian tube system are similar in those two types of cleft palate.
    In SMCP patients after palatoplasty, middle ear disease was less common in patients with levator muscle sling formation than in those without muscle sling formation. The abnormal pathway of the levator muscle was thought to have some effect on the middle ear. Some patients without muscle sling formation, however, had no middle ear disease, suggesting that other anatomical anomalies of the eustachian tube system also play an important role in the high incidence of middle ear disease in cleft palate patients.
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  • Marked Epistaxis Caused by Decreased Factor XIII
    Shigenori Matsubara
    1991 Volume 84 Issue 10 Pages 1403-1410
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1403
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    A 58-Year-old male was admitted in a pre-shock state due to marked epistaxis.
    After discharge, bilateral epistaxis occurred repeatedly. He had a history of hypertension and arteriosclerosis, and further examinations of his bleeding tendency showed decreased factor XIII. This decrease in factor XIII in addition to hypertension and arteriosclerosis seems to have caused marked epistaxis. Administration of factor XIII was effective.
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  • Endoscopic Findings in the Nasopharynx of Subjects with No Subjective Symptoms
    Kyosuke Kurata, Iwao Honjo
    1991 Volume 84 Issue 10 Pages 1411-1415
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1411
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    Endoscopic examination of the nasopharynx was performed in 100 normal subjects with no subjective symptoms. Pathological studies were performed in 21 cases.
    1) Evidence of chronic inflammation, such as redness, edema or swelling of the nasopharyngeal mucosa was detected in the nasopharyngeal region in 58% of the subjects who did not report any subjective symptoms.
    2) Pathologic studies revealed a high incidence of inflammatory changes in those cases in which endoscopy demonstrated redness, edema or swelling in the nasopharynx.
    Our study revealed that redness, edema and swelling of the nasopharynx evident on endoscopy accompanied by pathological changes in the ciliated epithelial cells and basal membranes. These changes were thought to originate not only from external stimuli but also from inflammatory events occurring within the nasopharyngeal regions.
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  • Blood Boil of the Maxillary Sinus with Massive Bone Destruction; A Case Report
    Masahiro Kawaida, Naoyuki Kohno, Yoshihisa Kawasaki, Hiroyuki Fukuda
    1991 Volume 84 Issue 10 Pages 1417-1422
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1417
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    A 59-year-old man complained of swelling of the cheek, nasal obstruction and nasal bleeding. Radiographic examination showed massive bone destruction of the left maxillary sinus. The tentative diagnosis was malignant tumor of the maxillary sinus. The patient was treated with maxillotomy. Histopathological examination revealed no evidence of malignancy, but hematoma and necrotic tissue with pseudostratified columnar ciliated epithelium.
    Blood boil is a clinical term and the etiology is indefinite. It is possible for several causative factors to exist. It is difficult to distinguish such a lesion from malignant tumor and careful examination with long term follow-up is necessary.
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  • Metastasis of Grawitz's Tumor to the Tongue; A Case Report
    Kazunari Oda, Takaharu Tatsukawa, Kazuyuki Kawaguchi, Noriyuki Fukushi ...
    1991 Volume 84 Issue 10 Pages 1423-1427
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1423
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    Grawitz's tumor metastasizing to the tongue is very rare. Only six cases have been reported in Japan. We treated a patient with Grawitz's tumor metastasizing to the base of the tongue. The patient is a 66-year-old male with a complaint of dysphagia. He had undergone left nephrectomy for Grawitz's tumor six years earlier, Cryosurgery was performed to reduse the mass of the tongue, but he died of pulmonary metastasis six months later.
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  • Trapezius Osteomyocutaneous Flap in Reconstructive Surgery for Mandibular and Oral Defects
    Yo Kimura, Tadashi Nakamura, Hitoshi Tojima, Ryoji Kanayama, Shigeru F ...
    1991 Volume 84 Issue 10 Pages 1429-1436
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1429
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    Reconstruction of the mandibular arch after ablative surgery of the oral cavity is extremely difficult. Recently, in cases of more complex defects, including bone and soft tissue loss, an osteomyocutaneus flap is commonly used for one-stage repair. This study examines the trapezius myocutaneous flap incorporating the spine of the scapula in reconstructive surgery for mandibular and oral defects.
    We utilized this technique in 3 patients with oral cavity carcinoma. All the patients had been irradiated and treated with anti-cancer drugs before operation. In one patient this technique failed because of stagnant venous return caused by an intraoperative procedure. Reconstruction was performed by a compound rib-latissimus dorsi osteomyocutaneous flap two days after operation. All the patients had successful healing with excellent esthetic and functional resuslts. The 99mTc labeling bone scan and panorex radiographs showed evidence of active bony turnover. The spine of the scapula-trapezius osteomyocutaneous flap is thus useful for repair procedures for mandibular and oral defects.
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  • Recurrent Cervical Abscess Due to a Piriform Sinus Fistula; A Case Report
    Tomoo Suzuki, Mariko Hayashi, Keisuke Mizuta, Hiromichi Shirato, Takah ...
    1991 Volume 84 Issue 10 Pages 1437-1442
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1437
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    In 1979, Takai and Miyauchi reported that piriform sinus fistula is a common route of infection in acute suppurative thyroiditis (AST). We describe a 40-year-old patient who had four recurrent episodes of abscess of the left anterior area of the neck without symptoms of AST. We diagnosed left piriform sinus fistula by barium hypopharyngography.
    The fistula was completely removed under general anesthesia. At surgery, a fistula could be traced from the left upper lobe of the thyroid to the Piriform sinus between the thyroid and cricoid cartilages. In cases of repeated cervical abscess due to unknown causes, we should consider infection via piriform sinus fistula without episodes of AST.
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  • Cavernous Hemangioma of the Hypopharynx; A Case Report
    Norihiko Ishikawa, Hitoshi Hentona, Kazunori Miyake, Atsushi Komatsuza ...
    1991 Volume 84 Issue 10 Pages 1443-1449
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1443
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    A 68-year-old woman complained of a feeling of a lump in her throat for one month. Indirect laryngeal examination revealed a round irregular-surfaced dark purple mass about 2 cm in diameter in the left pyriform sinus. The tumor was completely excised by left lateral pharyngotomy. The wound was closed primarily. The postoperative course was uneventful.
    Twenty cases of hemangioma of the hypopharynx have been reported in Japan and nine cases in the English literature. These cases were reviewed and analyzed.
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  • So-Called C arcinosarcoma of the Larynx with Dyspnea; A Case Report
    Hidekazu Ebihara, Hisao Miyashita
    1991 Volume 84 Issue 10 Pages 1451-1456
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1451
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    So-called carcinosarcoma of the larynx was diagnosed in a 59-year-old male.
    The stalk of the tumor was in the left vocal cord, and the growth pattern was exophitic. Serious dyspnea was present, although the pathological classification of T1.
    Total laryngectomy was performed, and the postoperative clinical course has been uneventful for 36 month.
    The diagnostic and therapeutic aspects and the concept of carcinosarcoma are discussed.
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  • Clinical Observations on Bilateral Recurrent Laryngeal Nerve Paralysis
    Tohru Tsuzuki, Hiroyuki Fukuda, Tadashi Fujikao, Etsuyo Takayama, Masa ...
    1991 Volume 84 Issue 10 Pages 1457-1462
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1457
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    A clinical study was conducted on 48 patients with bilateral recurrent laryngeal nerve paralysis, 29 females and 19 males. In 38 patients (79%), the paralysis was seen as surgical or post-operative. In a fairly large number of female patients it occurred after thyroid surgery and in males after surgery for esophageal cancer.
    This paralysis was often seen in males in the 6th and 7th decades of life, but in females seen from the 4th to 8th decades. Hoarseness was the most common symptom, followed by dyspnea, but dyspnea was never observed if there was more than 2 mm between the vocal folds. There was no significant correlation between the distance between the vocal folds and aspiration. There was also no instance of dyspnea becoming more serious, according to the answers to our questionnaire.
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  • Experimental Studies on Eustachian Tube Function in Otitis Media with Effusion
    Eimoto Hamada
    1991 Volume 84 Issue 10 Pages 1463-1482
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1463
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    The pathogenesis of otitis media with effusion (OME) in relation to eustachian tube function was investigated in rats.
    First, the passive function of the eustachian tube was examined by the inflation-deflation test and the forced response test in experimental OME induced by the intratympanic injection of E. coli endotoxin (ET). Before injection passive opening pressure (Po) was 292.1±64.7 mmH2O, closing pressure (Pc) was 184.5±49.1 mmH2O, tubal resistance (R2) was 85.8±23.7 mmH2O/ml/min. OME persisted for up to 2 days. On the day after inoculation Po, Pc, and R2 were significantly higher than before.
    Second, the third branch of the trigeminal nerve (V3), which supplies the tensor veli palatini muscle (TVPM), was cut and the four eustachian tube function tests were repeated. The three passive tubal ventilatory tests (inflation-deflation, forced response, and eustachian tube function in a pressure chamber) showed that Po, Pc, and R2 were significantly lower than before the nerve was cut; the negative pressure test indicated that negative middle ear pressure was not released even by swallowing. This dysfunctional eustachian tube model is considered to represent the compliant tube (floppy tube), which is characterized by low middle ear pressure for passive opening and functional obstruction under negative middle ear pressure.
    Third, three eustachian tube function tests (inflation-deflation, forced response, and negative pressure) were performed after ET inoculation and V3 section. Middle ear effusion was observed for 5 days or longer in all the rats. Compliant tube features were seen on the fourth day, and they persisted even after the effusion cleared.
    In conclusion, these experimental studies indicate that both inflammation and tubal dysfunction are probably important factors in the pathogenesis of OME.
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  • Effect of Fosfomycin on Nasal Ciliary Activity
    Takechiyo Yamada, Hitoshi Saito, Ichiro Noda, Shigehito Mori, Noriyuki ...
    1991 Volume 84 Issue 10 Pages 1483-1487
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1483
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    The effect of fosfomycin on the nasal ciliary activity of the C3H mouse was examined by a photo-electric method.
    Ciliary activity was observed from 30 min to 24 hrs after incubation in RPMI-1640 including fosfomycin (1% to 5%). Ciliary activity was affected time- and dose-dependently. Investigation with several osmotic pressures suggested that the major impediment factor was osmotic pressure. Osmotic pressure of about 3, equivalent to 5% fosfomycin in water, did not severely affect the ciliary activity for at least 2 hrs after the incubation. Therefore, 5% fosfomycin in water is clinically advisable for in vivo concentration in consideration of dilution with nasal discharge and retention-time in the nasal cavity.
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  • Prophylactic Treatment of Japanese Cedar Pollenosis with Beclomethasone Dipropionate Nasal Spray
    Hiroshi Ogawa, Kazuhiro Hashiguchi, Hatsumi Hamada, Yoshiji Yamazaki
    1991 Volume 84 Issue 10 Pages 1489-1496
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1489
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    Japanese cedar (Cryptomeria japonica) pollenosis is a common clinical problem in otorhinolaryngeal practice. Japanese cedar pollen affects a very large fraction of the population, and its symptoms are more severe and various than perennial allergic rhinitis. Beclomethasone dipropionate is a potent, topically active corticosteroid drug and most widely used, but patients with severe rhinitis often fail to obtain relief. Therefore, a clinical trial was undertaken to assess the efficacy of pre-seasonal administration in the prevention of Japanese cedar pollenosis. Pre-seasonal treatment with beclomethasone appeared to significantly suppress attacks in comparison with patients who are not treated before the pollen season.
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  • Effect of Ketotifen on Rhinitis with Nasal Hyperresponsiveness
    Ken-ichi Hisamatsu, Tsutomu Nakazawa, Mani Nakazawa, Tetsuya Ganbo, Yo ...
    1991 Volume 84 Issue 10 Pages 1497-1502
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1497
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    Eleven patients with perennial allergic rhinitis were treated with 2mg of ketotifen, an anti-allergic drug, for 8 weeks, and the clinical effect and improvement on hyperresponsiveness of the nasal mucosal glands to acetylcholine chloride were studied. Acetylcholine chloride was employed at low concentrations of 1 μg/ml and 10 μg/ml to provoke nasal secretion without sneezing. The provoked nasal secretions were measured by a fluorestinstained thread method.
    Overall improvement of the nasal symptoms was 81.8% with no side effects. Acetylcholine provoked nasal secretion was significantly inhibited with 1 μg/ml (p<0.01) and 10 μg/ml (p<0.05).
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  • Extensive Denker's Operation in the Treatment for Maxillary Sinus Carcinoma
    [in Japanese]
    1991 Volume 84 Issue 10 Pages 1504-1505
    Published: October 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.1504
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