Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 84, Issue 4
Displaying 1-20 of 20 articles from this issue
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  • Diagnosis and Surgical Treatment of Pharyngeal Dysphagia
    Hiroshi Okamura, Toshihiro Mori, Shoko Inaki
    1991 Volume 84 Issue 4 Pages 413-424
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.413
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    We introduce here our diagnostic approaches for pharyngeal dysphagia and briefly discuss the results of surgical treatments. In dysphagia, we routinely use fluorography, manometry, electromyography and endoscopy. Fluorography in conjunction with manometry particularly provides valuable information for understanding the function of pharyngeal swallowing.
    Fluorography is the most important diagnostic means of studying the function of swallowing. We utilize the double contrast pharyngogram using Computed Radiography as the screening method for detecting clinical and subclinical dysphagia, since barium coating or remaining on the pharyngeal mucosa is always observed in patients with organic or functional dysphagia. Moreover, we devised a new system of pharyngo-esophagography using a video tape recorder, digital fluorography and a multiformat camera, because a contrast medium rapidly passes through the pharyngeal phase of swallowing. The video signal from the fluoroscopic unit is fed into the video tape recorder, and recorded images are transferred through the digital fluorography to the multiformat camera. Sequential images of barium swallowing in one deglutition are copied on sheet film at the rate of 30 frames per second. By this method, qualitative and quantitative assessments of pharyngeal swallowing can be carried out easily.
    Manometric study indicates the constricting power of pharyngeal muscles for propulsion of a bolus into the esophagus and timing of relaxation of the esophageal orifice during swallowing. The relaxation of the esophageal orifice cannot be detected by fluorography. Only a manometric approach indicates the timing, duration and degree of relaxation.
    We also describe our experience with surgical treatment of 19 patients with pharyngeal dysphagia caused by cerebro-vascular accidents, degenerative diseases of the neuromuscular system and myositis, and we discuss briefly the use of cricopharyngeal myotomy, section of the infrahyoidal muscles and a laryngeal elevation technique in these diseases.
    Finally, we emphasize the importance of multidimensional diagnostic approaches to pharyngeal dysphagia, on the basis of which the most suitable method of treatment can be selected.
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  • Head and Neck Anomalies and hysphagia in Thalidomide Embryopathy
    [in Japanese]
    1991 Volume 84 Issue 4 Pages 426-427
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.426
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  • Rehabilitation for Bilateral Loss of Vestibular Functions
    Akihiro Matsuoka, Kouji Tokumasu, Akihiro Higuchi, Akito Fujino, Satos ...
    1991 Volume 84 Issue 4 Pages 429-443
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.429
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    Vestibular stimulation is a popular clinical treatment for enhancing the acquisition of central compensation in cases of unilateral vestibular disturbance (BPPV, Vestibular neuritis etc…), but it is not often used for bilateral vestibular disturbances. A 37-year-old woman, given 20g of Streptomysin sulfate intramuscularly, suffered from dizziness and oscillopsia for about 20 years. Her caloric test indicated almost total canal paralysis bilaterally, so it was thought to be a bilateral vestibular disturbance. She was trained by a new combination of vestibular, visual and proprioceptive stimulation for 32 days. Our training was useful of disequilibrium and dizziness in reducing complaints. We evaluated the effects of training on equilibrium by stabilometry, stepping test, and gait test.
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  • Incidence of Occult Otitis Media in Healthy Infants under One Year of Age
    Akira Kodama, Eiyu Takeda, Youichi Ishizuka
    1991 Volume 84 Issue 4 Pages 445-451
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.445
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    We studied the incidence of occult otitis media in healthy infants under one year of age who visited the pediatric out-patient clinic for a routine medical checkup.
    For this study, we examined the eardrums of 137 infants by otomicroscopy from June through December 1988.
    In addition, we used the questionnaires to check the present and past conditions of the ears and nose in these infants.
    Asymptomatic otitis media was seen in 23 children (17%). The eardrum findings were more compatible with otitis media with effusion than acute otitis media. The incidence of otitis media increased with age; 13% in infants under 3 months of age, 16% in those from 4 to 6 months of age, and 22% in those from 7 to 12 months of age.
    The responses to the questionnaire showed that none of the mothers suspected any ear disease in the infants at the time of examination, and only infant had a past history of otitis media. The incidence of otitis media was 51% in infants with nasal symptoms, and 4% in those without nasal symptoms.
    It is important for pediatricians to realize that many infants have asymptomatic otitis media.
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  • Glomus Tympanicum Tumor; A Case Report
    -Benefits of Preoperative Diagnostic Imaging-
    Taketoshi Fujita, Mituaki Takahashi, Megumi Kumai, Naoki Kanai, Tokuji ...
    1991 Volume 84 Issue 4 Pages 453-458
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.453
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    The patient was 67-year-old female who complained of pulsatile tinnitus in the right ear. Otoscopy revealed a reddish mass that extended to the annulus.
    CT, MRI and angiography localized it in the middle ear cavity and distinguished it from the jugular bulb. The tumor was completely resected by posterior hypotympanotomy after embolization of the superior tympanic artery. Absence of tumor recurrence was con-firmed 8 months after surgery. We discuss the benefits of preoperative diagnostic imaging methods.
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  • Primary Cyst in the Mastoid
    A Case Report
    Yasushi Ohta, Hiroaki Funai, Bunji Tajima
    1991 Volume 84 Issue 4 Pages 459-553
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.459
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    Formation of cysts in the paranasal sinuses is common but in the mastoid cavities, it is rare. A 49-year-old female had a primary cyst in a mastoid cavity. Operation confirmed that the aditus was completely obliterated by the cyst wall and a cholesterol granuloma. There was no communication between the mastoid cavity and the epitympanic cavity. The etiology of mastoid cysts has been uncertain, but obstruction of the air ventilation in the middle ear space at the aditus is thought to play an important role in the etiology. Mastoid cyst is diagnosed by aspiration of the cyst, but it is important to differentiate it from meningoencephalocele and meningocele protruding into the mastoid cavity. Radiologic imaging, especially CT and MRI, should be done before the aspiration.
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  • Enhanced MRI in Patients with Facial Palsy
    -Study of Time-Related Enhancement-
    Masahiro Yanagida, Tsutomu Kato, Koichi Ushiro, Masanori Kitajiri, Tos ...
    1991 Volume 84 Issue 4 Pages 467-473
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.467
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    We performed Gd-DTPA-enhanced magnetic resonance imaging (MRI) examinations at several stages in 40 patients with peripheral facial nerve palsy (Bell's palsy and Ramsay-Hunt syndrome). In 38 of the 40 patients, one and more enhanced region could be seen in certain portion of the facial nerve in the temporal bone on the affected side, whereas no enhanced regions were seen on the intact side.
    Correlations between the timing of the MRI examination and the location of the enhanced regions were analysed. In all 6 patients examined by MRI within 5 days after the onset of facial nerve palsy enhanced regions were present in the meatal portion. In 3 of the 8 patients (38%) examined by MRI 6 to 10 days after the onset of facial palsy, enhanced areas were seen in both the meatal and labyrinthine portions.
    In 8 of the 9 patients (89%) tested 11 to 20 days after the onset of palsy, the vertical portion was enhanced. In the 12 patients examined by MRI 21 to 40 days after the onset of facial nerve palsy, the meatal portion was not enhanced while the labyrinthine portion, the horizontal portion and the vertical portion were enhanced in 5 (42%), 8 (67%) and 11 (92%), respectively. Enhancement in the vertical portion was observed in all 5 patients examined more than 41 days after the onset of facial palsy.
    These results suggest that the central portion of the facial nerve in the temporal bone tends to be enhanced in the early stage of facial nerve palsy, while the peripheral porton is enhanced in the late stage. These changes of Gd-DTPA enhanced regions in the facial nerve may suggest dromic degeneration of the facial nerve in peripheral facial nerve palsy.
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  • Spontaneous Cerebrospinal Fluid Rhinorrhea
    A Case Report
    Kazunari Oda, Akira Nagasawa, Kazuyuki Kawaguchi, Naoki Mori, Katsuhir ...
    1991 Volume 84 Issue 4 Pages 475-481
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.475
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    A 46-year-old male had complained of persistent rhinorrhea since October 24, 1988. Two days after the onset of rhinorrhea be developed meningitis.
    Plain X-ray and tomography revealed a fluid shadow in the sphenoid sinus. RI cisternography (111In-DTPA) showed evidence of a CSF leak. The precise site of the CSF leakage could be detected by metrizamide CT. Surgery was performed through a transmaxillary approach under an operating microscope.
    Several small holes were found in the posterior wall of the sphenoid sinus.
    The leak site was covered with femoral fascia and muscle. He has remained symptomfree 14 months postoperatively. Metrizamide CT is usefull to determine the precise leak site in patients with active leaks.
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  • Paranasal Sinusitis in Children and SIgA in Nasal Secretions
    Yasuyuki Ishikawa
    1991 Volume 84 Issue 4 Pages 483-487
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.483
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    The cause of paranasal sinusitis is still unknown although several factors have been implicated: underdevelopment of the paranasal sinuses, intranasal deformities, dysfunction of the mucosal defense mechanisms and allergy. Among them, the local immune system, including secretory IgA (SIgA), plays an important role in the defense mechanism of the upper respiratory tract. However, there have been no reports relating the concentration of SIgA in nasal secretions with the development of paranasal sinus infection.
    We examined the concentration of SIgA in the nasal secretions of 48 patients with paranasal sinusitis, aged 3 to 15 years. Nasal secretion was obtained by the filter-paper method and diluted in 1cc of saline. The value of SIgA in these solutions was determined by enzyme-immunoassay and expressed as μg (SIgA)/g(nasal secretion). Furthermore, 12 patients were treated conservatively and the SIgA was determined periodically. The control group included 41 normal subjects aged 3 to 15 years.
    The value of SIgA in nasal secretions was significantly lower in patients (569.0±291.0μig/g) with paranasal sinusitis than in the normal controls (847.7±387.6μg/g). The concentration of SIgA decreased significantly during treatment for paranasal sinusitis. These data suggest that the concentration of SIgA in nasal secretions might be lower congenitally in patients with paranasal sinusitis and that it was elevated after the onset of bacterial infection of the nose and paranasal sinuses.
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  • Clinical Effect of Low-Dose Erythromycin Chemotherapy on Chronic Sinusitis
    Shinichi Takagita, Hiroyuki Kitamura, Shohaku Oyagi, Atsuko Nishikawa, ...
    1991 Volume 84 Issue 4 Pages 489-498
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.489
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    Fifty three patients with chronic sinusitis were treated with 600mg of erythromycin (EM) per day for an average of 5.5 month.
    Symptoms disappeared in 25 patients (52.1%), and some subjective improvement was noted in 21 cases (43.8%). Local signs of infection in the nasal cavity were significantly improved in 25 patients (52.1%). Improvement was observed during the second month in most cases. No positive correlation was noted between the efficacy of EM and the sensitivity to EM of microorganisms in the discharge from the middle nasal meatus. The clinical effects were less in patients with higher serum IgA before EM chemotherapy. The EM effect on chronic sinusitis was not considered to be associated with bactericidal control.
    Low-dose, long-term EM therapy is useful in the treatment of chronic sinusitis.
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  • Parapharyngeal Abscess
    Report of Two Cases
    Junko Nakata, Noritake Watanabe, Masashi Suzuki, Goro Mogi
    1991 Volume 84 Issue 4 Pages 499-504
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.499
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    Deep neck abscesses involving the parapharyngeal area must be treated promptly because of the anatomical characteristics of the parapharyngeal space. A 51-year-old male and a 54-year old female were treated for parapharyngeal abscesses. Their chief complaints were painful swelling of the neck and trismus following sore throat with fever. The diagnosis was parapharyngeal abscess due to tonsillar infection. The abscesses were drained through a cervical skin incision. Bacteriological studies in both cases revealed anaerobic infections of the parapharyngeal space due to Peptostreptococcus anaerobius, Bacteroides bivius and Peptostreptococcus intermedius. After surgery, Clindamycin, to which anaerobes are sensitive was administered intravenously.
    The parapharyngeal space lies adjacent to the naso- and oro-pharynx between the skull base and the hyoid bone. In this space there are many vital organs, such as the carotid artery, the jugular vein, the vagus, the glossopharyngeal and hypoglossal nerves, and the sympathetic chain and cervical lymph nodes. Prompt surgical drainage of the abscess and therapy with antibiotics to which anaerobic pathogens are sensitive are needed, because parapharyngeal abscess spread quickly and invade surrounding vital organs and tissues.
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  • Pendulous Lingual Tonsil
    A Case Report
    Yasutaka Nawata, Hiroshi Yoshikawa, Atsuko Eto, Atsushi Sakurai, Tomoy ...
    1991 Volume 84 Issue 4 Pages 505-509
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.505
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    A 66 year-old male consulted another doctor because of pharyngeal discomfort. He was referred to our hospital with suspicion of mesophryngeal tumor. A round tumor was found in his mesopharynx hanging over a lingual tonsil and was removed surgically. It was a round elastic hard mass 2cm×3cm. Its surface was covered by normal mucosa. Histological examination showed normal tonsillar tissue.
    In 1885 Jurasz first described pendulous tonsil, and many cases have been reported since then. However, almost all were pendulous palatine tonsil, and ours is only the third originative from another site in the Waldeyer ring. The one other two were pendulous pharyngeal tonsil and one pendulous tonsil from the salpingopharyngeal fold.
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  • Primary Small Cell Carcinoma of the Larynx
    A Case Report
    Yoshinao Nishida, Kyosuke Kurata, Izuru Matsuoka, Tetsuya Ogata
    1991 Volume 84 Issue 4 Pages 511-523
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.511
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    Primary small cell carcinoma of the larynx is not frequent. Since the first report of this disease in 1972, 93 cases have been reported in the world. The treatment of this disease, however, is yet well established, and the median survival time is 18.3 months.
    A case of primary small cell carcinoma of the larynx, treated with combination chemotherapy and radiotherapy, is reported here. A 47-year-old male had a tumor in the right ventricular cavity staged T2N0M0. He is still alive 34 months after diagnosis without evidence of disease.
    On the basis of our clinical experiences and examination of the literature, we proposed the following regimen of treatment; 1) Concurrent chemotherapy (CDDP/VP-16) and radiotherapy. 2) Radiotherapy with a total dose of 50Gy. 3) Repeated chemotherapy (CDDP/VP-16) until complete remission. No surgical therapy was recommended.
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  • Malignant Lymphoma of the Thyroid with the Sarcoid Reaction
    Hisashi Mikuni, Yasushi Furuta, Masaaki Kashiwamura, Keiji Iizuka
    1991 Volume 84 Issue 4 Pages 525-531
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.525
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    A patient with a malignant lymphoma of the thyroid with the sarcoid reaction was treated with surgery and radiotherapy and has had no recurrence for about 3 years after surgery.
    For the preoperative diagnosis delayed scintigraphy with 201Tl and scintigraphy with 67Ga and fine needle aspiration were quite useful in differentiating thyroid malignant lymphoma from other thyroid tumors.
    Treatment should be a combination of surgery and radiotherapy, and chemotherapy should be employed as adjuvant treatment in advanced cases.
    The altered immune reaction in the Sarcoid reaction may be considered to be the causative factor in malignant lymphoma.
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  • Statistical Survey of Emergency Services at an Otorhinolaryngological Clinic
    Tetsuya Tahara, Toru Sekitani, Yoshihiko Okinaka, Hiroshi Yamashita
    1991 Volume 84 Issue 4 Pages 533-540
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.533
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    From April, 1988 to March, 1989, 542 patients were treated in the emergency clinic of the ENT department of Yamaguchi University Hospital.
    1. Otitis media was the most common diagnosis (35.1%), followed by foreign body (14.6%) and epistaxis (12.9%).
    2. More than half of the patients were under ten years of age.
    3. More than half of the patients were seen on weekends and national holidays.
    4. Sixty eight patients (12.5%) required emergency admission.
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  • Adenylate Cyclase and Endolymphatic Ionic Composition
    -A Possible Mechanism for Endolymphatic Hydrops Formation-
    Katsumi Doi, Nozomu Mori, Toru Matsunaga
    1991 Volume 84 Issue 4 Pages 541-547
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.541
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    The pathophysiologic mechanisms leading to endolymphatic hydrops in Meniere's disease are not well known. The changes in ionic permeability of cellular membranes between the endolymph and the perilymph, which can alter the inner ear fluid composition and its osmolarity, may be a major factor in the cause of Meniere's disease. In the present study, activities of endolymphatic K+, Na+, Cl- ([K+], [Na+], [Cl-]) and the endocochlear potential (EP) were measured by ion-selective microelectrodes while cochlear adenylate cyclase was intensively activated by perilymphatic perfusion with forskolin. We observed a rapid and marked increase in the [Cl-] activity and delayed decrease in the [K+] activity, accompanying an EP increase the onset of which was much slower than that of the increase in the [Cl-] activity. The results suggest that cochlear adenylate cyclase may play a major role in triggering the development of acute endolymphatic hydrops in attacks of Meniere's disease.
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  • Isolation of Cochlear Inner Hair Cells of Guinea Pigs
    Toshio Yamashita, Hajime Amano, Narinobu Harada, Makiko Ohtani, Tadami ...
    1991 Volume 84 Issue 4 Pages 549-553
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.549
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    Cochlear inner hair cells of guinea pigs were isolated by enzymatic and mechanical techniques. Truly isolated single inner hair cells are flask, oval or round-shaped. The apical part of the cell is a layer known as the cuticular plate, and on this plate, short hairs (stereocilia) are arranged in several rows. The round nucleus is usually found at the base of the cell. The points which distinguish inner hair cells from outer hair cell are discussed.
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  • Usefulness of Cornell Medical Index Health Questionnaire for Treatment of Abnormal Sensation in the Throat with Kampo Medicine
    Saiko-ka-ryukotsu-borei-to
    Mikikazu Yamagiwa, Yasuo Sakakura, Kazuhiko Takeuchi, Haruki Fukuo
    1991 Volume 84 Issue 4 Pages 555-563
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.555
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    Diagnostic procedures in oriental medicine are quite different from those in western medicine because of the difference in basic concepts of medicine. From that oriental point of view, it is claimed that Saiko-ka-ryukotsu-borei-to (Chaff-Hu Jia-Long-Gu-Mu-Li-Tang), like other Kampo prescriptions, should be selected after a diagnostic procedure based on oriental medicine for more effective treatment of patients with abnormal sensation, such as a lump or choking in the throat. However, it is not easy for physicians trained in western medicine to learn these procedures.
    In this study, we used the Cornell Medical Index Health Questionnaire (CMI) as an aid for selecting patients for whom Saiko-ka-ryukotsu-borei-to is supposed to be effective, and we evaluated its actual clinical usefulness. Eighty-nine male and 50 female patients with abnormal sensation in the throat were classified as normal (Area I), almost normal (Area II), slightly neurotic (Area III) and neurotic (Area IV) by Fukamachi's method, and normal (Type I), autonomic nerve dysfunctioning (Type II), neurotic (Type III) and psychosomatic (Type IV) by a modification of Abe's analysis of CMI responders. In addition, we chose 13 questions (Saiko-ka-ryukotsu-borei-to Sho questions) from the CMI list which are supposed to be very important from the oriental medicine point of view for selecting Saiko-ka-ryukotsu-borei-to. According to their answers to the 13 questions, the patients were placed in 3 groups: supposedly good, supposedly moderate and supposedly poor responders.
    Tsumura Saiko-ka-ryukotsu-borei-to® (7.5g/day) was given orally for 2 weeks and the clinical effect was evaluated 1, 2 and 3 weeks after the start of treatment. When the abnormal sensation as evaluated subjectively by the patient was reduced by more than 50%, treatment was considered to be effective. Evaluation of the answers to the CMI and of the effectiveness of the medicine revealed the following:
    1) In both male and female patients, improvement increased gradually and was highest at the end of the 3rd week.
    2) Among the male patients, those in Area I or Type I were the best responders, while among the female patients those in Area I or Type I were the worst responders.
    3) As expected, good responders of both sexes had much higher effective rates at the end of each week than did poor responders.
    These results indicate that an analysis of the answers to the CMI questionnaire is very useful for predicting the efficacy of Saiko-ka-ryukotsu-borei-to in patients with abnormal sensation in the throat.
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  • Osteocalcin and Multiple Scanning X-Ray Photodensitometry (MD/MS) for Postoperative Hypoparathyroidism Treated with Vitamin D3
    Megumi Kumai, Naoki Hatayama, Yutaka Hayashi, Motoharu Uehara, Mitsuak ...
    1991 Volume 84 Issue 4 Pages 565-571
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.565
    JOURNAL FREE ACCESS
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    In order to rule out low-grade osteoporosis in postoperative hypoparathyroidism patients treated with activated vitamin D3, we examined (1) the midportion of parathyroid hormone (M-PTH, relatively stable compared to other PTH), (2) osteocalcin (osteoblast producing Gla protein), (3) multiple scanning X-ray photodensitometry (MD/MS method, using X-ray film of secondary metacarpal bone with alminium steps).
    Sixteen patients were examined: 13 of a series of 45 who had had total thyroidectomy and 3 of a series of 49 who had had subtotal thyroidectomy. In spite of normal serum calcium levels, 9 patients were diagnosed as osteoporosis by the MD/MS methods. Increasing of the vitamin D3 dose reduced the lower-grade osteoporosis in these patients within 3-4 months.
    It is concluded that osteocalcin and the MD/MS methods are useful in demonstrating mild osteoporosis in patients with postoperative hypoparathyroidism, in spite of normal serum calcium levels. We can monitor the doses of vitamin D3 during long term therapy with the use of these examinations.
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  • Platysma Myocutineous Flap for the Reconstruction of the Posterior Wall of the Hypopharynx
    [in Japanese]
    1991 Volume 84 Issue 4 Pages 572-573
    Published: April 01, 1991
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.84.572
    JOURNAL FREE ACCESS
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