Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 86, Issue 3
Displaying 1-21 of 21 articles from this issue
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  • Clinical Symptoms in Relation to Nasopharyngeal Carcinoma
    Mitsuru Furukawa
    1993 Volume 86 Issue 3 Pages 305-310
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.305
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    Squamous cell carcinoma accounts for approximately 98 per cent of all malignant neoplasms that occur in the nasopharynx. The high incidence of nasopharyngeal carcinoma (NPC) is a characteristic of the Oriental races. Viral and environmental factors appear to have an etiologic impact on this disease. The most common sites are the lateral wall followed by the roof. NPC spreads primarily by local infiltration and regional metastases. Local infiltration of the eustachian tube is evidenced clinically when the patients presents with a unilateral conductive hearing loss secondary to the development of a secretory otitis media. Multiple cranial nerve deficits can develop. The maxillary and mandibular branches of the trigeminal complex (V2 and V3) are the most commonly involved cranial nerves and indicate extension of the tumor through the foramen rotundum and foramen ovale. Lateral rectus deficits cause the patient to complain of diplopia, especially on lateral gaze, indicating tumor involvement along the course of cranial nerve VI. More extensive internal and external ophthalmoplegias suggest orbital or cavernous sinus involvement. Lateral extension or spread into the pterygomaxillary fossa and the infratemporal fossa can easily affect the lower cranial nerves (IX, X, XI, XII), indicating that the tumor has progressed into the area of the jugular foramen. Lack of significant tumor bulk in the nasopharynx or parapharyngeal spaces with paralysis of the lower cranial nerves usually indicates involvement of adjacent lymph nodes surrounding the jugular foramen rather than direct extension from the primary tumor. Lymphatic spread from the nasopharynx may be either unilateral or bilateral. When the tumor has spread into the upper deep cervical lymph nodes, a cervical mass usually first becomes detectable clinically.
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  • Skull Base Surgery for Complication of the Otitis Media
    [in Japanese]
    1993 Volume 86 Issue 3 Pages 312-313
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.312
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  • Anterior Infbrior Cerebellar Artery Syndrome Followed by Facial Nerve Paralysis; A Case Report
    Meiho Nakayama, Shigeru Inafuku, Isao Takimoto, Kaoru Suzuki, Noboru M ...
    1993 Volume 86 Issue 3 Pages 315-320
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.315
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    A 67-year-old female was admitted for treatment of vertigo and bilateral hearing loss. Although ATP and vitamin were administered immediately, left upper facial nerve paralysis appeared three days later. CT and MRI revealed old cerebral infarctions without any abnormality in the brain stem or cerebellum. Left anterior inferior cerebellar artery syndrome was detected by vertebral angiography (VAG) with defects in the left anterior inferior cerebellar artery (AICA) and left posterior inferior cerebellar artery (PICA).
    The observations of spontaneous nystagmus were important for the diagnosis in this case. Early diagnosis is necessary for the prevention of progressive pathology.
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  • Acute Sensorineural Hearing Loss due to Cerebral Infarction; A Report of Three Cases
    Taisuke Kobayashi, Kiyofumi Gyo, Naoak Yanagihara, Yasushi Matsumoto, ...
    1993 Volume 86 Issue 3 Pages 321-327
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.321
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    Case 1: a 59-year-old male with a one-year history of diabetes mellitus complained of right sudden deafness with vertigo. Otoneurological examinations showed sensorineural hearing loss of the right ear and bidirectional horizontal gaze nystagmus. MRI revealed infarction of the right cerebellar hemisphere indicating occlusion of the anterior inferior cerebellar artery (AICA). With conservative treatment his hearing returned to the contralateral ear level. Case 2: a 49-year-old female who complained of right sudden deafness with vertigo and ipsilateral facial palsy. Audiometric studies showed total deafness on the right. Bidirectional horizontal gaze nystagmus, together with V, VII, IX and X cranial nerve palsies were recognized. CT and MRI proved infarction of the right cerebellum and pons. Her hearing improved only partially. Other neurological signs disappeared within eight months. Case 3: a 54-year-old male with a history of hypertension and angina pectoris complained of right sudden deafness with dizziness. Right sensorineural hearing loss and spontaneous nystagmus toward the left were noted. His hearing improved on the next day. Two days later, however, he lost consciousness. CT showed no abnormality, but angiography revealed occlusion of the basilar artery.
    These three cases showed the importance of differential diagnosis between acute hearing loss due to cerebral infarction and idiopathic sudden deafness. We emphasize the diagnostic importance of risk factors such as hypertension and diabetes mellitus and the sign of vertigo with nystagmus of central origin in cases of cerebral infarction.
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  • Anomaly of the Handle and Anterior Process of the Malleus
    Toru Minatogawa, Ikuo Fukuda, Michiko Nakamura, Yasunori Masutani
    1993 Volume 86 Issue 3 Pages 329-334
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.329
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    We present 4 cases of ossicular anomaly combined with anomalous tympanic membrane and/or stenosis of the external auditory canal. In 3 cases, a thick bony bridge connected the head of the malleus with the inferior posterior wall of the tympanic bone, and, in the other, a V-shaped ossicle surrounded by thick fibrous tissue was present inferior to the neck of the malleus. In 2 of the former 3 cases, a cartilageous bone was observed branching from the bony bridge anteriorly, the tip of which was clearly identified as the umbo of the malleus. Thus, the bony bridge was recognized as an anomaly which had developed on the anterior process of the malleus process of Folius in 3 cases, while in the other the malleus handle was completely absent. The area of the epithelial layer of the tympanic membrane was restricted due to partial protrusion of the tympanic bone in all cases. We speculate that the bridge anomaly developed at about the 19th week of gestation, when an intramembranous spicule (os goniale) directed towards the anteromedial surface of the immature cartilagenous malleus handle failed to fuse with it, and instead developed further to extend to the infero-posterior part of the tympanic bone. The V-shaped ossicle is thought to be an anomalous anterior process but not handle of the malleus because it is hard and does not contain any cartilaginous part characteristic to some part of the malleus handle.
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  • Intractable Otorrhea Caused by Iatrogenic Foreign Body in the Temporomandibular Joint
    Yoshiro Yazawa, Keiko Komada
    1993 Volume 86 Issue 3 Pages 335-339
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.335
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    A 5-year-old boy was hospitalized for intractable otorrhea and a polyp in his right ear. Pathological examination of the ear polyp revealed foreign body giant cells with severe inflammatory reaction. Two and a half years prior to his admission, he had received arthroplasty of the right temporomandibular joint (TMJ) with a diagnosis of joint ankylosis in the oral surgery department; a silicone sheet had been used to prevent reunion of the excised condylar head. A CT scan showed a spherical bony swelling of the joint, compressing the right external ear canal. A preauricular incision revealed an abscess surrounded by bone tissue in the right TMJ area which formed a fistula into the external ear canal. A silicone sheet 2cm×2cm was found inside the abscess and was removed. Daily change of gauze tampons through the ear canal fistula stopped the aural discharge, and the fistula closed in 20 days. Pathological examination of the ear polyp and CT scan were helpful in the diagnosis.
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  • Hypernasal Speech Following Removal of a Choanal Polyp; A Case Report
    Keiko Komada, Kazutomo Kitajima, Sei Ikeda
    1993 Volume 86 Issue 3 Pages 341-346
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.341
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    A 20-year-old female developed hypernasal speech and nasal regurgitation of food following removal of a choanal polyp. The cause of these complications was found to be congenital velopharyngeal incompetence, which had escaped detection due to the compensatory valving effect of the polyp. Procedures helpful for the pre-operative detection of velopharyngeal incompetence are discussed.
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  • Abnormal Dental Eruption in Epipharynx; A Case Report
    Hiroe Miyasaka, Yuko Hata, Hideki Muraoka, Atsushi Komatsuzaki
    1993 Volume 86 Issue 3 Pages 347-353
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.347
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    A 32-year old female visited our hospital complaining of anabnormal sensation in the anterior neck. Posterior rhinoscopy revealed a tooth-like mass in her epipharynx on the left side.
    A Davis mouth-opener was applied, and the mass was removed with an ecraseur under general anesthesia. The pathological diagnosis was ectopic tooth in the epipharynx.
    Including this case, 136 patients (143 teeth) with dental abnormalities have been reported in the Japanese literature. Most of these abnormalities were in the nasal cavity.
    The etiology in this case may have been movement of rudiment No. 8 with growth in the epipharynx.
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  • MRI of Paranasal Sinuses of Patients with Various Diseases
    Yasushi Ohta, Tetsuo Semba, Ken Ito, Tadashi Tanaka, Masahiro Fukuda
    1993 Volume 86 Issue 3 Pages 355-365
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.355
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    Twenty-one patients with paranasal sinus disease were studied with magnetic resonance imaging (MRI) and CT: two with acute in Hammatory sinus disease, seven with chronic inflammatory sinus disease, four with squamous cell carcinomas, two with papillomas, one with malignant lymphoma, and five with mucoceles. In a few cases, no characteristic MRI abnormalities were detected. The distinction between paranasal tumor and in Hammatory mucosa was almost seen in MRI through clearness of periphery, homogeneity of structure, signal intensity, and enhancement by Gd-DTPA. However, there were some exceptions.
    CT was useful mainly for bone details, and MRI for soft tissue, so CT and MRI provide different information. The use of both CT and MRI is recommended for the correct diagnosis of paranasal sinus disease. CT should be used initially and MRI should be a secondary examination.
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  • Branchial Cysts in the Parotid Gland; A Report of Nine Cases
    Hiroshi Iwai, Toshio Yamashita, Koichi Tomoda, [in Japanese], Chiyonor ...
    1993 Volume 86 Issue 3 Pages 367-372
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.367
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    Branchial cysts in the parotid gland are rare. Among 392 parotid masses which we examined and operated on during the past 15 years and 7 months in our hospital nine were branchial cysts. All were identified as second branchial cysts. Ultrasonography showed a septum structure in two of the cysts. Although ultrasonography and magnetic resonance imaging (MRI) provide useful information in the diagnosis of cysts, those which contain non-serous materials are sometimes misdiagnosed as solid tumor.
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  • Hepatocellular Carcinoma with Metastasis to the Pharynx; A Case Report
    Michitaka Kato, Ichio Inuzuka, Kazumi Yamada, Shigeru Inafuku, Hiromic ...
    1993 Volume 86 Issue 3 Pages 373-378
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.373
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    A 58-year-old male with hepatocellular carcinoma complaining of dysphagia and dysarthria was found to have a pharyngeal tumor. Despite chemotherapy, the tumor grew rapidly. Tracheostomy was performed because of upper airway obstruction. A review of the literature revealed very few reports of pharyngeal metastasis of hepatocellular carcinoma.
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  • Eosinophilic Granuloma of the Mandible in an Infant; A Case Report
    Tomoko Okumura, Shin-ichi Takagita, Kazuhiko Shoji, Koichi Omori, Hisa ...
    1993 Volume 86 Issue 3 Pages 379-384
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.379
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    In an 1 year 6 month old male with solitary eosinophilic granuloma of the mandible, histopathological examination and radiographic skeletal survey were essential for diagnosis. In 16 Japanese patients reported previously, solitary eosinophilic granuloma of the mandible was tended to heal spontaneously over time. We treated our patient with surgical curettement only and fobllowed him closely. Five months has passed since surgery and satisfactory bone repair has proceeded spontaneously.
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  • Sclerodermoid Skin Metastasis to the Neck from an Undetermined Primary Site; A Case Report
    Toru Takimoto, Makoto Itoh
    1993 Volume 86 Issue 3 Pages 385-388
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.385
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    An 86-year-old man with a sclerodermoid lesion of the neck visited our outpatient clinic complaining of slight dyspnea. Histological examination revealed anaplastic infiltrating carcinoma with various degrees of cellularity, a loose stroma, and scattered signet ring cells that contained intracytoplasmic mucin and laterally displaced nuclei. Signet ring cells are most commonly seen in metastases of adenocarcinoma of the stomach, and occasionally in metastatic lesions from adenocarcinoma of the lung and breast. However, in our patient the primary cancer remains undetectable despite careful work-up and eight-month follow-up examinatlons.
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  • Complications Following Surgery for Thyroid Carcinoma
    Koji Miyata, Hiroyuki Kitamura, Ken-ichi Kaneko, Ryo Asato, Shigeru Hi ...
    1993 Volume 86 Issue 3 Pages 389-395
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.389
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    From 1981 to 1989, 245 patients underwent operation for thyroid carcinoma. Postoperative recurrent nerve palsy occurred in 44 patients; in 25 of the 44 patients the recurrent nerve was preserved during the operation. Although there was nodifference in the incidences of recurrent nerve palsy between patients who had paratracheal neck dissection and those who did not, the recovery time was longer in patients with paratracheal neck dissection.
    Postoperative tetany occurred in 53 patients. All patients with permanent tetany exclusively had total thyroidectomy. The incidence of tetany was higher and recovery time of tetany was longer in the patients with paratracheal neck dissection.
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  • Surgical Treatment for Adult Patients with Sleep Apnea Syndrome
    Masaya Kato, Toshimi Kojima, Masami Ohnishi, Katsuhiro Ojio, Youji Kat ...
    1993 Volume 86 Issue 3 Pages 397-404
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.397
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    Seven adult patients with sleep apnea syndrome (4 with the obstructive type and 3 with the mixed type) were treated surgically; septoplasty plus conchotomy in two, tonsillectomy in one and uvulopalatopharyngoplasty in four. We then evaluated the clinical symptoms of snoring, excessive daytime sleepiness and night sleeplessness, in addition to the apnea index (AI) and apnea time/sleep time (AT/ST). Snoring and excessive daytime sleepiness were reduced in six of the seven patients and night sleeplessness in four of the five patients. AI improved in five of the seven patients and AI/ST in six. Two patients expressed great satisfaction with their subjective improvement, and three were fairly well satisfied. One patient noted no change, and one was dissatisfied with the results. We found that the degree of satisfaction noted by the patients was not proportional to the quantitative improvement in AI and AI/ST. The degree of satisfaction reflected qualitative improvement related to a reduction in snoring, excessive daytime sleepiness and night sleeplessness.
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  • MRSA on the Otolaryngological Ward
    Shugo Shiraishi, Tadashi Iwano, Kaoru Kawasaki, Tadashi Doi, Koichi Us ...
    1993 Volume 86 Issue 3 Pages 405-411
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.405
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    A clinical and statistical study of methicillin-resistant Staphylococcus aureus (MRSA) was conducted on 27 patients with malignany tumor who had been on the ward for over 2 months and 27 medical personnel on the otolaryngological ward. Seven of the 27 patients (25.9%) had MRSA in the oralcavity and 2 of the medical personnel (7.4%) in the nasal cavity. Two background factors seem to be correlated to the colonization of MRSA. The reduced local host defense in the oral cavity after surgical or radiation therapy and the application of third generation cephalosporins. These patients with MRSA in the oral cavity were treated with iodine mouth wash 6 times a day for 14 days, but no reduction of MRSA was observed.
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  • Effect of Duct Ligationon Rat Submandibular Salivary Gland
    Yoshihiko Kohno
    1993 Volume 86 Issue 3 Pages 413-426
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.413
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    The effect of duct ligation on the submandibular salivary gland was studied in rats. Submandibular gland ducts were ligated, and the location of peroxidase activity was examined 2, 4 and 8 weeks later.
    After 2 weeks secretory granules in the acinar cells were markedly decreased and the substructure was visible in the granules of some acinar cells.
    After 4 weeks the acini consisted of two types of cells. One type contained granules which were occasionally seen in normal intercalated duct cells, and the other contained no secretory granules. Both types showed no peroxidase activity. Microscopically the first type corresponds to terminal tubule cells and the second type corresponds to cells which are less differentiated than proacinar cells.
    After 8 weeks there was some evidence of regeneration. Reduction of the pressure in the acinar lumen may be involved in this regeneration.
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  • Azelastine Therapy of Allergic Rhinitis
    Yuzo Yamamoto, Hiroaki Takahashi, Kazuo Makimoto, Jun Sakakura, Shuich ...
    1993 Volume 86 Issue 3 Pages 427-437
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.427
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    The effectivenes and safety of Azeptin® (azelastine hydrochloride) were examined in 151 patients with perennial and seasonal allergic rhinitis after oral administration of 1mg twice daily for more than 2 weeks. Slight to marked improvement occurred in 93.1% of the perennial and in 91.5% of the seasonal group. Since there was almost nodiffeerence between the two, in the present statistical study, they were dealt with as one group. The overall effectiveness was 92.7%. Slight to high usefullness was recorded in 93.3%. Improvement was greatest in the following groups: older patients, those with a 5 to 10 year history of symptoms, those with sneezing, the group treated for 6 to 8 weeks, and the group with eosinophils in the nasal discharge. Side effects were noted in 4 patients (2.6%), but the symptoms were slight and did not interfere with ordinary life. The present study showed that in a dose of 1mg twice daily for more than 2 weeks, Azeptin® has a definite inhibitory effect on both perennial and seasonal allergic rhinitis and is a safe medicine.
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  • Long-Term Low-Dose Roxithromycin (RXM) Therapy for Chronic Sinusitis
    Yoshifumi Uno, Ryusuke Saito, Atsushi Hatano, Makoto Kanatani
    1993 Volume 86 Issue 3 Pages 439-445
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.439
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    Seventeen adult patients with chronic sinusitis, who had been operated on or received conservative therapy for a long time but still complained of nasal symptoms, were treated with 150mg roxithromycin (RXM) per day for 6 months or more.
    1) Significant improvement both in nasal symptoms and in rhinoscopic findings was noted after 6 months, little improvement after 1 month of therapy.
    2) Great subjective improvement in nasal obstruction was noted, and volume and quality of nasal discharge showed objective improvement.
    3) No significant side effects were noted in any of the patients during this therapy.
    4) Long-term, low-dose RXM therapy was effective even when RXM-resistant bacteria were present. Therefore, this effect was not considered to be associated with its antibacterial activity but with some as not yet unknown mechanism.
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  • Fundamental and Clinical Studies of Ofloxacin Treatment of Otolaryngeal Infections
    Tatsuya Ishida, Yasuo Koike, Shuji Okada, [in Japanese], [in Japanese] ...
    1993 Volume 86 Issue 3 Pages 447-464
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.447
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    1. Ofloxacin (OFLX) was administrated to 203 patients with ear, nose and throat infections.
    1) The overall efficacy rate (cases of excellent and good responses as judged by the attending otolaryngologist) was 83.0%.
    2) The overall efficacy rate, as judged by the committee, was 74.6%.
    3) The bacteriological sensitive rate for OFLX was 92.2%.
    4) The bacteriological efficacy rate was 81.0%.
    5) The rates of excellent and good results by X-ray findings were 72.7% for chronic paranasal sinusitis and 70.0% for acute exacerbation of chronic paranasal sinusitis
    6) Side effects were suspected in 3 patients (1.5%), but the symptoms were mild and no treatment was required.
    2. Tissue (sinus membrane) and serum levels were determined 5-6 hours after a dose of 200mg of OFLX. The concentrations were 1.10-3.40μg/ml in serum and 0.50-4.20μg/g in sinus membrane relatively high levels.
    These results indicated that OFLX is effective in the treatment of otolaryngeal infections.
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  • Olfactory Neuroblastoma
    [in Japanese]
    1993 Volume 86 Issue 3 Pages 466-467
    Published: March 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.466
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