Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 86, Issue 4
Displaying 1-21 of 21 articles from this issue
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  • Acoustic Tumor Presenting as Sudden Hearing Loss
    Jun Kusakari, Akira Hara, Kuniaki Takahashi
    1993 Volume 86 Issue 4 Pages 471-478
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.471
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    Acoustic tumor (AT) most commonly arises from the inferior vestibular nerve and its initial symptom is sensori-neural hearing loss. This hearing loss is progressive with a gradual onset in the majority of cases. Since Cushing's report (1917), however, it is also known that some patients present with sudden hearing loss which may or not be temporary. Since 1978, unilateral AT has been diagnosed in 157 patients in our clinic, and in 19 of them the hearing loss of sudden onset was the chief complaint. Hearing was restored in 6 but was permanent in 13 patients. Although there were no significant differences in clinical and otoneurological findings between AT patients with gradual onset and those with sudden hearing loss without recovery, the patients with sudden onset followed by recovery of hearing showed several findings different from the other two groups: smaller tumor, trough type hearing loss and higher percentage of normal or slightly abnormal responses in caloric tests, X ray examinations and auditory brainstem response. In a review of the available literature, we found 22 AT cases in which sudden onset hearing loss followed by recovery had been reported with sufficient clinical information. The clinical and otoneurological findings in those cases were quite similar to our own. The most common ear disease with hearing loss of sudden onset is sudden deafness and the estimated incidence is 16, 663 every year. Although AT patients with sudden onset of hearing loss followed by recovery are very few (estimated 31 to 62/year), it is extremely important for otolaryngologists to consider the possibility of AT, when patients present with sudden hearing loss.
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  • Sound of “One Hand Clapping”
    - Left Hand's Action in Surgical Procedure -
    [in Japanese]
    1993 Volume 86 Issue 4 Pages 480-481
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.480
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  • Acoustic Neurinoma with an Atypical Course; A Case Report
    Koji Yuen, Hiroko Sugihara, Yu Masuda
    1993 Volume 86 Issue 4 Pages 483-487
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.483
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    A 46-year-old woman complained of discomfort of the left side of her tongue. Six months later, she complained of a subjective loss of speech discrimination on the left side, but hearing loss was not seen on a pure-tone audiogram. One year later, a C-P angle tumor was found by MRI and a dip of 500 Hz was seen on her audiogram. At that time, she complained of numbness around the left corner of her mouth and discomfort of the left side of her face. However, the internal acoustic meatus was not enlarged on plain craniograms or a CT scan. During the course of her illness, the woman did not complain of tinnitus, and nystagmus was not observed either through Frenzel's glasses or by electronystagmography.
    We conclude that, although there was no tumor in the internal acoustic meatus, the brain stem may have been compressed by the tumor with cyst formation, thereby causing such atypical symptoms and clinical course.
    This case emphasizes 'the importance of recognizing the neurological relationship between hearing loss and other cranial nerve symptoms.
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  • Sudden Deafness; A Statistical Analysis of Ninety-Five Cases
    Keiko Nishikawa
    1993 Volume 86 Issue 4 Pages 489-498
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.489
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    Ninety-five patients with sudden deafness were examined and treated at JA Yamaguchi Shuto General Hospital from 1982 to 1992, and their clinical data were analyzed statistically.
    Prognostic factors were; time from onset of hearing loss to initiation of therapy; degree of hearing loss at the first examination; presence or absence of vertigo.
    In regard to efficacy of therapy, we observed no significant correlation between age of onset and prognosis.
    All patients were treated with several drugs and other forms of treatment. The effectiveness of steroids, alprostadil, dextran 40. lactated Ringer's solution, urokinase and stellate ganglion blocking was evaluated. Each was effective in some but not all patients, and no significant differances were noted among the therapuetic regimens.
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  • Long-Term Isosorbide Therapy for Meniere's Disease
    Izuru Nozawa, Kaori Hashimoto, Shin-ichi Shimomura, Kazuhito Kikushima ...
    1993 Volume 86 Issue 4 Pages 499-507
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.499
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    Isosorbide, an osmotic diuretic, has been used in the medical treatment of Meniere's disease since Kitahara et al first described it in 1980. Since then, there have been several reports on the efficacy of this drug for Meniere's disease, but there have been few long-term clinical evaluations.
    The long-term therapeutic effect of Isosorbide was evaluated clinically in 19 patients (9 males and 10 females) followed in our clinic for more than 2 years. Isosorbide was given orally continuously or intermittently for 27 to 183 weeks, depending on each patient's condition. The effectiveness of the drug was determined by the AAOO and AAO-HNS evaluation criteria.
    Definite dizzy spells were successfully controlled in 8 (73%, according to the AAOO criteria) or 9 (82%, according to the AAO-HNS criteria) of the 11 patients who received Isosorbide continuously, and in 6 (75%, according to both criteria) of the 8 patients given the drug intermittently. Hearing improved in 4 (21%) and tinnitus was reduced in 9 (47%). Among the patients who responded well to treatment, the dosage of Isosorbide could be tapered to a daily dose of 21g (30ml), less than one-third of the usual daily dose of this drug, but in a few patients episodes of vertigo were not well controlled despite continuous medication for more than 6 months.
    These results suggest that most patients should continue medical management for several months before a decision can be made that the medical response is good or poor and that the long-term use of Isosorbide is offen effective in stabilizing the disabling symptoms of Meniere's disease.
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  • Classification of the Ossicula in Cases with Congenital Conduction Deafness
    Toru Minatogawa, Naoyuki Kano, Hiroshi Iritani, Fumio Satiomi, Yoshihi ...
    1993 Volume 86 Issue 4 Pages 509-514
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.509
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    We classified functional anomalies of the ossicles of 14 ears in patients with congenital conduction deafness with stenosis of the external auditory canal or abnormal tympanic membrane based on embryological considerations. Each area of the ossicles is embryologically derived from one of the following 4 tissues of origin: Meckel's cartilage; Reichert's cartilage; process of Folius (derived from the mesenchyme); and the annular ligament, including the foot plate of the stapes (derived from the mesenchyme of the stapes and otic capsule). The functional anomaly of the ossicles was located in Reichert's region alone in 5 ears (in the malleus handle in 3 and in the long process of the incus in 2); in 4 ears in both the process of Folius and the malleus handle (derived from Reichert's cartilage); in one ear in a region derived from both Meckel's and Reichert's cartilages ; and in one ear in the process of Folius only. In the remaining 3 ears the ossicles showed no marked abnormality. Anomaly of the annular ligament (fixation of the stapes foot plate) was not noted in any of the ears. The tympanic membrane showed some anomaly in all ears, and, in the 3 ears with normal ossicles, this anomaly and stenosis of the external aural canal were factors in the conduction deafness. The auricle appeared normal in 4 ears and slightly abnormal in 10; no relationship was found between anomaly of the ossicles and that of the auricles.
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  • Comparison of Passive Opening Tests of the Eustachian Tube
    Takuya Kinoshita, Tadashi Iwano, Eimoto Hamada, Akihiro Kaneko, Yasuo ...
    1993 Volume 86 Issue 4 Pages 515-522
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.515
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    Endoscopic and roentgenographic studies were done to clarify the significance of catheter insufflation as a tubal ventilatory test. These studies showed that passive opening pressure by catheter insuffiation indicates the condition of the Eustachian tube except the pharyngeal part, which is thought to be easily affected by inflammatory or allergic changes in the nasal or paranasal cavity. On the other hand, passive opening pressures of the Valsalva maneuver and inflation-deflation tests indicate the condition of the whole Eustachian tube when the tube is insuffiated from the pharynx to the middle ear or in the reverse direction. A study in which these different passive opening pressure tests were applied to 10 ears with traumatic eardrum perforation, indicated that a comparison of the results of these different tests can reveal the condition of the Eustachian tube, especially organic change in the pharyngeal part, more clearly than can each individual test by itself.
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  • Effect of Ketotifen Nasal Spray on Eosinophils in Nasal Mucosa
    Nobuhisa Terad, Akiyoshi Konno, Hiroyuki Tada, Kiyoshi Togawa
    1993 Volume 86 Issue 4 Pages 523-529
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.523
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    The effect of ketotifen nasal spray was investigated in 19 patients with perennial allergic rhinitis sensitized by house dust antigen.
    To evaluate the effect of ketotifen nasal spray on eosinophils in nasal mucosa, we calculated the number of eosinophils, the amount of eosinophil cationic protein (ECP) and the percentage of EG2 positive eosinophils in nasal lavage fluid before and after topical use of the spray. Nasal lavages were carried out before and 30 minutes after a nasal antigen challenge with 40ml of normal saline at 37°C.
    Moderate and more than moderate improvement was observed in 63.2% of the patients and slight or greater improvement in 73.7%. After the antigen challenge, the number of eosinophils and the concentration of ECP in nasal lavage fluids increased significantly. Topical use of ketotifen significantly inhibited the increase in the ECP level and tended to reduce the increase in the number of eosinophils. In addition, topical use of ketotifen significantly reduced the percentage of EG2 positive eosinophils. The percent changes in the increase in eosinophil counts and ECP level were compared between the group with moderate or greater moderate improvement and that without improvement. Both of them were significantly decreased in that with moderate or greater improvement.
    The results indicate that the topical use of ketotifen nasal spray inhibits the accumulation, activation and degranulation of eosinophils in the nasal mucosa and that it is useful in the treatment of patients with allergic rhinitis.
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  • Laser Surgery for Perennial Nasal Allergy
    - 1st Report; Clinical Evaluation of Long-Term Effects -
    Shigeki Kawamura, Nobuo Kubo, Tomoshige Fukutake, Toshio Yamashita, Ta ...
    1993 Volume 86 Issue 4 Pages 531-539
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.531
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    The long-term results of CO2 laser surgery in 45 patients with perennial allergic rhinitis were reviewed, and compared with the short-term results in 365 patients. Improvement was noted in 78% of the patients one month after laser surgery, and in 76% two years later. Symptoms of nasal blockage, sneezing and nasal discharge did not seem to be different between the short-term and long-term treatment groups. Laser surgery was more effective in younger than in older patients. The results were supported by the histological appearance of the nasal mucosa: a layer of abundant fibrous tissue was evident even 5 years after CO2 laser surgery.
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  • Lymphoepithelial Cyst in the Parotid Gland; A Case Report
    Mamoru Fuji, Wataru Tada, Mamoru Suauki, Yasuo Harada
    1993 Volume 86 Issue 4 Pages 541-545
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.541
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    A 67-year-old female had a one-year history of a painless gradually enlarging mass in the right parotid region. Under general anesthesia, a 20×20mm cyst was removed by superficial parotidectomy. The histological diagnosis was lymphoepithelial cyst. The origin of this type of cyst is still controversial. In the present case, salivary ductal epithelial cells forming tubular structures were observed in the cystic wall. Therefore, the cyst was possibly formed from parotid gland cells included in a lymph node.
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  • Monomorphic Adenoma in Accessory and Main Parotid Glands; A Case Report
    Manabu Minoyama, Hiroshi Hosoi, Hisaya Tanaka, Yutaka Takeyama, Kiyota ...
    1993 Volume 86 Issue 4 Pages 547-552
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.547
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    Accessory parotid glands are located far anterior to main parotid glands. They have been reported to be present in 20-30% of human cadavers. However, tumors of accessory parotid glands are rare. Only 18 cases have been reported in Japan.
    We treated a 49-year-old woman who had had a mass in her left cheek for one year. The diagnosis was confirmed by sialogram and palpation of the parotid gland. The accessory parotid gland had its own duct which flowed into Stensen's duct. Although the sialogram revealed no tumors of the parotid gland, palpation was suggestive of small tumors in both the accessory and main parotid glands on the left. The tumor was resected surgically with en bloc resection of the main parotid gland. Histopathological study revealed a monomorphic adenoma.
    Tumors arising in accessory parotid glands are a distinct entity. The diagnosis is made on the basis of clinical examination and a high index of suspicion.
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  • Hypopharyngeal Cyst; A Case Report
    Yasutaka Aihara, Munenaga Nakamizo, Toshikatsu Shibata, Hiroko Egami, ...
    1993 Volume 86 Issue 4 Pages 553-557
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.553
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    A 10-year-old boy was examined because of snoring. Laryngoscopy revealed a light yellow cyst extending from the mesopharynx to the hypopharynx.
    Fiberscopic examination showed a pedunculated cyst originating in the right pyriform sinus.
    The cyst was aspirated, and a portion of the cyst wall was removed to prevent reaccumulation of fluid.
    Pathological examination revealed a retention cyst.
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  • Laryngeal Reconstruction of Laryngeal Injury; A Case Report
    Tetsuo Watanabe, Noritake Watanabe, Shigehiro Ueyama, Goro Mogi
    1993 Volume 86 Issue 4 Pages 559-565
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.559
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    The management of chronic stenosis of the larynx continues to be a difficult problem. We report favorable results using hydroxyl apatite in the successful management of a case of chronic laryngeal stenosis.
    A 17-year-old male sustained a traffic accident requiring lifesaving tracheostomy. Decanulation was not successfully achieved because of paralysis in both vocal cords. This patient underwent insertion of a silicone T-tube following lateralization of arytenoid cartilage initially, then insertion of a silicone T-tube followed by right cordectomy. The stents were removed after one and two months, respectively, and he subsequently developed laryngeal stenosis. He then underwent laryngeal reconstruction using hydroxyl apatite. A plate of hydroxyl apatite was interposed between the thyroid cartilage, and a silicone T-tube was inserted. There was no foreign body reaction or infection. The silicone T-tube was removed after 3 months and his airway was adequate for breathing without need for a tracheostomy.
    Reconstructing the laryngeal framework and inserting a silicone T-tube for laryngeal stenosis are important. Hydroxyl apatite is safe and effective for use in the reconstruction of the larynx.
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  • Neck Lipoma; A Report of Two Cases
    Nobuhisa Takatsu, Yuichi Majima, Hiroyuki Yamada, Ryo Amesara, Hidetos ...
    1993 Volume 86 Issue 4 Pages 567-572
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.567
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    A 67-year-old female had a soft cervical mass for more than 20 years. The extirpated mass weighed 800g and was 20×20×20cm in size and surrounded by a fibrous membrane. The second case was a 40-year-old female who noted a cervical mass accidentally. The extirpated mass weighed 35 g and measured 8×6×3cm. In both cases, preoperative CT scans showed a hypo-dense mass with the same density as normal fat tissue. Although lipomas are common cervical benign tumors, such a large mass as was present in the first case has rarely been reported. In both patients, the postoperative course was good and there has been no recurrence.
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  • Manometric Evaluation of Dysphagia
    Yukio Ohmae, Tetsuzo Inouye
    1993 Volume 86 Issue 4 Pages 573-583
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.573
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    Thirty three patients with dysphagia were examined fluoroscopicallis and manometricallis while swallowing. Manometric examination was performed with solid state transducers with four sensors oriented posteriorly with the most distal sensor positioned at C6 (anatomic upper esophageal sphincter). Manometric patterns observed in dysphagic patients were compared to those of 15 normal controls and abnormal patterns were categorized into 4 types:
    1) Abnormal depression of swallowing pressure at the oropharynx and/or hypopharynx.
    2) Insufficient relaxation of the resting pressure at the UES.
    3) Dyscoordination of pharyngeal constrictive waves.
    4) Unclassified type.
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  • Regeneration of Rat Submandibular Gland after Release of Duct Ligation
    Yoshihiko Kohno
    1993 Volume 86 Issue 4 Pages 585-594
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.585
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    The ducts of rat submandibular glands were ligated for 4 weeks, and the location of peroxidase activity in the glands was examined for 24 weeks.
    One week after release, the pattern of peroxidase activity was identical to that immediately after the release of the 4-week duct ligation.
    At 2 weeks some cells revealed peroxidase activity in the cisterna of the rough endoplasmic reticulum and in the nuclear envelope. Those cells contained no secretory granules.
    At 4 weeks the cisterna of the rough endoplasmic reticulum, the nuclear envelope, and the secretory granules showed high peroxidase activity.
    Granulated cells with high peroxidase activity were increasingly numerous after 8 weeks and 16 weeks. A fine filamentous substructure was found in some granules with peroxidase activity.
    At 24 weeks cells containing granules with high peroxidase activity were scarce, and most of the acini consisted of cells similar to those in the control specimens.
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  • Ca2+ Mobilization of CDDP-Resistant KB Cells
    Takuya Tachikawa, Hirobumi Kumazawa, Narinobu Harada, Yoshio Hori, Sum ...
    1993 Volume 86 Issue 4 Pages 595-601
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.595
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    Cisplatin (CDDP) is one of the most potent and useful anticancer agents for head & neck cancers. The cytotoxicity of this drug is known to include inhibition of DNA synthesis. However, the development of resistance by tumor cells to this drug is an important problem. In order to elucidate the mechanism of CDDP resistance, we established CDDPresistant KB cell lines (KBrc cells) from oral epidermal carcinoma cell lines (KB cells). In this study, we investigated the mobilization of intracellular free calcium ion concentration ([Ca2+]i) to elucidate the mechanism of CDDP resistance in case of contact with a high dose of CDDP (500μg/ml) using these cell lines. Incubation with CDDP markedly increased [Ca2+]i in both cell lines. In contrast, a low dose of CDDP resulted in the reduction of [Ca2+]i toward the resting level. Furthermore, the peak and plateau of [Ca2+]i were higher in KB cells than in KBrc cells, and the speed toward the plateau phase was later in KB cells in comparison with that in KBrc cells. This increase in [Ca2+]i was thought to be due mainly to an influx of extracellular calcium ions. Moreover, the viability of KB cells was lower than that of KBrc cells. It was speculated that KBrc cells possesed the ability to protect CDDP compared with KB cells and the change of [Ca2+]i in KBrc cells was less than that in KB cells. It appears that CDDP can injure cell membranes as well as inhibit DNA synthesis.
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  • Efficacy of Low Dose Erythromycin Treatment of Sinusitis in Children
    Yoshihiro DAKE, Takaaki Kawaguchi
    1993 Volume 86 Issue 4 Pages 603-608
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.603
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    The clinical efficacy of low dose erythromycin (10mg/kg/day) was investigated in 58 children with sinusitis.
    1. Intranasal findings were completely cleared in 50.0% of patients, improved in 25.9% and unchanged in 24.1%. Follow-up X-ray films of the sinuses showed complete cure of the disease in 13.3%, improvement in 53.3% and no change in 33.3%.
    2. The shorter the period of infection, the higher was the response rate.
    3. Patients below 4 years of age showed a much better response to this treatment than did patients above 4 years of age.
    4. Treatment for two months is recommended for maximum efficacy.
    5. Mild diarrhea in one patient was the only side effect observed. In conclusion, our data indicate that low dose erythromycin is useful in the treatment of children with sinusitis.
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  • Clarithromycin (CAM) in the Treatment of Chronic Sinusitis
    Satoshi Hiraga
    1993 Volume 86 Issue 4 Pages 609-613
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.609
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    The clinical usefulness of CAM was studied in the treatment of chronic sinusitis. Fifty nine patients with chronic sinusitis were treated with CAM in this study.
    1) Subjective symptoms: the efficacy rates were 89.2% for nasal obstruction, 93.3% for rhinorrhea, 78.9% for postnasal drip, 28.6% for olfactory disturbance and 100% for headache.
    2) Objective signs: the efficacy rates were 81.1% for quality of rhinorrhea, 77.8% for nasal polyps and 42.9% for X-ray appearance of the maxillary sinuses.
    3) Side effects were observed in 4 patients (6.8%), but they were not significant.
    4) Fifty four patients (91.5%) were satisfied with CAM chemothrapy. CAM chemotherapy was therefore concluded to be very useful in the treatment of chronic sinusitis.
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  • Intratumor Injection of OK-432/Fibrinogen for Head and Neck Carcinomas
    Hirobumi Kumazawa, Toshio Yamashita, Hiroshi Iwai, Takuya Tachikawa, N ...
    1993 Volume 86 Issue 4 Pages 615-621
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.615
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    We studied the antitumor effect of intratumoral injections of OK-432 mixed with fibrinogen, including factor-XIII, and 1ml of aprotinin on head and neck carcinoma. Out of 10 patients, macroscopic evidences of reduction of tumor size were observed in two cases. The other 8 showed histopatholgical degeneration of tumor cells and marked infiltration of inflammatory cells in the area of injection. These findings suggest that OK-432 in conjunction with fibrinogen solution may play a role in the immunotherapy of head and neck carcinoma.
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  • A Key to Successful Immunotherapy
    [in Japanese]
    1993 Volume 86 Issue 4 Pages 622-623
    Published: April 01, 1993
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.86.622
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