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86 巻, 5 号
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北原 正章, 児玉 章, 北西 剛1993 年 86 巻 5 号 p. 625-631
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーThis article is based on a review of the literature on bilaterality of Meniere's disease. On the basis of the results of our study using the same diagnostic criteria of bilateral involvement of Meniere's disease, the clinical characteristics of Meniere's disease with bilateral fluctuant hearing loss were examined. In this series of patients 204 had normal hearing in the contralateral ear (unilateral cases) and 135 had fluctuant cochlear symptoms in the other ear (bilateral involvement). The latter group had a high degrees of hearing loss, cluster attacks, evolvement from vertigo to continuous dizziness and disruption of daily life. In addition we found that bilateral cases responded poorly to therapy with diuretics, steroids or hospitalization. Thus, early diagnosis of the bilaterality of the disease and intensive treatment such as sac operation or drug therapy is necessary. It is the obligation of ENT specialists to clarify the pathophysiology of the disease, to understand the importance of its development in the second ear, and to perform preventive therapy.抄録全体を表示PDF形式でダウンロード (738K) -
―視神経の所見―森山 寛1993 年 86 巻 5 号 p. 632-633
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (1422K) -
永瀬 茂代, 加藤 朗夫, 平出 文久, 河野 淳, 飯塚 尚久, 舩坂 宗太郎1993 年 86 巻 5 号 p. 635-639
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーA 62-year-old male patient with Ramsay Hunt's syndrome was admitted to Toda Central General Hospital.
He complained of slight peripheral facial palsy, loss of abduction of the right eye, right hearing impairment and vertigo. Herpetic vesicles were noted on the right auricle and in the external meatus. Examinations of auditory and vestibular function revealed sensorineural hearing loss of decreasing type at higher frequencies and right canal paresis. ABR showed prolongation of latency of wave V and interpeak latency of waves III - V. The antibody titer against herpes zoster virus was definitely high.
These findings suggested herpes zoster infection of the Vth, VIth, VIIth, and VIIIEth cranial nerves. A steroid hormone and an antiviral drug were administered. In spite of the treatment, his hearing worsened to total deafness, and disorders of the VI th and VIIth cranial nerves did not improve.
The pathogenesis of the signs and symptoms in this patient is discussed.抄録全体を表示PDF形式でダウンロード (1108K) -
瀬成田 雅光, 西川 典秀, 原 晃, 草刈 潤, 黒崎 喜久1993 年 86 巻 5 号 p. 641-645
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーWe report two cases of large vestibular aqueduct syndrome, which was first described by Valvassori and Clemis in 1978. A 12-year-old female and a one-year-old male presented with bilateral profound hearing loss. Auditory evoked brainstem response was performed in the latter case, but no reproducible wave was recorded bilaterally. High-resolution axial CT of the temporal bone revealed markedly enlarged vestibular aqueducts bilaterally in the former case and unilaterally in the latter. No significant anomaly was found in any other part of the temporal bone on C T scans.
The possible etiology of sensorineural hearing loss in this syndrome is discussed, and the available literature is reviewed.抄録全体を表示PDF形式でダウンロード (3338K) -
―特に結果が不十分な症例について―伊藤 壽一, 榊原 淳二, 高木 明, 川野 通夫1993 年 86 巻 5 号 p. 647-651
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーWe performed Australian multichannel cochlear implantation in 27 patients with severely impaired hearing. The surgical procedures were not difficult if preoperative exminations had been performed accurately. Postoperative complications were not severe.
The results in postlingually deaf patients had been reported to be satisfactory. However, we found that some of those patients had problems of speech comprehension.抄録全体を表示PDF形式でダウンロード (508K) -
磯野 道夫, 福山 泰彦, 村田 清高1993 年 86 巻 5 号 p. 653-662
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーWe attempted to close 26 eardrum perforations with fibrin glue in Shiroyama Hospital from November, 1990 to October, 1992 with a success rate of approximately 96%. The average hearing improvement was 17.7dB. This procedure can be carried out in one day but the patients must be carefully selected. Dry central perforation is the best indication for this procedure, but if careful inspection of the middle ear through the perforation is carried out, patients with slight ear discharge can be helped by this procedure.
We used autograft temporal fascia in almost all cases. After denuding of the perforation margin, several small pieces of gelatin sponge were placed in the middle ear just beneath the perforation to support the fascia in place beneath the perforation. The fascia was then pulled into the middle ear through the perforation and made to fit on the drum beneath the perforation. A small amount of fibrin glue was dripped onto the lateral margin of the perforation.
This technique can be used not only for small perforations, but also for large perforations which lack a posterior margin or total perforations of the membrane. This technique is very useful in the preservation of the tympano-meatal angle of the membrane and prevents lateralization of the membrane in the future. In addition, this technique with some modifications can be extended to tympanoplasty.抄録全体を表示PDF形式でダウンロード (5748K) -
―複数の検査法による検討―木下 卓也, 岩野 正, 濱田 栄幹, 金子 明弘, 細田 泰男, 牛呂 公一, 熊澤 忠躬1993 年 86 巻 5 号 p. 663-668
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーPassive opening pressure in various middle ear diseases were measured with three different ventilatory tests (catheter insuffiation, Valsalva's maneuver and inflation-deflation test). The organic status of the Eustachian tube could be divided into four types: normal, stenotic, patulous and pharyngeal stenotic. The pharyngeal stenotic type was found in half of the patients with otitis media with effusion and in 37.5% of those with adhesive otitis media. In this organic change of the tube, the tube does not dilate with swallowing, because the M. tensor veli palatini is not located in the pharyngeal part of the tube. The pharyngeal stenotic type is thought to be one of the causes of disturbed active ventilation of the middle ear and to play an important role in the pathogenesis of otitis media with effusion and of adhesive otitis media.抄録全体を表示PDF形式でダウンロード (681K) -
―鼻疾患との関連について―八木沼 裕司, 小林 俊光, 高坂 知節1993 年 86 巻 5 号 p. 669-674
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーTo clarify the role of nasal disease and the habit of sniffing in the pathogenesis of middle ear diseases, 123 pediatric patients with secretory otitis media (199 ears) were examined for associated nasal diseases and the habit of sniffing. Middle ear pressure and nasopharyngeal pressure were simultaneously measured during forceful sniffing.
(1) More than half of the patients with secretory otitis media had allergic rhinitis and/or chronic sinusitis. (2) Fifty-nine percent of the patients with and 32% of those without nasal diseases sniffed habitually. (3) The patients with the habit of sniffing tended to create a higher negative pressure in the nasopharynx upon forceful sniffing than the patients who did not sniff. (4) In 27.8% of the patients with the habit of sniffing, negative pressure was observed in the middle ear during sniffing. In contrast, this occurred in only 16.5% of patients without the habit of sniffing.
This study suggests that, in many patients with secretory otitis media, nasal disease plays an important role in its pathogenesis through the creation of negative nasopharyngeal pressure upon sniffing provoked by nasal diseases. This mechanism is presumed to be present in 5 - 10% of pediatric patients with secretory otitis media.抄録全体を表示PDF形式でダウンロード (667K) -
羽藤 直人, 有友 宏, 稲木 匠子, 河北 誠二, 柳原 尚明1993 年 86 巻 5 号 p. 675-680
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーTwo cases of atresia of the cartilaginous external auditory canal are presented to emphasize importance of 1) preoperative assessment of the obstructive portion and 2) prevention of recurrence. Case 1: A 12-year-old girl consulted us with complaints of right otorrhea and otalgia. She had right congenital external auditory canal atresia with a fistula draining pus from the bony external canal. CT showed the atresia limited to the cartilaginous portion. Case 2: A 26-year-old female consulted us with a complaint of left hearing loss. She had left traumatic external auditory canal atresia. CT showed the ear canal totally obstructed with connective tissue, and MRI showed that the atresia was limited to the cartilaginous portion with effusion in the bony external canal. A canalplasty was done successfully in both cases. In case 1, the canalplasty was combined with tympanoplasty to control the complicated severe chronic otitis media with adhesive ear drum and defect of the lenticular process. The bony external canal was filled with cholesteatoma mass. Early surgical treatment is needed to avoid such complications. A stent must be placed for a long time to prevent the recurrence of stenosis. We recommend the placement of a silastic tube for that purpose.抄録全体を表示PDF形式でダウンロード (5404K) -
―第2報: 再手術の有効性の検討―川村 繁樹, 久保 伸夫, 福武 知重, 山下 敏夫, 熊澤 忠躬1993 年 86 巻 5 号 p. 681-686
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーTo control the recurrence of nasal allergic symptoms, we performed revaporization with CO2 Laser beam in 27 patients with perennial nasal allergy whose nasal symptoms had been alleviated after the initial laser surgery. Revaporization was effective in 85% of the patients one month after surgery in 78% 2 years after surgery and in 64% 3 years after the revaporization. Patients with relapse within one year after surgery had little improvement in subjective symptoms, while patients with relapse later than one year after surgery responded well, and long-term results were good. No differences were found in the severity of the preoperative symptoms, RAST score, or IgE values between patients with early and with late recurrence.抄録全体を表示PDF形式でダウンロード (604K) -
―起源細胞の免疫組織化学的検討―李 雅次, 佐伯 哲郎, 大橋 伸也, 河合 真, 市村 彰英, 吉田 知之, 平出 文久, 舩坂 宗太郎1993 年 86 巻 5 号 p. 687-690
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーThe histogenesis of granular cell tumor is still controversial.
A 21-year-old woman complained of a tumor on the dorsum of her tongue. Since the tumor had no capsule, it was resected totally together with muscle tissue of the tongue.
The tumor cells were proliferated diffusely and arranged in small nests in H. E. stained sections. Axon-like dark brown fibrils were seen in the tumor nests in sections stained by the Bodian technique.
Immunohistochemical studies showed reactivity for S100 protein. On the other hand, neither NSE nor GFAP were detected in the tumor cells.
These findings suggest that this tumor is derived from Schwann cells of peripheral nerve fascicles.抄録全体を表示PDF形式でダウンロード (3761K) -
―学校健診の立場から―角田 浩幸, 石塚 洋一, 秋元 淑子, 小島 好雅1993 年 86 巻 5 号 p. 691-697
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーSevere hypertrophy of the palatine tonsils is known to be a cause of respiratory disorders. We sent questionnaires to parents of school children and evaluated the effects of hypertrophy of the palatine tonsils. The results suggest that hypertrophy of the palatine tonsils affects not only respiration but also other functions, such as swallowing.抄録全体を表示PDF形式でダウンロード (798K) -
井上 良江, 齋藤 裕夫, 中川 美紀, 田中 康夫1993 年 86 巻 5 号 p. 699-702
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーWe attempted to prevent Frey's syndrome by using solvent dehydrated human dura mater in the closing procedure after parotidectomy. The area was covered by the dura and sutured. The presence or absence of symptome was noted subjectively and by Minor's method. One out of 17 patients reported a positive symptom during the observation period of 6 to 35 months.
Neither foreign body reaction, infection nor other adverse reaction occured after the dura implantation. This method is useful in prevention of Frey's syndrome.抄録全体を表示PDF形式でダウンロード (463K) -
―心理的背景を中心として―蔦佳 尚, 細田 泰男, 岩野 正, 馬場 一泰, 山下 敏夫, 熊澤 忠躬1993 年 86 巻 5 号 p. 703-712
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーA survey was conducted of 201 patients with abnormal sensation in the throat who stopped treatment for various reasons. The respose to therapy and the psychological background were the main focuses. Anxieties about cancer at the first medical examination and desire for treatment for non-cancerous conditions were recorded. The reasons for discontinuing treatment and expectations for help from the staff, etc were considered.
1. When treatment was discontinued the intensity of the abnormal sensation was 63% of that recorded at the first examination. The period of ambulatory therapy averaged 3 months.
2. The response to therapy was not related to anxiety about cancer. However, the prognosis was better in patients who could ignore symptoms if cancer was ruled out than in those who wanted treatment even though cancer was not present.
3. The reasons for discontinuing treatment were closely related to the degree of symptomatic improvement. Remission of symptoms was the reasons for discontinuing treatment in 27.5%; no change in symptoms was the reasons in 10.8%; in a third group some other reasons for discontinuing treatment were noted although the abnormal sensation was 74% as severe as at the first examination.
The above results suggest that abnormal sensation in the throat is due to some unknown local and general factors other than psychological.抄録全体を表示PDF形式でダウンロード (1155K) -
中田 誠一, 中島 務, 海田 政英, 鈴木 亨, 曽根 三千彦, 江尻 弘也, 柳田 則之1993 年 86 巻 5 号 p. 713-717
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーRupture of the common carotid artery is one of the most feared postoperative complications of neck dissection.
A 55-year-old-male patient with carcinoma of the hypopharynx (T4N2CM0) underwent a total pharyngolaryngoesophagectomy, radical neck dissection on the right side and conservative neck dissection on the left side. Ten days later the right common carotid artery ruptured. We suspect that the artery rupture was secondary to MRSA infection.
Ligation of right common carotid artery was performed and the patient survived without neurological problems. In order to determine the safety of resection of a common carotid artery, we measured stump pressure and monitored electroencephalogram changes during surgery.
The incidence and risk factors of carotid artery rupture are discussed. To our knowledge, this is the first report of carotid artery rupture due to MRSA infection.抄録全体を表示PDF形式でダウンロード (3100K) -
稲木 匠子, 丘村 煕, 森 敏裕, 福井 康二1993 年 86 巻 5 号 p. 719-724
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーThe purpose of this paper is to discuss the differences of pharyngeal swallowing according to the type of bolus. Using hand-made solid boluses, the authors examined the swallowing function of 36 individuals, 17 patients with a sensation of lump in the throat (group 1) and 19 patients with difficulty swallowing a solid bolus (group 2) through the fluorography. Two transit times of the movements of the boluses (liquid and solid) were measured; phase 1 represented the time between the passing of the apex of the bolus from the faucial isthmus to the entrance of the esophageal, and phase 2 the time it took the bolus to pass through the esophageal orifice. For liquid boluses, no significant difference was detected between the 2 groups for either phase 1 or phase 2. On the other hand, the phase 1 transit time for a solid bolus was longer than that for a liquid bolus, especially in group 2. In addition, the solid bolus was arrested at the level of the vallecula and/or pyriform sinus in 15 patients (42%). Therefore, the use of the solid bolus made clear the existence of a swallowing disorder in the pharyngeal phase, especially the decrease of swallowing power of the oral and pharyngeal muscle and/or the lowered sensitivity of the swallowing reflex.抄録全体を表示PDF形式でダウンロード (3123K) -
滝元 徹, 本田 敬宜1993 年 86 巻 5 号 p. 725-730
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーForestier's disease is characterized by extensive and exaggerated osteophyte formation and is an entity well described in the radiology and orthopedic literature. But it is little known to otolaryngologists. Dysphagia from mechanical obstruction of the hypopharynx due to Forestier's disease is a very rare occurrence.
Two patients with Forestier's disease in whom cervical osteophytes caused dysphagia are described. The diagnosis was made by plain cervical X-ray films, a barium swallow esophagogram and a CT scan of the neck. The barium esophagograms demonstrated narrowing of the esophagus at the level of the hypopharynx, and the CT scan showed anterior osteophyte formation of cervical vertebrae.抄録全体を表示PDF形式でダウンロード (3963K) -
田部 哲也1993 年 86 巻 5 号 p. 731-754
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーThe changes of tissue temperature and the damage to soft tissue induced by CO2 laser irradiation were investigated for the purpose of setting up conditions of laser irradiation with minimal tissue damage. The tongue and the larynx of mongrel dogs were irradiated under intravenous nembutal anesthesia. The temperature was recorded by a digital thermometer (DTM-900), and the morphological changes were studied with a light microscope and a scanning electron microscope. The tissue temperature was below 45°C at a distance of 2mm or more from the edge of the irradiated area, and no tissue damage was observed. The tissue temperature was over 70°C within 1mm from the edge of the irradiated area, and thermal denaturation of the tissue was seen. Extensive tissue damage followed low power, long duration, large spotsize and continuous wave irradiation.
Fifty six cases of glottic carcinoma (46 T1 and 10 T2) treated with CO2 laser or KTP/532 laser were reviewed. The 3-year determinate survival rate was 100% and the 5-year determinate survival rate was 100% for T1 and 67% for T2. The voice conservation rate was 96% for T1a, 80% for T1b and 60% for T2, so vocal function was satisfactorily preserved for daily life. These results led to the following conclusion: 1) lesions involving the anterior commissure can be treated by laser excision and vaporization; 2) glottic T1 carcinomas can be treated by laser surgery alone; 3) laser surgery followed by radiation therapy for glottic T2 carcinomas improves the voice conservation rate.抄録全体を表示PDF形式でダウンロード (13934K) -
坂下 勤武, 真鍋 恭弘, 斎藤 武久, 斎藤 等1993 年 86 巻 5 号 p. 755-759
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーThe clinical effects of a calcium channel blocker, flunarizine, which acts especially on intracranial blood vessels, were evaluated in 55 patients with tinnitus. Subjective improvement was reported in 70.9% (53.4% in the control group). Edema of the extremities as a side effect was observed in 2 patients, but it was not severe. This study suggests that the calcium blocker, flunarizin, is useful in the treatment of tinnitus.抄録全体を表示PDF形式でダウンロード (601K) -
藤森 俊也, 松岡 出, 中村 隆, 杉丸 忠彦, 池上 聡1993 年 86 巻 5 号 p. 761-766
発行日: 1993/05/01
公開日: 2011/12/12
ジャーナル フリーThe clinical efficacy of roxithromycin was examined objectively in 17 patients with chronic sinusitis. X-ray opacity of the maxillary sinuses and changes in subjective symptoms and objective signs were evaluated.
The patients were treated with 300mg of roxithromycin per day for 55.2 days on the average. X-ray opacity was evaluated with a microdensitometer, and the ratio of the maxillary sinus density to the orbital density (M/O ratio) was calculated.
Subjective improvement was noted in 70.6% and objective improvement in 58.8%. The M/O ratio was reduced in 42.1%, and clinical symptoms decreased in most of those with an improved M/O ratio. Nasal mucosal swelling was observed in 91.0% of the patients who didn't improve in M/O ratio after treatment. It was concluded that patients with mucosal swelling need surgical treatment.抄録全体を表示PDF形式でダウンロード (623K) -
佐藤 武男1993 年 86 巻 5 号 p. 768-769
発行日: 1993/05/01
公開日: 2011/11/04
ジャーナル フリーPDF形式でダウンロード (269K)
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