Practica Oto-Rhino-Laryngologica

Fundamental Frequency Control; Aerodynamic Viewpoint

Kazutomo KITAJIMA, Kazunari TANAKA

1995 Volume 88 Issue 4 Pages 419-425
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.419

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The change of Fo per unit change of transglottal pressure (dF/dP) was investigated. Since the length and stiffness of the vocal folds determine the values of dFldP, it was expected that the relationship between dF/dP and Fo would show the effects of these adjustments of the vocal folds. Six males and six females participated in this study.
A specially designed tube is equipped with a mouthpiece into which the subject phonates and a shutter valve which can be partially closed during sustained phonation to create a sudden pressure increase inside the tube. The voice signal was picked up by a throat contact microphone and fed into the microcomputer simultaneously with the pressure reading inside the tube (Po). The valve was programmed to close for 300 msec during the utterance. The subjects repeated the utterance at different pitches which were raised by small steps. The computer program was designed to calculate the change of Fo per unit change of Po (dF/dP).
Within the modal register, the values of dF/dP became smaller with Fo up to 200 Hz in males, and up to 250-400 Hz in females. With Fo higher than these levels, dF/dP became larger. The values of dF/dP in the modal register were smaller than those in the falsetto register. On the basis of these observations, we suggest that there is a difference between low-pitched modal register and high pitched modal register in the manner of adjustments of length and stiffness of the vocal folds.

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Therapy of Plunging Ranula

[in Japanese], [in Japanese], [in Japanese]

1995 Volume 88 Issue 4 Pages 426-427
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.426

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Idiopathic Scoliosis and Stabilometry

Makoto MIURA, Masahiko HAYASHI, Shigeo SUZUKI

1995 Volume 88 Issue 4 Pages 429-434
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.429

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The equilibrium funciton of 24 patients with idiopathic scoliosis was examined by stabilometry and other equilibrium tests (Romberg test, Mann test, gaze nystagmus test, positional and positioning nystagmus test, eye tracking test and optokinetic nystagmus test). In the group aged 10 to 15 years (18 patients), there was a fairly high correlation between the magnitude of Cobb's angle and the area of center of gravity movements. The magnitude of spinal rotation, as well as that of Cobb's angle, correlated well with the area of the center of gravity movements. On the other hand, in the group over 15 years of age (6 patients), the area of the center of gravity movements showed no significant correlation with Cobb's angle or spinal rotation. Eight of 24 patients (33%) had abnormal findings in the Mann test. Four of 24 patients (17%) showed diminution in the optokinetic nystagmus test. The other test results were normal in all patients. We conclude that stabilometry is a more quantitative test of equilibrium function in patients with idiopathic scoliosis than are other tests.

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Labyrinthine Fistula Caused by Cholesteatoma Noted at Second Stage Operation

Haruo HIRAKAWA, Yukiko ILINO, Seiji SAWAKI, Yasushi NAKAMURA, Shinichi ...

1995 Volume 88 Issue 4 Pages 435-440
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.435

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A labyrinthine fistula was present in 41 (7.9%) of 517 patients with middle ear cholesteatoma operated on in Teikyo University Hospital between January 1983 and December 1993. All the operations except one were “open-and-closed method” staged tympanoplasties. A second stage operation was performed on 16 of these 41 patients 6 to 16 months later. Their fistulae had been treated at the first stage as follows: in 6 patients the cholesteatoma matrix on the fistula was removed and the fistula was covered, in 6 the matrix over the fistula was left in situ, and in the remaining 4 the matrix was removed, and the subepithelial granulation was left in place with the fistula untouched. In the present study, we analyzed the operative findings and post operative course after the second look in these 16 patients. 1) In 2, the matrix left over the fistula at the first stage had disappeared by the second stage. 2) In 3, the matrix left over the fistula at the first stage had grown larger and formed a pearl by the second stage. However, removal of the matrix over the fistula was easily performed at the second stage. 3) In 5, growth of new bone closed the fistula. 4) Inner ear function showed no reduction after the second stage operation in any patient. 5) Middle ear infection was not seen at the second stage. 6) These findings suggest that staged tympanoplasty is preferable in patients with a labyrinthine fistula.

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Residual and Recurrent Cholesteatoma after Open and Reconstruction Tympanoplasty

Akira KODAMA, Satoru TAKEBAYASHI, Akio SHINO, Miwa SHINO

1995 Volume 88 Issue 4 Pages 441-444
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.441

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In the present study, we examined 109 patients operated on by open and reconstruction tympanoplasty and review and discuss postsurgical problems of residual and recurrent cholesteatomas. Sixty four patients (59%) were treated by one-stage operation, and 45 (41%) required two-stage procedures. Residual cholesteatoma was found in four patients at the second look and recurrent cholesteatoma in two after the first operation. However, in all patients who have been followed for one to four years after one- or two-stage operations, there has been no evidence of residual or recurrent cholesteatoma.

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Cholesterol Cyst of the Mastoid; A Case Report

Iwao YOSHIOKA, Tetsuo HIMI, Shinji OHGURO, Hiroko SAITOH, Akikatsu KAT ...

1995 Volume 88 Issue 4 Pages 445-448
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.445

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We report a case of cholesterol cyst of the mastoid, which was revealed by CT and MRI before otologic symptoms appeared. CT findings showed destruction of the temporal bone. MR imaging showed characteristic findings of the cholesterol cyst; both T1 and T2-weighted images demonstrated abnormal high signals at the affected site in the mastoid. These findings were extremely useful in making the differential diagnosis from cholesteatoma. Surgical removal of the cyst was performed and histological findings revealed that the genesis of the cyst was based on the cholesterol granuloma. The cholesterol cyst can occur in various sites in the temporal bone, and the initial symptoms depend on the affected regions. This disease causes progressive bony destruction, but it is suspected that the asymptomatic period may be long when the cholesterol cyst occurs in the mastoid cavity, as in this reported case.

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Ventilation Tube Therapy for Otitis Media with Effusion in Infants

Naoko KAWAMURA, Kimiko ASANO, Tomoko SUGIUCHI

1995 Volume 88 Issue 4 Pages 449-456
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.449

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We reviewed 26 infants (26 ears) up to 2 years of age with persistent otitis media with effusion (OME). There were recurrences of acute otitis media in 10 ears and 16 ears had prolonged hearing defect which affected language development. Ventilation tube therapy showed good results.
We have followed these patients for 14 months to 4 years and 3 months. Tubes have been removed from 20 ears. Otitis media with effusion recurred and ventilation tube therapy was respected in 4 of the 20 ears. Perforation was seen in 2 ears.
Five infants had no improvement in one ear and recurrence in the other. When one ear improved and had no effusion, recurrence of otitis media with effusion was not seen in the other ear.Therefore, we conclude that the condition of the contralateral ear is important in the decision to remove a tube.

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Multiple Epidermal Cysts of External Ear in a Son and Father

SATO, Fumihisa HIRAIDE, Shinya OHASHI, Kazuo WATANABE, Hitoshi INOUE, ...

1995 Volume 88 Issue 4 Pages 457-461
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.457

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Multiple epidermal cysts of the external ear are extremely rare. A 27-year-old man was admitted to Tokyo Medical College Hospital with multiple small masses on and around the auricles. They were diagnosed as cystic lesions by palpation and echography, and extirpated under local anesthesia. Histopathological examination revealed that the cystic lesions were lined by stratified squamous epithelium with keratotic lesions and no skin appendages. The diagnosis was epidermal cysts. It is interesting that his father had identical cystic lesions on and around the auricles. A genetic factor may be involved in the pathogenesis of epidermal cysts in these cases.

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Regrowth of New Bone after Curettage of Ameloblastoma

Mamoru MIYAGUCHI, Schunichi SAKAI

1995 Volume 88 Issue 4 Pages 463-467
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.463

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Ameloblastoma of the mandible is an extremely rare neoplasm. It is usually treated with radical surgery, including marginal resection, segmental resection, and hemimandibulectomy, because of its frequent recurrence. Even when the primary site is well controlled, patients complain of severe dysfunction of swallowing and speech after radical treatment.
We treated a 50-year-old female with ameloblastoma of the mandible conservatively. The tumor was enucleated and curetted. The postoperative cavity was left open and has gradually become smaller. Although the tumor recurred, it was curetted several times in the outpatient clinic and has been well controlled. Regrowth of the mandible occurred and the patient can live as normal a life as before surgery without any disability.
Conservative therapy with enucleation and curettage is effective for patients with ameloblastoma of the mandible, and good quality of life can be achieved. However, we must follow patients for a long time and control local recurrences.

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Lymphoepithelial Cyst in a Parotid Gland; A Case Report and Review of the Literature

Shigeki HIYAMA, Hiroo YOSHITSURU

1995 Volume 88 Issue 4 Pages 469-472
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.469

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A 63-year-old female was seen with the chief complaint of a painless mass in the right parotid region.
The mass was non-tender, mobile, elastic soft and measured 2×3 cm. Various examinations, including ultrasonography and CT scan, led to a preoperative diagnosis of benign tumor in the right parotid gland. A partial parotidectomy was performed, and a cystic mass was found in the superficial lobe. Histopathological examination revealed a lymphoepithelial cyst within the parotid gland. The histogenesis of the lymphoepithelial cyst is controversial; branchial hypothesis vs lymph node hypothesis. In the last 10 years, lymphoepithelial cysts within the parotid gland have been found increasingly in patients with HIV disease. This fact supports the lymph node hypothesis.

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Warthin's Tumor in Deep Lobe of Parotid Gland; Reason for Its Rarity

Keiko TAKIZAWA, Ichirou ANDOU, Atsushi SAKURAI, Michitaka WATANABE, Na ...

1995 Volume 88 Issue 4 Pages 473-477
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.473

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Warthin's tumor in the deep lobe of the parotid gland is comparatively rare. We treated four male patients with Warthin's tumor in the deep lobe.
The histogenesis of Warthin's tumors is discussed.
Heterotopic ductal epithelial tissue probably invades lymphnodes, which are numerous in the pre- and supratragal areas, but scarce in the deep lobe. Therefore, Warthin's tumor rarely arises from the deep lobe.
Scintigraphic studies were performed in case 1 and case 2: 99 mTcO4-pertechnetate scintigraphy showed a cold spot in case 1 and a normal image in case 2; 67 Ga-citrate scintigraphy showed hot areas in both patients. We consider that these findings were due to abscess formation.

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Undifferentiated Carcinoma of the Parotid Gland

Yoshihiko ISHIZU

1995 Volume 88 Issue 4 Pages 479-482
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.479

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Undifferentiated carcinoma of the parotid gland is a relatively rare malignant tumor. A 65-year-old male was referred to our hospital with a mass in the left parotid region and the left upper neck. The superficial lobe of the left parotid gland was resected and modified neck dissection was performed on clinical suspicion of malignancy. Pathological examination confirmed the diagnosis of undifferentiated carcinoma with cervical lymph node metastasis.
Postoperative radiation therapy was performed immediately, but lymph node metastasis on the left side of the neck was detected 2 months later. The patient then underwent additional radiation therapy and chemotherapy (CBDCA+PEP). One year later, regional lymph node recurrence was confirmed, and additional chemotherapy (CDDP+THP-ADM+PEP) was administered. There has been no evidence of recurrence since the last treatment.

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Deep Neck Infection; A Report of Seven Cases

Nobumitsu HONDA, Koshiro NAKAMURA, Shinji KITANI, Hidemitsu SATO, Taka ...

1995 Volume 88 Issue 4 Pages 483-491
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.483

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Without appropriate and quick treatment, deep neck infection can lead to a severe and dangerous state. From April 1991 to December 1993, we treated seven patients with deep neck infection, five males and two females, 40 to 85 years of age. Their chief complaints were neck swelling with hyperemia and pain.
Maintaining the air way is the first thing to do in the treatment of deep neck infection. In two patients who were close to death on arrival, tracheal intubation or tracheostomy was required, but the other five did not need any aid to respiration. The second emergency treatment is drainage of the deep neck abscess, if present.
The CT scan was very helpful in demonstrating how far the infectious lesion extended in the neck. Abscess formation was found with CT scans in five patients, and drainage was performed in three of them. The other two patients appeared to have phlegmon on the CT scan and drainage was not done. These two patients developed disseminated intravascular coagulation syndrome (DIC), and one of them died of septic shock within 24 hours after admission. This patient had no problem with respiration on the first examination.
In this series of patients with deep neck infection, the following two points should be emphasized: 1) Careful general follow-up is most important even if there is no problem with respiration, because severe and dangerous complications such as DIC or septic shock can develop from deep neck infections. 2) Surgical drainage should be tried even in patients with phlegmon.

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Castleman's Lymphoma in Posterior Auricular Region; A Case Report

Kazue ATSUMI, Atsushi SAKURAI, Ryuta TOKUMARU, Fuyuki ENMOTO, Naoyuki ...

1995 Volume 88 Issue 4 Pages 493-497
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.493

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A 34-year-old male was found to have a tumor in the posterior auricular region. Malignancy was strongly suggested by a preoperative fine needle aspiration biopsy and CT scan. Complete enbloc resection of the tumor was carried out.
Histopathological diagnosis revealed hyaline-vascular type of Castleman's lymphoma.
Until now 74 cases of Castleman's lymphoma in the head and neck region have been reported in Japan, but none in posterior auricular region.
The pathogenesis and differential diagnosis are discussed, and the literature is reviewed.

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Thyroid Papillary Carcinoma; Recent Trends

Ryo ASATO, Hiroyuki KITAMURA, Sanson HAN, Kouji MIYATA, Shigeru HIRANO ...

1995 Volume 88 Issue 4 Pages 499-502
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.499

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Of the 55 patients with thyroid papillary carcinoma (PAC) operated on in 1991 in Tenri Hospital, 32 (58.2%) had PAC discovered during medical examinations for non-thyroid complaints (NTC), 19 patients (34.5%) were examined for thyroid complaints (TC), and 4 because of foreign body sensation of the larynx. We compared the TC and NTC patients.
The average diameter of the thyroid nodule in the TC patients was 34 mm and that of the NTC patients was 14 mm, a significant difference. In the NTC patients the incidence of lymphnode metastasis or extra-thyroid invasion was 7.1%, and in the TC patients it was 26.3%. The incidence of lymphnode metastasis was not a significantly different between the two groups, but the incidence of lymphnode metastasis beyond the central nodes was 42.1% in the TC patients and 12.5% in the NTC patients. Therefore, palpation of the neck is very important for the early detection of PAC.

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Sequential Therapy Involving Pretreatment with 5-FU/Leucovorin Followed by Treatment with Cisplatin for Patients with Recurrent Head and Neck Cancer

Hirobumi KUMAZAWA, Takuya TACHIKAWA, Yoshikazu TSUTA, Hironobu NAKAGAW ...

1995 Volume 88 Issue 4 Pages 503-507
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.503

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Combination chemotherapy which involves pretreatment with 5-FU+leucovorin and treatment of cisplatin (CDDP) was performed on patients with recurrent head and neck cancer. Most patients, who initially underwent chemotherapy with CDDP or carboplatin (CBDCA), were thought to be resistant to platinum agents. Using the combination chemotherapy to improve antitumor effect by biochemical modulation, two patients achieved complete response and 3 partial response among 10 were observed. Further-more, two of 3 patients with partial response who underwent after combination chemotherapy became with disease free. Our pilot study suggests the usefulness of combination chemotherapy for patients with recurrent head and neck cancer.

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Evoked Otoacoustic Emissions in Meniere's Disease

Takeshi KUBO

1995 Volume 88 Issue 4 Pages 509-523
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.509

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Evoked otoacoustic emissions (EOAEs) were recorded from patients with Meniere's disease and the “main frequency” of the emissions, which shows the maximal peak in the frequency spectrum, was examined as a variable. The results were as follows: 1) EOAEs were detected even in ears with moderate or severe hearing loss of more than 50 dBHL. 2) The main frequencies in ears with Meniere's disease ranged mainly from 0.8 kHz to 1.1 kHz and existed at lower frequencies than that in those with normal hearing which ranged mainly from 1.0 kHz to 1.6 kHz. 3) The main frequency changed from lower to higher after administration of osmotic diuretics such as isosorbide or glycerol. 4) On serial observations along the time course, the changes in the main frequency corresponded to those of the clinical state of Meniere's disease. From these observations, it was speculated that in ears with Meniere's disease, lower frequency dominant emissions might be elicited by modification of the basilar membrane in endolymphatic hydrops and that the main frequency changed from lower to higher with reduction of endolymphatic hydrops induced by osmotic diuretics. It was considered that the EOAE testing might be useful in diagnosing endolymphatic hydrops in Meniere's disease.

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Evaluation and Basic Study of Efficacy of AA-673 Nebulization Therapy for Perennial Allergic Rhinitis

Hiroshi TAKENAKA, Fumikazu MIZUKOSHI, Kenji DEJIMA, Nobuo TAKAGI, Tosh ...

1995 Volume 88 Issue 4 Pages 525-534
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.525

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A single-blind study with envelopes of AA-673 for nebulization was conducted to assess its efficacy and to establish the proper dosage in the treatment of perennial allergic rhinitis. Some fun-damental conditions of nebulization were studied.
1. AA-673 prevented histamine release from basophile in nasal fluid for 5 minutes, when 2.5 mg for 2 minutes was nebulized on in normal 7 volunteers.
2. The clinical efficacy rate (good and excellent ratings combined) according to the doctors in charge was 33.3% for 0.85 mg vs. 71.4% for 2.5 mg.
3. No side effects was found in treated patients.
The above results suggest that AA-673 nebulization therapy is as effective as and sometimes more effective than, systemic therapy or nasal spray with AA-673.

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Efficacy of Low-dose and Long-term Roxithromycin (RXM) Therapy for Chronic Sinusitis and Distribution of RXM to Paranasal Mucosa

Junichi ISHITOYA, Tetsuya MASUDA, Atsuhito NAKAI, Koichi AMBE, Hironar ...

1995 Volume 88 Issue 4 Pages 535-542
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.535

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Twenty-eight patients with chronic sinusitis received low-dose long-term roxithromycin (RXM) therapy (RXM therapy). Half the usual dose of RXM, 150 mg, was given for 3 months and changes in symptoms and signs were evaluated before and after the treatment. Favorable clinical response (improvement of such problems as rhinorrhea, postnasal drip, nasal obstruction etc.) were obtained in approximately 70% of the patients. Then, we investigated the tissue concentration of RXM in the nasal mucosa to provide initial information for the discussion about the mechanism of this therapy. RXM (150 mg) was administrated orally 2-8 hours before surgery and both nasal mucosa or tonsil and blood was obtained at the surgery. The concentration in the specimens were measured using bioassay method. The tissue concentrations of RXM in nasal mucosa and tonsil increased as a function of time and reached 1.01pg/mg and 0.62 pglmg 6 hours after administration, respectively. The tissue concentration of RXM co-related well with the serum concentration. These concentrations were not higher than the MIC50 of RXM for H. inluenzae and S. aureus. We discuss these results compared with the concentration of RXM necessary to induce neutrophils activation, cytokine production and ciliary motility.

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Effect of Saiboku-to on Abnormal Sensation in the Throat

Hiroko KAWAMOTO, Katsuhiro HIRAKAWA, Nobuharu TAGASHIRA, [in Japanese] ...

1995 Volume 88 Issue 4 Pages 543-549
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.543

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We administered an oral Kampo medicine, Tsumura Saiboku-to (TJ-96) to 30 male and 102 female patients with abnormal sensation in the throat. At the same time, 12 male and 41 famale patients were examined psychologically with MAS. The drug was effective in 68.2% of the patients.
The drug was more effective in relieving abnormal sensation in the throat than in reducing other psychologic symptoms such as anxiety, depression etc. Mild side effects were observed in 4 patients (2.7%).

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Treatment for Paranasal Sinus Cysts

[in Japanese]

1995 Volume 88 Issue 4 Pages 550-551
Published: April 01, 1995
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.88.550

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