耳鼻咽喉科臨床
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
89 巻, 10 号
選択された号の論文の20件中1~20を表示しています
  • 亀井 民雄
    1996 年 89 巻 10 号 p. 1167-1176
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    From recent literature, the clinical implications of head-shaking nystagmus (HSN) can be summarized as follows:
    1. HSN with more than four distinct consecutive beats is generally pathological, when observed using Frenzel's glasses in a dark room. However, HSN may be physiological only when the patient's vision is completely blocked such as when the patient's eyes are closed.
    2. Horizontal HSN may have a peripheral or central vestibular origin, but a distinct vertical (usually down beating) HSN strongly suggests a central lesion.
    3. HSN appears usually in a monophasic or biphasic pattern. The pattern which appears in peripheral vestibular disorders (PVD) depends mainly on the stage of recovery.
    4. The second phase of biphasic HSN is usually weaker in nystagmus intensity but longer in duration than the first phase in PVD. A second phase that is as strong or stronger than the first phase may suggest a central origin.
    5. In long-lasting PVD, HSN beats toward the normal ear in about 75% of monophasic cases and in more than 85% of biphasic cases in the first phase.
    6. In many cases with long-lasting PVD, both of spontaneous nystagmus (SPN) and HSN reverse their nystagmus directions during the course of the recovery in the following order: SPN toward the impaired ear (irritative nystagmus), SPN toward the normal ear (paretic nystagmus), monophasic HSN toward the normal ear, biphasic HSN in the first phase toward the normal ear, monophasic HSN toward the impaired ear, and finally SPN toward the impaired ear (recovery nystagmus).
    7. Biphasic HSN in which the nystagmus in the first phase beats toward the impaired ear (reversed biphasic HSN) is rarely encountered in long-lasting PVD. In Meniere's disease, on the other hand, this type of HSN is relatively common and amounts, when added with monophasic HSN toward the impaired ear (reversed monophasic HSN), to about 30% of cases.
  • 阪上 雅史, 小笠 原寛, 湊川 徹
    1996 年 89 巻 10 号 p. 1178-1179
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
  • 本間 利生, 川端 五十鈴
    1996 年 89 巻 10 号 p. 1181-1187
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    This study describes 15 special cases of sudden deafness with further progression of hearing loss after initial examination in our clinic. The authors examined the otological, audiological and laboratory findings of those patients, including family and past history, Results were as follows;
    1. The patients consisted of 5 males and 10 females, with an average age of 41 years.
    2. Audiological findings with respect to hearing loss were variable.
    3. Hearing loss progressed after the initial examination and reached a maximum at about 7 days after the onset of initial hearing loss.
    4. Patients could be divided into four groups on the basis of increased hearing loss at various sound frequencies;
    (1) increasing hearing loss in the low tone range,
    (2) in the middle tone range,
    (3) in the low-middle tone range,
    (4) in all ranges of tones.
    The third group was greatest in number.
    5. The progression of hearing loss could be classified into 3 types according to the mode of increasing hearing loss.
    Type I hearing loss was characterized by rapid progression after increased hearing loss had begun.
    Type II was characterized by slow progression.
    Type III was characterized by progression starting after 1 to 3 stable days. These results were discussed from the perspective of clinical audiology.
  • 宮田 耕志, 庄司 和彦, 児嶋 久剛, 大森 孝一, 篠原 尚吾
    1996 年 89 巻 10 号 p. 1189-1193
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    Many types of hearing aids apply low-cut filtering for noise reduction. This method is based on the fact that background noises are mainly low frequency. The advantages of low-cut filtering for speech recognition with noise have been contentious. We evaluated the effectiveness of the low-cut filtering method for improving the recognition of Japanese sentences with noise.
    Speech recognition tests were undertaken by 56 patients with sensorineural hearing loss and 14 volunteers with normal hearing. Multitalker noise was added to sounds of four Japanese sentences by a male announcer at an S/N ratio of 6 dB. Two of the four sentences were processed through a low-cut filter (1000 Hz cutoff frequency, -12 dB per octave filter slope). In 48 of the patients with sensorineural hearing loss, the two filtered sentences were not understood better than the unfiltered sentences. In 34 of these patients, speech recognition deteriorated as a result of low-cut filtering. These results indicated that low-cut filtering is not effective for speech recognition with noise.
  • 山口 朝, 氷見 徹夫, 原渕 保明, 浜本 誠, 横山 雄司, 形浦 昭克
    1996 年 89 巻 10 号 p. 1195-1199
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    Kearns-Sayre syndrome (KSS) is one of a mitochondrial disease characterized by progressive eye disorders, such as pigmentary retinopathy, and complete heart blockage. A recent study revealed that the etiology of this syndrome involves sporadic large scale rearrangements of mitochondrial DNA. Other neurologic symptoms are frequently associated with this syndrome, and hearing loss is the other main symptom. At the age of 37 years, this female patient began to suffer progressive hearing loss, and eventually became completely deaf. MRI imaging showed diffuse, abnormally high signals in the brain white matter, in T2-weighted images. Further neurological examination revealed eye abnormalities, and a genetic analysis confirmed a diagnosis of KSS. In this case, no sensory agnosia or other focal signs of disorder in the brain cortex were found, and the electrophysical criteria for cochlear implant were fulfilled. Cochlear implantation was performed on May 19, 1995. Post-operatively, the patient underwent vowel and consonant recognition tests. The patients scored well with an accuracy of 75% for vowels and 36% for consonants. The accuracy of vowel and consonant recognition with lip reading was elevated to 100% and 72%, respectively. Sound recognition in this patient seemed to be quite high compared to that reported in other implanted patients. The excellent results obtained in this KSS patient suggest pure neural deafness, and raise the possibility of cochlear involvement in this condition.
  • 入江 和美, 飯野 ゆき子, 水谷 俊美, 宮澤 哲夫, 寺島 邦男
    1996 年 89 巻 10 号 p. 1201-1206
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    It is known that ear piercing can cause various complications such as infection, allergic contact dermatitis, granulation, dermoid cyst formation buried earring and so on. We describe a case of earlobe keloid caused by ear piercing. The patient, an 18-year-old female, visited our hospital complaining of a large tumor hanging from the left earlobe. The tumor was excised and a histological examination revealed keloid tissue with subcutaneous clusters of lymphocytes.
    An immunohistochemical study of the keloid tissue was performed using a polyclonal antibody against human IgG and IgE. Numerous IgE positive cells, presumably mast cells, were found below the epidermis, suggesting that the keloid was still active and still sensitized by some stimulation. The inflammatory response seemed to have contributed to formation of the large keloid.
  • 設楽 仁一, 加納 有二
    1996 年 89 巻 10 号 p. 1207-1211
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    A young girl, 5 years and 9 months of age, was referred to our hospital because of nasal obstruction, mouth breathing and coughing at night. At 6 years of age, reconstructive surgery for the treatment of bilateral choanal atresia was performed using a transnasal approach. Airway tubes were retained in each choanae for 4 months after the surgery. Reobstruction of both choanae was not recognized until two years after the surgery. Nasal obstruction and mouth breathing had improved, but mouth breathing sometimes occurred unconsciously. The patient was able to recognize strong smells, but could not identify what the smells were. It is generally agreed that bilateral choanal atresia in the newborn with dyspnea is an emergency situation. This patient evidently did not experience dyspnea and survived without surgery because she was able to breathe orally since newborn. Considering that the patient's problems, such as nasal obstruction and disturbances of the sense of smell had been prolonged, surgical treatment for bilateral choanal atresia was recommended as soon as possible. This paper comprises a discussion of clinical symptoms in a case of untreated congenital choanal atresia.
  • ―acoustic rhinometryによる検討―
    前田 陽一郎, 加瀬 康弘
    1996 年 89 巻 10 号 p. 1213-1216
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    This study involved total laryngectomy patients and controls who were free from nasoantral disease. Acoustic rhinometry, by which nasal cavity volume as an index of nasal patency can be easily evaluated in laryngectomy patients with stomal breathing, was used in this investigation. Three studies, as follows, were performed and the results in the laryngectomy group were compared with those in the control group. The first study investigated total nasal cavity volume, the second evaluated the degree of change in nasal cavity volume, and the third examined the standard deviation of the difference between nasal cavity volume in the left versus the right side. The third measurement was considered to be representative of reciprocal alternation, that is, the activity of the nasal cycle. In laryngectomy patients, the total nasal cavity volume was increased and the degree of change in ipsilateral volume was decreased relative to that of controls. Moreover, the activity of the nasal cycle was decreased in laryngectomy patients. These results suggested that laryngectomy caused vascular constriction in the nasal mucosa and that the volume of nasal mucosa was decreased. While laryngectomy did not cause the nasal cycle to cease, the nasal cycle of laryngectomy patients showed a low amplitude.
  • 高村 博光, 高崎 賢治, 弦本 日芳
    1996 年 89 巻 10 号 p. 1217-1222
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    The distribution of fibronectin, an extracellular matrix component, was examined in patients with nasal allergy and in non-allergic patients. The distribution and the number of EG2 positive cells in the nasal mucosa was investigated with respect to the clinical effects of anti-allergic agents.
    We investigated 11 patients with nasal allergy (5 males and 6 females, age 19 to 57 years) and 8 non allergic patients (6 males and 2 females, age 16 to 72 years). Biopsy specimens were obtained from the inferior turbinate under general or local anesthesia, and then frozen at -70°C. The samples were then sectioned to a thickness of 4 pm using a cryostat. The presence of fibronectin, EG2 positive cells and macrophages was then identified using each monoclonal antibodies and streptavidin-biotin peroxidase complex staining method (DAKO).
    In this study, we found that fibronectin was distributed mainly around the basement membrane and vessel walls, and its distribution was similar between patients with nasal allergy and non-allergic patients. The clinical effects of anti-allergic agents correlated well with the number of EG2 positive cells in the superficial layer, but not with the distribution of fibronectin in the nasal mucosa.
  • ―MRIによる動態観察―
    相原 隆一, 河北 誠二, 松本 康, 貞本 昌規, 湯本 英二
    1996 年 89 巻 10 号 p. 1223-1232
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    Operative indications for orbital blow-out fracture (OBF) remain controversial. One of the major sources of this controversy is that an accurate diagnosis of ocular movement disturbances can not be made by conventional procedures such as the Hess screen test, traction test, or CT scan.
    Disturbances in ocular movement resulting from OBF can occur not only with entrapment of the extraocular muscle but also with intraorbital bleeding, edema, and/or a variety of other unclear factors.
    To obtain a more accurate diagnosis and to assist in the choice of treatment, ocular movement was examined using orbital “tine mode” MR imaging. MR images were obtained in multiple phases of vertical and horizontal ocular movements by using the “fast SE” capabilities of the SIERRA, GEYMS MR scanner (1.5 Tesla, superconductive).
    The fixed eye method was applied to two normal volunteers and to patients with “pure” OBF. Five marks for binocular fixation were affixed to the inner wall of the gantry : one at the primary position and four at secondary positions. While keeping the subject's eye focused on each of these marks for about 30 sec, MR images (head coil) of the axial view and bilateral oblique sagittal view along the optic nerve were carried out.
    In the normal volunteers, a good demonstration of smooth movement of the eye ball, extraocular muscles, and the optic nerve could be obtained. In the OBF patients, it was clearly observed that the disturbance in ocular movement was caused by poor extension of the external ocular muscles, specifically the inferior rectus muscle in the orbital floor fracture, and the internal rectus muscle in the medial wall fracture.
    These observations suggested that dynamic orbital imaging with MR would be extremely valuable in the assessment of disturbances of ocular movement in OBF.
  • 内藤 健晴, 浦野 誠, 岩田 義弘, 大山 俊廣, 高須 昭彦, 岩田 重信
    1996 年 89 巻 10 号 p. 1233-1238
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    A patient who developed toxic shock syndrome (TSS) following sinus surgery is described. A 22-year-old male complaining of pyrexia (39°C), general fatigue, watery diarrhea, nausea, muscle soreness and sore throat was admitted as an emargency patient to one of our infirmaries 19 days after sinus surgery had been performed at another hospital. Hypotension with a systolic blood pressure of 80 mmHg and erythroderma on his palm and sole were noted. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in pus secreted from the right nasal cavity. Appropriate hydration, antibiotics and local clearance of the infection was applied in the management of the TSS. Good prognosis ensued without γ-globulin therapy. TSS should currently be con-sidered as an important complication of nasal surgery.
  • 田中 晃, 谷垣 内由之, 浅井 忠雄, 豊田 由香, 白坂 邦隆, 馬場 廣太郎
    1996 年 89 巻 10 号 p. 1239-1243
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    Neurilemmomas are benign neurogenic tumors and usually occur in the head and neck region. The neurilemmoma is a solitary, slowly growing tumor and usually involves peripheral nerve.
    We reported a case of several neurilemmomas occurring simultaneously in the pharynx and the skin of the antebrachium.
    A 61-year-old man visited our hospital complaining of abnormal sensation in his pharynx and a tumor of the antebrachium. A fiberendoscopic examination revealed a submucosal smooth round mass occupying the right side of the nasopharynx and oropharynx. CT and MRI examinations revaled a clearly demarcated tumor in the submucosal region, expanding from the nasopharynx to the oropharynx. Two tumors were then surgically extirpated, and both tumors were histpathologically diagnosed as a mixed type neurilemmoma consisting of Antoni type A and B cellular patterns with
    Verocay body.
  • 棚本 洋文, 佐藤 宏昭, 田渕 圭作, 村井 紀彦, 北林 かおる
    1996 年 89 巻 10 号 p. 1245-1248
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    A rare case of ectopic tonsillar tissue in the hypopharynx, meeting the 4 histological criteria for tonsil tissue as defined by Fioretti, is described in this report. A 68-year-old woman, in whom a mass in the hypopharynx had been found during endoscopic examination of the esophagus, was referred to our hospital. Endoscopic and X-ray examination revealed that the mass was located in the right postarytenoid region. Under general anesthesia, the tumor was extirpated by lateral pharyngotomy.
  • 朝倉 光司, 志藤 文明, 坪田 大, 新谷 朋子, 小笠原 英樹, 形浦 昭克, 晴山 雅人, 森田 和夫
    1996 年 89 巻 10 号 p. 1249-1252
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    We performed endoscopic laser surgery for the treatment of post-irradiation recurrences of T1 and T2 laryngeal carcinomas. Two out of the 5 T1 glottic type carcinoma cases and 1 out of the 4 T2 cases were controlled after the laser surgery. Recurrences in the successfully treated cases were confined to the vocal cords. In 2 out of the 4 supraglottic type patients, the recurrences were confined to the false vocal cords and were controlled after the laser surgery. These findings suggest that small recurrences after irradiation can be controlled by endoscopic laser surgery.
  • ―当科の現状と今後の問題点―
    久保井 敬之, 岡本 茉莉子, 大日向 由光, 杉田 邦洋, 荒木 倫利, 牧本 一男
    1996 年 89 巻 10 号 p. 1253-1260
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    From 1992 to 1995, 313 tumorous lesions in the head and neck area were examined by ultrasound-guided fine needle aspiration cytology (FNA). We compared the preoperative cytological findings with the postoperative pathologic results for 78 lesions from patients who underwent surgery or open biopsy. Of these 78 cases, 39 (50%) were diagnosed postoperatively as malignant tumors. Six of 42 cases (14.3%), which were diagnosed as class I or II according to cytological classification, were revealed to be malignant by pathologic examination. Two of 31 cases (6.5%), which were diagnosed as class N or V, were shown to be benign. Four of 5 cases (80%), which were diagnosed as class IQ were shown to be malignant. The accuracy of cytological diagnosis was 83.3%. Among five biopsy sites (thyroid gland, parotid gland, submandibular gland, lymph node, and other cervical mass), the accuracy of the thyroid gland cytological diagnosis was the highest (92.3%), and that of other cervical masses was the lowest (69.2%). Parotid gland tumors and soft tissue tumors were difficult to diagnose accurately by FNA. Among the patients examined by FNA, there were no complications such as tumor seeding, metastasis, hematoma, or infection. Unsatisfactory material for cytological analysis was obtained in only 15 of 313 cases (4.8%). We conclude that FNA can be used not only to distinguish benign tumors from malignant tumors of the head and neck, and to detect lymph node metastasis, but also to suggest their pathological types.
  • 北南 和彦, 吉田 真子, 坂東 伸幸, 高橋 光明
    1996 年 89 巻 10 号 p. 1261-1264
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    This report describes a 59-year-old woman with a foreign body in the neck found by chance during an X-ray examination. The foreign body was discovered when she visited a neighbourhood hospital because of a heavy feeling in the posterior region of her neck. When she was referred to our hospital, this complaint had diminished, but surgical removal of the foreign body was conducted. A lateral neck incision revealed a 20 mm long wire, the tip of which was embedded in the esophageal wall. Following removal, the wire was shown to the patient, who indicated that she had not seen it before. We concluded that the foreign body had penetrated the wall of the esophagus when the woman was a child.
  • ―アンケート調査成績より―
    佐伯 忠彦, 小林 丈二, 上甲 英生
    1996 年 89 巻 10 号 p. 1265-1269
    発行日: 1996/10/01
    公開日: 2011/12/12
    ジャーナル フリー
    Otorhinolaryngological disorders through a questionnaire were investigated in 163 scuba divers (99 males and 64 females) over the period August, 1994 to December, 1995. Seventy-four cases (45.4% of the 163) had dived excessively as indicated by poor Eustachian tube function. Moreover, 14 cases (8.7%) of 161 had taken medication to perform valsalva's method more easily. During underwater navigation, earache, hearing loss, tinnitus, vertigo (or dizziness) and sinus squeeze were reported in 95 cases (63.3%) of 150, 10 cases (6.7%) of 150, 13 cases (8.8%) of 147, 17 cases (11.4%) of 149 and 25 cases (16.4%) of 152, respectively. In surface navigation, the incidence of the same problems was 21 cases (14.7%) of 143, 5 cases (3.3%) of 150, 12 cases (8.1%) of 149, 21 cases (14.7%) of 143 and 11 cases (7.3%) of 150, respectively. Alternobaric facial palsy occurred in 6 cases (4.1%) of 148 after diving. Thirty-three cases (20.5%) of 161 visited the hospital because of otorhinolaryngological disorders related to scuba diving. The incidence of problems in divers who dived excessively and the number of hospital visits among those who dived excessively, were higher than those among other divers. In conclusion, divers should be advised to stop diving during conditions of tubal dysfunction owing to the common cold and so on.
  • ―UPPPの有効群と無効群の相違―
    多田 裕之
    1996 年 89 巻 10 号 p. 1271-1281
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    The purpose of this study was to determine whether the sites of narrowing of the airway of good responders to uvulopalatopharyngoplasty (UPPP) differed from the sites in poor responders. Twenty patients with obstructive sleep apnea syndrome (OSAS) were examined using pressure transducers placed in four different sites, in addition to routine polysomnography and cephalometric analysis. UPPP was then performed in all patients. Twelve patients were good responders and eight patients were poor responders. The good responders had a smaller apnea hypopnea index (All) preoperatively (39.3) than the poor responders (72.0). Preoperative cephalometric analysis revealed that the mean subspinal-nasion-supramental angle (ANB) of the poor responders (4.2°) was larger than the good responders (0.2°). Preoperative airway pressure examination revealed the following: 1) the site of narrowing in the good responders was almost always in the oropharynx; 2) the site of narrowing in poor responders was at the tongue base in half of the patients. For all patients the AHI was correlated with the mean absolute value of the pressure in the hypopharynx (Phyp) and in the esophagus (Pes) during sleep stage 1 and 2 and with the body mass index (BMI). BMI was correlated with Pes during sleep stage 1 and 2. ANB was correlated with the Phyp and Pes during sleep stage 1.
    These findings indicate that, due to obesity and mandibular deficiencies, poor responders to UPPP have a higher AHI and tend to have sites of obstruction at the tongue base.
  • 山際 幹和, 徳力 俊治
    1996 年 89 巻 10 号 p. 1283-1291
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
    We evaluated the efficacy of a fluticasone propionate aqueous nasal spray (FPANS) at 200μg/ day for 2 weeks on nasal obstructions in 13 patients (8 males and 5 females, aged 19—51 years, mean age 32.9 years) with perennial nasal allergy symptoms. A 100 mm visual analogue scale (VAS) was used for the subjective measurement of the nasal sensation of airflow, and acoustic rhinometry (AR) was used for the objective measurement at one, two and 3 weeks after the start of the medication.
    1) The mean±standard error (SE) of the VAS score was 46.1±4.2 before the medication, 33.8±5.6 at one week, 31.8±4.8 at two weeks and 41.6±6.0 at three weeks post-medication. A significant difference in the VAS score was detected by Friedman's test (p=0.0011).
    2) The mean±SE of the right+lef t minimal cross-sectional area (MCA) of the nose was 0.59±0.08cm2 before the medication, 0.74±0.08cm2 at one week, 0.75±0.08 cm2 at two weeks and 0.72±0.06cm2 at three weeks post-medication. A significant difference in the MCA was detected by a one-way repeated-measures ANOVA (P=0.0178).
    3) The mean±SE of the right + left nasal cavity volumes (NCV) was 12.62±1.07cm3 before the medication, 14.44±1.15cm3 at one week, 14.68±1.13cm3 at two weeks and 14.12±0.74cm3 at three weeks post-medication. A significant difference in the NCV was found by a one-way repeatedmeasures ANOVA (P=0.0471).
    In conclusion, our VAS and AR studies demonstrated that FPANS was effective in reducing allergy-induced nasal obstruction.
  • 坂倉 淳
    1996 年 89 巻 10 号 p. 1292-1293
    発行日: 1996/10/01
    公開日: 2011/11/04
    ジャーナル フリー
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