Practica Oto-Rhino-Laryngologica

KTP Laser Surgery with Small Caliber Quartz Fiber

Ken KITAMURA

1996 Volume 89 Issue 12 Pages 1417-1424
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1417

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We report our experiences using the KTP laser (Laserscope, USA, Model SL20/50) to treat patients. The KTP laser can easily be moved by fiberoptic cable or delivered by a micromanipulator attached to a microscope. We usually use hand-held flexible quartz fiber because precise and easy manipulation is possible. Because the laser uses visible light, the same beam is used for both aiming and vaporizing. Therefore, the aiming beam and firing beam are focused on the exact same spot.
Three patients with fixed stapes and one patient with chronic otitis media were presented for KTP laser treatment and the KTP laser was found to be effective in microsurgical applications, such as for otosclerosis and for removing lesions around stapes.
A histological study was performed in a posterior crus of the stapes which received 5W of laser irradiation using a 0.2mm quartz fiber. The depth of the lesion, as determined by laser irradiation, was no more than 60μm. The granulation tissue in the tympanum, which received 2W of laser irradiation using a 0.3mm quartz fiber, demonstrated histological changes and a depth of no more than 20μm.
The system can also be used with a flexible scope by employing the suction port for fiber placement. A 2-month-old baby with bilateral choanal atresia was successfully treated using both the endoscope and the KTP laser. The present study demonstrated the advantages of using the KTP laser in otorhinolaryngology.

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Nasal Polypotomy Using “Rummer” MicroDebrider System

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

1996 Volume 89 Issue 12 Pages 1426-1427
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1426

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Cerebellopontine Angle Lipoma; A Case Report

Kazumasa WATANABE, Hiroyuki TAKEZAWA, Masafumi NAKAGAWA, Shinya SOHMA

1996 Volume 89 Issue 12 Pages 1429-1432
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1429

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Intracranial lipomas are rare, especially at the cerebellopontine angle. We report a case of a right cerebellopontine angle lipoma. An 8-year-old male presented with hearing loss during a school medical examination. A neurological examination in the hospital showed right sensorineural hearing loss. A MRI demonstrated a high intensity mass lesion at right cerebellopontine angle. The lesion was markedly hypointense on a short T1 IR (STIR) image. We made a diagnosis of a cerebellopontine lipoma. Since he had no symptom except moderate hearing loss, we decided to follow the patient closely without immediate surgical exploration.

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Easy Screening of Psychogenic Hearing Loss

Hitoshi Satoh, Hajime OHTAKI, Toshiyuki FUJISAKI, Yuichi Nakano

1996 Volume 89 Issue 12 Pages 1433-1437
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1433

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An easy screening method for psychogenic hearing loss was developed using an air conduction pure-tone audiometer.
We performed pure-tone audiometry using 7 continuous and 7 interrupted pure tones from 125Hz to 8000Hz, and then compared differences in the thresholds of hearing in 13 patients with psychogenic hearing loss. Eleven out of 13 patients (85%) showed an improvement in their thresholds in over 4 out of 7 tones when stimulated by a continuous pure tone in one ear or both ears.
On the other hand, the other 73 sensorineural hearing loss patients showed no such improvements in their thresholds by a continuous pure tone.
These results suggest that this method of comparing the threshold of continuous and interrupted pure tones may easily differentiate psychogenic hearing loss from other types of sensorineural hearing loss. When improvements in the hearing threshold are observed by this method, psychogenic hearing loss should be suspected. Bekesy audiometry and auditory evoked brain stem responses should be performed for an accurate diagnosis.

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A Case of Bezold's Mastoiditis Following Traumatic Stenosis of the External Auditory Canal

Joji Kobayashi, Hidemitsu Sato, Kiyofumi GYO, Naoaki YANAGIHARA

1996 Volume 89 Issue 12 Pages 1439-1444
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1439

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A 72-year-old man was referred to our hospital with a seven day history of left otorrhea and swelling of the neck despite conservative treatment. He had suffered from chronic otitis media and stenosis of the external auditory canal of the left ear following a traffic accident twenty years ago. A CT-scan revealed mastoiditis of the left ear and an abscess formed behind the left sternocleidomastoid muscle. Emergency drainage of the neck abscess was performed under local anesthesia. An anaerobic bacterium Prevotella species was cultured from the abscess.
Mastoidectomy and meato-tympanoplasty were performed under general anesthesia on the 44th day after the drainage operation, since diabetes mellitus and heart disease were not well controlled. The mastoid cavity was completely filled with granulation and a bone defect was found at the mastoid tip cell suggesting the propagation route of the infection. Postoperative courses were uneventful and the otorrhea did not recur.

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The Use of Steroid Therapy for Bell's Palsy ; A Proposal

Kazunari ODA, Ikuo INOKUCHI, Nobuhiko KIMURA, Keiko NISHIOKA, Teruhiro ...

1996 Volume 89 Issue 12 Pages 1445-1449
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1445

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Based on the pathophysiology of Bell's palsy, Stennert employed a high dose of steroid plus lowmolecular weight dextran, and reported a high cure rate. This report was undertaken to evaluate the effects of intermittent corticosteroid pulse therapy on Bell's palsy.
Sixteen patients with Bell's palsy who had complete facial paralysis were enrolled. The treatment performed was intermittent corticosteroid pulse therapy, given between January 1993 and May 1995. In our intermittent corticosteroid pulse therapy protocal, methylprednisolone sodium succinate, low-molecular weight dextran, ATP and vitamins were also used in combination.
The cure rate of this therapy was 87.5%, and no side effects were observed during the treatment. Therefore, this therapy was considered to be very effective in curing Bell's palsy.

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A Case of Brain Abscess due to Sinusitis

Kazunari Tanaka, Ken-ichi MATSUMURA

1996 Volume 89 Issue 12 Pages 1451-1457
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1451

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A case of a rhinogenic brain abscess is reported. A 19-year-old male presented with a onemonth history of headache and pyrexia. He also had nausea and vomiting with concomitant progressive decline of initiativity and level of consciousness. CT and MRI scans revealed a huge brain abscess in the left frontal lobe in association with a small amount of pus collection in the epidural space, left frontal-ethmoid-maxillary sinusitis, and a fracture line on the posterior wall of the left frontal sinus. The brain abscess was totally removed with frontal craniotomy following aspiration and external drainage through a burr hole. The left frontal-ethmoid-maxillary sinuses were treated by endoscopic sinus surgery. The patient recovered without neurological deficit. Infection seemed to have spread directly from the frontal sinus to the intracranial space through the bone defect in the posterior wall of the frontal sinus and a tear in the underlying dura mater, both of which were probably the result of a previous head injury.

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The Experiences of Gamma Knife Surgery for the Nasopharyngeal Carcinoma

Yoshiyasu IWAI, Hiromasa CHOU

1996 Volume 89 Issue 12 Pages 1459-1462
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1459

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Stereotactic radiosurgery using a Gamma Knife is a very effective treatment for both benign and malignant intracranial masses. This method can deliver a focused single high dose of radiotherapy with minimun effect to surrounding tissues. We treated four cases of nasopharyngeal carcinoma that had invaded to the skull base that had recurred after surgery, chemotherapy, and radiotherapy. All cases showed theraputic tumor shrinkage after treatment. The Gamma Knife may be a therapeutic option for the treatment of skull base invasion by nasopharyngeal carcinoma.

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A Case of Osteosarcoma of the Maxilla

Hiroyuki YAMADA, Akihiko KATOH, Hajime ISHINAGA, Toru MATSUURA, Jun SH ...

1996 Volume 89 Issue 12 Pages 1463-1468
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1463

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Osteosarcoma arising from the maxilla is a rare tumor of the head and neck region, accounting for only 6% to 7% of all osteosarcomas. Although therapy for maxillary cancer is well established, that for sarcoma of the maxilla, especially osteosarcoma is less clearly defined. In our department, a case of osteosarcoma arising from the maxilla was treated with surgery and chemo-radiotherapy. Surgery preceded postoperative irradiation with adjuvant intra-arterial chemotherapy. In the literature, surgery is the most readily available form of therapy, whereas radiotherapy and chemotherapy are not commonly used in the treatment of osteosarcoma. The Japanese literature suggests that a combination of chemotherapy and surgery might improve the outcome in cases of osteosarcoma of the maxilla.
In cases of osteosarcoma, recurrence at the primary site is common, and the prognosis in these cases is generally poor. Therefore, precise evaluation of the extent of the osteosarcoma is more essential. In our patient, 3-dimension CT was used preoperatively, and proved useful for the evaluation of the extent of disease and the determination of suitable operative procedures.

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Diagnostic Problems in a Case of the Mucoepidermoid Carcinoma in the Maxillary Sinus

Hiroshi IWAI, Masahiro YANAGIDA, Jun KITA, Tadashi OOBAYASHI, Motoki N ...

1996 Volume 89 Issue 12 Pages 1469-1473
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1469

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Mucoepidermoid carcinoma of the maxillary sinus is a rare neoplasm. We describe diagnostic difficulties in a case of low grade mucoepidermoid carcinoma of a cystic pattern in a 72-year-old man. The patient complained of double vision and nasal bleeding. CT findings indicated a shadow in the unilateral maxillary sinus as well as bony destruction of the maxilla on the same side. Although biopsies and maxillary operations were repeatedly performed over a period of 7 years, the histopathological diagnoses were chronic sinusitis with necrotic characteristics or squamous cell carcinoma.
Several cases of mucoepidermoid carcinoma have been similarly misdiagnosed as squamous cell carcinoma because mucoepidermoid carcinomas contain epidermoid cell components similar to squamous cell carcinomas. Tumor necrosis in our case were extensive and the mucous discharge secreted by mucous cell components in this type of carcinoma may increase pressure inside the cystic tumor causing tumor necrosis. The significance of a differential diagnosis between mucoepidermoid carcinoma and chronic inflammation or squamous cell carcinoma in the maxillary sinus should be emphasized.

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Salivary Duct Carcinoma in the Parotid Gland; A Case Report

Eiji Takahashi, Tomoo SUZUKI, Yatsuji Ito, Keisuke MIZUTA, Hiromichi S ...

1996 Volume 89 Issue 12 Pages 1475-1480
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1475

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Salivary duct carcinomas are uncommon tumors which were first described by Kleinsasser et al. in 1968. They pointed out the histologic resemblance of this tumor to ductual carcinomas of the breast, and termed it salivary duct carcinoma. Recently, we treated a 67-year-old male with a salivary duct carcinoma of the parotid gland. He complained of left facial palsy at first, which we identified as a left Bell's palsy. However, his facial palsy did not improve. His parotid region and inferior external ear canal wall also grew larger. We therefore diagnosed a malignant parotid tumor. An en block resection including the nerve of the parotid gland was performed, and a final pathological diagnosis of a salivary duct carcinoma was confirmed. Thereafter, we treated him with postoperative radiation and chemotherapy. The patient is still alive without any evidence of recurrence at 16 months postoperatively.

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A Clinical Study of Parotid Tumor; Analysis of 57 Cases

Sanaaki ONO, Tsutomu NAKASHIMA, Noriyuki YANAGITA

1996 Volume 89 Issue 12 Pages 1481-1486
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1481

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A clinical investigation of 57 parotid gland tumors was carried out over a period of six years (1989-1994). In each case, the diagnosis had been confirmed histologically. A relatively high value (75 to 95%) was obtained for the correct diagnosis ratio, sensitivity, and specificity in the detection of benign and pernicious diseases using CT scanner images, echo checking system, and scintigrams of this laboratory. The correct diagnosis based on cytology was 68%. Consequently, we concluded that any method is not sufficiently reliable to accurately determine the various clinical aspects of parotid gland tumors ; such tumors should be diagnosed using combination of examination methods. Decisions regarding the most appropriate treatment method should similarly be based on comprehensive knowledge.

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Sore Throat Associated with Pain when Swallowing

Shinya TAKANO, Hajime ARAMAKI, Yumiko OKAMURA, Kohji SHIGI

1996 Volume 89 Issue 12 Pages 1487-1491
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1487

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The association between the symptoms of various conditions was investigated in patients first presenting with a sore throat (n=613) and pain when swallowing (n=109).
This study was performed at the Department of Otorhinolaryngology of the Tokyo Women's Medical College Daini Hospital.
1) Many patients with lesions of the palatine tonsils complained of a sore throat.
2) Lesions of the nasopharynx were detected in 4.6% of those patients presenting with a sore throat.
3) Many patients with lesions involving the lateral pharyngeal wall complained of pain when swallowing.
4) Many patients with lesions of the epiglottis or when pyriform fossa complained of pain when swallowing.
5) Some patients with cancer of the thoracic esophagus complained of pain when swallowing.
6) When a patient presents with a complaint of pain when swallowing, the site of the pain and its association with food intake should be fully clarified by a careful history.

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A Case of Prolonged Presence of a Foreign Body (a Fishhook) in the Esophagus

Takekazu MISHIMA, Ichirou ANDOU, Taichi TEZUKA, Takashi NISHIJIMA

1996 Volume 89 Issue 12 Pages 1493-1497
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1493

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This paper describes a 65-year-old male who presented with a condition involving the long-term presence of a foreign body, a fishhook, in the cervical esophagus. Apparently, the patient suffered severe and sudden pain in the throat while eating fish. He immediately visited the otolaryngological clinic and underwent a medical examination, however no remarkable findings were noted in the examination report. As the severity of the patient's pain gradually diminished, and his condition improved, no additional medical action was provided. Approximately one year later, a foreign body was discovered in the course of a cervical X-ray ordered by the orthopedics department. The patient then returned to our hospital, and a fish hook was successfully removed by esophagoscope under general anesthesia. An additional review of the prolonged presence esophageal foreign bodies was conducted in the present study. If the presence of an esophageal foreign body is suspected, in a patient, a cervical X-ray should be ordered to prevent over looking this possibility in the first examination.

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Magnetoencephalogram in Visual Language Stimulation and Vocalization

Nobuya FUJIKI, Yasushi NAITO, Yosaku SHIOMI, Shigeru HIRANO, Iwao HONJ ...

1996 Volume 89 Issue 12 Pages 1499-1506
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1499

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Event-related magnetic fields (ERFs) were recorded in seven subjects when they were presented with a rectangle and Japanese Kanji characters, followed by vocalizations. The ERF averages for the Kanji characters were different from those for the rectangle at latencies of about 100ms over the occipital lobe and 150-500ms over the temporo-parieto-occipital region. This observation suggests that the first stage of visual word processing might arise in the occipital lobe.
In some cases, difference between the ERFs for the Kanji characters and those for the rectangle were also seen in the frontal lobe at latencies greater than 250ms. This observation suggests that frontal lobe activity may be also involved in visual word processing.
Three equivalent current dipoles were estimated on the bilateral precentral gyrus (motor area) and the posterior part of the superior frontal gyros (supplementary motor area) at a latency of about 500ms during vocalization.
In some cases, early responses at latencies of less than 150ms were obtained in not only the occipital lobe but also the frontal and temporal lobes. This suggests that parallel processing might occur during visual word processing.

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Course of the Chorda Tympani in the Human Tympanic Cavity

Nagisa HOSHINO

1996 Volume 89 Issue 12 Pages 1507-1519
Published: December 01, 1996
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1507

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The course of the Chorda tympani in relation to the malleus, tensor tympani tendon, annulus, and facial nerve in the middle ear was investigated in 30 human temporal bones.
The temporal bones were fixed in 10 percent formalin solution, decalcified in 5 percent trichloroacetic acid solution, and dissected under an operating microscope.
The tympanic membranes with the malleus, a part of the chorda tympani, and facial nerve were dissected. Sudan black B stain was applied to the dissected tympanic membranes and their surrounding tissues.
After entering the middle ear cavity, the chorda tympani runs forward along the lower margin of the posterior mallear fold.
The following measurements were made and results were obtained:
1. The mean distance between the lowest point of the articular surface of the malleus and the chorda tympani was 0.7mm.
2. The mean diameter of the chorda tympani on the neck of the malleus was 0.4mm.
3. The mean distance between the chorda tympani and the tendon of the tensor tympani was 0.3mm.
4. The mean diameter of the tendon of the tensor tympani was 0.7mm.
5. The mean length of the chorda tympani between the facial nerve and the annulus was 8.8mm.
6. The mean shortest distance between the chorda tympani and the tympanic annulus was 0.9mm.
7. The mean angle between the chorda tympani and the tympanic annulus was 30°.
8. The angle between two lines, one perpendicular to the axis of the malleus at the umbo and the other connecting the umbo and the point where the chorda tympani crosses the annulus, was 15°.

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Concentration of CMX in the Maxillary Sinus after Nebulization

Shunkichi BABA, Kenji SUZUKI, Naoya MIYAMOTO, Akira YOKOTA, Takehiro K ...

1996 Volume 89 Issue 12 Pages 1521-1524
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1521

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In order to evaluate the effectiveness of CMX nebulizer therapy in chronic paranasal sinusitis, the CMX concentration in the maxillary sinus and in the nasal cavity after CMX nebulization was measured in chronic paranasal sinusitis patients.
Following the inhalation of 2ml of 1% CMX solutuion (20mg potency) using a supersonic wave nebulizer, the mean CMX concentration in the mucous membrane surface of the maxillary sinus reached 6.11μg/ml-26.41μg/ml. This was higher than the MIC needed against the causative organisms of paranasal sinusitis.
CMX nebulizer therapy is expected to exert a direct effect on the paranasal sinus, and seems to be extremely useful in the treatment of paranasal sinusitis.

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Chemosensitivity Test and Head and Neck Cancer

[in Japanese]

1996 Volume 89 Issue 12 Pages 1526-1527
Published: December 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1526

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