Practica Oto-Rhino-Laryngologica

Adhesive Otitis Media; Etiology and Surgical Treatment

Hiroshi MORIYAMA

1996 Volume 89 Issue 2 Pages 147-152
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.147

JOURNAL FREE ACCESS

Show abstractHide abstract

Impairment of function and obstruction of the tympanic orifice of the eustachian tube are more common in patients with adhesive otitis media than in those with other forms of chronic otitis media. Moreover, in patients with adhesive otitis media the middle ear mucosa is also damaged. Therefore, the results of tympanoplasty are poor. To cope with this difficulty, we tried various surgical approaches, but in the past 69 cases of adhesive otitis media (total adhesion) hearing was improved only 45%. In addition to the presence of tubal dysfunction, the following is thought to be a cause of this poor result. In association with abrasion of the adherent tympanic membrane, the mucosa of the tympanic promontory is lost resulting in exposure of a broad surface of bone, and the delay in postoperative epithelization of the middle ear cavity causes impairment of the ciliary function of the middle ear mucosa and reduces transmucosal gas exchange. Therefore, we now think it is important to facilitate early regeneration of middle ear mucosa, as well as to assure aeration in the middle ear cavity immediately after operation. For this reason, in patients with total ear drum adhesion we attempt to minimize exposure of middle ear bone surface as much as possible. We perform tympanoplasty and insert a ventilation tube to the fascia. In some patients, a silastic sheet is placed in the middle ear cavity. In patients with extensively exposed bone surface in the middle ear cavity, we graft mucosa from the inferior nasal concha onto the bone surface to facilitate epitheliazation.

View full abstract

Download PDF (2324K)
A Case Report of Lipoma which Extended from Temporal Fossa to Cheek Region

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

1996 Volume 89 Issue 2 Pages 154-155
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.154

JOURNAL FREE ACCESS

Download PDF (1780K)
Etiology of Sudden Deafness with Positional Nystagmus of the Direction Changing Type

Koji YUEN, Hirofumi AKAGI, Hiroko KAWARAI, Kazunori NISHIZAKI, Yu MASU ...

1996 Volume 89 Issue 2 Pages 157-163
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.157

JOURNAL FREE ACCESS

Show abstractHide abstract

We present two patients with sudden deafness and positional nystagmus of the direction changing type in which the nystagmus was directed toward the upper ear with the head in a lateral position. The first case was a 60-year-old man; the second was a 50-year-old man. Both patient exhibited this type of nystagmus for more than a year. The first patient showed a well developed nystagmus on caloric test and head tremor by gazing. The second patient had accompanying visual symptoms due to circular insufficiency of the posterior cerebral artery.
We have often encountered cases of sudden deafness with vertigo or dizziness. In most cases, equilibrium disorder and nystagmus disappeared soon after the recovery of a vestibular function and the compensation of the central nervous system. Some cases of sudden deafness showed positional nystagmus of the direction changing type that directed toward the upper ear with the head in the lateral position. This type of nystagmus was first reported as a characteristic sign of vertigo associated with central nervous disorder. Recently, several papers have reported that some cases of vestibular disorder showed this type of nystagmus which usually changes to an other type or disappears within a short period. Because nystagmus of our two patients remaind unchanged for more than a year, we considered that the causes also participate in the disorder of the central equilibrium system. The anterior inferior cerebellar artery supplies the blood to the vestibulocerebellum and its branch, the labryhthine artery, which also supplies the inner ear. Thus, the function of both the cerebellum and the inner ear would be damaged, in cases involving a disorder of this vessel. In our patients, the cause was a vascular disorder associated with a disorder of both the peripheral and central nervous systems.

View full abstract

Download PDF (2340K)
Congenital Inner Ear Anomalies Associated with Recurrent Meningitis; A Case Report

Yuka NAKAGAWA, Akiko MORI, Tomoko HOSOKAWA, Shindow LIN, Akira Tanaka, ...

1996 Volume 89 Issue 2 Pages 165-171
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.165

JOURNAL FREE ACCESS

Show abstractHide abstract

A case of inner ear anomalies (Mondini dysplasia) associated with recurrent meningitis was found in a 5-year-old boy. The patient had 3 episodes of meningitis since he was 3 years old. During surgical treatment, we found cerebrospinal fluid (CSF) leakage through a bony defect in the stapedial footplate. The inner ear was obliterated with small pieces of connective tissue and the oval window was sealed with auricular cartilaginous chips. He has remained free from recurrent meningitis during 7 months follow up.

View full abstract

Download PDF (4275K)
Two Cases of Otogenic Intracranial Complications

Hideo HAGIWARA, Ken KITAMURA, Kou INOUE, Toyonori YASUDA

1996 Volume 89 Issue 2 Pages 173-178
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.173

JOURNAL FREE ACCESS

Show abstractHide abstract

Otitis media, especially chronic otitis media with cholesteatoma continues to be a frequent cause of intracranial complications despite the benefits of antibiotics and computed tomographic examinations. In the present study, we report two cases of intracranial complications caused by the uncommon infectious extension of cholesteatoma and granulations from the membranous labyrinth to the internal auditory meatus. The first case was a 44-year-old man with meningitis who was treated by intraveous antibiotics. Cholesteatoma and granulations were found to erode the surgical dome and extend to the fundus of the internal auditory meatus at surgery. The second case was a 40-year-old man who complained of right facial nerve palsy, fever and otalgia. A CT scan and MRI showed meningitis and cerebellar abscess secondary to labyrinthitis and cholesteatoma. In this case, cholesteatoma and granulations also extended to the fundus of the internal auditory meatus via the cochlea. Cholesteatoma has been infrequently reported to invade the fundus of the internal auditory meatus through the labyrinth. However, we should consider possible otogenic intracranial complications caused by labyrinthine extension of the cholesteatoma when we conservatively treat patients with cholesteatoma.

View full abstract

Download PDF (4168K)
Sonotubometrical Test of Eustachian Tube Function after Middle Ear Surgery

Katsunori ISHIDA, Atsushi SHINKAWA, Chieko HAYASHI, Makoto SAKAI

1996 Volume 89 Issue 2 Pages 179-184
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.179

JOURNAL FREE ACCESS

Show abstractHide abstract

We evaluated sonotubometrical test of eustachian tube function on 41 ears with improved prognoses after middle ear surgery. In 58.5% of ears at the first examination, the active opening of the eustachian tube was positive. However, this result was worse than expected, so we reexamined the negative cases that might include false negative findings, because they showed better clinical and morphological findings. As a result, 6 of 17 negative ears were positive, and so active opening of the eustachian tube was shown in 73.2% of 41 ears. It suggested that we need consider false negative findings when judging eustachian tube function by sonotubometry after middle ear surgery.

View full abstract

Download PDF (2273K)
Ventilation Tube Therapy for Otitis Media with Effusion in Children

Satoko FUKUYAMA, Yukiko Ito, Yukimitsu Takahashi, Tomohiko FUJITA

1996 Volume 89 Issue 2 Pages 185-189
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.185

JOURNAL FREE ACCESS

Show abstractHide abstract

We studied 97 ears of 50 children with otitis media with effusion (OME), undergoing insertion of a long-term ventilation tube between February 1989 and January 1994 in contrast with a previous study of 49 ears of 27 children with OME who were undergone insertion of a short-term ventilation tube. The tubes used for this study included a Butterfly ventilation tube for 78 ears, Shepard grommet for 16 ears and Paparella type I for 3 ears. Simultaneous adenoidectomy was performed on 30 patients. Follow-up examinations consisting of color and retraction of the ear drums, audiometric evaluation such as pure tone audiometry and tympanometry, were scheduled routinely every month. The overall mean follow-up period was 27.9 months. Extrusion occurred after an average of 17.5 months. In April 1994, 46 ears appeared to be effusion-free, however 18 ears developed recurrent OME. The percentage of effusion-free patients in this study was higher than that in the previous study. There was no significant difference between the mean period until extrustion in the effusion-free group and that in the recurrent group.
We discussed the relation between OME recurrence and upper respiratory infection after the tube dropped out, as well as complications.

View full abstract

Download PDF (615K)
Inverted Papilloma of the Nasal Cavity; A Case Report

Tomoko HOSOKAWA, Shinichi TAIRA, Akiko MORI, Kohtaro BABA

1996 Volume 89 Issue 2 Pages 191-197
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.191

JOURNAL FREE ACCESS

Show abstractHide abstract

Inverted papillomas in the nasal and paranasal cavities are uncommon benign tumors which are very difficult to distinguish from other nasal tumors and are prone to recurrence and malignant change. They are usually situated on the lateral nasal wall. Inverted papilloma of the nasal septum is rare. Our patient, an adult female, had inverted papillomas on both sides of the nasal septum, and severe malformation of the face.

View full abstract

Download PDF (8988K)
Clinical Observation of the Paranasal Sinus Mycosis

Tadahiko SAIKI, Kazuhiko Takeda, Nobuhiro HAKUBA

1996 Volume 89 Issue 2 Pages 199-207
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.199

JOURNAL FREE ACCESS

Show abstractHide abstract

The authors reported 30 cases of paranasal sinus mycosis treated at Uwajima Municipal Hospital between 1989 and 1994. These 30 patients (7 males and 23 females) ranged in age from 34 to 74 years old with a mean of 55.2. The most common chief complaint was rhinorrhea, nasal obstruction and cheek pain. The disease was unilateral in 29 cases and bilateral in one case. The original lesion of the mycosis was the maxillary sinus in 29 cases and the frontal sinus in one case. In 25 cases, high density areas similar to calcification were seen in the maxillary sinus and in 11 cases, bone destruction was detected in the medial wall of the maxillary sinus by CT scan. A diagnosis of mycosis was mainly confirmed by pathological examination. In one case, the authors found actinomycosis, while the remaining cases showed aspergillus. Surgical procedures were performed in all cases. Of 30 cases, 22 were treated by Caldwell-Luc's procedure, 7 cases by endoscopic endonasal sinus surgery and one case by Killian's technique and craniosurgery, respectively. Prognosis was good in all cases.

View full abstract

Download PDF (4866K)
Diagnosis of Major Salivary Gland Tumors by UltrasonographyGuided Fine Needle Aspiration Biopsy

Masaki FURUKAWA, Hideki MATSUDA, Tadayuki YAGO, Yuumi KAGESATO, Hayash ...

1996 Volume 89 Issue 2 Pages 209-214
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.209

JOURNAL FREE ACCESS

Show abstractHide abstract

Fine needle aspiration cytology under ultrasonography is a safe and fairly reliable diagnostic technique in most head and neck tumors, but it is less accurate in major salivary gland tumors.
We devised a new type of 21G needle called SONOPSY C1 (F type) to obtain the histologic specimen of head and neck tumors, and assessed its usefulness in major salivary gland tumors.
Fine needle aspiration of 14 parotid gland tumors and 3 submandibular gland tumors was performed under ultrasonographic guidance, and adequate histological specimens were obtained in 12 parotid tumors and 2 submandibular gland lesions.
All of 12 benign tumors were correctly diagnosed as benign from the histologic material obtained by fine needle aspiration, and the 2 malignant tumors as malignant. The histopathological diagnosis was confirmed in 12 cases. Adenolymphoma in one patient and malignant mixed tumor in another were not diagnosed correctly.

View full abstract

Download PDF (6503K)
A Case of Double Laryngeal Cancer

-Malignant Melanoma and Squamous Cell Carcinoma-

Yutaka NAKANISHI, Eiji TAKEUCHI, Hiroya KITANO, Kazutomo KITAJIMA

1996 Volume 89 Issue 2 Pages 215-220
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.215

JOURNAL FREE ACCESS

Show abstractHide abstract

Primary malignant melanoma of the larynx is very rare. We treated a 79-year-old man with double laryngeal cancer including malignant melanoma and squamous cell carcinoma.
The patient consulted our hospital with compliant of hoarseness and a left neck mass noticed 2 weeks previously. A blue-black tumor was found on the left vocal cord. Preoperative fiberscopic biopsy of the tumor revealed squamous cell carcinoma. Total laryngectomy and left radical neck dissection were performed.
Postoperative histological analysis was performed with H-E staining, HMB-45, and S-100 immunological staining. Malignant melanoma had arisen in the subepithelium of the left vocal cord, and formed nets with spindle cells and melanin. In another portion of the left vocal cord, squamous cell carcinoma had arisen in the epithelium, and formed sheets without melanin. The final diagnosis was double laryngeal cancer including malignant melanoma and squamous cell carcinoma.
The origin of these two tumors was discussed. The combination of these two cancers is very rare.

View full abstract

Download PDF (6559K)
Long-Term Result of Treatment for Laryngeal Cancer from a Viewpoint of Preservation of the Larynx

Kenichiro KOGA, Masamitsu HYODO, Toshihiro MORI, Eiji YUMOTO

1996 Volume 89 Issue 2 Pages 221-227
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.221

JOURNAL FREE ACCESS

Show abstractHide abstract

We have treated 181 patients with laryngeal cancer for the past 16 years (Oct. 1, 1976 to Dec. 31, 1992). The male to female ratio was 19: 1, and their ages ranged from 23 to 90 years with a mean of 65. Of these 181 patients, 69 (38%) had supraglottic type, 103 (57%) glottic type, 9 (5%) subglottic type. The larynx is considered to have been preserved when the patient can breathe through the glottis, swallow without aspiration into the trachea, and phonate. The preservation rates of the larynx for five years were calculated for patients with stages T1 or T2 in each affected region using the Kaplan-Meier method. The five-year larynx preservation rates for supraglottic T1 and T2 cancers were 75% and 36%, respectively, and those for glottic T1 and T2 cancers were 85% and 50%, respectively. To improve the five-year larynx preservation rate, eradication of the disease during primary treatment while preserving the larynx is essential. Usefulness of radiation therapy combined with laser surgery for debulking the cancer mass or with low dose cisplatin administration are now under study.
Furthermore, 17 patients died of a second primary cancer, even though the laryngeal cancer was eradicated. Detecting second cancers in the early stage is also important.

View full abstract

Download PDF (654K)
Neurilemmoma of the Cervical Vagus Nerve; A Case Report

Hidetoshi HARAGUCHI, Hideji OKUNO

1996 Volume 89 Issue 2 Pages 229-235
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.229

JOURNAL FREE ACCESS

Show abstractHide abstract

Neurilemmoma of the cervical vagus nerve is relatively uncommon. We present a 38-year-old woman who complained of a tumor on the lower right side of the neck. Physical examination revealed a 2×2 cm, smooth surface, almost round, elastic hard tumor behind the anterior margin of the sternocleidomastoid muscle. Surgery was performed under general anesthesia, and it was revealed that the tumor originated from the vagus nerve. The tumor was excised by dividing the vagus nerve. Histologically, it was a neurilemmoma showing Antoni types A and B. Postoperatively, the patient developed hoarseness caused by paralysis of the right vocal cord, and we treated this by injecting silicone into the paralyzed vocal cord.
Two years later, a tumor was found under the skin of her left axilla. Surgery was performed at another hospital and the tumor was histologically diagnosed as neurilemmoma.
To our knowledge, this is the 87th case of neurilemmoma of the cervical vagus nerve reported in Japanese literature.

View full abstract

Download PDF (4525K)
Results of Treatment for non-Hodgkin's Lymphoma of the Head and Neck

Katsunari YANE, Toshiaki YAMANAKA, Takashi UEDA, Yoshinobu OGAWA, Nobu ...

1996 Volume 89 Issue 2 Pages 237-242
Published: February 01, 1996
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.89.237

JOURNAL FREE ACCESS

Show abstractHide abstract

Fifty-seven patients with non-Hodgkin's lymphoma of the head and neck were treated at Nara Medical University Hospital between 1986 and 1994 : 26 females and 31 males, with a median age of 60 years. The 5-year survival rate according to the Ann Arbor classification was 81% for 18 stage I patients, 49% for 26 stage II patients, 0% for 13 stage III and IV patients and 50% for the total series. The survival rate of stage I and stage II patients was significantly higher than that for stage III and stage IV patients (p<0.01). The 5-year survival rate was 67% for 13 patients with extranodal lymphomas other than those in Waldeyer's ring, 62% for 19 with nodal lymphomas, and 35% for the 25 patients with lymphomas in Waldeyer's ring. The 4-year survival rate was 100% for 5 patients with histologically low grade lymphomas, 47% for 47 with intermediate grade lymphomas and 40% for 5 with high grade lymphomas. The differences in survival rates among histologic subtypes and among site groups are not statistically significant. Twenty patients were treated with CHOP and 18 with MACOP-B. The median age was 62 years for the former and 51 years for the latter. The 5-year survival rate was 64% and the complete remission (CR) rate was 85% in the MACOP-B-treated group, and 25% and 67% respectively in the CHOP-treated group. These differences are not significant, but MACOP-B therapy tended to result in a higher survival rate and CR rate. Early toxic death occurred in 5% of CHOP patients and 11% of MACOP-B patients.

View full abstract

Download PDF (719K)
Acquired Toxoplasmosis; Report of Two Cases in a Family

Keiji MORIYA, Yoshihiko OKINAKA

1996 Volume 89 Issue 2 Pages 243-248
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.243

JOURNAL FREE ACCESS

Show abstractHide abstract

Toxoplasmosis is a rare disease. A 45-year-old female visited our hospital because of painless masses in her neck. Physical examination revealed bilaterally swollen lymph nodes. She underwent surgical excision. The histological diagnosis was probable toxoplasmosis. Serological examination confirmed the diagnosis. A 17-year-old male, her son, presented later with swollen lymph nodes. Serological examination confirmed the diagnosis of toxoplasmosis. Both patients were treated successfully with acetylspiramycin, a useful antitoxoplasma agent.

View full abstract

Download PDF (5079K)
The Fungiform Papillae of the Tongue and the Electric Gustatory Threshold in Diabetics

Hatsuko KAWAGUCHI

1996 Volume 89 Issue 2 Pages 249-262
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.249

JOURNAL FREE ACCESS

Show abstractHide abstract

Information obtained from microscopic observation of the fungiform papillae of the tongue could be a sensitive and useful indicator of diabetic complications. To evaluate its clinical significance, the f ungif orm papillae of diabetics (n=33) were investigated under microscopy and histologically observed in 4 patients from whom informed consent was obtained. Fungiform papillae of the tongue were morphologically classified into 4 groups (I-IV) and the capillary vessels in the papillae into 5 groups (A-E). correlations between the morphological changes of the fungiform papillae and the disease period of diabetic complications were evaluated. Each type classified was tested for the clinical significance as an indicator of electric gustatory threshold abnormality. The results obtained were as follows;
1. In diabetics, the fungiform papillae were flattened, thickened and atrophic. The capillary vessels in the papillae were obscured or absent under microscopy.
2. The above changes appeared before the three major diabetic complications became clinically evident.
3. Elevation of the electric gustatory threshold was most sensitively reflected by an increase in type IV (remarkable flattening and atrophy of the papillae) and type E (disappearance of the vessels).
4. Histological observations of the fungiform papillae in diabetics showed flattening of the papillae, parakeratinization and thickening of the epithelium. Immunohistology of the capillary vessels revealed thickening of the type 1V collagen positive layer.
In conclusion, microscopic observation of the fungiform papillae is a sensitive and clinically useful examination for detection of diabetic microangiopathy and neuropathy.

View full abstract

Download PDF (6985K)
Histopathology of Supraglottic Carcioma

Tetsuyoshi UMENO

1996 Volume 89 Issue 2 Pages 263-274
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.263

JOURNAL FREE ACCESS

Show abstractHide abstract

1. In NO cases of supraglottic carcinoma the incidence of micrometastasis on the side of the lesion was 22% in patients with T1, 19% in those with T2, 33% in those with T3 and 40% in those of T4 disease. The overall incidence of micrometastasis of supraglottic carcinoma was 25%.
2. The incidence of metastasis on the side of the lesion was 46% during the entire course of the disease.
3. Radical neck dissection on the side of the lesion was repeated in 18% of the patients in University Hospital.
4. The prognosis of patients with recurrent cancer after neck dissection is very poor.
5. Extracapsular invasion, capsular invasion and necrosis and/or cystic change of metastatic nodes are signs of recurrence in the neck or of distant metastasis.
6. Extracapsular invasion of a metastatic node was frequent if the node was 3 cm or more in diameter. Capsular invasion seems to occur in nodes 2 cm or more in diameter.

View full abstract

Download PDF (3100K)
Clinical Evaluation on Granisetoron Hcl on Administration of Cisplatin

Kazuhiro YAMAMOTO, Hiro-omi Takahashi, Makito OKAMOTO, Kazuo YAO, Kats ...

1996 Volume 89 Issue 2 Pages 275-281
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.275

JOURNAL FREE ACCESS

Show abstractHide abstract

In patients with head and neck cancers who were administered cisplatin (CDDP ; 50mg/body at least 3 days), the effect of Granisetoron on nausea, vomiting and diet was examined for 5 days after administration. Histological controls were used for comparison.
Inhibition of vomiting, suppression of gastrointestinal signs and symptoms, and maintenance of food intake were best on day 1 after CDDP administration, and effect gradually decreased after 2 days. The effect of supplementary doses of Granisetoron on delayed nausea and vomiting was less adequate during later stages than during earlier stages of hemotherapy.
Granisetoron has a beneficial effect on acute drug-induced nausea and vomiting and is safe to administer. Granisetoron is, for the time being, an essential drug for chemotherapy using antineoplastic agents ; however, this drug fails to which sufficiently affect delayed nausea and vomiting develop during the later stage of chemotherapy. It is therefore expected that the developmental mechanism of delayed nausea and vomiting will be further elucidated and that new antiemetics which can be combined with antineoplastic agents will be developed in the future.

View full abstract

Download PDF (799K)
Cholesteatoma of the External Auditory Canal

[in Japanese]

1996 Volume 89 Issue 2 Pages 282-283
Published: February 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.282

JOURNAL FREE ACCESS

Download PDF (1824K)