Practica Oto-Rhino-Laryngologica

Basic and Clinical Aspects of Hearing Preservation in Acoustic Neuroma Surgery

Jin KANZAKI, Kaoru OGAWA, Tatsuo MATSUNAGA

1996 Volume 89 Issue 3 Pages 285-295
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.285

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Hearing preservation is one of the ultimate goals of acoustic neuroma (AN) surgery. In this paper, we present the surgical results of hearing preservation surgery in our department, as well as our recent basic research on hearing preservation in AN surgery.
Subjects consisted of 95 AN patients who underwent hearing preservation surgery via the extended middle cranial fossa approach and the middle cranial fossa approach. The overall hearing preservation rate was 51%. From the analysis of surgical results, we discussed the indications for hearing preservation surgery and the evaluation of pre- and post-operative hearing. In addition, we proposed a new classification system for pre- and post-operative hearing evaluation.
We also present our basic research on “the relationship between cochlear blood flow and electrocochleographic findings during cochlear ischemia”, and “the morphological studied of the MU cranial nerve in AN patients”. The changes in N1 and N2 in electrocochleography depended on the cochlear blood flow. Thus, we can estimate the degree of cochlear ischemia using the electrocochleography. Furthermore, the impairment of cochlear blood flow and cochlear nerve damage could be distinguished by the electrocochleographic findings. The morphological findings of the VU cranial nerves of AN patients demonstrated tumor invasion in approximately 67% of the cochlear nerves, suggesting that total tumor removal together with hearing preservation could not be performed in these patients. In addition, gliosis in the transitional region of the cochlear nerve in AN patients was observed, which might lead to a change in capillary distribution. Angiogenesis was also found in tumor tissues from the cochlear nerve. These morphological findings indicated that the impairment of cochlear blood flow may be easily induced by manipulation during tumor removal, especially those around the transitional region.

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Obliterative Otitis Media with Tympanic Membrane Perforation

[in Japanese], [in Japanese]

1996 Volume 89 Issue 3 Pages 296-297
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.296

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Effect of the Canalith Repositioning Procedure on Benign Paroxysmal Positional Vertigo

Hiroaki ICHIJO, Satoko ABE, Kenji ISHII, Takeshi TOMINAGA, Hideichi SH ...

1996 Volume 89 Issue 3 Pages 299-304
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.299

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To investigate the pathophysiology of benign paroxysmal positional vertigo (BPPV), we observed positional nystagmus and assessed the efficacy of the canalith repositioning procedure (CRP). Nystagmus was recorded using an infrared CCD camera. Subjects were 36 patients who exhibited typical rotatory nystagmus of BPPV with Hallpike maneuvers. The therapy given to the control group (Group A, n=18) was medication only, while Group B (n=18) was treated by both CRP and medication. In almost all patients, rotatory nystagmus was provoked by slow position change from the healthy ear down (head hanging position with a 45-degree tilt to the healthy side) to the affected ear down (head hanging position with a 45-degree tilt to the affected side). This phenomenon indicates that rapid movement is not necessary for provocation, and a 45-degree off sagittal tilt indicates that the lesion is in the posterior semicircular canal. The period of disease in Group B was significantly shorter than that in Group A. In Group B, CRP was effective in 16 patients (89%). We conclude that free-moving particles in the posterior semicircular canal is the cause of BPPV. We suggest that rotatory positional nystagmus is a result of ampullofugal flow of sinking particles in the posterior semicircular canal and secondary ampullof ugal flow in the anterior semicircular canal.

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Effect of Aging on Active Opening of the Eustachian Tube

Fumio OHNO, Kenshi KATSUDA, Tsutomu ISHIKAWA, Kunihiko SAKAMOTO

1996 Volume 89 Issue 3 Pages 305-309
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.305

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Middle ear pressure is thought to be important in the pathogenesis of otitis media with effusion and its sequelae, and pressure is regulated by the opening of eustachian tube with deglutition (active opening function). This investigation examined the effect of aging on the active opening function of the eustachian tube. Seven-hundred and fifty-two otologically healthy subjects were selected to evaluate the ability of the eustachian tube to open actively. We recorded the duration of tubal patency with deglutition by sonotubometry. The results were as follows;
1) The active opening function was absent in approximately one quater of normal ears.
2) Active opening function was lower in males than in females.
3) The positive rate of active opening function tended to be lower in the older generation.
4) The duration of tubal patency with deglutition tended to be longer in the older generation.

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Long-Term Clinical Outcome of Treatment for Epistaxis with Nd-YAG Laser in Osler's Disease

Mitsuaki Takahashi, Taketoshi FUJITA, Toshihide ADACHI, Keiichi ENOMOT ...

1996 Volume 89 Issue 3 Pages 311-314
Published: March 01, 1996
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.89.311

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The Nd-YAG laser was used to treat 3 patients with hereditary hemorrhagic telangiectasia (Osler's disease). Long-term clinical outcome (2-6 years period) after endonasal laser photocoagulation (ELP) for epistaxis was estimated. Repeated ELP (7-17 times over 6 years) was effective in decreasing the frequency and severity of nasal hemorrhage in 2 patients, though septal cartilage perforation resulted from the laser treatments. The other patient did not benefit from ELP performed 3 times over 2 months. Because of the formation of new lesions, repeated treatment was necessary at 2- to 14-month intervals, and the interval was prolonged after several treatments. Repeated ELP is necessary for successful treatment of epistaxis associated with Osler's disease.

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Laser Turbinate Surgery for Allergic Rhinitis and Hypertrophic Rhinitis

Mitsuhiro MORI, Takashi HIRAMATSU, Hikari KOIZIMI, Takahiro YAMADA

1996 Volume 89 Issue 3 Pages 315-319
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.315

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We perform contact Nd-YAG laser surgery for allergic and hypertrophic rhinitis.
Of 26 patients treated effectively, 11 could be evaluated by comparisons of subjective symptoms, nasal findings nasal mucosal reflex before and after Naphazoline-nitrate. All 11 cases showed nasal mucosal reflex.
One patient was examined histopathologically (preoperative, one month after surgery, three months after surgery). In preoperatively, the submucosa showed slight edema. One month after surgery, the epithelium had disappeared. Three months after surgery, the epithelium had regrown. The histopathological appearance of the nasal mucosa three months after laser surgery was similar to the preoperative appearance.
Contact Nd-YAG laser surgery had little affect on the subepithelial layer of the inferior turbinate.

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Nasopharyngeal Tuberculosis; A Case Report

Fuyuki NOMOTO, Hideki SAITOU, Ichirou ANDOU

1996 Volume 89 Issue 3 Pages 321-325
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.321

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Nasopharyngeal tuberculosis is a rare disease with few cases having been reported in recent years.
A 43-year-old male complained of multiple cervical masses. Posterior rhinoscopy showed a white mass in the right nasopharynx. Biopsy of the epipharyngeal mass showed tuberculous changes. Anti-tuberculosis chemotherapy was administed for 3 months, which greatly reduced the nasopharyngeal and cervical masses.
Nasopharyngeal tuberculosis was difficult to differentiate from malignant diseases (carcinoma, malignant lymphoma), so pathological examination was useful for definitive diagnosis.

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Nasopharyngeal Tuberculosis; A Case Report

Michiko TAYA, Setsuo NAKAMOTO, Tetsuya MURATA, Tsutomu NONOYAMA, Satos ...

1996 Volume 89 Issue 3 Pages 327-333
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.327

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Inverted papilloma of the nose and paranasal sinuses is an uncommon lesion recognized as a neoplastic growth of the epithelium which inverts into the underlying stroma rather than proliferating outwardly from the surface. This neoplasm is uniquely characterized by its capacity to destroy bone, tendency to recur after incomplete removal, and association with malignancy. Most authors recommend lateral rhinotomy as the initial surgical approach. In 1992 and 1993, we treated 5 patients with inverted papilloma, one of which presented with bilateral disease. On computed tomography, 3 patients demonstrated opacification of the maxillary sinus, 2 showed localized mass. None of the patients showed bone destruction. Antrostomy and ethmoidectomy were performed in 5 of these cases. Lateral rhinotomy was added in one patient. Intranasal ethmoidectomy was performed in one case. Complete resection and lifelong follow-up are recommended to prevent recurrence and association with malignancy.

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Carcinoma of Tongue during Pregnancy; A Case Report

Yoshihiro NOGUCHI, Norihiko ISHIKAWA, Hitoshi HENTONA, Yuzuru Nakamura ...

1996 Volume 89 Issue 3 Pages 335-338
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.335

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Malignant tumors during pregnancy are rarely seen by otolaryngologists, and they cause various problems which require special treatment with careful consideration of both the mother and the fetus.
A 27-year-old female at 27 weeks of pregnancy was referred to our department for examination and treatment of a tumor on the right edge of the tongue. Examination including biopsy revealed a moderately differentiated squamous cell carcinoma (T3NOMO). It was treated with irradiation (Linac X-ray, total 39.4 Gy). A healthy female infant was delivered by Caesarean section at 33 weeks of pregnancy. We performed an operation to remove the tongue carcinoma 12 days after delivery. The tumor grew, however, and multiple metastases were seen in the lungs 6 weeks after the operation. She died 6 months after the first examination.

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Malignant Lymphoepithelial Lesion of Parotid Gland; A Case Report

Yukar ODA, Noriyuki FUKUSHIMA, Noriaki TANIMITSU, Toshihiro NISHIDA

1996 Volume 89 Issue 3 Pages 339-343
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.339

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A 78-year-old female was admitted because of a painless mass in the right parotid gland of 3 month's duration. On September 14, 1994, the mass was excised, and she was additionally treated with irradiation. There was no evidence of recurrence until November, 1995.
Malignant lymphoepithelial lesion (MLEL) is a rare tumor with a relatively high incidence in Eskimos. Epstein-Barr virus (EBV) may play a role in the etiology of MLEL. Our patient's serum contained EBY antigen (EBNA). There is controversy about the origin of MLEL of the salivary glands and its relation to benign lymphoepithelial lesions.
Microscopically, the tumor was seen to be growing in diffuse sheets with many areas of lymphocytic infiltration and considerable fibrous stroma. Mitoses were numerous, and the nucleoli were prominent, so it appeared to be MLEL-an undifferentiated or poorly differentiated squamous cell carcinoma associated with abundant lymphocytes. Benign lymphoepithelial lesions have been reported in the literature as preceding or co-existing with malignant lesions in some patients. Our patient also had a benign lymphoepithelial lesion with smaller nuclei and fine chromatin. The pathological findings may support the above-mentioned theory of the etiology of MLEL. Persistent EBV infection might have induced a pronounced lymphoid reaction against parotid duct tissue leading to a BLEL. Finally malignant changes of the ducts might have arisen from the hyperplastic, squamous metaplastic and dysplastic epithelium.

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Hemangioma of the Hypopharynx; A Case Report

Yutaka NAKANISHI, Eiji TAKEUCHI, Hiroya KITANO, Kazutomo KITAJIMA

1996 Volume 89 Issue 3 Pages 345-350
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.345

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We treated a 47-year-old male with hemangioma of the hypopharynx.
He visited our hospital with a complaint of dysphagia and laryngeal discomfort which had persisted for 3 months. Fiberscopic examination showed a dark-red mass on the right piriform sinus. However, the vocal cord moved normally and there was no mass in the neck. Esophagraphy and MRI revealed a tumor with a clear margin in the right piriform sinus. Dynamic CT was performed to evaluate tumor vascularity. The time-concentration curve demonstrated almost the same vascularity as the opposite hypopharyngeal mucosa. The patient underwent lateral pharyngotomy. The tumor arose from the anterior hypopharyngeal wall, but there was no feeding vessel. It did not bleed easily, and its vascularity conformed with that seen on dynamic CT. The tumor was totally removed, histological examination showed hemangioma.
We conclude that dynamic CT is useful for evaluating the vascularity of hypopharyngeal hemangioma.

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Renal Metastasis of the Hypopharyngeal Carcinoma; A Case Report

Mineko TSUCHIDA, Masao ASAI

1996 Volume 89 Issue 3 Pages 351-354
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.351

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A 74-year-old woman with a 2-month history of progressive dysphagia consulted our hospital in March 1991.
ENT examinations including barium hypopharyngoesophagography revealed right pyrif orm sinus carcinoma. She was referred to Tokyo University Hospital and received 41 Gy radiation followed by surgery.
She remained well until polyuria and thirst developed in Dec. 1991. During hospitalization, hematuria was noted.
Carcinoma cells in the urine as well as CT finings led to an ante mortem diagnosis of renal metastasis, which was confirmed at autopsy.
It is rare for renal metastasis to be diagnosed clinically.

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Thirty-Two Cases of Epiglottic Cysts

Shigeyuki MURONO, Takayo OHMURA, Satoshi SUGIMORI, Ikuo NAGAYAMA, Mits ...

1996 Volume 89 Issue 3 Pages 355-358
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.355

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Thirty-two cases of epiglottic cysts were treated surgically with direct laryngoscopy between January 1984 and December 1994. Nineteen cases were epidermoid cyst, 8 were retention cyst, one was branchial cyst, and 4 were idiopathic. Two or three cysts were found in 8 cases (7 males and 1 famale), among which 6 were epidermoid cyst, one was retention cyst, and one was unconfirmed. The literature regarding epiglottic cysts is reviewed.

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Jugular Foramen Neurinoma; A Case Report

Akira TONAI, Motoyuki HASHIBA, Syunkichi BABA

1996 Volume 89 Issue 3 Pages 359-363
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.359

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We report a case of jugular foramen neurinoma, a rare tumor of the skull base. A 45-year-old female complained of dysphagia and hoarseness. The patient presented with Co11et-Sicard syndrome, that is, cranial nerve palsies of the K, X, XI and XQ nerves. CT scan and MRI showed a tumor arising from the jugular foramen, which extended to both the parapharyngial space and intracranial region. We succeeded in totally removing the tumor using a combined lateral suboccipital-infralabyrinthine approach.

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Cellular and Molecular Biological Diagnosis of Rhabdomyosarcoma Originating in the Head and Neck

Tohru SUGIMOTO, Hajime HOSOI, Takafumi MATSUMURA, Chiaki SHIRA, Hirosh ...

1996 Volume 89 Issue 3 Pages 365-370
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.365

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Histological differential diagnosis of malignant head and neck tumors in childhood, including malignant lymphoma, neuroblastoma and rhabdomyosarcoma, is occasionally difficult, since these tumors are classified as small-round-cell tumors. Recently we diagnosed and treated four children with rhabdomyosarcoma, originating in the head and neck. In three patients, immunohistological diagnosis using monoclonal antibodies against cytoskeletal proteins led to the accurate diagnosis of rhabdomyosarcoma. In the remaining one patient, the myogenic regulatory gene (MyoD1) RNA expression in the tumor tissue facilitated a final diagnosis of immature rhabdomyosarcoma.
The usefulness of immunohistological and molecular diagnosis of rhabdomyosarcoma is emphasized.

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Speech Processing System Demonstrated by Positron Emission Tomography (PET)

-A Review of the Literature-

Shigeru HIRANO, Yasushi NAITO, Hisayoshi KOJIMA

1996 Volume 89 Issue 3 Pages 371-378
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.371

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Histological differential diagnosis of malignant head and neck tumors in childhood, including malignant lymphoma, neuroblastoma and rhabdomyosarcoma, is occasionally difficult, since these tumors are classified as small-round-cell tumors. Recently we diagnosed and treated four children with rhabdomyosarcoma, originating in the head and neck. In three patients, immunohistological diagnosis using monoclonal antibodies against cytoskeletal proteins led to the accurate diagnosis of rhabdomyosarcoma. In the remaining one patient, the myogenic regulatory gene (MyoD1) RNA expression in the tumor tissue facilitated a final diagnosis of immature rhabdomyosarcoma.
The usefulness of immunohistological and molecular diagnosis of rhabdomyosarcoma is emphasized.

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The Effect of Erythromycin on Cochlear Potentials

Toshihiko CHIBA, You RONG, Toshimitu Kobayashi, Tomonori TAKASAKA

1996 Volume 89 Issue 3 Pages 379-384
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.379

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The mechanism of hearing loss following administration of intravenous erythromycin lactobionate was investigated using the albino guinea pig. This hearing loss was found, for the first time, to be due to cochlear dysfunction caused by erythromycin administration.
The endocochlear potential (EP) and the cochlear microphonics (CM), recorded at the first or second cochlear turn, transiently decreased when erythromycin was administered intravenously at dosages of 100 and 150 mg/kg. The decrease in EP and CM was clearly related to dose. A complete recovery of EP and CM ensued after each erythromycin application. However, perilymphatic perfusion with 3 mM of erythromycin caused an immediate and drastic decrease in CM, while it caused a mild decrease in EP following its initial elevation. The magnitude of the negativity of EP in response to anoxia was small after perilymphatic perfusion, while it remained within the normal range with intravenous application.
These findings suggest that intravenously applied erythromycin has a direct effect upon the stria vascularis, while erythromycin applied via the perilymph exerts its potent action predominantly on the hair cells.

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Compound Action Potentials of Normal Human Auditory Nerves Evoked by Speech Stimuli

Shogo SHINOHARA, Kazuhiko SHOJI, Hisayoshi KOJIMA, Shigeru HIRANO, Koj ...

1996 Volume 89 Issue 3 Pages 385-390
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.385

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Compound action potentials (CAPs) of human auditory nerves evoked by the short syllables /a/ and /ka/ were recorded with extratympanic electrocochleography in ten volunteers. Periodic CAPs at the same frequency as the fundamental frequency of the voice were observed in the vowel /a/ and the voiced segment of ka . At the beginning of both syllables a prominent CAP was observed, although no CAP was evoked at the voice onset of /ka/. The voiced segment of /ka/ showed different discharge patterns of CAPs from the vowel /a/. These results suggest that some frequency information of vowels can be transformed to temporal information in the human cochlea. Temporal patterns of CAPs are believed to contribute to consonant recognition.

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Oxatomide Therapy for Allergic Rhinitis

Nobuo OHTA, Shigeru FUKASE, Ken SAKATA, Kazutoshi INAMURA, Takeshi BEP ...

1996 Volume 89 Issue 3 Pages 391-398
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.391

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Oxatomide was administered to 27 patients with allergic rhinitis and serum concentrations of MPO and arylsulfatase B were measured to determine its effectiveness. Oxatomide was effective in reducing nasal symptoms. It did not affect the serum concentrations of MPO or arylsulfatase B. No side effects were noted in the present study.

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Blood Flow of Pedunculated Cutaneous or Myocutaneous Flaps and Effectiveness of a Prostacyclin Derivative in Head and Neck Reconstructive Surgery

Toshiro UMEZAKI, Toshihiko SUGIMOTO, Toshiaki MATSUSE, Takemoto SHIN

1996 Volume 89 Issue 3 Pages 399-403
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.399

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Pedunculated cutaneous or myocutaneous flaps are still often used in head and neck reconstructive surgery even, although recently a free flap technique with microvascular anastomosis has been recommended. It is well known that the survival of such pedunculated flaps depends on the microvascular blood flow perfusing them, which is in turn affected by platelet activities such as aggregation and release reactions. In the present study, we measured the blood flow in pedunculated flaps used for reconstruction following the extirpation of head and neck tumors, and we examined its relationship to platelet activity. We also examined the effect of a prostacyclin (PGIZ) derivative (beraprost sodium, 120 mg/day) administered for 14 days after surgery upon blood flow in the flaps.
The relative blood flow in the flaps generally decreased to a minimum on the third postoperative day. Corresponding to this decrease in blood flow, serum PF4 and j3-TG levels, which indicate platelet activity, appeared to increase to a maximum at the same time and to return to nearly the preoperative level toward the 7th postoperative day. When beraprost sodium was given, the postoperative increases in serum PF4 and jS-TG levels were significantly lower than in those who did not receive beraprost sodium. Thus, the prostacyclin derivative is considered to be effective in improving the blood flow in pedunculated flaps by suppressing platelet activity.

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Pleasure of Research

[in Japanese]

1996 Volume 89 Issue 3 Pages 404-405
Published: March 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.404

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