Practica Oto-Rhino-Laryngologica

Morphogenesis of the Otoconia from the Viewpoint of Physiological Calcification

Masafumi SAKAGAMI

1996 Volume 89 Issue 9 Pages 1035-1041
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1035

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Although it is known that mammalian otoconia consist of calcium bicarbonate and organic materials, none of the protein components have been identified in mammals at the molecular level, and the mechanism of morphogenesis and calcification of the otoconia remains unclear. In the present study, we demonstrated the presence of osteopontin (OPN) in rat otoconia by using immunohistochemistry, and detected OPNmRNA in the sensory hair cells using a non-radioisotopic in situ hybridization technique. These results indicate that OPN is one of the protein components in rat otoconia and suggest that sensory hair cells are involved in the production of otoconia.

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Clinical Histopathology of Cochlear Implant

[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...

1996 Volume 89 Issue 9 Pages 1042-1043
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1042

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Cochlear Implants in Cases with Residual Hearing

Takeshi KUBO, Mieko SUMI, Takako IWAKI, Masako OHKUSA, Yoshifumi Takah ...

1996 Volume 89 Issue 9 Pages 1045-1049
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1045

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We have experienced seven cases of cochlear implants (CI), in whom residual hearing was noted in the low to middle frequency region in the better hearing ear. Five out of the 7 subjects used a hearing aid (HA) before the CI, and two subjects did not used HAs because of the poor speech reception. The auditory threshold for pure tone, speech reception score and the discrimination of environmental sounds were evaluated before and after the CI. Although the CI operation was performed on the ear with poor hearing, auditory perception with the CI showed better result than with a HA in all of these tests. The auditory threshold with the CI was around 40 dBHL and was better than with the HA. These recent results confirm the results from other reports which compared the benefits between CI and HA.

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Statistical Analysis of Patients with Vertigo and Dizziness over the Last 14 Years at Our Clinic

Yasuteru YAMANAKA, Ryo OKA, [in Japanese], [in Japanese], [in Japanese ...

1996 Volume 89 Issue 9 Pages 1051-1060
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1051

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Statistical analysis was carried out on 2637 patients (male 40%, female 60%) with vertigo and dizziness at the Department of Otolaryngology, Nissei Hospital over 14 years from April, 1980 to March, 1994. The average number of cases was 188 per year, accounting for 5.4 percent of the total number of outpatients.
The number of patients increased each year especially until 1987. The age distribution showed a peak in the fifties until 1990, the peak shifted to the sixties thereafter. The trend is explained by increases in longevity.
The cases were classified into four groups; 1) peripheral disorders (29.4%), 2) central disorders (17.2%), 3) disorders of other origins (36.7%), and 4) disorders of unknown origins (16.7%). The first and third groups increased in number each year.
Fifty-six percent of all patients were referrals; 35.8% from the Department of Internal Medicine at our hospital, 7.6% from other Departments, and 12.2% from other medical facilities. The fact that the number of referrals decreased each year indicates that patients with vertigo see otologists or specialists immediately.

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Canalith Repositioning Procedure in Benign Paroxysmal Positional Vertigo

Kazuhiko TAKEUCHI, Tsutomu NONOYAMA, Eisaku OKADA, Sawako MASUDA, Yasu ...

1996 Volume 89 Issue 9 Pages 1061-1064
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1061

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The canalith repositioning procedure is designed to relocate free-floating otoliths from the posterior semicircular canal back into the utricle, thus relieving the patient of bothersome, often long-standing vertigo. We treated ten cases of benign paroxysmal positional vertigo using the canalith repositioning procedure. On follow-up, 7 patients were free from dizziness, 2 had improved significantly and one patient remained unchanged. This procedure is simple and cost-effective. We highly recommend this procedure for the treatment of benign paroxysmal positional vertigo.

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Labyrinthine Fistula during Chronic Ear Surgery

Manabu MAETA, Ryusuke Saito, Fumio NAKAGAWA, Yoshifumi UNO, Noriko SON ...

1996 Volume 89 Issue 9 Pages 1065-1070
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1065

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Twenty cases of labyrinthine fistula have been reviewed. From 1988 to 1993, surgery was performed on 384 ears with chronic otitis media, and 20 of these cases had a labyrinthine fistula (incidence 5.2%). All twenty cases had a lateral semicircular canal fistula and one case had an additional superior semicircular canal fistula. There was no relationship between the size of the labyrinthine fistula and the incidence of vertigo or fistula symptoms. Also there was no relationship between the size of the labyrinthine fistula and preoperative bone conduction thresholds. All twenty cases were characterized by chronic otitis media with cholesteatoma, and the matrix of the cholesteatoma was completely removed in all patients with the exception one case where the cholesteatoma was enormous. Preoperative bone conduction hearing was preserved after removal of the cholesteatoma matrix in all cases except the latter.
These results suggest that lesions over the lateral semicircular canal fistula should be completely removed, at best with care, when they are discovered during chronic ear surgery. This policy rarely causes lateral semicircular canal fistula bone conduction hearing to become worse.

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A Case of Allergic Otitis Media

Tetsuo KOZAWA, Hidemitsu Satoh, Eiji YUMOTO, Kiyofumi GYO, Naoaki YANA ...

1996 Volume 89 Issue 9 Pages 1071-1076
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1071

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A 44-year-old man with a history of nasal allergy and drug eruption was complaining of persistent bilateral hearing loss, otorrhea and dizziness. He had previously undergone middle ear surgery twice on his right ear and 5 times on his left ear over the past 2 years. The characteristic findings were abundant eosinophils in the thick, glue-like otorrhea, high serum IgE levels to house dust, and bilateral paranasal sinusitis of an allergic origin. He had previously undergone surgery twice for bilateral sinusitis and three times for recurrent chronic otitis media. Histologic examinations of the middle ear granulation tissues revealed an enormous infiltration of eosinophils, suggesting that there was allergic inflammation. Desensitization to house dust allergens together with the general and topical administration of steroids were effective in controlling the disease. However, the patient still suffered from intermittent otorrhea from both ears. The allergic otitis media was believed to be caused by a type 1 allergy to house dust in this case.

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Malignant Fibrous Histiocytoma of the Auricle; A Case Report

Tooru SAKAMOTO, Satoshi FUKUDA, Nobukiyo Satoh, Yoshiki KURIYAMA, Seig ...

1996 Volume 89 Issue 9 Pages 1077-1081
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1077

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Malignant fibrous histiocytoma (MFH) is considered to be a relatively uncommon neoplasm in the head and neck region, especially in the auricular region.
We report the extremely rare case of a 25 year-old female with a MFH in her left post-auricular area. After a biopsy operation, the pathologic diagnosis revealed a MFH of the ordinary type. We performed a radical operation, including excision of the regional skin, periosteum and part of the auricular cartilage. After 2 years, the patient is still alive without any recurrence. We also reviewed and analyzed our 5 most recent cases of MFH and discussed their pathologic diagnosis and treatment modalities.

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Six Cases of Malignant Melanoma of the Nasal Cavity

Hiroshi NISHINO, Hanako YAMAGIWA, Masato IGARASHI, Mamoru MIYATA, Mamo ...

1996 Volume 89 Issue 9 Pages 1083-1088
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1083

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Six patients with malignant melanoma of the nasal cavity were treated at the Department of Otolaryngology, Jichi Medical School, from January 1990 to August, 1995. Their ages ranged from 57 to 75 years old, with a mean age of 67 years. Primary site of the tumor was the turbinates in three patients, the olfactory region in two, and the inferior meatus in one. Histologically, four cases were the amelanotic type, one was the oligomelanotic type and one was the melanotic type. The treatment consisted of surgery, radiotherapy, chemotherapy, hormonal therapy, immunotherapy, or a combination of these treatment. All patients also received surgical treatment. Four patients received combination therapy with radiotherapy and surgery, one received combination therapy with radiotherapy, chemohormonal therapy and surgery, and one received only surgery. Four patients were treated radically, and two patients underwent palliative resection. Irradiation was used as the preoperative therapy in four patients. Combination therapy with radiation and chemohormonal therapy (dacarbazine+nimustine+vincristine sulfate+tamoxif en citrate) was performed on one patient as an adjuvant therapy. The total tumor dose varied between 40 and 48 Gy. Two cases survived for two years after their diagnosis. Two cases died because of local recurrence, and two cases died because of metastasis. The cumulative survival rate among our cases was 40±20% after two years by the Kaplan-Meier method. None of the cases was alive three years after their diagnosis.

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Adenosquamous Carcinoma of the Ethmoid Sinus with Intracranial Extension

Akiko OKUYAMA, Yusuke WATANABE, Ritsu SEO, Osamu SEMBA

1996 Volume 89 Issue 9 Pages 1089-1095
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1089

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Adenosquamous carcinoma of the nasal cavity and paranasal sinuses is very rare. We report a 56-year-old man with adenosquamous carcinoma of the left ethmoid sinus extending to the anterior skull base. Chief complaints of the patient were left nasal obstruction and left epistaxis. CT scan and MRI revealed a tumor shadow in the left ethmoid sinus extending to the nasal cavity, the left maxillary sinus, and the anterior skull base. Concomitant chemoradiotherapy (CBDCA+radiation) was performed preoperatively. Using a combined craniof acial approach, the tumor was completely removed, including the anterior skull base. There has been no evidence of recurrence for two years and six months since the operation.

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Conservative Treatment for Acute Sinusitis

Shinnya TAKANO, Hajime ARAMAKI, Sei KITAJIMA, Kasumi YOSHIKAWA, Manami ...

1996 Volume 89 Issue 9 Pages 1097-1103
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1097

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We present here 141 patients with sinusitis. The duration from the acute crisis to the first medical examination was 90 days, and duration from crisis to resolution was clear.
As the duration from the acute crisis increases, the pain decreases and nasal obstructions begin to predominate as the chief complaint. In addition, otorhinolaryngological treatment can decrease the period from the acute crisis to emission or resolution. If the duration from the acute crisis to the first medical examination is 90 days, then no significant differences one found in either children or adults in the time required from the acute crisis to remission and resolution. We found that the best therapy was antibiotics added in the proper volume to the Scmidt inhaler.
There were numerous cases in which the treatment for bilateral sinusitis was postponed; of the convertional cases and 25% of the allergy cases. The administration of the correct volume of antibiotics on the 10th day is appropriate for the discrisis of acute sinusitis or chronic sinusitis.

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Mucoceles of the Posterior Paranasal Sinuses and Visual Disturbance

Eiji YUMOTO, Masamitsu HYODO, Seji KAWAKITA, Ryuichi AIBARA

1996 Volume 89 Issue 9 Pages 1105-1111
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1105

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We treated 15 patients (13 males and 2 females) with mucoceles occurring in the posterior paranasal sinuses by surgery. All of the patients complained of varying degrees of visual acuity disturbances, and their ages ranged between 40 and 55 years, with an average of 48.3 years. All had undergone a Caldwell-Luc or Watsuji-Denker operation on the affected side 5 to 30 years (mean: 24.3 years) before the occurrence of the visual disturbances. The mucoceles which had caused the visual disturbances were located in the posterior ethmoid sinus in 6 patients, in the sphenoid sinus in 6 patients, and in both sinuses in the other 3 patients. According to endoscopic observations, bony defects were detected along the optic nerve canal in 12 patients, and dural pulsation due to partial absorption of the anterior skull base bone (minor wing of the sphenoid bone) was seen in 11 patients except for one patient who had suffered an iatrogenic cerebrospinal fluid leak. Severe visual disturbances were noted in 7 patients, two of these patients received an immediate surgical drainage within 24 hours after the onset, and both recovered their visual acuity postoperatively. Another three patients underwent surgery 1 to 7 days after the onset, and the visual acuity improved in only one of these patients. The other two patients had surgical treatment over 8 days after the onset, and only one of them showed minimal improvement in visual acuity. Eight patients who had only slight or mild visual disturbance recovered their original visual acuity and/or remission of blurred vision. However, the surgical drainage was performed relatively late (10 days to 1 year) after the onset of their symptoms. We conclude that visual acuity does not recover when the visual disturbances are severe and the optic disc is atrophic. However, even when the visual disturbances were severe and the optic disc was inflamed, prompt surgical drainage of the mucocele was able to restore the visual acuity. In addition, when the preoperative visual acuity remained measurable, then the postoperative visual acuity could improve, regardless of the findings of the ocular fundus. The early diagnosis of mucoceles in the posterior paranasal sinuses as a cause of visual disturbances and prompt surgical drainage is indispensable.

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Epithelial-Myoepithelial Carcinoma of the Oral Cavity Minor Salivary Gland

Yoko NOBUTO, Nobuaki AYADA, Takashi KAWAKAMI, Mamoru MIYAGUCHI, Kazuno ...

1996 Volume 89 Issue 9 Pages 1113-1118
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1113

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An epithelial-myoepithelial carcinoma arising from the oral cavity minor salivary gland in a 81-year-old man is reported. The patient suffered from a large tumor with ulceration of the soft palate, however, his swallowing and speech were not disturbed.
The tumor showed characteristic histological features, such as double-layered tubular structures composed of inner ductal cells and outer clear cells. Inner ductal cells were positive for epithelial membrane antigen. Outer clear cells had rich glycogen and were positive for S-100 protein. The inner and outer cells differentiated into epithelial and myoepithelial cells, respectively.
The tumor is considered biologically to be a low grade malignancy because of its pattern of local infiltration growth and low rate of recurrence and metastasis. In this case, metastases to a cervical lymph node and the liver were detected. Although no treatment for the primary lesion has been performed, the patient is still alive at home one year after the diagnosis.

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Fibrous Lesions of the Tongue

Yuichi ONO, Katsuhide INAGI, Kazuo YAO, Hiro-omi Takahashi

1996 Volume 89 Issue 9 Pages 1119-1125
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1119

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The so called “fibrous lesion” is one of the diseases sometimes seen in tumors of the tongue. This injury is the most famous cause of fibrous lesions, and is formed by a variable inflammatory response.
We report here the clinicopathologic investigation of fibrous lesions in the tongue.
Seventy-eight cases of fibrous lesions were investigated, including 30 males and 48 females. The fibrous lesion was located most frequently at the apex of the tongue, followed in order by both sides of the tongue, the surface, and the back side.
The period between the patient's first visit to our clinic and the onset of his/her complains was not related to the location. The lesion were relatively larger in those cases with lesions on both sides and on the back side.
The pathological feature included fewer capillaries, fibrous cells and inflammatory small round cells in the apex and on both sides than on the surface and back side our clinical impression is that there are pathological differences in this lesion.

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Parathyroid Tumor; A Case Report

Tomohiko FUJITA, Yukinori MIYAHARA, Yasuo SAKAKURA

1996 Volume 89 Issue 9 Pages 1127-1130
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1127

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A 58-year-old woman was referred to our department because of globus. X-ray examination, real-time ultrasonography, CT, and MRI were performed. A parathyroid tumor was revealed at the back of the left lobe of the thyroid. A functional parathyroid adenoma was suspected based on the results of a fine needle aspiration biopsy and high serum levels of both calcium (12.4mg/dl) and PTH (2800pg/ml). The patient subsequently underwent surgery. During surgery a parathyroid tumor was removed and the histological diagnosis was benign parathyroid adenoma.

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Analysis of Epstein-Barr Virus in Hodgkin's Disease

Tomohiro MAKOSHI, Hiro-omi Takahashi, Makito OKAMOTO, Kazuo YAO, Meiji ...

1996 Volume 89 Issue 9 Pages 1131-1136
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1131

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Six cases of Hodgkin's disease (HD) were examined for the presence of Epstein-Barr virus (EBV) genome, Immunohistochemistry with an antibody against the latent membrane protein antigen (LMP) of EBV, was used in combination with the polymerase chain reaction (PCR) and in situ hybridization technique (ISH).
EBV was detected in 2/6 (33.3%) of the cases using immunohistochemistry with LMP. Internal repeat 1 of EBV DNA was detected in 2/6 (33.3%) of the cases using PCR. ISH with a digoxigeninlabeled EBER-1 oligonucleoid probe achieved positive results in 3/6 (50.0%) of the cases.
Since positive rates and cases differed depending on the method used, EBV should be examined using several different methods.

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Bleeding from the Superior Thyroid Artery Secondary to Endotracheal Intubation; A Case Report

Nobuhiro UEYAMA, Toyotoshi YASUDA, Kazuhiro ISHIKAWA, Mamoru MIYATA, K ...

1996 Volume 89 Issue 9 Pages 1137-1141
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1137

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Pharyngeal or esophageal injuries secondary to endotracheal or nasogastric intubation are not uncommon. Since complication related to injuries of the pharynx and esophagus can be fatal, early diagnosis and adequate treatment are essential. We present a case of hypopharyngeal bleeding following a difficult endotracheal intubation and difficult nasogastric tube placement. Our patient was a 60-year-old man who complained of excessive pharyngeal bleeding. Angiography revealed extraluminal leakage from the left superior thyroid artery. The neck was explored surgically through the left anterior border of the sternocleidomastoid muscle. We ligated the vessel responsible for the bleeding, removed the ulcerated mucosa on the left pyriform sinus, and then closed the defect in the pharyngeal mucosa. The total blood loss was 7000ml from the initial bleeding to the end of the surgical procedure. The patient did not suffer from bleeding, mediastinitis and other complications after the operation. The patient then made an uneventful and prompt recovery.

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Carboplatin Dosage, AUC, and Side Effect

Kenji OKAMI, Yuji IMATE, Shiro ENDO, Masahiro Takahashi

1996 Volume 89 Issue 9 Pages 1143-1146
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1143

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Twenty-two patients with head and neck cancer were treated with carboplatin (CBDCA) in combination with 5-fluorouracil (5-FU). The correlation of myelosuppression with CBDCA dosage and area under the blood concentration-time curve (AUC) was analyzed. The AUC was related to the lowest platelet count. In 4 cases treated with a CBDCA dosage determined by the formula of Calvert, the actual AUC resembled the expected AUC. The formula of Calvert was useful for determining the dosage of CBDCA.

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A Histochemical Study of the Intrinsic Laryngeal Muscles of Infants and Adults

Zhenhai WANG, Shilin YANG, Eazuyosi UENO, Yutaka HANAMURE, Masaru OHYA ...

1996 Volume 89 Issue 9 Pages 1147-1151
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1147

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The intralaryngeal muscles of 5 infants and 10 adults were studied by myosin-ATPase histochemistry. We found different proportions of muscle fiber constitution in the intralaryngeal muscles of infants versus adults. In adults, most of the type 1 muscle fibers were found in the posterior cricoarytenoid (PCA) muscle, a moderate amount was found in the lateral cricoarytenoid (LCA), internalarytenoid (INA) and cricothyroid (CT) muscles, and the least amount of type 1 fibers in the thyroarytenoid (TA) muscle. In infants, the largest amount of type 1 muscle fiber was observed in the PCA, moderate amounts in the CT, and the smallest amounts were found in the LCA, INA and TA muscles. These results showed that the PCA, both in infants and adults, was capable of resisting fatigue and thus adaptable to the requirements of respiration. The TA muscle could contract fast enough to adapt itself to the requirements of voice production, and would function less in the protection of the respiratory tract. The proportion of type 1 fibers in infant's intralaryngeal muscles was greater than in adults, indicating that infants have more immature voice production and poorer protection of their respiratory tract than adults.

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Prophylactic and Therapeutic Effects of Emedastine Difumarate in the Treatment of Japanese Cedar Pollinosis

Kazuhiro HASHIGUCCI, Keiichi ICHIMURA, Kimitaka KAGA, Jin KANZAKI

1996 Volume 89 Issue 9 Pages 1153-1161
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1153

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Japanese cedar pollinosis has been a social and clinical problem in the otolaryngeal field because of the increase in patients and the severity of the symptoms.
A multicentered, clinical trial was performed to evaluate the efficacy of pre-seasonal administration of Emedastine difumarate (ED) in the treatment of Japanese cedar pollinosis. The total airborne pollen count in 1995 was 7454/cm², the highest level in the last decade.
Pre-seasonal treatment with ED suppressed clinical symptoms more effectively throughout the pollen season than non-treatment.

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Pharmacotherapy to Japanese Cedar Pollinosis

[in Japanese]

1996 Volume 89 Issue 9 Pages 1162-1163
Published: September 01, 1996
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.89.1162

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