Practica Oto-Rhino-Laryngologica

Basic and Clinical Aspects of Middle Ear Ventilation

Yuichi Nakano

1997 Volume 90 Issue 10 Pages 1073-1081
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1073

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1. In reviewing the literature regarding the regulation of middle ear pressure, the importance of gas ventilation by the middle ear mucosa instead of aeration through the Eustachian tube has received recent attention. It has since been clarified that gas-exchange by the middle ear mucosa plays an important role in the maintenance of middle ear pressure in the stable state.
2. Middle ear gas-exchange is chiefly performed by the mucosa of the mastoid air cell system, as shown in experiments using piglets, whose middle ear has air cell systems resembling the human middle ear. In addition, middle ear pressure has been shown to be closely related to the partial pressure of carbon dioxide (CO₂) in the blood.
3. Until now, complete mastoidectomy has usually been applied in cases of chronic otitis media for the purpose of the eradication of pathological lesions. Since realizing the importance of the mastoid air cell system, mastoidectomy has been modified to focus on the removal of the severely pathological mucosa and the preservation of normal mastoid air cells. Favorable postoperative results have subsequently been obtained.

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Application of Dental Silicon Coremold for Pediatric Subglottic Stenosis

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

1997 Volume 90 Issue 10 Pages 1082-1083
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1082

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A Case of Bilateral Sensorineural Hearing Loss Associated with Unilateral Infarction of the Auditory Cortex

Hiroshi HIBINO, Katsumi DOI, Takeshi KUBO, Harumi KUMAGAYA

1997 Volume 90 Issue 10 Pages 1085-1090
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1085

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A patient with bilateral sensorineural hearing loss on a pure tone audiogram (PTA), associated with unilateral (right side) cerebral infarction in the auditory cortex is described. The PTA on the left (contralateral) side initially showed a “scale out”. The PTA threshold improved rapidly, and finally returned to almost normal levels within 2 months. The PTA on the right side initially showed mild sensorineural hearing loss. The PTA threshold gradually returned to normal levels within 2-3 months. In contrast to the rapid recovery of the PTA threshold, the maximum speech perception ability on the left side showed a very low score during the follow-up period of 2 years, and showed little improvement. The maximum speech perception ability on the right side maintained a high score from the time of first examination. All of the objective auditory examinations, including the auditory brainstem response (ABR), oto-acoustic emission (OAE), electrocochleogram (ECoG), middle latency response (MLR), and slow vertex response (SVR), indicated that hearing loss on the left (contralateral) side was closely associated with unilateral (right side) cerebral infarction of the auditory cortex. These results suggest that sensorinueral hearing loss on the PTA could be detected at the early stages of onset, even after unilateral damage to the auditory cortex.

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Clinical Study of Acoustic Neurinomas

Shinichiro MATSUI, Naoya SHIDARA, Tadashi WAKATABI, Toshiyuki IIZUKA, ...

1997 Volume 90 Issue 10 Pages 1091-1096
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1091

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Forty-three patients (19 males, 24 females) with acoustic neurinoma who were treated in our clinic between 1984 and 1994, were analyzed clinically. Their ages ranged from 20 to 89 years (mean, 48.7 years). Comparisons were made of clinical data before and after April, 1989, when MRI was introduced into our hospital. Intracanalicular tumors or small tumors were diagnosed only after MRI was introduced. A case of normal ABR was also seen after the introduction of MRI. The incidence of head-shaking nystagmus and the average pure tone threshold were lower after April 1989. Furthermore, intracanalicular tumors showed low positive findings in function tests. In conclusion, MRI study is essential for the early diagnosis of acoustic tumors, but function tests are also informative in determining the extent of functional involvement.

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Treatment of Sudden Deafness with Prostaglandin E₁

Shinsei NISHIHARA, Hidemitsu Sato, Kiyofumi GYO, Naoaki YANAGIHARA

1997 Volume 90 Issue 10 Pages 1097-1100
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1097

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Fifteen patients with sudden deafness were treated with prostaglandin (PG) E₁(120μg/day) in combination with other medicines such as corticosteroids, methyl mecobalamin and ATP. These patients were compared with a control group consisting of 41 patients treated without PGE₁. The results showed that the incidence of recovery and marked improvement of hearing was 60.0% in the PGE₁ group and 48.8% in the control group; there was no significant difference between these two groups. PGE₁ was more effective in patients over 50 years of age, patients with severely impaired hearing or protracted cases, compared with the conventional therapy. There were no serious side effects associated with PGE₁ administration.

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Traumatic Perforation of the Eardrum and Closed Sensation in the Contralateral Ear

Makoto MIYAZAKI

1997 Volume 90 Issue 10 Pages 1101-1109
Published: October 01, 1997
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1101

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A clinical study of 111 patients (112 ears), 58 males and 53 females, with traumatic perforation of the eardrum was performed. These perforations were treated in our clinic between July 1990 and February 1997. Many of the patients were in the second decade of age. The ratio of direct to indirect injuries was 32:79 (1:2.5). Removal of ear wax was most frequently causative in cases of perforation by direct injury, and slapping or striking was observed as causative in cases of indirect injury. Ninety-seven cases of perforations (87%) were found within one quadrant. Most injuries were in the antero-inferior quadrant. About 90% of perforations were closed with conservative therapy. A closed sensation of the ear (65 cases) was the most frequent complaint. Twelve of these 65 patients complained of a closed sensation in the contralateral ear. This closed sensation in the contralateral ear was easily cured as soon as the perforation was covered with a patch. These results suggest that a closed sensation in the contralateral ear is caused by a disturbance of equilibrium in both middle ears.

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Langerhans Cell Histiocytosis of the Bilateral Temporal Bone; A Case Report

Takeshi MORITA, Keisaku TABUCHI, Kaoru KITABAYASHI

1997 Volume 90 Issue 10 Pages 1111-1115
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1111

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The case of an 13-month-old boy with Langerhans cell histiocytosis of the bilateral temporal bone is presented. He was referred to our clinic after three months of conservative treatment following a diagnosis of chronic otitis media, and the development of a polyp. A histopathological examination and computerized tomography were performed, which were essential for the diagnosis. Chemotherapy consisting of VCR, AraC and prednisolone was initiated, with a good response so far. Satisfactory bone repair has proceeded spontaneously over the six-month follow-up period. In cases of aural polyp, especially when those demonstrating resistance to conservative therapy, early evaluation using sufficient biopsy tissue and computerized tomography should be considered.

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Two Cases of Paranasal Mycosis Treated by Endonasal Sinus Surgery with Counter Opening

Shinya KAWAGUCHI, Taro MAEDA

1997 Volume 90 Issue 10 Pages 1117-1121
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1117

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Paranasal mycosis is a comparatively rare disease. Case reports have recently increased with the more frequent use of cortical hormones and antibiotics. We treated 2 cases of paranasal mycosis and performed endonasal sinus surgery with counter opening. Both of the cases have subsequently shown no symptoms and successful endoscopic findings since undergoing surgery. In previous reports, the majority of patients have been treated by transmaxillary sinus surgery. We stress the usefulness of counter opening in endonasal sinus surgery and think that this operation may be indicated in cases of paranasal mycosis.

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Endoscopic Examination of OSAS Patients during Drug Induced Sleep

Koichi IWANAGA, Tadao NISHIMURA, Kiyokazu HASEGAWA, Nobuhiro SHIBATA, ...

1997 Volume 90 Issue 10 Pages 1123-1127
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1123

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Objective: 55 patients diagnosed as having obstructive sleep apnea syndrome (OSAS) underwent uvulopalatopharyngoplasty (UPPP). The effects of surgery were studied based on the findings of endoscopic examination under drug-induced sleep and AHI measurements performed before and after the operation. Changes in airway form during sleep were observed, and the usefulness of upper airway endoscopy in the diagnosis and surgical treatment of OSAS was studied.
Methods: The site of airway obstruction during sleep induced by intravenous injection of 10mg of diazepam was classified into five types, and changes in AHI and the site of airway obstruction were compared before and after surgery.
Results: The postoperative improvement rate was 73.5% in the soft palate type of obstruction, 75.6% in the tonsillar type, 52.3% in the full-circumference palatal type and 32.3% in the mixed type. Surgical treatment by UPPP had an excellent or good effect on the soft palate and tonsillar types. However, many patients with the ful1-circumference palatal type and the mixed type showed less improvement compared with the soft palate and tonsillar type.
Conclusion: In the full-circumference palatal type and the mixed type, improvement can be expected following operations which include surgical treatment of the posterior pharyngeal wall or the lateral funiculus, or midline laser glossectomy.

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Postoperative Evaluation after Arytenoid Adduction

Masamitsu HYODO, Eiji YUMOTO, Toshihiro MORI, Yoshimi KADOTA

1997 Volume 90 Issue 10 Pages 1129-1134
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1129

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Arytenoid adduction surgery was performed on 27 patients with unilateral recurrent laryngeal or vagus nerve palsy, and the results were evaluated. The AC/DC ratio and mean airflow rate were significantly improved (p<0.01) and the improvements persisted for a long follow-up period postoperatively in the majority of patients. The results of phonatory function showed no difference between cases with or without type I thyroplasty or intracordal injection, although there was considerable variability in the AC/DC ratio after surgery. Differences in the level and thickness ratio between the vocal folds were significantly corrected on laryngeal tomography (p<0.01). In patients with combined vagal and hypoglossal nerve palsy, swallowing disturbance is a serious problem. Arytenoid adduction surgery decreased misswallowing and improved the ability to expel an aspirated bolus or sputum in the trachea. Oral feeding became possible in four patients out of seven. These improvements were primarily attributed to increased infraglottic pressure.

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Vagus Nerve Paralysis as a Result of Viral Infection; A Case Report

Akiko TAURA, Juichi Ito, Kozo OTA, Shuji FUJITA, Yoshiko SHIOMI, Toshi ...

1997 Volume 90 Issue 10 Pages 1135-1140
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1135

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A 61-year-old man consulted our hospital, complaining of hoarseness and throat pain. Inspection of the larynx revealed an abnormal mass in the region of the left arytenoid and left laryngeal palsy. Laboratory data revealed slight leukocytosis and an elevation in CRP. Laryngeal carcinoma was suspected based on CTscanning, MRI, esophagography and Ga scintigraphy. Histopathological findings, however, showed only inflammation. A few days after the patient's first visit, left soft palate paralysis and severe hiccups appeared. Jugular foramen syndrome was suspected, but no abnormal mass was detected by MRI. Examination of serum viral titers revealed varicella-zoster virus antibody to be increased by 128 times, and vagal nerve paralysis caused by the varicella-zoster virus was highly suspected. Following therapy, the abnormal mass in the larynx disappeard, but the patient's laryngeal palsy remains.

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A Case of Triple Carcinoma with Malignant Fibrous Histiocytoma of the Larynx

Tetsuya OGATA, Yasuyuki TASAKA, Etsuo YAMAMOTO, Tomoko TUJI, Takayoshi ...

1997 Volume 90 Issue 10 Pages 1141-1145
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1141

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A sixty-three-year-old man who had complained of dyspnea visited our department. On physical examination, there was a yellow tumor that almost obstructed the airway in the laryngeal space. After detailed examination he was shown to have a thoracic esophageal carcinoma and hepatic carcinoma. The laryngeal tumor was removed by laryngomicrosurgery, and the thoracic esophageal tumor and the hepatic tumor were also removed at the same time. Histopathological examination revealed the thoracic esophageal tumor and the hypopharyngeal tumor to be squamous cell carcinomas, the hepatic tumor to be a hepatic cell carcinoma, and the laryngeal tumor to be a malignant fibrous histiocytoma. A total of 60Gy irradiation was administered after surgery. No recurrence was seen in the larynx but the patient subsequently died due to recurrent thoracic esophageal carcinoma.
Our report reviews this rare case of combined laryngeal malignant fibrous histiocytoma and other triple carcinomas.

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Metastasis of Renal Cell Carcinoma to the Neck; A Case Report

Noriko ABE, Tsukasa SAKO, Toshiki TOMITA, Yutaka SAKAMOTO

1997 Volume 90 Issue 10 Pages 1147-1150
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1147

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Metastasis of a renal cell carcinoma to head and neck regions is very rare. A 53-year-old woman presented with a large neck tumor on her left side. Several examinations revealed the mass to be metastasis of renal cell carcinoma. The patient also demonstrated complications of disseminated intravascular coagulation (DIC) about 3 weeks after the appearance of the neck tumor symptoms. A frozen section revealed the metastatic tumor to be a higher grade malignancy than the primary tumor. Thereafter the patient deteriorated rapidly. When lower cervical or supraclavicular adenopathy is found, the possibility of metastasis from peritoneal organs, including the kidney, should be considered.

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A Clinical Study of Differentiated Thyroid Carcinoma

Takashi Satoh, Hiroko KAWAMOTO, Takahiro KIMURA, Ken HAYASHI, Yoshie H ...

1997 Volume 90 Issue 10 Pages 1151-1155
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1151

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We analyzed 48 cases of differentiated thyroid carcinoma which were operated on for the first time at this hospital in the nine-year period from 1986 to 1994. Histologically, 45 were papillary adenocarcinomas, and 3 were follicular adenocarcinomas. Twelve of the patients were men and 36 were women. All 12 male cases were papillary adenocarcinomas, while 33 of the female cases were papillary adenocarcinomas and 3 were follicular adenocarcinomas. Patient age ranged from 11 to 76, with a mean age of 48.6 for men and 50.5 for women. The total average patient age was 50.0 years.
The TNM classification breakdown, as specified by the standards for thyroid carcinoma, was as follows: 11 cases of type T1, 23 cases of T2, 4 cases of T3, and 10 cases of T4. The breakdown by N classification was as follows: 33 cases of N0, 14 cases of N1a, and 1 case of N1b. There was only one M1 case, which involved metastasis to the lungs. Tumors recurred post-operatively in 4 men, one of whom died from respiratory failure following metastasis to the lungs. All recurring tumors were well differentiated papillary adenocarcinomas, but there was no correlation between histopathological differentiation and prognosis.
These results indicated that prognosis may be poor in some cases of thyroid carcinoma, even when they are well differentiated papillary adenocarcinomas. Therefore, diagnostic standards which address the biological behavior of cancer, are required.

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Two Cases of Mediastinitis with Empyemas due to Deep Neck Infection

Mariko HIZUME, Toshio YOSHIHARA, Michiko Sato, Megumi MORITA

1997 Volume 90 Issue 10 Pages 1157-1162
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1157

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Two cases of mediastinitis with empyemas due to deep neck infection are presented. Case 1 was a 24-year-old male who complained of high fever, sore throat and marked neck swelling. A chest X-ray and a CT-scan showed an enlargement of the mediastinum and bilateral empyemas. Epiglotitis was considered to be the cause of mediastinitis in this patient. Case 2 was a 26-year-old male who complained of bilateral neck swelling, and was transferred to our department because of dyspnea. A chest X-ray showed gas formation in the neck and mediastinum. A CT-scan showed an enlargement of the mediastinum and pleural effusion. Odontogenic infection was considered to be the cause of severe mediastinitis in this case. Both patients underwent drainage and irrigation of the neck and mediastinal abscesses in combination with antibiotic treatment. In case 1, drainage of the pleural cavities by thoracoscopic surgery was performed. Both cases recovered in about 2 months.

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Radiologic Study of Dysphagia in Dermatomyositis and Polymyositis

Isao HOSHINO, Makito OKAMOTO

1997 Volume 90 Issue 10 Pages 1163-1167
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1163

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Features of the esophageal and pharyngeal lesions in dermatomyositis or polymyositis were investigated in this study. Seventy-four patients who were admitted between April 1979 and June 1992 were examined retrospectively. They were 24 males and 50 females, aged 9 to 84 years old (average: 45.5). Thirty-one of the patients had complained of dysphagia.
Fluoroscopy was performed in thirteen patients. Ten patients out of these thirteen complained of dysphagia. The contrast material was regurgitated into the nasopharynx in 6 patients. It was retained in the valleculae and in the wide atonic pyrif orm fossae in 8. It was aspirated into the trachea in 6. A pharyngoesophageal diverticulum was detected in 1 and a diverticulum of the thoracic esophagus in 1, but significant lesions were absent in 2 patients.

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Efficacy of CPFX vs CPDX-PR in the Treatment of Exacerbation of Chronic Otitis Media

Kimitaka KAGA, Taeko OKUNO, Suguru FUKAYA, Masaaki YAMANE, Hiromitsu F ...

1997 Volume 90 Issue 10 Pages 1169-1179
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1169

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The efficacy and safety of ciprofloxacin (CPFX) and cefpodoxime-proxetil (CPDX-PR) for the treatment of acute aggravation of chronic otitis media were compared in 95 adults treated at the Department of Otolaryngology of Tokyo University Hospital or related institutions.
Both CPFX and CPDX-PR were effective in the treatment of acute aggravation of chronic otitis media. Moreover, CPFX was very effective in the treatment of severe infections and Pseudomonas aeruginosa infections. No serious adverse reactions occurred with either drug.

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Clinical and Pathologic Differences between Wegener's Granulomatosis and Nasal T-cell Lymphoma

[in Japanese], [in Japanese]

1997 Volume 90 Issue 10 Pages 1180-1181
Published: October 01, 1997
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.90.1180

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