Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 91, Issue 1
Displaying 1-20 of 20 articles from this issue
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  • Middle Ear Diseases from the Viewpoint of Gas Exchange Function in the Mastoid
    Iwao HONJO
    1998 Volume 91 Issue 1 Pages 1-7
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.1
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    The physiology and pathophysiology of middle ear ventilation in ears with various diseases was evaluated from the perspective of gas exchange through the mucosa of mastoid air cells as well as from the perspective of eustachian tube function.
    1. In 50% of patients with otitis media with effusion (OME), gas exchange function was impaired. The size of the mastoid and the presence or absence of aeration in the middle ear were closely correlated with gas exchange function. After myringotomy and removal of the effusion, gas exchange function recovered in most of the ears with impaired function. These results indicate that impairment of the gas exchange function in OME appears to be reversible, and that the surgical treatment of OME can be interpreted as being directed toward the recovery of gas exchange function.
    2. In refractory OME which has not been cured before the age of 10, both eustachian tube and gas exchange functions are highly impaired.
    3. Middle ear surgery involving mastoidectomy results in total abolishment of gas exchange function in the mastoid and a failure of recovery of aeration. These observations suggest that the canalwall-down procedure is recommended, rather than the canal-wall-up procedure, after mastoidectomy to avoid the risk of unexpected sequelae, such as recurrent cholesteatoma. Mastoid obliteration is also justified after mastoidectomy in the sense that such functional dead space should be abandoned.
    4. In the future of middle ear surgery, therefore, surgeons should consider minimally invasive surgery in combination with the conservative preoperative treatment which is now prevalent in nasal surgery.
    5. Organic and irreversible impairment of both eustachian tube function and gas exchange function seems to be related to the pathogenesis of cholesteatoma as an ultimate outcome of these impairments in refractory OME.
    6. Finally, a new concept of middle ear ventilation was proposed; ventilation of the middle ear may be managed primarily by gas exchange function and the eustachian tube may play a key role in clearance of the middle ear rather than in ventilation.
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  • A Case of Maxillary Ameloblastoma
    [in Japanese]
    1998 Volume 91 Issue 1 Pages 8-9
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.8
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  • Case Report of Basal Meningoencephalocele and a Literature Review
    Masanori OSHIKA, Kenji SUZUKI, Kunimitsu SAKAI, Yumeji TAKEICHI, Satoa ...
    1998 Volume 91 Issue 1 Pages 11-16
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.11
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    Meningoencephaloceles (MECs) are extracranial protrusions of the meninges, cerebrospinal fluid (CSF), and brain tissue through cranial bone defects. We report a case of a MEC located in the anterior skull base. The patient was a 33-year-old male with CSF rhinorrhea and refractory meningitis. He underwent surgery by an intracranial approach. After the prolapsed brain tissue and encephalic dura mater had been excised, the defect in the dura was repaired with a pedicled temporal fascial flap and the bone defect in the anterior skull base was covered with a calvarian bone flap.
    To our knowledge, only 7 cases of MEC located in the anterior skull base have been reported in the otolaryngological field in Japan. Since adult cases of basal MEC often present with CSF rhinorrha, masses in the nasal cavity, and meningitis, it is important to consider the presence of MEC.
    Biopsies for histological examination of MEC are not recommended because of the risk of CSF rhinorrhea and meningitis. Coronal and sagittal MRI were very useful in the diagnosis of basal MEC.
    The treatment of MEC consisted of resecting the protruded lesion and complete separation of the intracranial and extracranial spaces. An intracranial approach is recommended for the treatment of large basal MEC. Our case suggested that preoperative prevention of intracranial infections is essential.
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  • A Case of V-P Shunt Insufficiency with Dizziness and Hearing Loss
    Hiroyuki Ito
    1998 Volume 91 Issue 1 Pages 17-21
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.17
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    A case of ventro-peritoneal (V-P shunt) shunt insufficiency with dizziness and sensorial hearing loss is reported. The patient was a sixteen-year-old boy who had been diagnosed as hydrocephalic at six of age. Subdural space-peritoneal shunt was performed in February 1980, but because of the insufficiency, V-P shunt was subsequently required in September 1984. He began to experience dizziness in the middle of September 1995, which worsened with both standing and sitting. While his dizziness was improved in the supine position, however, it was gradually accompanied by progressive headache, nausea and vomiting. The patient subsequently admitted to a hospital, where a brain CT scan revealed narrow and slit-like ventricles. Further exacerbation of a month resulted in transfer of the patient to the department of a neurosurgery in Kanagawa Rehabilitation hospital and consulted for a neurlo-otological examination. Directional nystagmus detected during the initial examination had disappeared but left-sided positional horizontal nystagmus was found the following day. The eye tracking test revealed ataxia while the optokinetic pattern was lightly impaired. The result of the caloric test were normal. The right ear showed sensorial hearing loss at all frequencies which was more marked in the lower frequencies. The left showed sensorial hearing loss in the lower frequencies. The patient's cerebral spinal pressure was 1-2 mmH2O in supine position and 0 mmH2O at thirty degrees with the head up. The patient's hearing loss was gradually recovered. After reconstruction of the V-P shunt, however, the hearing loss in lower frequencies remained. Although endolymphatic hydrops due to shut insufficiency was initially thought to have caused this patient's dizziness and hearing loss, the result of the caloric test was normal. The neuro-otological findings revealed the possibility that the dizziness originated in the cerebellum although the real cause remains uncertain. Fluctuating hearing loss without dizziness and vertigo has reported previously in a case of V-P shunt insufficiency. The observation suggested V-P shunt insufficiency can be clinically divided into two types, one of which the chief symptom was marked hearing loss without dizziness and the other one of which is characterized by hearing loss without dizziness.
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  • Toynbee Phenomenon as a Causative Factor in Middle Ear Diseases
    Masaharu SUDO, Haruo Takahashi, Makito TANABE, Seishi HASEBE
    1998 Volume 91 Issue 1 Pages 23-27
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.23
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    Although impairment of middle ear ventilation and subsequent middle ear negative pressure have been regarded as important pathogenetic factors in middle ear diseases, impairment of middle ear ventilation has not been proven to necessarily cause progressive negative middle ear pressure. Toynbee phenomenon is another possible cause of active production of negative middle ear pressure. Accordingly, we investigated the incidence and pathophysiology of Toynbee phenomenon in various middle ear diseases.
    The incidence of positive Toynbee phenomenon was 75% (18124) in controls. Whereas, the incidence was 14% (8/59) in cases of otitis media with effusion (OME), 50% (13126) in cases of chronic otitis media (COM), 38% (5/13) in cases of adhesive otitis media (Adh), and 30% (3/10) in patients with cholesteatoma. However, the negative pressure induced by the Toynbee maneuver was significantly more profound in cases of Adh (- 116.0±58.6 mmH2O) than in normal ears (-8.05±53.9 mmH2O, p<0.005). Also the average induced negative pressures in the other diseased ears tended to be more profound than in normal ears; -23.6±37.1 mmH2O in OME, -23.1±55.1 mmH2O in COM, -45.0±18.0 mmH2O in cholesteatoma. Considering that middle ear diseases often accompany nasal diseases and are also often induced or aggravated by upper respiratory infections or nasal allergies (when the nose is congested), and that the eustachian tubes in diseased ears often cannot equalize negative middle ear pressure, Toynbee phenomenon may be related to the pathogenesis of these ear diseases.
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  • Chronic Otitis Media Attributed to Allergy; A Case Report
    Norihiko MURAI, Etsuo YAMAMOTO, Yasuyuki TASAKA, Tomoko TSUJI, Takayos ...
    1998 Volume 91 Issue 1 Pages 29-33
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.29
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    A 44-year-old man with a past history of bronchial asthma and allergic rhinitis visited our hospital because of right otorrhea and hearing loss. Otoscopy showed a smooth polypous mass fully occupying the right external auditory meatus. Computed tomography revealed soft tissue density in the right tympanic cavity, epitympanum, and mastoid antrum without distinct bony erosion. Tympanoplasty was performed. A perforation of the tympanic membrane was considered to have pre-existed, and the aural polyp appeared to have grown from the mucosa of the middle ear through the perforation. Histologic examination revealed increased numbers of eosinophiles in the polyp. RAST showed positive scores for house dust, mites, silk, and other allergens. After surgery, the patient had no otorrhea and the aural polyp did not recur. Therefore we presumed that immediate allergy affected the progress of the otitis media in this case, and that the antigens entered the middle ear through the perforation.
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  • Malignant Transformation of an Inverted Papilloma in the Frontal Sinus; A Case Report
    Masakazu MIYZAKI, Sanson HAN, Hiroyuki KITAMURA, Shin-ichi TAKAGITA, T ...
    1998 Volume 91 Issue 1 Pages 35-38
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.35
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    An inverted papilloma in the frontal sinus is a rare finding. We recently treated an 81-year-old female with malignant transformation of an inverted papilloma in the frontal sinus.
    We performed the tumor resection with a transfrontal sinus approach and a transnasal approach, followed by radiation therapy.
    To our knowledge, there have been no previous reports of an inverted papilloma in the frontal sinus undergoing malignant transformation.
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  • Relationship between Acute Paranasal Sinusitis and Headache
    Shinnya TAKANO, Hajime ARAMAKI, Keiko YODA, Manami TAKAMATSU, Yumiko O ...
    1998 Volume 91 Issue 1 Pages 39-42
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.39
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    A total of 122 patients who visited our Hospital with untreated acute sinusitis with pain, were studied.
    1) Detailed anamnesis could locate the sinus with lesions considered to be the cause of pain.
    2) Maxillary sinusitis produced pain in the cheek.
    3) Ethmoid sinusitis often produced ocular pain.
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  • Late Tongue Ulcer Appeared 23 Years after Irradiation
    Hiroshi IWAI, Jun KITA, Hiroyuki TSUJI, Masayuki MINAMINO, Toyohiko MI ...
    1998 Volume 91 Issue 1 Pages 43-47
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.43
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    We report here the case of a 55-year-old woman who had a late tongue ulcer, which appeared 23 years after interstitial irradiation with 6500 rad against a tongue carcinoma in the same area as the ulcer. Inspection, palpation and MR imaging could not distinguish between the radiation-induced ulcer and a second malignancy. However, a histopathological examination diagnosed it as a radiation-induced ulcer.
    The recent popularity of high-dose-rate interstitial brachytherapy instead of low-dose-rate interstitial brachytherapy may ultimately increase the incidence of late complications after irradiation treatment.
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  • Recurrent Neck Abscess due to Pyriform Sinus Fistula
    Takayasu KIMURA, Masaki KAWAGUCHI, Takashi SHINOMIYA, Ryou KAWATA, Yas ...
    1998 Volume 91 Issue 1 Pages 49-55
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.49
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    Three patients with recurrent neck abscesses due to pyriform sinus fistula are reported. Accurate diagnosis could be made by means of barium study of the pyriform sinus.
    complete dissection of soft tissue next to the fistula together with the thyroid lobe was considered to be mandatory, and endoscopic infusion of a dye into the fistula was determined to be helpful for the purposes of surgery.
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  • A Case of Pneumomediastinum Caused by a Closed Injury of the Larynx
    Hideki CHIDIWA, Kazunori MORI, Kikuo SAKAMOTO, Minoru HIRANO
    1998 Volume 91 Issue 1 Pages 57-61
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.57
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    A 14-year-old girl with a closed injury of the larynx is reported. The patient's primary complaint was aphonia, and dysphagia occurred one day after an accidental contusion on her anterior neck. Computed tomography revealed an extensive neck emphysema including pneumomediastinum and fracture of the thyroid cartilage. After tracheostomy under local anesthesia, laryngoplasty and drainage of the mediastinum was performed under general anesthesia. After the operation, antibiotics and steroids were administered and continuous suctioning of the drainage was performed, resulting in a good postoperative course. In the case of a closed injury of the larynx, dyspnea due to upper airway edema and, pneumomediastinum are sometimes induced, resulting in a life-threating state. Therefore intensive care and follow-up taking conservation of the air way into consideration are necessary.
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  • A Tumor Occurring in the Bilateral Parapharyngeal Spaces
    Akihiro OTSUKA, Toshiya SUZUKI, Keiji Sato, Susumu EZAWA, Yuri UMEGAKI
    1998 Volume 91 Issue 1 Pages 63-67
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.63
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    A case of basal cell adenomas arising in the bilateral parapharyngeal spaces and the left parotid gland of a 70-year-old female is presented. The patient's primary complaint was discomfort in the right ear. All tumors were removed surgically. The histopathological diagnosis was trabecular and tubular variants of basal cell adenoma. Four cases of bilateral basal cell adenomas in the parotid gland have been reported previously. Tumors of the bilateral parapharyngeal space are extremely rare in the literature.
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  • Granular Cell Tumor in the Cervical Region; A Case Report
    Takuya TACHIKAWA, Tomoshige FUKTAKE, Shingo KAKIMOTO, Masafumi YOSHIMU ...
    1998 Volume 91 Issue 1 Pages 69-73
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.69
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    A 40-year-old female consulted our hospital complaining of frontal neck swelling and pain. Topographical imaging suggested a preoperative diagnosis of benign thyroid tumor (left lobe). On 24th Jan. 1996, a left thyroid lobectomy was performed. Histologically, the tumor was diagnosed as a granular cell tumor based on intraoperative examination of the specimen. Immunohistochemical examinations showed positive PAS, S-100 protein and NSE reactivity in the cytoplasm of the tumor cells. Electronmicroscopic findings showed autophagosomes. On the basis of these findings, the tumor was diagnosed as a benign granular cell tumor. Granular cell tumors are commonly found in the tongue, skin and subcutaneous regions. Tumors arising near the thyroid gland are rare. So far, only one case has been reported in Japan. Discussions of this case was made in the context of relevant literature.
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  • Three Cases of Plummer's Disease
    Kengo YAMAGUCHI, Manabu NAKANOBOH, Takehiro KARAHO, Tomoaki KAI, Michi ...
    1998 Volume 91 Issue 1 Pages 75-78
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.75
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    Three cases of Plummer's disease, which is relatively rare in our country, are presented. All cases were female, aged 51, 29, and 53. Two cases out of three complained chiefly of an anterior neck mass. Symptoms of hyperthyroidism, such as palpitation and hyperhidrosis, were observed in all cases. Diagnosis was made on the basis of thyroid function test results and the presence of a hot nodule in the thyroid scintigram which coincided, with the findings of thyroid ultrasound scans and computed tomography. After normalization of thyroid function by antithyroid therapy, lobectomy was performed in all cases. Even though a decrease in postoperative thyroid function was observed in two cases, this decrease was transient and thyroid hormone levels returned to the normal range within two months. Surgical intervention ultimately cured all three patients with Plummer's disease.
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  • Clinical Analysis of Factors Related to the Viability of Pectoralis Major Myocutaneous Island Flap
    Koutetsu LEE, Noriya KAKITSUBA, Kazuo MAKIMOTO, Ryuichi KANAI, Hiroshi ...
    1998 Volume 91 Issue 1 Pages 79-85
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.79
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    In the present study, we analysed patient characteristics and other factors related to flap viability in 19 patients who underwent reconstructive surgery using a pectoralis major myocutaneous island flap in our department over 6+ the past eight years. In these 19 patients (15 males and 4 females), the flap was used on the luminal side of the oral cavity and oropharynx after radical surgery for the treatment of carcinoma of the tongue (10 cases), carcinomas of the oral floor and gingiva (5 cases), and oropharyngeal carcinoma (1 case). Wound complications in the island flap or cervical skin incision site occurred in 11 out of 19 patients, and included partial necrosis of the island flaps (8 cases), dehiscence of the cervical skin incision site (7 cases), dehiscence of the island flap margin (3 cases) and so on. All four of the patients with diabetes mellitus had some wound complications. A comparison of blood data a month before surgery patients with and without wound complications, revealed the mean value of total protein to be significantly lower in the group with wound complications than that in the group without wound complications. A comparison of blood data one month after surgery revealed a significantly higher leukocyte count in the group with wound complications than in the group without wound complications. When a comparison of the incidence of wound complications was made between the group with radiation therapy and that without radiation therapy, the former group showed a higher incidence of complications in the cervical skin incision site than the latter group did, in cases of cervical irradiation.
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  • Quadruple Primary Cancers in the Head and Neck Region; A Case Report
    Tatsuo KIKUGAWA, Mitsuharu NONOMURA, Nobuya FUJIKI, Ken ISHIJIMA, Yasu ...
    1998 Volume 91 Issue 1 Pages 87-90
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.87
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    The incidence of multiple primary cancers in the head and neck region has increased in recent years. While we often treat double cancers, triple or more primary cancers are rare. We report a case of metachronous quadruple primary cancer in the head and neck region of a 65-year-old man. The 1st cancer, a left tonsillar carcinoma was diagnosed in Sep.1993; the 2nd one, a tracheal carcinoma was in Jan. 1994; the 3rd, a lingual carcinoma, in Oct. 1995; and the 4th, a hypopharyngeal carcinoma, in Feb. 1997. All of the cancers were highly differentiated squamous cell carcinomas. All of tumors were resected curatively without lymph node imvolvement or distant metastasis.
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  • Expression of Cytokine Receptors and HLA in Nasal Epithelial Cells
    Manabu NONAKA, Reiko NONAKA, Manel JORDANA, Jerry DOLOVICH
    1998 Volume 91 Issue 1 Pages 91-97
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.91
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    Epithelial cells can actively contribute to airway inflammation by virtue of their ability to participate in antigen presentation, and to synthesize and release proinflammatory cytokines. This study used immunocytochemistry to investigate interleukin 1 receptor (IL-1R) type I, tumor necrosis factor a receptor (TNF-aR) 55 kD and HLA-DR on epithelial cells obtained via nasal brushing from 10 patients with allergic rhinitis in season and 15 healthy non-allergic subjects. Firstly, we found that approximately 40% of healthy non-allergic subjects had some macroscopic evidence of inflammation in the nasal mucosa and that their epithelial brushings contained more than 10% neutrophils. These subjects were described as having subclinical inflammation. Secondly, in brushings from control subjects, we found that 8.0±7.5% of epithelial cells stained positive for HLA-DR, about one third stained positive for IL-1R and TNF-αR. The percentage of epithelial cells staining positive for these three markers was similar in patients with allergic rhinitis in season and with subclinical neutrophilic inflammation, and significantly increased compared to control subjects. Thirdly, in non-allergic subjects, a significant correlation was found between HLA-DR expression and both neutrophil and lymphocyte content in the epithelial brushings. These findings further support a contribution of epithelial cells to the regulation of inflammatory and immunological processes in the nasal mucosa.
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  • Efficacy of Emedastine Difumarate (DAREN®) for Sever Perennial Allergic Rhinitis
    Tadashi ISHIMARU, Takaki MIWA, Takeo DONJO, Makoto SAKUMOTO, Toshiro N ...
    1998 Volume 91 Issue 1 Pages 99-109
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.99
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    The therapeutic efficacy, safety and usefulness of emedastine difumarate (DAREN) given at doses from 2 to 4 mg/day for 8 weeks to patients with severe perennial allergic rhinitis were investigated.
    Among a total of 36 patients enrolled, 34 patients were evaluated for efficacy and usefulness, 36 for safety.
    The results were as follows.
    1) In the final global improvement rating, 28 of 34 cases (82.4%) were assessed as “moderately improved” or more.
    2) In 29 of 34 patients (85.3%), the severity of the subjective and objective (nasal) symptoms were ameliorated from “severe” to “slight” or “none”.
    3) In the overall safety rating, the percentage of cases evaluated as “no adverse reaction and safe” was 88.9%.
    4) Adverse reactions were observed in 4 cases (11.1%), of which drowsiness was the reaction (3 cases).
    Administration was, however, continued in all cases throughout the study period, because the side-effects were mild and not clinically serious.
    5) In the usefulness rating, the treatment was rated as “fairly useful” or better in 76.5% (26/34), of the cases.
    In conclusion, DAREN is considered to be markedly effective, safe and useful in the treatment of severe perennial allergic rhinitis.
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  • Surgical Treatment for Nasal Allergy
    [in Japanese], [in Japanese]
    1998 Volume 91 Issue 1 Pages 110-111
    Published: January 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.110
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  • Erratum to : Effects of Ambroxol on the Transfer of Ceftizoxime into the Ethmoid Cell Mucosa
    1998 Volume 91 Issue 1 Pages e1
    Published: 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.1_e1
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