Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 91, Issue 3
Displaying 1-18 of 18 articles from this issue
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  • The Hyper Responsiveness of the Nasal Mucosa for Allergens
    Kohtaro BABA
    1998 Volume 91 Issue 3 Pages 209-217
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.209
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    The hyper responsiveness of the nasal mucosa to Japanese cedar pollen was categorized as either sensitivity and the reactivity. Sensitivity was judged on the basis of a clinical evaluation of the first day of nasal allergic symptoms. The first day of nasal allergic symptoms was dependent upon the threshold point of the nasal allergy patient. The Japanese cedar pollen count is small at the beginning of the allergy season and increases day by day over the year. The first days of nasal allergic symptom occurred over a period of two months, evidencing individual patient variability. Accordingly, the allergy patients were divided into a high sensitivity group and a low sensitivity group.
    Reactivity to allergen challenge was evaluated by the nasal provocation test, and patients were divided into a high response group and a low response group on the basis of symptom degree and amount of sneezing. The patients were challenged by the nasal provocation test once a day for six days. Reactivity increased day by day. These results suggest that the increasing of reactivity is dependent upon the repetition of allergen challenges.
    In conclusion, the severity of nasal allergy symptoms depends on both individual sensitivity and reactivity. There is no relationship between sensitivity and reactivity in allergic hyper responsiveness.
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  • Congenital Stapes Fixation with Symphalangism
    [in Japanese], [in Japanese], [in Japanese]
    1998 Volume 91 Issue 3 Pages 218-219
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.218
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  • Four Cases of Idiopathic Sudden Sensorineural Hearing Loss
    Taisuke KUROKAWA, Kaori YAMAURA
    1998 Volume 91 Issue 3 Pages 221-225
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.221
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    We have encountered 4 cases of severe idiopathic sudden sensorineural hearing loss (ISSHL) with vertigo. The worst hearing level over the course of the illness exceeded 90 dB in all cases. Steroid treatment, followed by defibrinating therapy (batroxobin preparation) were administered to 2 of the cases, but recovery of hearing loss was not obtained.
    Steroid therapy was also performed in the other 2 cases, but hearing worsened despite the therapy. Steroid therapy was discontinued and r-globulin was administered to 1 case and acyclovir to the other case. The hearing of these 2 cases improved significantly with this medication. These observations suggest that cases of severe ISSHL should receive anti-viral treatment in addition to steroid therapy.
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  • Gas Exchange Function of the Middle Ear Mucosa in Patients with Cleft Palate
    Makito TANABE, Haruo Takahashi, Iwao HONJI, Masaki SAWADA
    1998 Volume 91 Issue 3 Pages 227-231
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.227
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    Using nitrous oxide, the gas exchange function of the middle ear mucosa was examined in 14 patient with cleft palates, twenty-five ears without otitis media, who had undergone various surgeries under general anesthesia, as well as 18 normal ears with neither cleft palate nor otitis media (controls) were examined. The middle ear pressure increased after the inhalation of nitrous oxide in all of the ears with the cleft palates and controls. However, the middle ear pressure increase was significantly smaller in the ears with the cleft palates than in the controls (Mann-Whitney U-test, P<0.05). This gas exchange function was also examined using the same method in 84 ears with otitis media with effusion (OME), including 7 patients (14 ears) with cleft palates. In 9 of these 14 ears with the cleft palates, the gas exchange function was found to be impaired, and it was also impaired in 33 of the 70 ears without cleft palates. In the ears with OME, the gas exachange function tended to be more impaired in the ears with the cleft palates than in those ears without the cleft palates. In those ears with OME, the area of the mastoid examined by X-ray (Schuller's view) was significantly larger in these ears without the cleft palate than in those with the cleft palate (Mann-Whitney U-test, P<0.05).
    It is suggested that the gas exchange function of the middle ear mucosa was poorer in these ears with a cleft palate than in normal ears. In the ears with a cleft palate, both the eustachian tube function and the gas exchange function of the middle ear mucosa seemed to be disrupted. This might cause susceptibility to middle ear diseases and refractory middle ear diseases.
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  • The Pedicled Temporalis Fascial Flap (Hong Kong Flap) for Ear Surgery
    Shin-ichiro KITAJIRI, Haruo Takahashi, Makito TANABE, Masaharu SUDO
    1998 Volume 91 Issue 3 Pages 233-236
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.233
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    The pedicled temporalis f ascial flap (Hong Kong flap) is vasculized by a branch of the superficial temporal artery. We used this flap procedure for ear surgery on 6 ears; three ears for an obliteration of the mastoid cavity, two for meatoplasty, and one for a closure of a recurrent eardrum perforation. All 6 of these ears had uneventful courses after surgery without any complications. This flap procedure is considered to be applicable to surgeries for various ear diseases requiring a rich blood supply.
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  • Head Shaking Nystagmus in the Patient with Idiopathic Unilateral Peripheral Facial Palsy
    Izumi KOIZUKA, Misuzu KIMURA, Naoki KATSUMI, Hideo TOMISAWA, Toshiharu ...
    1998 Volume 91 Issue 3 Pages 237-242
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.237
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    A case of idiopathic unilateral peripheral facial palsy showing unique findings and time course of the head shaking nystagmus was reported.
    A 15 year-old woman complained of right facial paralysis. She was admitted to our hospital for treatment using a drip infusion of steroids. Three days after onset of the paralysis, she complained of vertigo. At that time she showed no spontaneous or positional nystagmus but manifested right beating nystagmus 5 seconds after the cessation of head shaking stimulation. Six days after onset of the vertigo, right beating nystagmus was also observed but it appeared 40 seconds after the cessation of head shaking. It is assumed that she showed only the 2nd phase of head shaking nystagmus without the 1st phase because of the long latency period. She showed a mild increase in complement fixing antibody titer to the varicella-zoster virus.
    The head shaking test is well known to be quite sensitive in the detection of unilateral vestibular disorders. Since the 1st phase of head shaking nystagmus is due to velocity storage, any process that interferes with velocity storage can alter the pattern of nystagmus. When velocity storage is very poor, the 1st phase of head shaking nystagmus may be brief or absent. Thus, it is assumed that the patient in the present report had a lesion in the central vestibular system, presumably in the velocity storage mechanism due to varicella-zoster virus infection.
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  • A Case of Adult Nasopharyngeal Teratoma
    Mitsuru GO, Yasuaki HARABUCHI, Junichi WAKASHIMA, Tadataka ISHIKAWA, A ...
    1998 Volume 91 Issue 3 Pages 243-250
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.243
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    We report tho case of a 40 year-old female with a teratoma of the nasopharynx. The teratoma was attached by a short pedicle, and extended from a location near the right torus tubarius and measured 16×18×12mm in size. It was composed of three germ layers; adipose tissue, sebaceous glands and cartilage. Using CO2 laser and endoscopic techniques, the tumor was completely resected and was diagnosed histologically as a mature teratoma. There were no intraoperative or post-operative complications, and the patient subsequently showed a remarkable improvement in sleep apnea.
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  • Treatment of Four Cases of Congenital Choanal Atresia by Laser Surgery
    Kaori HIGUCHI, Masaru UEDA, Susumu MARUYAMA, Saburo MIMAKI
    1998 Volume 91 Issue 3 Pages 251-259
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.251
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    Recently, four patients with congenital choanal atresia were operated upon using a carbon dioxide laser, in our department. All patients were female, and patient age at the time of surgery ranged from 13-days to 4-months after birth. Three patients had bilateral choanal atresia and one had unilateral atresia and contralateral stenosis. All patients suffered from dyspnea at birth that required intubation or opening of an oral airway. The atresia plate was bony in 2 sides, membranous in 3 sides, and mixed in 2 sides. Three cases were accompanied by CHARGE association: C-coloboma, H-heart disease, A-atresia choanae, R-retarded growth and retarded development and/or CNS anomalies, G-genital hypoplasia, E-ear anomalies and/or deafness. Surgery was performed via a transnasal approach under a surgical microscope. In 2 cases, the newly created choanae closed again, and re-operation was necessary. Respiratory condition improved after surgery in all cases.
    We emphasize that using a carbon dioxide laser via a transnasal approach under a microscope is a valuable method for treatment of small infants requiring early treatment. The advantages of this method include excellent visualization and minimal potential for damage. To prevent re-obstruction of choanae, a tubular stent should be in place for at least 6 weeks postoperatively.
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  • Papillomas of the Nasal Cavity and Paranasal Sinuses; A Clinical Study of 11 Cases
    Ichiro TATEYA, Morimasa KITAMURA, Masahiko HAYASHI, Eiji TAKEUCHI, Mas ...
    1998 Volume 91 Issue 3 Pages 261-265
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.261
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    Papilloma of the nasal cavity and paranasal sinuses is histologically a benign neoplasm, but it exhibits a high recurrence rate, and an association with malignancy. Therefore, nasal and paranasal papilloma must be thoroughly treated. The authors treated 11 patients with papilloma, 10 of them with the Caldwell-Luc approach. One case of papilloma showed a malignant change to a verrucous carcinoma during the following up period. The recurrence rate of papilloma was 9%, following surgical treatment.
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  • A Case of a Hemangioma in the Ethmoidal Sinus
    Kuni SASAKI, Yoshiyuki TANIGAITO, Kohtaro BABA
    1998 Volume 91 Issue 3 Pages 267-272
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.267
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    Epistaxis is a disease which is often encountered in the course of otorhinolaryngological treatment. We treated a 48 year-old female with a hemangioma of the left ethmoidal sinus. Hemangiomas are clinically classified into two types ; capillary hemangiomas and cavenous hemangiomas. A CT scan with enhancement revealed vascularity. An MRI scan demonstrated the interface between the hemangiomas and the normal tissues well. Angiography with selective arterial embolization served to identify the feeding artery as well as to decrease bleeding during surgery.
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  • Two Cases of Bullous Dermatoses Arising from Oropharyngeal Lesions
    Reiko NONAKA, Kazumi KOSAKA, Manabu NONAKA, Akihiko NAGAI, Tetushi MOR ...
    1998 Volume 91 Issue 3 Pages 273-280
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.273
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    Two cases of bullous dermatoses are reported here. A 74-year-old male complained of pharyngeal pain and blood in his sputum. Slight redness of the pharyngeal mucosa was noted. One month after the onset, multiple erosions with a white coating were noted in the oral cavity, oropharynx and epiglottis. Gradually, several bullae appeared. Another two weeks later, multiple bullae and erosions with crusts were noted along with the skin lesions. A biopsy of the skin lesions showed subepidermal bullae and IgG deposition on the basement membrane was demonstrated by a fluorescent antibody test (direct method). These findings led to the diagnosis of bullous pemphigoid. An oral administration of prednisolone (30mg/day) was given initially. The patient responded well and the amount of prednisolone was gradually decreased. Therapy with 2.5mg of prednisolone has been maintained since, and the patient has not had any further oropharyngeal complaints or relapses. Another 35-year-old male complained of oral pain and a sore throat. Multiple erosions were found on the lip, buccal mucosa and tongue. Anti-viral drugs were used initially, but the patient did not respond to them. Gradually, several bullae appeared on his skin. A biopsy of the oral mucosa showed intraepidermal bullae caused by acantholysis. Pemphigus antibodies in his serum were detected by a fluorescent antibody test (indirect method). These findings led to the diagnosis of pemphigus. An oral administration of prednisolone (initially 60mg/day) resulted in only a transient response. Subsequently, the amount of prednisolone was increased to 80mg/day, but the patient showed no response to it. He was therefore treated with pulse intravenous methylprednisolone. However, he still showed a poor response, and his general condition worsened. Finally, he died of sepsis as a result of widespread infection due to the erosins on his skin 26 months after the onset.
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  • Elevated Serum Carcinoembryonic Antigen Levels with Sublingual Mucoepidermoid Tumor; A Case Report
    Akihito WATANABE, Akihiro KATAYAMA
    1998 Volume 91 Issue 3 Pages 281-284
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.281
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    Although elevated serum CEA levels have been reported in association with a variety of tumors including those arising from the epithelia of the colon, rectum, stomach, pancreas, lung, breast, female reproductive tract, and urinary bladder, this association has not previously been reported for patients with salivary gland tumors.
    Here, we report a 71-year-old male with sublingual mucoepidermoid tumor. He was admitted to our hospital because of elevated serum carcinoembryonic antigen levels, and an examination of his upper GI tract and colon in addition to a urological examination and otolaryngolical examination were conducted. A sublingual mucoepidermoid tumor was subsequently diagnosed, and the patient underwent radical surgery to remove the tumor. The postoperative course was uneventful and the patient's serum CEA level decreased to within normal range.
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  • A Case of a Branchial Cyst in the Parapharyngeal Space
    Hiroshi YOSHITAKE, Takao IKARASHI, Takashi NASU, Tadashi Nakamura, Mas ...
    1998 Volume 91 Issue 3 Pages 285-290
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.285
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    A rare case of a branchial cyst in the parapharyngeal space was reported. The patient was a 22-year-old male who complained of swelling on the right side of the pharynx. When the patient was first examined, the right palatine tonsil was found to be projecting forward, and swelling of the soft palate and the right palatopharyngeal arch were evident. Based on CT, MRI and angiography findings, the tumor detected in his right parapharyngeal space was suspected to be cystic and neurogenic. The tumor was completely removed through an external incision, and pathological examination revealed the tumor to be brancial cyst. Pathological diagnosis of parapharyngeal tumors, in addition to the pathogenesis and type of branchial cyst and surgical treatment of parapharyngeal tumors were discussed.
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  • Combined Therapy Approach for Carcinoma of the Oropharynx
    - Comparison with Previous Outcomes -
    Kazunori MORI, Tadashi NAKASHIMA, Minoru HIRANO, Kazuyuki KOJIMA, Naof ...
    1998 Volume 91 Issue 3 Pages 291-298
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.291
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    Recently in the Kurume University Hospital patients with carcinoma of the oropharynx have undergone the combined therapy approach by team practice, involving otolaryngologists, radiologists and plastic and reconstructive surgeons. In this paper this treatment modality by this team practice was described in detail and treatment outcome was compared with the previous outcome.
    The details of this combined therapy approach are as follows. Specialists in otolaryngology and radiology initially discuss and determine the choice of treatment modalities before initiating treatments. The response during treatments is then evaluated by otolaryngologists and radiologists and the treatment modalities are flexibly modified. When some kind of reconstruction is required during the operation, both otolaryngologists and plastic surgeons see the patient together and determine the surgical procedure before the operation. Functional problems such as aspiration after the operation are managed based on discussions between otolaryngologists and plastic surgeons.
    66 patients (60 males and 6 females) were treated before the application of this combined therapy and 67 patients (55 males and 12 females) were treated after initiating this combined therapy in the Kurume University Hospital. The five year local control rate for patients before combined therapy was 59.5% while that after combined therapy was 69.8%. The disease specific five year survival rate for patients before combined therapy was 54.9% while that after combined therapy was 71.8%.
    These results suggest that the most problematic points for the treatments of carcinoma of the oropharynx are as follows. The treatment outcome for carcinoma of the posterior wall remains very poor. It also remains difficult to conserve the larynx for carcinoma of the anterior wall. The treatment outcomes for carcinoma of the lateral wall are not significantly improved by a combined therapy, and the outcomes of salvage operations are still unsatisfactory.
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  • A Case of Adenosquamous Carcinoma of the Hypopharynx
    Junichi WAKASHIMA, Yasuaki HARABUCHI, Haruhiro YAMAGUCHI, Koji ASAKURA ...
    1998 Volume 91 Issue 3 Pages 299-304
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.299
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    A case of adenosquamous carcinoma of the hypopharynx is reported. A 50-year-old male complained of right upper neck lymph node swelling. The posterior wall of the hypopharynx and the right aryepiglottic fold were swollen. The initial histological diagnosis based on a biopsy specimen was squamous cell carcinoma. After radiotherapy with 60 Gy and neoadjuvant chemotherapy (CDDP, fluorouracil), total pharyngolaryngectomy with bilateral neck dissection was performed. The postoperative histological diagnosis was adenosquamous carcinoma. Retrospective study revealed that a small amount of intracytoplasmic mucin was present in the initial biopsy specimen. Thereafter, recurrence in the skull base was detected and the patient died 19 months later. On histopathological examination of squamous cell carcinomas of the head and neck, it is important to examine whether the tumor also contains an adenocarcinoma component or not.
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  • Extended Posterior Glottic Opening by CO2 Laser Laryngomicrosurgery in Bilateral Vocal Cord Paralysis; Subsequent Phonatory Function
    Yoshihiro IWATA, Shigenobu IWATA, Kazuo SAKURAI, Akihiko TAKASU, Ryuic ...
    1998 Volume 91 Issue 3 Pages 305-312
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.305
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    The extended posterior glottic opening technique was performed in 10 patients with bilateral vocal cord paralysis by CO2 laser laryngomicrosurgery. The subsequent phonatory function was then examined by the use PS-77 phonatory function test equipment, with the simultaneous measurement of subglottic pressure, during easy phonation preoperatively and again at one month post operation.
    This extended glottic opening technique consisted of an extended posterior cordectomy and a medial arytenoidectomy or arytenoidectomy. After the operation, the patients were free from dyspnea, and the tracheal fistulae were closed at 3 weeks after the operation.
    The patients' voices became slightly husky, weak, and the pitch was noticeably lower.
    The mean pre versus post operative phonatory function values (from pre-mean value to postmean value) revealed a shorter maximum phonation time (from 6.3 to 5.3 sec), a higher air flow rate (from 316 to 429ml/sec), a decreased subglottic pressure (from 12.7 to 5.9 cmH2O), a lower laryngeal resistance (from 93.3 to 34.1 cmH2O), and a lower level of laryngeal efficiency (from 2.09 to 1.53×10-4), respectively.
    However, the subglottic power remained almost the same (from 5.0 to 4.9×106) from pre to post operation.
    Based on our study, the extended posterior glottic opening technique by CO2 laser laryngomicrosurgery might be sufficient to open the glottis to avoid dyspnea and to maintain voice production in patients with bilateral abductor vocal paralysis.
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  • Ischemia-Induced Hearing Loss and Glutamate Efflux in the Perilymph; An Experimental Study in the Gerbil
    Nobuhiro HAKUBA
    1998 Volume 91 Issue 3 Pages 313-321
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.313
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    Cochlear compound action potentials (CAPS) and glutamate efflux in the perilymph before, during and after transient cochlear ischemia were studied in the gerbil to reveal the mechanisms of ischemia-induced inner ear damage. Cochlear ischemia was created by occluding the bilateral vertebral arteries for 5 minutes, since the posterior cerebral communicating arteries are lacking and the labyrinthine arteries are solely nourished by the vertebral arteries in the gerbil. Occlusion of the vertebral arteries caused a remarkable increase in the CAP threshold, which subsequently recovered following release of occlusion in all 10 animals. The threshold for acoustic stimulation at 60 minutes after recirculation was, however, higher than that in the preischemic state. Glutamate concentration in the perilymph was measured using a microdialysis technique followed by enzyme cycling analysis. Before occlusion, the glutamate level of the perilymph was 0.35±0.22 pmol/μl in the scala tympani (n=12) and 0.42±0.32 pmol/μl in the scala vestibuli (n=6). Ischemic insult caused an immediate rise in the glutamate level, which rose further even after recirculation, reaching a maximum of 11.72 pmol/μl in the scala tympani (n=12) and 8.49 pmol/μl in the scala vestibuli (n=6). In four animals, the cochlea was processed for transmission electron microscopic study at 30 minutes after ischemic load. The ischemia induced swelling of the afferent auditory nerve endings and vacuolation of the inner hair cells. These results suggest that the release of glutamate in the perilymph may aggravate ischemia-induced hearing dysfunction.
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  • Functional Imagingin Otolaryngology
    [in Japanese]
    1998 Volume 91 Issue 3 Pages 322-323
    Published: March 01, 1998
    Released on J-STAGE: November 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.91.322
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