Practica Oto-Rhino-Laryngologica

Brain Function in Patients with Hearing Loss

Iwao HONJO

1999 Volume 92 Issue 3 Pages 211-217
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.211

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The most frequent complaint of individuals with hearing loss is poor understanding of spoken language. Recent findings in the study of the function of brain, the final site of language recognition, examined among individuals with hearing loss are as follows. In prelingually deaf children, language recognition usually does not improve much with input from cochlear implant, but we experienced one case who showed apparent activity in the auditory association areas in the brain by PET several years after cochlear implantation. This indicates the possibility of new formation of the neural networks for language recognition in the temporal lobe. Examining patients with dysacusis by MEG, we observed an interesting tendency. The response of these individuals to noise was comparatively large, resulting in diminution of differences in the brain response between noise and language. In PET studies of patients with cochlear hearing loss, we failed to observe significant activation in the right hemisphere by language stimulation. Thus, degree of activation of the right temporal lobe by language stimulation may be utilized as one of the indices for the estimation of language recognition or effects of hearing aids in patients with hearing loss. In the future, clarification of the mechanism of hearing loss and development of its treatment are expected from the viewpoint of language recognition in the brain.

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Maxillary Sinus Mycosis

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

1999 Volume 92 Issue 3 Pages 218-219
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.218

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A Case of Multiple Cranial Nerve Palsy due to Varicella-Zoster Infection

Yasuko MORI, Kayoko KAWASHIMA

1999 Volume 92 Issue 3 Pages 221-225
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.221

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We experienced a case of multiple cranial nerve palsy due to varicella-zoster virus (VZV) infection. The patient was a 52-year-old man who complained of sudden onset of symptoms including left hearing impairment, sore throat and hoarseness. Physical examination and findings included sensorineural deafness, palatoplegia and recurrent laryngeal nerve palsy on the left side. No other abnormal neurological findings were noted. No vesicles were noted in the ear, oral cavity or pharynx, and there was no facial palsy. Brain CT and MRI revealed no abnormal findings. The cerebrospinal fluid, however, showed pleocytosis. A diagnosis was a suspected central nervous system viral infection. The patient was treated with an anti-viral agent (Acyclovir). Remission of all symptoms occurred gradually after approximately one month of treatment. The serum and CSF antibody titers for VZV were elevated. Localized brainstem encephalitis due to VZV was the final diagnosis. In cases of 8th, 9th and 10th cranial nerve involvement with unknown etiology, the serum and CSF antibody titers for VZV should be evaluated.

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A Case of Cerebellopontine Angle Metastasis of Renal Cell Carcinoma- with Hearing Impairment

Satsuki YASUMURA, Hitomi MOTOSHIMA, Yukiko MIZUKAMI, Hideo SHOJAKU, Yu ...

1999 Volume 92 Issue 3 Pages 227-231
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.227

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We experienced a rare case of metastatic cerebellopontine (CP) angle tumor, originating from a renal cell carcinoma with hearing impairment. A 61-year-old male was admitted to our hospital complaining of sudden hearing impairment of the left ear. He had been well for six years, after a diagnosis of left renal cell carcinoma two years previously, with lung metastasis and brain metastases in the frontal lobe. Brain tumors had been removed twice. Magnetic resonance imaging (MRI) of the head showed a new lesion at the CP angle with recurrence of the left metastatic tumors.
Hearing impairment was achieved by the administration of corticosteroid. The patient showed loss of II -V waves on left ABR, and optokinetic nystagmus test depression on the counterclockwise. Hearing impairment and dizziness progressively worsened during the subsequent two year period, but he was managed as an out-patient until March in 1998.

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Vestibular Findings of Periodically Changing Positional and Positioning Nystagmus

Mamoru SUZUKI, Satoshi HORIGUCHI, Kumiko YUKAWA, Akihide ICHIMURA, Nob ...

1999 Volume 92 Issue 3 Pages 233-237
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.233

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Three cases of periodically changing positional and positioning nystagmus are reported. All of the cases showed unremarkable findings on the neurological tests and a brain MRI. However, they all presented with peculiar types of positional and positioning nystagmus. The majority showed a direction-changing geotropic nystagmus and a down-beating nystagmus. The direction and type of the nystagmus changed frequently. The direction changing geotropic type often altered into the apogeotropic type, or the direction changing nystagmus was observed to be mixed with a downbeating nystagmus. Since no space occupying lesions were observed, a vascular disorder within the brain stem or cerebellum was suspected. The above findings support the importance of a nystagmus test, even when the MRI findings are unremarkable.

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A Case of Primary Mastoid Cholesterol Cyst

KANDA KANDA, Haruo Takahashi, Seishi HASEBE, Kazuo FUNABIKI

1999 Volume 92 Issue 3 Pages 239-243
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.239

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A case with a primary mastoid cholesterol cyst accompanying massive bone destruction is reported. The patient was a 43-year-old male, who visited our clinic because of vertigo. Otoneurological examination revealed the patient' s hearing and vestibular function to be nearly normal. A temporal bone CT showed a soft tissue mass in the left mastoid with large bone defects in the posterior and middle cranial fossae, and fistulas in all of the semicircular canals. MRI revealed a huge mass in the mastoid cavity apparently compressing the temporal lobe of the brain. The patient refused surgical treatment, and during the subsequent 4 year follow-up period the mass developed further and a cholesterol cyst was suspected based on the results of another MRI. Surgery revealed a huge cholesterol cyst located in the mastoid cavity with large bone defects and an exposed dura. Histological examination showed cholesterol granuloma accompanied by inflammation and bleeding and surrounded by thick scar tissue.
Obstructive and persistent inflammation in the mastoid was considered to be related to development of the mastoid cholesterol cyst.

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Surgical Treatment of Osteoradionecrosis

Yoshihumi UNO

1999 Volume 92 Issue 3 Pages 245-251
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.245

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Three cases of osteoradionecrosis (temporal and maxillary bones) were reconstructed using the microvascular tissue transfer method. These patients had received combination therapy consisting surgery, radiotherapy and chemotherapy. After the combined therapy, local infection, pain and bleeding continued. Furthermore, inflammation appeared due to necrosis of the affected bones and soft tissues. The large tissue defect was reconstructed with a rectus abdominis flap (case 1), a latissumus dorsi flap (case 2) and an anterolateral thigh flap (case 3), with microvascular anastomosis. In all of these cases, the anastomosis succeeded. However, in case 2, the free flap necrosed at 10 days after the operation, and deltoid-pectoneal flap was then used for reconstruction. The microvascular tissue transfer method was useful for the treatment of osteoradionecrosis, but this method must be performed keeping in mind that a revised operation may be necessary.

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A Case of Dyskeratosis Congenita Complicated by Tongue Cancer

Akiko SADAMOTO, Masamits HYODO, Yasuyuki HINOHIRA, Eiji YUMOTO

1999 Volume 92 Issue 3 Pages 253-257
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.253

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Dyskeratosis congenita (DC) is a rare form of ectodermal dysplasia characterized by reticulated hyperpigmentation of the skin, leukoplakia of the mucosa, and dystrophic nails. Furthermore, malignant neoplasmas arising from the leukoplakia and bone marrow aplasia are critical complications. We reported a female case of DC with tongue cancer. She complained of leukoplakia of the tongue since the age of 6 years. She was diagnosed with DC when she was 20 years old based on typical findings of the skin and nails. Four years later, she returned to our clinic because of prolonged tongue pain, and tongue cancer (T3N1M0) was detected. Radiation was administered as an initial treatment, however, it was suspended due to development of severe radiation mucositis. Severe pancytopenia prohibited the choice of chemotherapy. We performed unilateral radical neck dissection and subtotal glossectomy followed by reconstruction of the tongue. Postoperative phonatory and swallowing functions were acceptable and she returned to work. However she subsequently died of recurrence due to contralateral neck lymph node and lung metastasis 8 months postoperatively. Surgical therapy seems to be beneficial in some patients suffering from DC complicated by malignancy, although careful management of the general condition is mandatory.

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Results of Treatment of Early Stage Tongue Cancer

Makito TANABE, Etsuo YAMAMOTO, Shogo SHINOHARA, Jun TSUJI, Yuki MUNETA ...

1999 Volume 92 Issue 3 Pages 259-262
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.259

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In our hospital, 29 cases of early stage tongue cancer (maximum tumor size < 3cm, NOMO) were treated between May 1987 and December 1997. Twenty two cases (T1; 20 cases, T2; 2 cases) were treated with radiotherapy (RT group), and 7 cases (T1; 4 cases, T2; 3 cases) with partial glossectomy (OP group). Radiotherapy was performed using external sources of radiation (2 Gy/day, total dose; 50-70 Gy, average; 65.3 Gy). The partial glossectomy was performed
with removal of the tumor including a safety margin of 10 to 15 mm. In the RT group, the tumors persisted locally after the radiotherapy in 6 cases and recurred locally in 9 cases. In the OP group, neither recurrent nor residual tumors were found in any of the cases. The tumors were controlled more effectively in the OP group than in the RT group (Fisher's exact probability test; P=0.05). There were however, no significant differences in the 5-year survival rate of the two groups of patients by the Kaplan-Meier's method: RT group (82.9%) and OP group (75.0%). From the perspective of local control, although the survival rate of the OP group was slightly lower, the partial glossectomy seems to be more effective treatment for early stage tongue cancer than external radiation.

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Lingual Thyroglossal Duct Cyst

Kaoru SHINOHARA, Koichi OMORI, Tomoko TSUJI, Kazuhiko SHOJI, Kimio HAS ...

1999 Volume 92 Issue 3 Pages 263-267
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.263

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A thyroglossal duct cyst usually occurs in the lingual location. We present a rare case of a lingual thyroglossal duct cyst. A nineteen-year old female visited our hospital complaining of discomfort sensation in the throat. A tumor at the base of the tongue which had pushed the epiglottis backward, was observed with a fiberscope. A preoperative CT scan and MRI revealed that the tumor was a cyst located along the midline of the tongue. A suprahyoid surgical approach was used and the cystic mass was completely removed along with a duct attaching the cyst to the mucosa at the base of the tongue. Histological examination proved that the cyst was a thyroglossal duct cyst. No sign of recurrence has been observed for one year after the operation.

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Pustulosis Palmaris et Plantaris and Tonsillar Focal Infection; A Report of Questionnaires to Dermatologists

Keiji FUJIHARA, Yoshikazu YAMAMOTO, Yasuhiro HAYASHI, Noboru YAMANAKA

1999 Volume 92 Issue 3 Pages 269-275
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.269

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It is widely accepted by otolaryngologists in Japan that the palatine tonsil is typically the site of focal infection in cases of pustulosis palmaris et plantaris (PPP). Numerous reports have indicated that about 80% of PPP cases are successfully treated by tonsillectomy. It is thus important to know how dermatologists treat PPP patients, especially in investigations of focal infection. Questionnaires were sent to 577 dermatologists in the Kinki district and 238 answers were analyzed. Dermatologists tended to treat PPP patients first with corticosteroid ointment and secondly with tonsillectomy. However the questionnaires revealed that tonsillectomy was performed on an average of 1.5 patients per year as treatment for PPP. Examination of focal infection, was carried out by about 70% of the dermatologists only in severe cases. Regarding the pathogenesis of PPP, 97% of the dermatologists agreed that PPP may be the result of tonsillar focal infection. However, almost all of them indicated that the percentage of patients in which the tonsil plays a role in the pathogenesis of PPP is less than 50%. The majority of dermatologists seem to feel that tonsillar focal infection plays a small part in the pathogenesis of PPP. On the basis of this study, it is stressed that we as otolaryngologists, should more clearly communicate the role of focal infections in dermatological disorders such as PPP and educate dermatologists regarding the very high curative rate of PPP by tonsillectomy.

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Postoperative Pain Control after Tonsillectomy

Tomoaki KAI, Ichiro MORITA, Nobuo Usui

1999 Volume 92 Issue 3 Pages 277-282
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.277

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The efficacy of cryotherapy for pharyngeal pain after tonsillectomy was studied.
The pain of 10 patients after tonsillectomy was controlled by the usual methods; i. e., neck icing, povidone iodine gargling, inhalation of aerosols containing antibiotics and corticosteroids, and administration of mefenamic acid syrup perorally (control group). In addition to these treatment methods, another 10 patients received shaved ice orally 30 minutes before each meal (ice group).
The pharyngeal pain of each patient was scored 5 times a day by the 10 cm analog scale and the 4 grades of classification. Scoring occurred at waking, 10, 14, 18, and 21 o' clock. The amount of food each patient could eat was also recorded.
The pain scores at waking were significantly reduced in the ice group on the 2nd and the 4th post-operative day (p < 0.05; Welch's t-test). The pain was the most severe at waking, diminished during the daytime, and was somewhat increased at night again in both groups (p < 0.05; one-way ANOVA). The patients in the ice group were advanced to more solid and more nutritive diets earlier than those in the control group.
We concluded that pharyngeal cryotherapy after tonsillectomy was useful for pain control after tonsillectomy, and the analog scale was suitable for continual recording of the pain levels of patients.

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Squamous Cell Carcinoma in Thyroid Papillary Carcinoma

Masayuki MINAMINO, Hiroyuk TSUJI, Akihiko Nakamura, Toshiya INOUE, Sum ...

1999 Volume 92 Issue 3 Pages 283-286
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.283

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We report the case of a 62-year-old man with a Squamous cell carcinoma of the thyroid gland which had invaded the hypopharynx. Primary squamous cell carcinoma of the thyroid gland is extremely rare. Its clinical course is very aggressive and the prognosis is poor. The patient underwent a radical resection of the thyroid, hypopharynx, larynx and resection of the trachea and esophagus was conducted concomitantly with bilateral neck dissection. Reconstruction of the terminal tracheostomy in the anterior mediastinum was created using a pectoralis major muscle flap.

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Delayed Auricular Composite Graft for the Reconstruction of Laryngotracheal Stenosis

Shigeru HIRNO, Kazuhiko SHOJI, Hisayoshi KOJIMA, Ken-ichi KANEKO, Ryo ...

1999 Volume 92 Issue 3 Pages 287-291
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.287

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Three cases of laryngotracheal stenosis were treated by a staged operation called the `trough method' in our hospital. After removing the stenotic tissues in the inner space, a trough was created. A composite auricular cartilaginous graft with overlying skin was used for the closure of the trough. First, the graft was embedded beneath the skin near the trough, with the skin graft facing the inner space of the trough. About 2 weeks later, the embedded grafts were slid over the trough. Using this procedure, the trough was closed and a firm framework could be reformed. This method has an advantage for the survival of the graft, and makes framework reconstruction safely.

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A Study of C-ANCA Negative Wegener's Granulomatosis

Hiroyuki FUJITA, Akira HAGIWARA, Taro YAMAGUCHI, Toshimasa TERADA, Mas ...

1999 Volume 92 Issue 3 Pages 293-298
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.293

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Wegener's granulomatosis is necrotic granulomatosis angitis frequently starting with otolaryngological symptoms. Diagnosis is established by histopathological examination of excised specimens. Recent studies demonstrated that C-ANCA, an anti-neutrophil cytoplasmic antibody serves as a supplemental diagnostic tool in the evaluation of the clinical activity of this disease. We treated two patients whose laboratory results were negative for C-ANCA and positive for P (MPO)-ANCA, a subset of ANCA. MPO-ANCA is a homologous antigen of P-ANCA which is said to show a high frequency of myeloperxydase reactivity in neutrophil cytoplasm a granules in microscopic polyarteritis (MPA) and necrotizing crescentic glomerulonephritis (NCGN) cases. In these cases, the fluctuation of these values served as a useful indicator in the evaluation of courses of treatment. The first patient was a 52-year-old female with bilateral exudative otitis media. The second patient was a 67-year-old female who complained of recurrent epistaxis and exudative otitis media as initial symptoms. The C-ANCA reactivity of these two patients was negative during the follow-up period. Their P (MPO)-ANCA levels decreased to levels within the normal range after treatment, although pretreatment levels were high. These findings suggest that P (MPO)-ANCA is an important autoantibody which can be used as a reliable indicator for the treatment of Wegener's granulomatosis.

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Clinical Efficacy of Cefzon® on Acute Otitis Media in Children

Kazunori OKAMOTO

1999 Volume 92 Issue 3 Pages 299-307
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.299

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Cefzon® (cefdinir, CFDN, Fujisawa Pharmaceutical Co., Ltd.) is an oral cephem antibiotic which was marketed in 1991. It has been confirmed that the clinical efficacy of cefdinir in the treatment of respiratory tract infections was 85.0% or more and the safety of cefdinir was high in the field of pediatrics. In this study the clinical efficacy of cefdinir in cases of acute otitis media was investigated in 47 pediatric patients aged 3 months to 11 years and 9 months. The clinical efficacy rate was 83.0% and the bacteriological eradication rate was 79.2% in all of these patients. The main pathogens isolated from these patients were Haemophilus influenzae (41.1%), Streptococcus pneumoniae (30.4%) and coagulase negative staphylococci (CNS) (12.5%). The eradication rates of these
pathogens were 82.6% (19/23 patients) for H. influenzae and 78.6% (11/14 patients) for S. pneumoniae. The efficacy rate of cefdinir in monomicrobial infections was 89.7% (26/29 patients) but the efficacy rate in polymicrobial infections was 64.3% (9/14 patients).
As adverse reactions, diarrhea was observed in 3 patients (6%) but disappeared in 1 patient 3 days after discontinuation of the drug and administration was continued in the remaining 2 patients.
The superior efficacy of cefdinir in treatment of acute otitis media was attributed to the high concentrations of cefdinir which exceeded MICs against H. influenzae or S. pneumoniae in tympanic mucosa.

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Clinical Evaluation of Mometasone Furoate Nasal Spray (1st Report)

-Dose Comparison Study in Japanese Cedar Pollenosis-

Satoshi OGINO, Morihiro IRIFUNE, Hiroe GOTO, Osamu SENBA, Teruhisa NOI ...

1999 Volume 92 Issue 3 Pages 309-324
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.309

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The clinical efficacy and safety of 200 μg/day (100μg b. i. d) of mometasone furoate nasal spray (MFNS) administered for 2 weeks was evaluated by comparison with a low dose of MFNS of 50μg/day (50μg o. d.) using the envelope-method in a total of 65 patients with Japanese cedar
pollenosis.
The pollen counts for Japanese cedar in 1995 were extremely high in the Kansai district. About 5, 000 counts/cmz was confirmed in and around Osaka.
In the analysis of final overall improvement, marked or moderate improvement was observed in 76.2% (16/21) and 20.8% (5/24) of patients receiving MFNS 200μg/day and 50μg/day, respectively. The difference in efficacy between the two dosage groups was confirmed independently of timing of the initiation of administration. In the analysis of overall safety, high safety was observed with both treatments. The above results suggest that 200μg/day of MFNS can be considered the recommended dose for the treatment of Japanese cedar pollenosis.

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Tuberciosis in the Field of Otorhinolaryngology

[in Japanese]

1999 Volume 92 Issue 3 Pages 326-327
Published: March 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.326

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Erratum to : Clinical Effects of Chronic Tonsillitis with IgA Nephropathy and Pustulosis Palmaris et Plantaris (PPP) Treated by Tonsillectomy

1999 Volume 92 Issue 3 Pages e1
Published: 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.3_e1

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