Practica Oto-Rhino-Laryngologica

Dipole Tracing and Functional MRI of Acoustically Evoked Events in the Brain

Ginichiro ICHIKAWA

1999 Volume 92 Issue 7 Pages 693-703
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.693

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The modality of neural activity in the brain is one of the most fascinating areas of neurological study. Current methodlogy for studying neural activity is imaging of brain function. Application of PET and MEG are most commonly used to estimate brain function. Dipole tracing and functional MRI (fMRI) are also potential tools for the evaluation of brain mechanism. Potentials generated by neuronal structure in the brain may be represented as current dipoles. Dipole estimation is based upon volume conduction which represents the physical spread of current. fMRI is widely applied for the research of the f orcus of epilepsy, somatosensory and visual evoked potentials. However, it is not easy to estimate the electrophysiological events arises from the auditory pathway, using dipole tracing and fMRI.
we have been attempting to use dipole tracing to study acoustically evoked potentials. Head models calculated from MRI of each subject were used to determine dipole location. We applied 1-dipole model or 2-dipole model. The current dipole of wave V of ABR is located at the contralateral mid-brain to the acoustic stimuli. Accordingly, the Pa component of MLR is 5mm-1Omm deep to the bilateral temporal lobe, with large individual variation. The N1 component of SVR is located in the bilateral temporal lobes and the midline cerebral structure. The P2 component of SVR is located in the contra or ipsilateral temporal lobe and along the midline of the cerebrum. The N2 component of SVR is situated in the frontal lobe, ipsi or contralateral temporal lobe and along the midline of the cerebrum.
Dipoles of “late components” showed several kinds of variation which suggested that they have more than 3-dipoles and these variations were caused by attention, habituation, awareness and other kinds of non-specific stimuli.
The modality of fMRI produced in response to pure tone or word stimuli tended to show signal enhancement at the superior/transverse gyrus, ipsi and/or contralateral to the stimulus.
Estimated dipoles and the modality of fMRI of acoustically evoked phenomena in the brain seemed to locate fairly near to the brain structures which have been reported to be the generators of certain components of AEPs, based on animal experiments and clinical data.
Imaging techniques such as dipole tracing and fMRI may represent alternative approaches to the study of intermediate auditory events and language function, together with PET and MEG.

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Use of Bone Pate in Cochlear Implant Surgery

[in Japanese], [in Japanese]

1999 Volume 92 Issue 7 Pages 704-705
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.704

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Basilar Migraine of Childhood; A Case Report

Koichiro KANAYA, Kazuko FUKUI, Yoshihiko OKINAKA, Yuji IMATE, Hiroshi ...

1999 Volume 92 Issue 7 Pages 707-712
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.707

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Many reports of migraine-associated vertigo from Western countries can be found in the literature. However, this condition is rarely reported in Japan, probably because of the lower incidence of migraines in comparison to the West. We report here the case of a ten year-old boy who had experienced recurring attacks of vertigo with severe headaches for seven years. There were no obvious neurological symptoms or aural symptoms. Sensorineural hearing loss and canal paresis of the left ear were revealed by pure tone audiometry and caloric testing. Auditory brainstem response testing demonstrated an elongation of the I -V interpeak latency on the left, although his electrocochleogram was normal. Brain MRI, MR angiography and temporal bone high resolution CT scanning all revealed no organic lesions. His EEG was also normal. Placebo, Tofisopam and Carbamazepine were administered successively to rule out psychogenic vertigo and epilepsy, respectively, but were not effective. In contrast, Adenosine Triphosphate Disodium was somewhat effective, and Dihydroergotamine Mesylate was remarkably effective. We concluded that the vertigo was probably due to a basilar migraine, with frequent vertebrobasilar ischemia during the migraine attack, which caused the left inner ear and eighth cranial nerve lesions.

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A Case of Monostotic Fibrous Dysplasia of the Temporal Bone

Tsugio ABE, Masashi SUZUKI, Tomoyo UEYAMA, Goro MOGI, Keisuke INA

1999 Volume 92 Issue 7 Pages 713-719
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.713

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A case of monostotic fibrous dysplasia of the temporal bone is reported. The patient was a 67-year-old woman, who complained of tinnitus in the right ear. Fibrous dysplasia of the left temporal bone was suspected on the basis of plain skull roentgenogram, CT scan, MRI and bonescintigraphy findings. A biopsy of the left temporal bone lesion was performed because of differential diagnoses. Histopathological examination confirmed the diagnosis of fibrous dysplasia, which is characterized by proliferation of fibrous tissue and scattered trabeculae of immature bone. Fibrous dysplasia is usually found in the long bones, and is rare in the head and neck areas. Among possible sites for the disease, monostotic fibrous dysplasia of the temporal bone is so rare that only 77 cases have been reported in the world. Ultrastructural findings in this lesion were obtained by electron microscopy. In this paper, the characteristics of this disease are discussed.

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Retrospective Study of Epistaxis

Shinnya TAKANO, Kanako UCHIMURA, Kouji SHIGI, Nobuaki Tanaka, Sei KITA ...

1999 Volume 92 Issue 7 Pages 721-724
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.721

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We examined 718 epistaxis cases who visited or were hospitalized in the Tokyo Women's Medical University Daini Hospital.
1) Many of the epistaxis cases were men, and a relation to arteriosclerosis was strongly suggested.
2) A relation to changes in the diastolic pressure was strongly suggested by the number of epistaxis patients with hypertension.
3) The bleeding area, excluding the Kiesselbach area, increased with aging.

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A Case in the Status of Pre-DIC with Intracranial Complications Caused by Paranasal Sinusitis

Suguru MATSUMOTO, Koshiro Nakamura, Hironobu KUROKAWA, Takashi KIKUCHI

1999 Volume 92 Issue 7 Pages 725-731
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.725

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A case with intracranial complications caused by paranasal sinusitis, who was also diagnosed with pre-Disseminated Intravascular Coagulation syndrome (pre-DIC). A 21-year-old male had complained of headache, high grade fever, general convulsions and consciousness disturbances. At the first examination his left superior eye lid and cheek were slightly swollen. The emergent CT revealed diffuse soft tissue density in the left ethmoidal, maxillary and sphenoidal sinuses and a low density area in the left frontal lobe. Laboratory examination of blood showed white blood cells increased, platelets decreased and fibrin degenerated products increased. These data suggested a status of pre-DIC. Moreover, analysis of cerebro-spinal fluid suggested bacterial meningitis. In order to control of sinusitis as the primary lesion, endoscopic sinus surgery was performed immediately. Not only intensive chemotherapy but also precise suction removal of the purulent secretion in the sphenoidal sinus under endoscopy were effective for control of inflammation. Nevertheless, the patient's consciousness level and left hemiplegia worsened and a head-CT revealed a subdural abscess. Neurosurgical drainage was successful and the patient returned to normal. Ten weeks after surgery the patient was discharged with no functional disorder. The following examination revealed no trouble in the paranasal sinuses. This case confirmed the usefulness of endoscopic sinus surgery for the treatment of paranasal lesions and the importance of follow-up in cases of intracranial complications.

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Unilateral Oculomotor Nerve Palsy; A Presenting Sign of Sphenoid Sinus Mucocele

Akihiro KATAYAMA, Akihito WATANABE

1999 Volume 92 Issue 7 Pages 733-737
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.733

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A 72-year-old woman developed left-side ptosis and diplopia. Opthalmological examination showed left-side ptosis, disturbance of ocular movement in the upward and medial direction on the left side, upward diplopia and right-side gaze. These symptoms were exclusively due to left oculomotor nerve palsy. CT and MRI revealed that smooth-margined lesions in the left sphenoid sinus expanding laterally and compressing the left cavernous sinus. The patient was diagnosed with sphenoid sinus mucocele and underwent endonasal endoscopic surgery under general anesthesia. The sphenoid sinus mucocele was marsupialized widely via a trans-ethmoidal approach. White pus was observed in the lesion. About 4 months later, all symptoms had completely disappeared.

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Small Cell Carcinoma of the Parotid Gland; A Case Report

Takashi GOTOH, Yoshifumi Kobayashi, Satoshi NONAKA

1999 Volume 92 Issue 7 Pages 739-742
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.739

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This is the case report of a rare, small cell carcinoma of the salivary gland. The patient was a 77 year-old female presenting with a swollen left neck. A sialo-CT scan demonstrated a mass occupying the left parotid gland. A biopsy specimen of the cervical lymp nodes was indicative of a small cell carcinoma on normal histological studies. Immunohistochemical studies of the specimen confirmed the diagnosis of a small cell neuroendocrine carcinoma. The clinical features of small cell carcinoma of the parotid gland are discussed in some detail.

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Treatment of 34 Patients with Tongue Cancer

Tetsuya MURAKAWA, Manabu NAKANOBOH, Tsuyoshi MATSUNAGA, Satoshi KITAHA ...

1999 Volume 92 Issue 7 Pages 743-748
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.743

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Surgery, chemotherapy, and radiotherapy are performed in most cases of tongue cancer, and the teatment outcome has recently improved.
We clinically examined 34 cases of tongue cancer that received primary care in the department of Otolaryngology, National Defense Medical College between May 1989 and April 1997.
The subjects consisted of 23 males and 11 females.
In most cases of stage I and II, partial glossectomy with laser therapy was performed following pre-operative chemotherapy. In cases of stage III and IV, after pre-operative chemotherapy, dilatation radical operation, neck dissection and reconstructive operation were performed. Prophylactic neck dissection or postoperative radiation was performed in some cases to prevent collum palindromia.
The accumulated 5-year survival rate by the Kaplan-Meier method was 77.8% in stage I, 60.6% in stage II, 58.1% in stage III, 0% in stage 1V, and 54.7% overall.
Death due to tongue cancer occurred in 8 cases, as follows : local recurrence in 2 cases, collum palindromia in 6 cases, distant metastasis in 2 cases.
Treatment of the neck should be further examined as a factor that may lead to improvement of the outcome of this disease.

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Oral Appliance for the Treatment of Snoring and Obstructive Sleep Apnea

Yukiko TAKAKUWA, Takeshi MORITA, Kyosuke KURATA, Nobuya FUJIKI, Kazuya ...

1999 Volume 92 Issue 7 Pages 749-754
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.749

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We evaluated the efficacy of an oral appliance (OA) for the treatment of snoring and obstructive sleep apnea (OSA) syndrome in 19 adult patients. Ten of 19 patients were assessed by a nocturnal apnomonitor before and after the treatment. The snoring improved in 17 of 19 patients (89.5%).
The oxygen desaturation index (ODI) was reduced to below 10 in 7 of 10 patients (70%). OA therapy is more effective in patients with mild or moderate OSA than in patients with severe OSA. These results indicate that OA therapy is useful not only for snoring but also for OSA.

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Clinical Outcome of Therapy for Squamous Cell Carcinoma of the Oropharynx; A Retrospective Study of 50 Cases

Norihiko MURAI, Shogo SHINOHARA, Etsuo YAMAMOTO, Jun TSUJI, Yuki MUNET ...

1999 Volume 92 Issue 7 Pages 755-761
Published: July 01, 1999
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.92.755

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We retrospectively reviewed 50 cases of squamous cell carcinoma of the oropharynx treated at the Department of Otolaryngology, Kobe City General Hospital, between 1987 and 1996. Twenty eight cases underwent radical radiotherapy, and the remaining twenty two were treated mainly by surgery with or without radiotherapy.
Multivariate analysis demonstrated that the N stage classification was the only significant parameter affecting the survival rate among the four co-parameters: T stage, N stage, histological differentiation and location of the primary lesion. In the well-differentiated group, the survival rate of the surgically-treated cases was significantly higher than that of cases treated with radical radiotherapy. We conclude that radical radiotherapy is less useful in cases of a high N stage (≥N2a) and in well differentiated types of squamous cell carcinomas.

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Two Cases of Foreign Body Ingestion that Required an Extracervical Incision

Chisato TOMODA, Hideyuki KATAOKA, Mikio SUZUKI, Yoshiro YAZAWA, Kazuto ...

1999 Volume 92 Issue 7 Pages 763-768
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.763

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We report two cases of pharyngeal foreign bodies that necessitated extracervical incision. The first case involved a 59-year-old woman who experienced a foreign body sensation in her throat after ingesting fish. No foreign body was found by esophagoscopic nor laryngoscopic examination. A CT scan however, showed a fish bone located near the thyroid cartilage. The second case occurred in a 71-year-old man who had a hernia of the nucleus pulposus in his neck. A foreign body, which was believed to be a wire, was found on the CT scan prior to the hernia operation. The wire was emdeded in the retropharyngeal space. An extracervical incision was required in both cases to access areas that were not visible during laryngoscopic examination. These cases highlight the importance of performing a CT scan even if no foreign bodies are found during laryngoscopic examination.

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A Case of Leiomyoma in the Posterior Neck

Kousei Takeda

1999 Volume 92 Issue 7 Pages 769-772
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.769

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Leiomyoma is a benign tumor of smooth muscle origin that is most commonly found in the uterus, gastrointestinal tract, and skin. It is rarely found in the head and neck area, especially in the skeletal muscles of the neck. A 21-year-old man complained of a painless mass on the right side of the posterior neck for one month. The tumor was removed surgically, and histopathological examination revealed a vascular leiomyoma. The postoperative course was uneventful, and no sign of recurrence has been noted 6 months after the operation.

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The Case of a Carcinoma Arising from a Thyroglossal Duct Remnant with a Thyroid Papillary Carcinoma

Kazuhiro YAMAMOTO, Tomoyuki HAJI, Akiko Tanaka

1999 Volume 92 Issue 7 Pages 773-777
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.773

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Carcinomas arising from a thyroglossal duct remnant are relatively rare. A 55 year-old woman visited our hospital complaining of a mass in her neck. CT scanning revealed a tumor which occupied the pre-epiglottic space behind the hyoid bone. She had undergone a total thyroidectomy and bilateral neck dissection two years ago at another hospital. The histopathologic diagnosis of the thyroid tumor was a papillary carcinoma. The mass consisted of a cystic lesion with calcification. Fine needle aspiration biopsy of the mass did not reveal any malignant cells. Her serum thyroglobulin levels had decreased from 190 ng/ml to 13.3 ng/ml after the thyroid operation, but increased again to 36.6 ng/ml when she visited our hospital. The mass was surgically resected by Sistrunk's procedure. The histopathologic diagnosis was a papillary carcinoma with normal thyroid tissue arising from a thyroglossal duct remnant. Her serum thyroglobulin levels decreased below 5 ng/ml after the surgery.

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Papillary Thyroid Microcarcinomas Revealed by Cervical Metastases

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

1999 Volume 92 Issue 7 Pages 779-783
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.779

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Papillary microcarcinomas (PMCs) which are 1.0cm or less in diameter are a specific subgroup of thyroid cancer. As the prevalence of these tumors found in autopsy cases was reported to be 10 to 28.4% in Japan, the necessity of surgical treatment of PMCs has been questioned. However, PMCs are often found in conjunction with advanced metastases in cervical lymph nodes, lung, etc..
We reviewed eight cases with PMCs revealed by the presence of cervical metastases over the past 10 years. Five cases were revealed by manifest cervical lymph node metastases. Two of the other three cases were operated on for treatment of metastatic lesions subsequent to other diagnoses, notably a parotid tumor and lateral cervical cyst. The PMCs were revealed in a postoperative histological study of these two cases. The remaining case was discovered incidentally during neck dissection for laryngeal cancer. Preoperative ultrasonography was undertaken in seven cases. Two cases showed multif ocal small high echoic spots without tumors and one case showed no abnormal findings in the thyroid.
In all cases, total thyroidectomy, unilateral or bilateral neck dissection and postoperative radioiodine scintigraphy were performed. Multifocal tumors in the thyroid were proven histologically in four cases. In one case, the primary lesion was not found even in a postoperative histological study.
In accordance with these observations, PMCs revealed by cervical metastases shoul be treated as advanced thyroid carcinomas.

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A Case of Hereditary Angioneurotic Edema (HANE)

Kenjiro Tanaka, Kentaro OCHI, Masao MITSUI, Isao KATO

1999 Volume 92 Issue 7 Pages 785-788
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.785

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We report a case of hereditary angioneurotic edema (HANE) which appeared in the tongue and larynx. The patient was a 56-year-old woman. Her chief complaint was dyspnea and swelling of the tongue. Since the patient did not respond well to medical treatments including steroids, tranexamic acid and antihistamine, a tracheostomy was performed to maintain her airway. Examination revealed reduction of the forth complement component (C4) and low activity of the inhibitor of the first complement component (C1 inhibitor). We subsequently iagnosed hereditary angioneurotic edema. It was reported that airway problems are common in cases of HANE. In fact a tracheostomy was required to maintain airway patency in our patient. It is difficult to diagnose HANE at the time of the first attack, however, careful examination of family history and previous medical records are potentially helpful. It is necessary to bear in mind that some angioneurotic patients require a tracheostomy to maintain airway patency especially in cases of HANE.

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Measurement of Glottal Flow Efficiency

-Using a Siren-type Laryngeal Model-

Masanao OHKAWA, Nobuhiko ISSHIKI

1999 Volume 92 Issue 7 Pages 789-800
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.789

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The glottal flow efficiency (GFE, AC/DC %) was measured through the use of a siren-type laryngeal model, which was capable of reproducing the voice exactly in terms of DC flow, intensity and pitch.
With the use of two kinds of revolving round discs, this model can simulate two different patterns representative of both normal and breathy phonations.
The measured AC/DC was close to the theoretical AC/DC calculated from the glottal area function, and thus this model can predict the approximate glottal area function and the degree of glottal closure incompetence. The average GFE was 65% for the normal pattern and 28% for the glottal insufficiency pattern.
A critical GFE value set at 50% permitted the differentiation of perfect versus imperfect closures of the glottis during phonation, and there was no overlap in these GFE values.
However, if the flow rate for phonation (DC) was unusually low as compared to the values obtained for normal or clinical cases, then the measured AC/DC value was lower than the value derived from the glottal area, and may not reflect glottal area function.

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Effects of Polaprezinc in the Treatment of Taste Disturbance

Akihiro IKUI, Minoru IKEDA, Takuma YOSHIKAWA, Itsuhiro KUDO, Keiko ONO ...

1999 Volume 92 Issue 7 Pages 801-804
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.801

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Polaprezinc is an anti-ulcerative drug that contains zinc. We used this drug for the treatment of 41 taste disorder patients (21 to 76 years). The rates of improvement were 80.0% in drug-induced, 100.0% in zinc deficient, and 62.5% in idiopathic taste disorders. The overall rate of improvement in all patients was 73.2% (30 cases). These results revealed that polaprezinc is useful for taste disorder patients lacking zinc.

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Reconstruction with Calvarial Bone Flap in Head and Neck

[in Japanese], [in Japanese]

1999 Volume 92 Issue 7 Pages 806-807
Published: July 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.806

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