Practica Oto-Rhino-Laryngologica

Long-term Outcome following Sudden Deafness

Tsutomu NAKASHIMA

1999 Volume 92 Issue 9 Pages 919-924
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.919

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We examined the long-term outcome of patients with idiopathic sudden sensorineural hearing loss (sudden deafness), and its association with presbycusis. A questionnaire was sent to 428 patients who were examined at Nagoya University Hospital within 2 weeks of the onset of unilateral sudden deafness between 1976 and 1985. Information concerning the course of their hearing ability, tinnitus, and vertigo was requested. The patients were asked to return to the hospital for otological examination if possible. One hundred and ninety-three (59.4%) of the 325 cases who received the questionnaire responded, and 95 patients returned to the hospital for follow-up examinations after a mean of 12.3 years. If hearing recovered completely from sudden deafness, no deterioration of hearing was observed afterwards except presbycusis that appeared in the same way as that in the non-affected side. If hearing did not recover or recovered only partially, some cases showed deterioration of hearing for a long period. Patients with severe hearing loss in high-tone frequencies and Jerger type II findings on Bekesy audiometry tended to show decreased hearing over time. However, in some cases, no hearing deterioration was recognized in the affected side even though presbycusis appeared in the non-affected side. As a whole, the degree of hearing deterioration was not significantly different between the affected and non-affected side over the long term.

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Medial Meatal Fibrosis

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

1999 Volume 92 Issue 9 Pages 926-927
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.926

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Seven Cases of Idiopathic Sudden Deafness in Children

Ryuichi MOCHIZUKI, Katsumi DOI, Ayako SUGII, Hiroshi MUTA, Ken KITAMUR ...

1999 Volume 92 Issue 9 Pages 929-933
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.929

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Seven children (two boys and five girls) with idiopathic sudden deafness (SD) are reported. Juvenile SD accounts for 3.2% of 216 SD cases. Their ages ranged from 7 to 14 years (mean age 10.4 years). Children over 5 years of age were aware of the onset and complained of it. However, the diagnosis is sometimes so difficult that treatment in the very early stages is often not undertaken in such cases.
The average pre-treatment hearing level was 81.7dB, and four cases (57%) complained of vertigo. The severity of hearing loss as well as the incidence of vestibular symptoms in juvenile SD seemed to be higher than in adult SD cases. All cases were initially treated with steroid-infusion therapy. In three cases were defibrinogenation therapy followed. Hearing improvement in the seven cases was as follows: 2 cases showed complete recovery, 2 cases showed remarkable improvement, 1 case showed slight improvement, and 1 case showed no improvement.
Juvenile SD is rare but accounts for up to 5% of all SD cases. Proper and early diagnosis and the prompt start of appropriate treatment should be initiated to obtain excellent responses.

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Functional Hearing Loss; Report of Three Cases

Akinobu Kakigi, Taizo Takeda

1999 Volume 92 Issue 9 Pages 935-940
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.935

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Three cases of functional hearing loss were reported. Cases 1 and 2 were considered Meniere's disease and perilymphatic fistula, respectively. Audiological examinations were performed. Due to normal responses of otoacoustic emissions, functional hearing loss was suspected. In case 3, otoacoustic emission was performed to confirm the diagnosis.
Functional hearing loss was diagnosed by objective examinations such as auditory brainstem response (ABR). ABR is necessary to diagnose functional hearing loss. However, it cannot be performed as a first step screening test. In daily clinic practice, simple screening tests are useful to differentiate functional hearing loss. As simple and useful screening tests for functional hearing loss, we employed stapedial reflex, otoacoustic emission, testing the difference of the pure tone threshold between intermittent and continuous tone stimulation, and checking the cross hearing level.

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Sudden Hearing Impairment during Interferon Therapy; A Case Report

Norio KASAI, Kunihiro FUKUSHIMA, Yuichi TSURUSAKO, Ken-ichi SUGATA, Mi ...

1999 Volume 92 Issue 9 Pages 941-945
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.941

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A 43-year-old male was admitted to our clinic because of sudden hearing impairment in his left ear. The patient had received intravenous injection of interferon beta for the treatment of HCV hepatitis. On the second day of interferon administration, he complained of ear fullness and tinnitus in his left ear. Pure tone audiometry revealed up-sloping hearing impairment.
An initial high-dose steroid therapy was successful for recovery of hearing loss. Interferon alpha was then administered for HCV hepatitis and hearing loss worsened 10 weeks after secondary interferon therapy. The same steroid regimen was unsuccessful and severe hearing loss developed. Hyperbaric oxygen therapy was then conducted and was the only effective treatment for this progression. One week after the recovery, left hearing impairment thrice occurred and no treatment was effective.
Audiological side effects were reported in 40% of the patients who received interferon administration. The side effects were usually temporary and recovered soon after termination of interferon therapy. The present case revealed that hearing loss found during interferon therapy does not always show a fair prognosis. Further study on the audiological side effects during interferon therapy should be performed.

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Deafness in Patients with Mumps

Hideaki KOUZAKI, Mikio SUZUKI, Tsuyoshi KITANISHI, Hiroya KITANO, Yosh ...

1999 Volume 92 Issue 9 Pages 947-951
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.947

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We reported 10 patients with deafness due to mumps. The diagnosis was made according to the criteria for the diagnosis of mumps deafness determined by the Acute Profound Deafness Committee set up by the Ministry of Health and Welfare, Japan. We reviewed the clinical features and observed the following:
1) The mean age of the patients was 18.1 years. The mean time of the onset of hearing loss was 6.1 days after the appearance of parotid swelling. All 10 cases had unilateral total or profound sensorineural hearing loss. Seven cases complained of dizziness.
2) Nine cases were treated with steroid hormones, gamma globulin and vitamins. Hearing loss of eight cases did not improve, but one case recovered hearing in the low tone range. Dizziness disappeared in six cases, but in one case, dizziness persisted.
3) In one case, delayed endolymphatic hydrops of the ipsilateral type was found 10 months after the onset of hearing loss due to mumps.

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A Case of CHARGE Association

Kazuhiko TAKEUCHI, Sawako MASUDA, Hiromi TSURUOKA, Teruhiko HARADA, Ko ...

1999 Volume 92 Issue 9 Pages 953-957
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.953

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A 7-year-old girl with CHARGE association is reported. This patient exhibited coloboma, tetralogy of Fallot, retarded development, ear anomaly and deafness, which fulfiled the criteria of CHARGE association. Pure tone audiography showed bilateral moderate conductive hearing loss. CT of her temporal bone revealed normal cochlea and hypoplastic bilateral semicircular canals. She was unresponsive to cold water stimuli in the caloric test. As an ossicular chain anomaly was suspected, an exploratory operation was carried out on her right ear. The stapes lacked its anterior crus and footplate, which was considered to be the cause of her conductive hearing loss. This disease is not rare and otorhinolaryngologists should consider this condition when examining young patients with deafness and ear anomalies.

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Clinical Evaluation of Pre-seasonal Cot Laser Vaporization for a Patient with Japanese Cedar Pollinosis

Shigeki KAWAMURA, Hiroki IKEDA, Mikiya ASAKO, Masahiko IZUMIKAWA, Nobu ...

1999 Volume 92 Issue 9 Pages 959-966
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.959

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Clinical evaluation of pre-seasonal Cot laser surgery was performed to compare pre-seasonal and seasonal administration of the antiallergic drug, Tranilast, for patients with Japanese cedar pollinosis during the cedar pollen season in 1996. Sixteen cases (the laser group) received Cot laser surgery 2-3 months before the pollen began to scatter. Seventeen cases (the Tranilast group) received Tranilast, at least 2-4 weeks before and during the scattering. In the laser group, nasal symptoms were suppressed more effectively than those of the Tranilast group throughout the pollen season. In the laser group, the rate of effectiveness was as high as 70% in patients with sneezing attacks, 56% in patients with rhinorrhea and 82% in patients with nasal obstruction, whereas the rates were 60%, 50% and 67% respectively in the Tranilast group. Comparison of the two groups for seasonal variations of cedar specific IgE antibody, the amount of plasma histamine, the number of eosinophils in the nasal smear and the response to the nasal provocation test, suggested that the allergic reaction in the inferior turbinate was inhibited by the laser surgery. Based on these results, we conclude that laser surgery was useful for the prophylactic treatment of Japanese cedar pollinosis.

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Olfactory Dysfunction following Occupational Head Trauma

Teruhiro Ogawa, Mitsuhiro Okano, Akira Doi, Shigenobu Nomiya, Yu Masud ...

1999 Volume 92 Issue 9 Pages 967-973
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.967

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Olfactory dysfunction following head trauma has been widely reported, but the risk factors regarding its development have not been fully elucidated. Therefore, 365 head injury patients, who were examined by the senior author (JAR) in Canada between 1993 and 1997, were assessed to determine the incidence of posttraumatic olfactory dysfunction and its association with the severity of head injury and the mechanism of injury in the same cohort group.
Olfactory dysfunction was identified in 13.7% (9.3% with anosmia, 4.4% with hyposmia). It occurred more often in cases of loss of consciousness >1hr (p=0.0005), severe head injuries (grade I vs III: p=0.000001) (grade I vs V; p<0.00001) and skull fractures (p=0.0001). The direction of the blow applied to the skull did not influence its presence although radiologically confirmed skull fractures in the frontal, occipital, skull base and midface were more likely than temporal and parietal fractures to result in an olfactory change (p<0.01).
Moreover by multivariate analysis, hypogeusia, nasal bone fracture, occipital bone fracture, skull base fracture, and positive rhinoscopic findings were found to be the most valuable or most closely related factors/conditions in that order among 46 factors that were initially presumed to cause posttraumatic smell disorder.

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Blowout Fracture of the Medial Orbital Wall with Endonasal Endoscopic Reconstruction

Hiroshi AZUMA, Masashi KAKIUCHI, Nanako TAMURA, Hidekazu YAMAMOTO

1999 Volume 92 Issue 9 Pages 975-980
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.975

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Blowout fracture of the orbital floor is common, but that of the medial orbital wall is less frequent.
As the use of computed tomography (CT) increased the diagnosis of blowout fracture of the medial orbital wall also increased. Diagnoses of blowout fractures of the medial orbital wall are presentry not uncommon.
Endonasal endoscopic reconstruction was performed in 5 cases of blowout fracture of the medial orbital wall under local anesthesia. The fractured bones and the pathological changes of the ethmoid sinus were removed.
The silicone plate, placed in the periosteum of the orbit, filled the orbital defect.
Results after endonasal endoscopic reconstruction in all cases were good.

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Wegener's Granulomatosis Presenting as an Orbital Pseudotumor; A Case Report

Kazumasa WATANABE, Yasuaki HARABUCHI, Jun-ichi WAKASHIMA, Tadataka ISH ...

1999 Volume 92 Issue 9 Pages 981-985
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.981

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A 44-year-old male who complained of left eye pain and double vision consulted our outpatient clinic in July 1996. He was diagnosed as having left orbital pseudotumor 3 years previously. Although steroids and radiotherapy were administered, his ocular symptoms did not remit.
A tumorous mass with crust was found in his left nasal cavity. CT findings showed a tumorous legion occupying his left orbita and ethmoid sinus. Microscopic examination of the biopsy specimen from his nasal cavity suggested Wegener's granulomatosis. Cyclophosphamide and prednisolone were administered. The tumor in the nasal cavity and ethmoid sinus shrank and he was discharged in December. Right parapharyngeal mass which was suspected to be recurrence of Wegener's granulomatosis was detected in January 1997. Following re-treatment with cyclophosphamide and prednisolone, a second remission was induced.

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G-CSF Producing Maxillary Sinus Cancer ; A Case Report

Takeharu KANAZAWA, Hiroshi NISHINO, Kazuhiro ISHIKAWA, Mamoru MIYATA, ...

1999 Volume 92 Issue 9 Pages 987-992
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.987

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A 64-year-old man with well-differentiated squamous cell carcinoma of the maxilla who presented with high levels of granulocyte-colony stimulating factor (G-CSF) is described. The extent of the tumor was staged as T4N1M0. Regional chemotherapy, radiotherapy and resection of the tumor were performed. The patient died of local recurrence and lung metastasis about four months after admission. During his clinical course, a peripheral blood analysis demonstrated marked granulocytosis and high G-CSF activity. G-CSF producing cancer cells were immunohistologically observed in the primary lesion and metastatic lymph nodes. Therefore, he was diagnosed with G-CSF producing maxillary cancer. The cancer tissue from this patient was transplanted into nude mice, and one of these mice demonstrated distant metastasis to the lung.

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Histopathological Findings and MRI in Salivary Gland Tumors

Takeshi KUSUNOKI, Kiyotaka MURATA

1999 Volume 92 Issue 9 Pages 993-997
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.993

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We studied the correlation between postoperative histological findings and signal intensities of preoperative magnetic resonance (MR) imaging in parotid tumors and submandibular gland tumors. Most cancer cases showed low signal intensities on T1 weighted MRI and an enhanced effect regardless of differentiated grades. However, our results showed that low signal intensities on T2 weighted MRI indicated low and moderately differentiated cancers, and reversely high signal intensities on T2 indicated highly differentiated cancers. These findings may be useful to plan surgical methods and to predict the prognosis.

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A Salivary Duct Carcinoma Arising from the Stensen's Duct; A Case Report

Shin-ichiro KITAJIRI, Keisaku TABUCHI, Takeshi MORITA, Harukazu HIRAUM ...

1999 Volume 92 Issue 9 Pages 999-1002
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.999

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A rare case of salivary duct carcinoma originating from the Stensen's duct is presented. The patient is a 73 year-old male who visited the otolaryngology outpatient clinic complaining of a mass in his left cheek as well as submandibular lymph node swelling. The mass in the cheek was located dorsal to the orifice of Stensen's duct. CT scan showed a solid mass anterior to the left masseter muscle as well as enlarged submandibular lymph nodes. There was no lesion in the parotid gland. Fine needle aspiration biopsy of the lymph node revealed malignant cells. The mass in the cheek was resected leaving the parotid gland, and lymph node dissection of the left neck was also carried out. Following histopathological examination, a salivary duct carcinoma was diagnosed. Postoperative radiation and chemotherapy were performed and the patient has been free of tumor for 15 months after the surgery.

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Spindle Cell Hemangioendothelioma of the Submandibular Region

Kazuma SUGAHARA, Yuji IMATE, Shiro ENDO, Kenji OKAMI, Masahiro Takahas ...

1999 Volume 92 Issue 9 Pages 1003-1006
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.1003

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A rare case of spindle cell hemangioendothelioma (SCH) was reported. The patient was a 62-year-old female, whose chief complaint was a soft nodule on the left submandibular region. She was treated by surgical excision. Pathological diagnosis was SCH. There has been no sign of recurrence to date. This is the first case of SCH at the submandibular region.

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Eight Cases of Malignant Melanoma of the Head and Neck

Rieko GOTO, Hiroshi HOSHIKAWA, Nozomu MORI

1999 Volume 92 Issue 9 Pages 1007-1011
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.1007

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Eight patients with malignant melanoma of the head and neck were treated in our department between 1983 and 1998. Their ages ranged from 49 to 84 years, with a mean age of 65. One case showed the amelanotic type histologically. These cases were classified according to the criteria of the National Institute of Health. Five and 3 cases were stage I and stage III, respectively. All cases were treated by combination therapy consisting of surgery, radiation, chemotherapy, immunotherapy and hormonal therapy. Four cases survived for 2 years and 2 cases more than 5 years.

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Pericutaneous Endoscopic Gastrostomy for Patients with Head and Neck Tumors

Hiroshi TSUBOTA, Yoshihiro KONDO, Hideaki KITA, Kazumasa WATANABE, Mas ...

1999 Volume 92 Issue 9 Pages 1013-1018
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.1013

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Pericutaneous endoscopic gastrostomy (PEG) was initially introduced in 1980, and has been applied to feed patients with cerebrovascular diseases.
Head and neck tumors and operations for such diseases often cause swallowing problems. Gastric tube insertion has been the most common method to resolve such conditions. However, several disadvantages such as necessity of frequent exchange of the tube, and gastroesophageal refiux have been reported. Intravenous hyper-alimentation is also a common strategy to feed patients. However, infections sometimes occur.
We report here, our findings using PEG for patients with head and neck tumors pre- or postoperatively. We recommend PEG as a useful method to provide good nutrition to patients with swallowing disturbance.

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Internal Jugular Vein Thrombosis Caused by Endoscopy; A Case Report

Maki YOKOYAMA, Kazuhiro HASHIGUCCI, Noriyuki HOYA

1999 Volume 92 Issue 9 Pages 1019-1023
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.1019

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A 71-year-old male with diabetes underwent endoscopy to examine the cause of iron deficiency anemia in the department of internal medicine at our hospital. He had difficulty swallowing the endoscope due to pharyngeal reflex, but succeeded it after several insertions. A few days after the examination, nausea, anorexia, and submaxillary pain developed, however, he did not return to the hospital or receive any medical treatment. He returned to our hospital 25 days after the endoscopy, complaining of ingestion difficulty with a tender swelling in the left side of the neck. Increased leukocytes showed a marked inflammatory response. The patient was therefore admitted with suspected acute infectious disease. We detected Streptococcus intermedius by venous blood sampling, and diagnosed left internal jugular vein thrombosis after plain CT and ultrasound imaging. Since the neck swelling and tenderness improved following intravenous administration of antibiotics, he was discharged after 24 days of medication. Follow-up examination by MRI and ultrasonography, no revealed blood flow in the left internal jugular vein. It was considered that the thrombus in the vein had already been organized. We concluded that injury of the hypopharynx by endoscopy may cause internal jugular vein thrombosis.

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Treatment after Endoscopic Endonasal Sinus Surgery

[in Japanese]

1999 Volume 92 Issue 9 Pages 1024-1025
Published: September 01, 1999
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.92.1024

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