Practica Oto-Rhino-Laryngologica

Clinical Features of Direction-Changing Positional Nystagmus

Mamoru SUZUKI

2000 Volume 93 Issue 3 Pages 177-183
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.177

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There are two major types of direction-changing positional nystagmus, namely, apogeotropic and geotropic nystagmus. Both peripheral and central lesions are involved in these two types of nystagmus. Peripheral lesions include various types of disorders such as Meniere's disease, sudden deafness, vestibular neuritis, and BPPV. In our series, there were 30 peripheral, 8 central, and 8 unknown lesions. On occasion, nystagmus is so intense that a surgical procedure is indicated. The present case is a 63-year-old woman who had a disabling positional vertigo for a period of 4 months. She showed intense direction-changing apogeotropic nystagmus. Conservative treatments failed to resolve her vertigo. From the findings of the nystagmus, cupulolithiasis of the right lateral semicircular canal was suspected. Plugging of the lateral canal was performed, which successfully eliminated the nystagmus and positional vertigo. Positional vertigo can sometimes be disabling and unresponsive to conservative therapy. Careful analysis of the nystagmus may allow selection of an appropriate treatment.

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Giant Parotid Tumor

[in Japanese], [in Japanese]

2000 Volume 93 Issue 3 Pages 184-185
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.184

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Aberrant Internal Carotid Artery; A Case Report

Toshihide ATAGO, Masashi IMANAKA, Yuzo YAMAMOTO, Hiroshi TAKENAKA

2000 Volume 93 Issue 3 Pages 187-190
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.187

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We report a rare case of an aberrant internal carotid artery running in the tympanic cavity. The patient was a 5-year-old girl with otitis media exudativa. During a myringotomy of the left ear, a profuse aural hemorrhage occurred. The bleeding was stopped by packing tightly with tampons. A CTscan revealed an aberrant internal carotid artery in the tympanic cavity. To avoid a faulty myringotomy, recognition of this entity is essential, and careful observation preoperatively under a microscope is required.

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Traumatic Dislocation of the Stapes

A Case Report

Hiromi NAGATA, Kazuo FUNABIKI, Seishi HASEBE, Haruo Takahashi

2000 Volume 93 Issue 3 Pages 191-194
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.191

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We report a case of traumatic dislocation of the stapes without disruption of the ossicular chain.
An 8-year-old boy visited our clinic because of left-sided hearing impairment. Pure tone audiography showed average conductive hearing loss of 50dB. Stapedial dislocation was suspected by temporal bone CT. Exploratory tympanotomy revealed that the stapes was dislocated inf eriorly with its footplate fused with the bony promontory wall. Both malleo-incudal and incudo-Stapedial joints were intact. The oval window was closed with thin scar tissue being covered by intact mucosa. When the superstructure of the stapes was removed and the overlying tissue of the oval window was incised, outflow of perilymph was observed. With the placement of a 4.5mm-long teflon wire piston, his hearing improved to 13dB on average, without particular complications. Although the history of head trauma he experienced was not severe enough to explain the dislocation of the stapes, a mechanical cause was more likely in this case than a congenital anomaly because there were no anomalies in his middle ear or any other parts of his body.

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Melkersson-Rosenthal Syndrome

A Case Report

Norihiko MURAI, Yosaku SHIOMI, Yoshiko SHIOMI, Kensaku HASEGAWA, Eiken ...

2000 Volume 93 Issue 3 Pages 195-199
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.195

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We report a case of Melkersson-Rosenthal syndrome. The case involved an eight-year-old girl. She had experienced left facial paralysis and its spontaneous regression two years before she first came to our clinic with left recurrent facial paralysis and lower lip swelling. Evoked electromyography revealed that the ratio between left and right was 5%. Recovery of facial nerve function was observed after administration of a steroid. Six months later, right facial paralysis occurred, but it disappeared after steroid therapy. Three years after her first visit, right facial paralysis recurred. Because lingua plicata was also exhibited, the diagnosis of Melkersson-Rosenthal syndrome was confirmed. Complete recovery from right facial paralysis was observed after steroid therapy. Although her mother had a history of sarcoidosis, the patient's chest roentgenography, serum angiotensin converting enzyme level, and ophthalmological evaluation for uveitis revealed no signs of sarcoidosis.

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Post-Traumatic Cholesteatoma of the External Auditory Meatus; Two Case Reports

Tsuyoshi KITANISHI, Yoshiro YAZAWA, Norikuni KASUYA, Masakazu HANAMITS ...

2000 Volume 93 Issue 3 Pages 201-205
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.201

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Two patients with post-traumatic cholesteatoma of the external auditory meatus are reported. The first patient (3-year-old male) was involved in a motor vehicle accident, and stenosis of the right external auditory meatus 10 months after injury was noted. The meatus, filled with a cholesteatoma cyst, was stenotic. A CT scan revealed a fracture of the bony canal and a soft tissue mass at the posterior part of the external auditory canal. During the operation, a cholesteatoma cyst in a well defined cholesteatoma sac was found medial to the stenosis of the ear canal, while the tympanic membrane was intact. The second patient (22-year-old female) showed left hearing impairment 6 months after a head injury. In this patient, the external auditory meatus was also stenotic and the posterior part of the meatus was filled with a cholesteatoma cyst. A CT scan displayed these features more clearly. In both patients, the canal stenosis and cholesteatoma were removed via a postaural approach.

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A Case of Embolization for Recurrent Epistaxis after Maxillary and Ethmoidal Artery Ligation

Takemitsu HAMA, Kenji DEJIMA, Masahiro MATSUI, Shigeyasu ISHIZAKA, Shi ...

2000 Volume 93 Issue 3 Pages 207-211
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.207

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Maxillary and ethmoidal artery ligation is generally effective for treating severe epistaxis. However, we have occasionally experienced continuous or recurrent bleeding after this procedure. We encountered a 81-year old male with severe epistaxis occuring 5 years after ligation of the internal maxillary artery and anterior ethmoidal artery. Nasal packing was not effective and angiography was performed by Seldinger's method in order to confirm the site of bleeding. As a result, the reconstruction of flow to the internal maxillary artery through a collateral was found, and embolization was performed with a gelatin sponge. No further epistaxis or side effects from the embolization occurred. Therapeutic intraarterial embolization is useful for controlling severe epistaxis such as that caused by failed ligation.

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Management of Odontogenic Maxillary Sinusitis with Nasal Polyp

Nobuya FUJIKI, Yosaku SHIOMI, Takeshi MORITA, Kyosuke KURATA

2000 Volume 93 Issue 3 Pages 213-217
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.213

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In previous reports, Caldwell-Luc surgery was performed in cases of odontogenic maxillary sinusitis that had not responded to dental and medical treatments. We reported three patients with odontogenic maxillary sinusitis and nasal polyps treated with endonasal polypotomy.
We encountered three patients with odontogenic maxillary sinusitis and nasal polyps in our out patient clinic. Although these patients had undergone dental treatment, sinusitis had not improved. We administered 150mg/day loxithromycin for a few months but nasal polyps did not decrease. Therefore, we performed endoscopic endonasal polypotomies. Several months later, the low-density shadow in the maxillary sinus had vanished on CT scanning and maxillary sinusitis had improved in all patients. This fact indicates that obstruction of the ostiomeatal complex might prolong some cases of odontogenic maxillary sinusitis.

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Indication of Preventive Neck Dissection for Carcinoma of the Tongue

Hirohito UMENO, Kazunori MORI, Mitsuji TAMURA, Yoshimi MIYAJIMA, Keiic ...

2000 Volume 93 Issue 3 Pages 219-222
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.219

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The validity of supraomohyoid neck dissection (SOND) for T1/T2 carcinoma of the tongue was investigated. One hundred eight patients underwent CO₂ laser resection between March 1980 and April 1997 in Kurume University Hospital. Metastatic lymph nodes were recognized in 41 patients (38%) throughout the follow-up intervals, and radical or modified radical neck dissection was performed in these patients. Occult neck metastasis was seen in 20 patients (19%). Five patients died of neck metastasis, and all of them showed recurrence at the neck after initial treatment. Twenty patients showed positive neck metastasis in the initial treatment. Metastatic lymph nodes were limited to the supraomohyoid area in patients who underwent RND or m-RND as an initial treatment. In contrast, in 21 patients who received RND or m-RND after the initial treatment, metastatic nodes were detected in jugular regions, too. Metastasis to the caudal deep cervical lymph nodes were seen in 2 patients. These results indicate that: (1) supra-omohyoid neck dissection would be satisfactory as an initial treatment to prevent neck dissection for T1/T2 carcinoma of the tongue, and (2) radical neck dissection is required for patients with neck recurrence.

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Hyoid Bone Syndrome

A Case Report

Naoki KATSUMI, Hiroya IWATAKE, Hideo TOMISAWA, Izumi KOIZUKA, Isao KAT ...

2000 Volume 93 Issue 3 Pages 223-228
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.223

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We describe the case of a 25-year-old man with pain on turning his head to either side attributable to a malformation of the hyoid bone. When the neck was turned further to the left, the greater cornu slipped over the tuberculum anterius of the processus transversus, and locked in front of the tuberculum posterius. At the same time the thyroid cartilage caused an upward movement and separated the locked greater cornu. At the moment of this separation, a clicking sound was produced. Diagnosis was established using 3-dimensional reconstruction of CT imaging. The greater cornu of the hyoid bone was noted to be elongated and malformed, and the left greater cornu was obviously blocked by the processus transversus of cervical vertebra V. Excision of both greater cornua relieved the symptoms.

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A Case of Cavernous Hemangioma of the Hypopharynx

Manabu MOGITATE, Akinori KIDA, Ryuichi KAMETANI, Ayako KAWAMOTO, Ryo A ...

2000 Volume 93 Issue 3 Pages 229-232
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.229

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Hypopharynx hemangioma is a rare disease. We reported a case of a 63-year-old woman who complained of laryngeal discomfort of nine months. Fiberscopy demonstrated a tumor with dark red, regular smooth surface that was located at the left piriform sinus.
The tumor was completely excised by Holmium YAG laser. Histological examination revealed that it was a cavernous hemangioma.
Recurrence of the tumor has not been observed in the three months since the surgery. The authors considered the effectiveness of the Holmium YAG laser in this case.

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Clinical Analysis of Neurinoma in the Head and Neck and Management of Dysphagia Following Surgery

Seiji KAWAKITA, Hidemitsu Sato, Masamitsu HYODO, Eiji YUMOTO

2000 Volume 93 Issue 3 Pages 233-239
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.233

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Neurinoma occasionally arises in the head and neck region. It is histologically benign; however, neural deficits can be critical problems following surgical extirpation of such lesions. Lower cranial nerve deficits are especially frequently accompanied by dysphagia and dysphonia. This paper contains clinical analyses of 14 patients with neurinomas in the head and neck, and discusses therapeutic strategies for postoperative dysphagia. Fourteen patients with neurinoma in the head and neck, excluding acoustic and facial neurinomas, were operated upon in our clinic between 1975 and 1998. They consisted of 6 males and 8 females with a mean age of 46.6 years. The tumors were located at the parapharyngeal space in 8 patients, lateral cervical region in 4, and oral cavity in 2. Their nerves involved were sympathetic nerves in 3 patients, vagal nerves in 2, hypoglossal nerves in 2, glossopharyngeal nerve in 1, accessorius nerve in 1, brachial plexus in 1, and unknown in 4. In 4 patients, paralysis of a nerve different from the originated nerve of the tumor appeared postoperatively. Lower cranial nerve paralysis causing oropharyngeal dysphagia occurred in 50% (7/14) of the patients. Restoration of oral alimentation through the use of compensatory maneuvers and changes in diet was achieved in 4 patients, while it was not in 3 others. Functional surgery for dysphagia, which consisted of cricopharyngeal myotomy, laryngeal suspension, or medialization of the paralyzed vocal fold, was performed in those 3 patients, resulting in successful outcomes. Conclusively, surgical management should be considered when patients continue to experience dysphagia in spite of rigorous conservative treatment following the removal of neurinoma of the head or neck.

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Corrosive Injury of Esophagus and Larynx Caused by Calcium Oxide

-A Case Report-

Yukiko SHINJO, Tomoyuki HAJI, Hideaki MAEDA, Akiko Tanaka, Shinji TAKE ...

2000 Volume 93 Issue 3 Pages 241-245
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.241

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Calcium oxide is commonly used as a desiccant for food in Japan. Calcium oxide, reacting with water, changes into calcium hydroxide and releases heat. Calcium hydroxide is a strong alkaline and seriously damages mucosa and skin together with heat. We report a rare case of a corrosive injury of the esophagus and larynx caused by calcium oxide. A 67-year-old male accidentally swallowed calcium oxide, mistaking it for a cookie. After 6 hours, he complained of dyspnea and dysphagia. An upper gastrointestinal endoscopic examination revealed an ulcer of the upper esophagus and edema of the pharynx and larynx. He underwent a tracheostomy and was treated with prednisolon, aluminum hydroxide and magnesium hydroxide and recovered with no complications.

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A Review of Delayed Endolymphatic Hydrops

Tamio KAMEI, Kenji WATANABE

2000 Volume 93 Issue 3 Pages 247-255
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.247

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Delayed endolymphatic hydrops (DEH), a disease entity that can be differentiated from Ménière's disease, typically develops in patients who have experienced a profound, long-term hearing loss in one ear. This condition was first reported by Kamei et al. ('71), who indicated that it occurred in about 20% of patients who had had unilateral profound deafness since early childhood (UPDC), and it appeared at various stages of adulthood, during or after puberty. Wolfson and Leiberman ('75) and Nadol et al. ('75) reported other types of unilateral profound deafness causing this condition that were due to viral and bacterial labyrinthitis, head trauma, or sudden deafness. Schuknecht ('78) defined DEH and classified it into two types: the ipsilateral type, in which vestibular symptoms identical to the vestibular symptoms of Ménière's disease develop in a previously deafened ear, and the contralateral type, in which a fluctuating hearing loss and/or vestibular symptoms develop in the hearing ear. The underlying pathophysiologic mechanism for the development of DEH has been explained as progressive endolymphatic hydrops in the inner ear due to delayed atrophy or fibrous obliteration of the endolymphatic resorption system, resulting from a previous inner-ear injury. In the ipsilateral type, episodic vertigo is not usually accompanied by fluctuating hearing levels and tinnitus because the hearing loss is profound. The period between the onset of pre-existent deafness in one ear and the onset of DEH ranges from several months to 74 years. The cause of the pre-existent deafness is UPDC in more than half of the cases of both types of DEH. Almost all kinds of other degenerative disorders of the inner ear are mostly due to inflammation (viral and bacterial) and trauma (physical and acoustic). The ipsilateral type of DEH is more frequently seen than the contralateral type. The onset age of the contralateral type is higher, in general, than that of the ipsilateral type. Medical treatment may be effective for both types of DEH. Complete relief from episodic recurrent vertigo may be expected in 65% of cases within 5 years after the onset of vertigo and in 90% of cases within 10 years. Labyrinthectomy or vestibular nerve section in the deaf ear is curative in the ipsilateral type, but no satisfactory surgical therapy is available for the contralateral type of the disease. The audiological definition of DEH by Schuknecht seems, however, to be somewhat arbitrary, as the patients' symptoms form a continuous spectrum with other Ménière's syndrome cases, occurring in association with less-marked degrees of sensorineural hearing loss. The existence of the contralateral type of DEH due to UPDC, which often shows typical symptoms of Ménière's disease, seems to suggest that Ménière's disease may occur as a delayed sequela of subclinical damage of the inner ear, especially damage sustained in childhood.

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Clinical Aspects of Malignant Lymphoma in the Thyroid Gland

[in Japanese]

2000 Volume 93 Issue 3 Pages 256-257
Published: March 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.256

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