Practica Oto-Rhino-Laryngologica

The Current Status of Infectious Diseases in Otorhinolaryngology with Special Emphasis on Acute Otitis Media and Treatment Strategy for Antimicrobial Resistant Pathogens

Noboru YAMANAKA, Muneki HOTOMI

2000 Volume 93 Issue 6 Pages 431-437
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.431

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The status of infectious diseases in otorhinolaryngology has changed in recent years. Acute otitis media is a common infectious disease among children. Recently, clinical features of the illness have changed by several factors including an increase of antimicrobial-resistant pathogens, altered life style, and derangement of immune responses of the host. Penicillin-resistant Streptococcus pneumoniae were identified in about 30% of nasopharyngeal cultures from children with AOM. The isolated strains also had ermAM and mefE genes that were associated with resistance to macrolides. A study of the changes of S pneumoniae in the nasopharynx by pulsed-field gel electrophoresis (PFGE) showed that the second episode was caused by the reinf ection with a different strain rather than by persistence and reemergence of the first strain. Analysis of strains from siblings with AOM by PFGE also suggested that person-to-person transmission of the pathogen can occur among children. A study of the immune responses to S. pneumoniae in otitis-prone children showed that about 54% of the patients had subnormal levels of anti-pneumococcal capsular polysaccharidespecific IgG₂.
These factors will be closely associated with the variation of the clinical features of AOM. We should pay much attention to the risks of selecting drug-resistant pathogens by empiric treatment. We should manage AOM with not only antibiotics but also otorhinolaryngological procedures like myringotomy, and washings of the nasopharynx and sinus to eliminate pathogens.

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Specific Infectious Disease of Pharynx

[in Japanese]

2000 Volume 93 Issue 6 Pages 438-439
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.438

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Statistical Analysis of 315 Cases of Sudden Deafness

Kazumasa KONDOH, Tadashi KITAHARA, Junko MURATA, Shin-ichi OKUMURA

2000 Volume 93 Issue 6 Pages 441-447
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.441

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We investigated 315 patients with idiopathic sudden deafness treated at our hospital between 1992 and 1997. Statistical analysis of the clinical data from these cases revealed several findings concerning the hearing prognosis. Prognostic factors for significantly better hearing were as follows: younger age, absence of vertigo, hearing loss configuration of low tone sudden deafness and trough type sudden deafness, mildness of the initial hearing loss and initial visit during the first one or two weeks after the onset.
Therapeutic effects on the hearing improvement were as follows: defibrinogenation therapy was as effective as steroid therapy. No significant difference could be observed in efficacy between treatments with and without stellate ganglion block (SGB), but the therapy was considered useful to some extent. With regard to the hyperbaric oxygen therapy (OHP), there was no significant difference in efficacy of treatments with and without OHP. Since the number of cases without OHP was small, additional studies are needed.

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A Long-term Prognosis of Sudden Deafness with Vertigo; A Retrospective Study

Tadashi Kitahara, Kazumasa Kondoh, Noriaki Takeda, Junko Murata, Shin- ...

2000 Volume 93 Issue 6 Pages 449-454
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.449

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We experienced 52 patients with idiopathic sudden deafness with vertigo treated at our hospital between 1992 and 1997. In order to investigate influences of long-term canal paresis (CP) on the patients' hearing prognosis and activity in their daily life, we examined caloric test, audiometry and several questionnaires with 30 out of 52 patients over long-term intervals (14-75 months) after the onset. These examinations revealed that 20 out of 30 patients had persistent CP and poor prognosis of hearing. Those with persistent CP also had a handicap in their everyday life because of the dizziness induced by head and body movements, resulting in disturbance of their mood. It is notable that hearing level of those with persistent CP was worsened during long-term follow up (more than 5 years).

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Inner Ear Damage in Acute Otitis Media

Masato NISHIMURA, Katsumi DOI, Takeshi KUBO, Yuko MIYAZAKI, Akiko OKUY ...

2000 Volume 93 Issue 6 Pages 455-459
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.455

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Clinical findings in 14 ears of 12 patients (7 females and 5 males) with inner ear damage due to acute otitis media were studied. The patients' ages ranged between 27 and 77 years (average 45 years). The patiens complained of otalgia, hearing loss, tinnitis, and vertigo at the time of their initial presentations. They were treated with antibiotics combined with steroids, vasodilators, and vitamins. Complete recovery of hearing was obtained in 6 ears. We recommend early auditory and vestibular testing for patients who were suspected to have sensorineural hearing loss, tinnitis or vertigo due to inner ear damage.

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Congenital Ossicular Disruption with Fluctuation of Hearing in 3 Patients

Seishi HASEBE, Haruo Takahashi, Masataka KAWANISHI

2000 Volume 93 Issue 6 Pages 461-465
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.461

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The diagnosis of ossicular disruptions of intact eardrums is not difficult because they have several specific clinical features (large air-bone gap, type Ad tympanogram and negative stapedial reflex). We report 3 patients (4 ears) with congenital ossicular disruption who were difficult to diagnose because of their mild or fluctuating conductive hearing loss. All 3 subjects showed a small air-bone gap when they had otitis media with effusion (OME), but their air-bone gap increased when their OME improved.
It was speculated that middle-ear effusion may have influenced the middle-ear sound conduction resulting in a temporarily small air-bone gap.

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Simple Method of Myringoplasty Using Chitin Fabric and Collagen Artificial SKIN

Hiromi TAKATA

2000 Volume 93 Issue 6 Pages 467-474
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.467

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Simple myringoplasties were performed in 35 patients with chronic otitis media with ear drum perforation. Chitin fabric only was used for 27 patients, and for the other 8, collagen artificial skin was used in addition. The success rate was 90.6% for ear drum perforations smaller than two quadrants in size. In success cases using only chitin fabric, the perforations were closed between 4 and 15 weeks, and the hearing improved to the patch test level before the operation in all patients.
The indications of this method are as follows: the perforation was positioned centrally and no discharge was noted from the middle ear, normal function of eustachian tube, and satisfactory hearing improvement by the patch test.
The author emphasizes that this method is very simple and useful for ENT outpatient clinics because it requires no admission and no autografts.

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A Case of Chondrosarcoma of the Nasal Septum

Hideaki KITA, Makoto HAMAMOTO, Tomoko SHINTANI, Atsushi HARIMAYA, Nobu ...

2000 Volume 93 Issue 6 Pages 475-481
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.475

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A chondrosarcoma is infrequently encounted in the head and neck region and is more uncommon in the nasal septum. A review of the Japanese and English literature showed only 57 reported cases.
We report here a case of chondrosarcoma which arised from the nasal septum of a 62 year-old woman. The patient visited our hospital complaining of a nasal obstruction of 12 months' duration. A rhinoscopic examination revealed that both nasal cavities were almost completely obstructed by a bulged nasal septum. A CT scan showed a mass with mottled calcification in the nasal cavity. Surgery was performed and the histological diagnosis was a chondrosarcoma (grade II ). Re-excision was performed because the surgical margin was positive. The tumor was completely resected and the patient has remained free of disease three years after surgery.

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A Case Report of Tuberculosis with Multiple Affections as in the Nose, the Cervical Lymphnodes and the Lung

Masako KINOSHITA, Eiji YUMOTO

2000 Volume 93 Issue 6 Pages 483-486
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.483

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We report a patient with tuberculosis in the nasal cavity, cervical lymph nodes and the lung. The patient's main complaint was rhinorrhea when she visited our clinic. The patient was a 67 year-old female who suffered from hypersecretion of the nose for approximately 5 years. The findings showed a nasal septum perforation and granuloma development on the bilateral inferior nasal turbinate. The perforation margin of the septum tended to bleed easily. The pathological finding of a biopsied specimen from the granuloma indicated some difficulties for differentiating between Wegener's granulomatosis and tuberculosis. Since the patient also had cervical lymph node swelling, we performed a surgical biopsy of the neck. The final diagnosis was tuberculosis.
During the diagnostic procedure, millions of lesions in the lung were noted, which were found by a chest X-ray examination.
The patient was treated with antituberculosis drugs such as streptomycin, isoniazid and rifampicin. The affections in the nose, cervical lymph nodes and the lung were brought into complete remission.
Nasal tuberculosis is a rare and important disease, which has to be differentiated from other inflammatory diseases as well as malignant tumors of the nose.

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A Case of Mucoepidermoid Carcinoma in the Oropharynx

Kyoichi TERAO, Masahiro ISHIKAWA, Hiroshi Nakamura, Kiyotaka MURATA

2000 Volume 93 Issue 6 Pages 487-493
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.487

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A comparatively rare case of a primary minor salivary gland mucoepidermoid carcinoma in the radix linguae is reported. A 21 year-old woman visited our hospital complaining of pain during swallowing. A smooth mass spreading to the lateral wall of the oropharynx from the left side of the radix linguae was found. CT showed a Gd enhanced homogenous mass 2cm in size on the left side of the oropharynx. The mass was suspected to be a benign tumor, and we attempted to remove it by oral approach. However, it was adherent to the lateral wall of the oropharynx. It was suspected to be a mucoepidermoid carcinoma after analyzing a frozen section. Therefore, it was removed during second operation. A median incision of the pharynx spread the range of vision sufficiently. A free radial forearm flap improved the postoperative functional disorders. The mass was a well differentiated mucoepidermoid carcinoma. There has been no evidence of recurrence for 8 months. A mucoepidermoid carcinoma is considered rare in primary minor salivary gland carcinomas and it is believed to be more rare finding a well differentiated mucoepidermoid carcinoma in the radix linguae of a young woman.

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A Case of Tracheal Tuberculosis with Hypopharyngeal Carcinoma

Koji IWASAKI, Koichi NAKAZAKI, Yasuyuki HASHIMOTO, Reiko Kuroda, Izumi ...

2000 Volume 93 Issue 6 Pages 495-499
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.495

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We report a case of tracheal tuberculosis with hypopharyngeal carcinoma.
A 77-year-old man complained of a right neck mass, and an open biopsy was performed. The biopsy specimens revealed a squamous cell carcinoma. At that time, laryngeal, pharyngeal, esophageal and gastric tumors were not found by fiberscopy, but chest CT revealed mediastinal lymphadenopathy. Three months later, a hypopharyngeal carcinoma, tracheal telangiectasia and tracheal granulation were found by bronchofiberscopy, and the biopsy specimen of tracheal granulation showed epithelioid cells, necrosis, lymphocytic invasion and giant cells. He was diagnosed with tracheal tuberculosis and treated with INH and RFP. Furthermore, radiotherapy was employed for the hypopharyngeal carcinoma and cervical metastasis.
A bronchoscopic examination 3 months after treatment revealed reduced tracheal granulation and no hypopharyngeal tumor or tracheal telangiectasia. However, the hypopharyngeal carcinoma recurred and the patient died due to a rupture of the carotid artery with carcinoma invasion. An autopsy showed that the tuberculous lesion had disappeared.

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A Device for Resection of Epiglottal Cysts

Masashi IMANAKA, Kanji SAKURAI, Toshihide ATAGO, Atushi SAKAKURA, Hiro ...

2000 Volume 93 Issue 6 Pages 501-504
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.501

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Epiglottal cysts in the larynx are not rare, but a standard resection method has not yet been established. We reported a new device and technique for resection of epiglottal cysts. According to usual laryngomicrosurgery, we approached the cyst by means of Karl Storz's direct laryngoscope and used scissors and forceps for laryngomicrosurgery. We treated the cyst wall with the scissors and forceps while they were electrified by an electrotome. Epiglottal cysts were removed easily, rapidly, and completely, and the hemostasis was easily obtained.
This “electrolaryngomicrosurgery” is an idea resembling that of Columbus' egg; however, it makes resection of epiglottal cysts easy and certain.

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A Case of Tetanus without a History of Trauma

Kazuhiko NARIO, Hiroshi MIYAHARA, Takashi MATUNAGA

2000 Volume 93 Issue 6 Pages 505-508
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.505

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A 63-year old woman who complained of severe dysphagia visited our hospital. A physical examination revealed rigidity of the sternocleidomastoid muscle. Laryngoscopy showed pooling of saliva at the bilateral pyrif orm sinus of the hypopharynx. Three days later, she complained of trismus. At that time, she was diagnosed with tetanus without a history of trauma. She was admitted and received human antitetanus immunoglobulin (3000 unit) at once and benzylpenicillin for 10 days intravenously. Opisthotonus, airway obstruction and circulatory disturbance did not occur. The patient recovered without tracheal intubation, mechanical ventilation or a tracheotomy. Although tetanus is rare in Japan, otorhinolaryngologists may encounter a patient with tetanus.

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Therapeutic and Bacterial Effect of CDTR-PI to Acute Otitis Media

Makoto Ito, Tomokazu YOSHIZAKI, Toshiro NISHIMURA, Yoshifumi YAMAZAKI, ...

2000 Volume 93 Issue 6 Pages 509-516
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.509

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Recently, a rapid increase in penicillin resistant pneumococci has been reported in most areas of the world. These penicillin resistant bacteria are becoming less susceptible to other commonly prescribed oral antimicrobial drugs, including extended-spectrum cephalosporins. Also, a rapid spread of ampicillin resistant Heamophilus influenzae in children with respiratory tract infections has been reported in Japan. Therefore, we carried out clinical and bacteriological studies on double quantities of cefditoren (CDTR) in patients with pediatric acute otitis media at 5 general hospitals.
Between February 1999 and May 1999, 118 strains of Streptococcus pneumoniae and 70 strains of Haemophilus influenzae were isolated from the nasopharynx in 144 children with acute otitis media. Of the 118 Streptococcus pneumoniae, penicillin G resistant S. pneumoniae (PRSP) and penicillin G intermediately resistant S. pneumoniae (PISP) accounted for 29% and 43%, respectively. On the other hand, of the 70 Haemophilus influenzae, the number of j3-lactamase-negative ampicillinresistant (BLNAR) strains was 24%.
The bacteriological efficacy of double quantities of CDTR in patients with PRSP, PISP and BLNAR was 20%, 43% and 63%, and the clinical efficacy of CDTR was 65%, 79% and 75%, respectively. These results suggest that the sterilization of pediatric nasopharynxes using oral antimicrobial drugs is difficult, but CDTR is a useful oral antibiotic for clinically acute pediatric otitis media.

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New Useful Instruments for Daily Treatment and Surgery

[in Japanese]

2000 Volume 93 Issue 6 Pages 518-519
Published: June 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.518

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