Practica Oto-Rhino-Laryngologica

Meniere's Disease

-Underlying Mechanism of its Clinical Features-

Taizo Takeda

2000 Volume 93 Issue 7 Pages 521-529
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.521

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Based on our previous reports, the pathogenesis of Meniere's disease was thought to be as follow.: Hearing loss caused by endolymphatic hydrops is closely linked to the degree of hydrops, not to the degree of pressure difference between the endolymph and perilymph. Both vertigo and deafness could be explained by high potassium in the scala tympani, not in the scala vestibuli. In addition to the dysfunction of the endolymphatic sac, a high concentration of plasma vasopressin is thought to be the other causative factor in the formation of endolymphatic hydrops.

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Rapid Diagnosis of Atypical Ramsay-Hunt Syndrome

[in Japanese], [in Japanese]

2000 Volume 93 Issue 7 Pages 530-531
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.530

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Treatment of Cisplatin Ototoxicity by Anti-oxidant Drugs

Masaya TAKUMIDA, Koji YAJIN

2000 Volume 93 Issue 7 Pages 533-539
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.533

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We performed a trial to assess the efficacy of glutathione and rebamipide in the treatment of cisplatin-induced ototoxicity. Glutathione was given at a dose of 300mg/day and rebamipide at a dose of 300mg/day orally for at least 4 weeks. Standard audiometry was performed regularly at 2
weeks intervals.
Eight of 10 patients showed improvement in hearing disorders. Significant improvement of hearing level was observed in 125, 250, 500 and 8000 Hz, while there was no significant difference noted in 1000, 2000 and 4000 Hz. Treatment with glutachione and rebamipid may be an effective new therapy for the CDDP-induced hearing loss.

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A Case of Aspergillosis of the Frontal Sinus

Yoshiaki HAYANO, Tadao NISHIMURA, Tatsuya SAWADA, Jun MORI, Mikio YAGI ...

2000 Volume 93 Issue 7 Pages 541-545
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.541

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We report an extremely rare case of aspergillosis of the frontal sinus. The patient was a 47-year-old man who presented with the chief complaint of left forehead pain. A nasal examination, CT and MRI suggested mycosis of the frontal sinus. The patient subsequently underwent endoscopic sinus surgery and aspergillosis was diagnosed based on the histopathological findings. Good results were obtained with irrigation of the frontal sinus after surgery. To our knowledge, there have been only four reports of frontal sinus mycosis in Japan, including ours. Aspergillus species was the causative organism in all four cases, and intracranial invasion was present in all of the patients except the one described here.

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Inflammatory Paranasal Sinus Diseases with Visual Disturbances

Takeshi KUSUNIKI, Kiyotaka MURATA, Kazutaka WAMOTO

2000 Volume 93 Issue 7 Pages 547-551
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.547

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Fifteen patients with inflammatory paranasal sinus diseases and visual disturbances were surgically treated at our clinic between 1988 and 1998. These patients were discussed regarding grades of visual disturbance, preoperative progress, medical history, results of bacterial examinations and preoperative CT. The interval between onset of visual disturbance and operation was not related to visual recovery grades. Two of 8 patients with second or third paranasal surgery recovered visual power after surgery. Five of 7 first operation patients recovered it as well. A group of first operation patients showed a greater visual recovery rate than a group of second or third operation patients. No relationship was observed between results of bacterial examinations and visual recovery grades. However, 2 patients with paranasal sinus mycosis and orbital apex syndrome showed no visual power at postoperation. Ten of 12 patients who underwent preoperative CT showed bone defects and mass lesions affecting the optic nerve. However, 5 of those 10 patients recovered visual power. On the other hand, 2 patients without bone defects did not recover visual power. Moreover, 1 of those 2 patients had orbital apex syndrome.

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Two Cases of the External Dental Fistula

Makoto MIYAZAKI, Masataka MURAKAMI, Kou TEI, Takashi SHINOMIYA, Toshiy ...

2000 Volume 93 Issue 7 Pages 553-557
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.553

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We report 2 cases of external dental fistula. Case 1 was 43-year-old man and case 2 was 23-year-old woman.
In case 1, the fistula was found in the middle of the left nasolabial fold. We performed surgery by the Caldwell-Luc procedure. The left upper canine was considered the cause of the external dental fistula and after extracting the affected tooth, the lesion recovered. Maxillary caries was the cause of the external dental fistula in this case, which was an extremely rare case.
As for case 2, a granulous papule and fistula were found in the mandibular area. On panoramic X-ray, there was a radiolucent area around the apex of the second left mandibular true molar. The causative tooth was extracted by a local dentistry clinic and the external dental fistula healed thereafter.
In both of these cases, postoperative healing was rapid, and there has not been any recurrence to date. Regarding diagnosis of external dental fistula, the initial diagnosis is very important. When a fistula is seen on the face and cheek region, the otolaryngologist should consider dental disorder and external dental fistula.

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Giant Dermoid Cyst in the Floor of the Mouth Totally Excised by an Intra-Oral Approach

Suetaka NISHIIKE, Morihiro IRIFUNE, Katsunori UMATANI

2000 Volume 93 Issue 7 Pages 559-564
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.559

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Dermoid cyst is commonly considered a rare finding in the floor of the mouth. We report a 20-year-old man who presented with a large cystic mass in the floor of the mouth extending into the submandibular region. The mass, which was totally excised by an intra-oral approach, was lined by squamous epithelium containing sweat glands, sebaceous glands and hair follicles and diagnosed as a dermoid cyst. In our case, the classification of Bergman-Hagisaki from relationships to the mylohyoid muscle was of little importance in determining the presentation of the cyst or the surgical approach. The cyst lining is generally so thick that it is relative easy to excise the cyst totally. Therefore, the intra-oral approach should be attempted first, even if the cyst is large. When the removal of cyst by an intra-oral approach is difficult, extra-oral approach must be combined.

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Ranula Extending into the Parapharyngeal Space; A Case Report

Hiroo UMEDA, Ryo ASATO, Kazuhiko SHOJI, Kenichi KANEKO, Shigeru HIRANO ...

2000 Volume 93 Issue 7 Pages 565-568
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.565

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We report a patient with a ranula extending into the parapharyngeal space. A 21-year-old male visited our clinic with complaints of right submandibular swelling for three months. Several tests including MRI were performed that led to the diagnosis of the ranula. Resection of the right sublingual gland was performed, which satisfactorily treated the cyst. We think the best treatment of a ranula is to resect the sublingual gland.

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Mixed Thyroid Tumor of Papillary and Medullary Carcinoma Arised in the Parapharyngeal Space; A Case Report

Shigetaka MORIAI, Yoshifumi KOBATASHI, Takeshi OGINO, Masanobu IMADA, ...

2000 Volume 93 Issue 7 Pages 569-573
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.569

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We report a rare case of a mixed thyroid papillary and medullary carcinoma originating in the parapharyngeal space. The patient was a 57-year-old female with a swollen subparotid area and no swelling of the lymph node in her neck. A CT scan and MRI demonstrated a large mass in the left parapharyngeal space. The tumor was resected surgically using the push-up method. Microscopic studies revealed that the tumor was composed of papillary carcinoma tissue positive for thyroglobulin and medullary carcinoma tissue positive for Grimelius and chromoguranin stains, supporting the diagnosis of a mixed papillary and medullary carcinoma. Lymphoid tissue was not identified in the tumor tissue. There was neither primary nor metastatic sites in any organs, suggesting that the tumor may have originated in the parapharyngeal space.

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Experience of Surgical Treatment for the Patient with Graves' Disease Affected by Agranulocytosis

Tetsuya TERADA, Kazuo MAKIMOTO, Kouhei WADA, Yukari FUJIMURA

2000 Volume 93 Issue 7 Pages 575-580
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.575

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The control of preoperative hyperthyroidism is considered to be the most important treatment for the surgery of Graves' disease. We describe a patient with Graves' disease who was treated preoperatively without the use of antithyroid drugs. Because of the side effects of antithyroid drugs, this patient developed agranulocytosis during the initial medical treatment period. Therefore, we treated the patient preoperatively using other drugs : Lugol's solution (potassium iodine), a-blocker, and a steroid hormone. More specifically, the treatment started with the administration of Lugol's solution and β-blocker, but levels of thyroid hormones increased again 14 days after administration. This was considered to be an "escape" phenomenon observed in the treatment using potassium iodine. Then we added a steroid hormone to this preoperative treatment and increased the dose of p-blocker. Thirty-five days after beginning the treatment, the thyroid hormone levels decreased to bring about an euthyroid state. A subtotal thyroidectomy was performed uneventfully 38 days after the beginning of the preoperative treatment. It should be stressed that a definite plan, especially for the starting point of Lugol's solution before surgery is necessary for such cases.

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Complications Following Surgery for Hyperthyroidisms

Ryo ASATO, Kazuhiko SHOJI, Ken-ichi KANEKO, Ichiro TATEYA, Shiger HIRA ...

2000 Volume 93 Issue 7 Pages 581-583
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.581

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Between 1992 and 1998, 67 patients underwent a subtotal thyroidectomy for hyperthyroidism (Basedow disease). Postoperative complications occurred in 6 patients (9.0%). In 4 patients (6.0%), postoperative bleeding occurred, which was stopped by a reoperation. Postoperative recurrent laryngeal nerve palsy occurred in 2 patients (3.0%); they recovered from the palsy within three weeks. One patient (1.5% needed vitamin) for 5 years after the operation due to hypo calcemia.
We should choose a subtotal thyroidectomy as treatment for hyperthyroidism because very few patients are expected to suffer from severe complications.

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Two Cases of Schwannoma Arising from the Vagus Nerve in the Neck

Toshiaki SHIBATA, Masataka MURAKAMI, Hirotsune OHNISHI, Nobuo TAKAGI, ...

2000 Volume 93 Issue 7 Pages 585-591
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.585

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A schwannoma arising from the vagus nerve is relatively uncommon in the neck. In 3 years, 2 patients with a vagus nerve schwannoma were at the Kyoto First Red Cross Hospital. The two patients were 50 and 59-year-old-males. A CT scan showed the tumor between the common carotid artery and the internal jugular vein, and between the internal carotid artery and the internal jugular vein, respectively resulting in an increase in the distance between the artery and the vein (separation). Both patients underwent complete removal of the tumor using an external approach following a CT preoperative diagnosis of a neurilemmoma of the vagus nerve.
A discussion was then made on clinical problems related to the diagnosis including FNA (fine needle aspiration cytology).

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One Stage Reconstruction after Resection of Malignant Head and Neck Tumor without Skin Graft

Tetsuji TAKABAYASHI, Hitoshi Saito, Shigeharu FUJIEDA, Yoshiyuki SHIBA ...

2000 Volume 93 Issue 7 Pages 593-597
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.593

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Head and neck surgeries for cancers require not only extirpation of primary organs but also reconstruction of the affected area. When a patient with head and neck cancer undergoes reconstruction of a large flap, a skin graft is necessary for the defect, which could be a disadvantage. Here, we report one-stage reconstruction using large cervical and chest dermal flaps without skin grafting in 3 patients who had large dermal defects caused by tumor resection or by closing of a post-operative pharyngeal fistula. Since this method is not difficult and requires little time, it is considered a treatment of choice.

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Effects of Suplatast Tosilate (IPD®) for Allergy of the Larynx

Hayato MISAWA, Tsutomu NAKASHIMA

2000 Volume 93 Issue 7 Pages 599-606
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.599

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Twenty-three patients with an allergy of the larynx, who complained of a foreign body sensation in the throat or a persistent cough, inclusive of eight suspected patients, were treated with suplatast tosilate (IPD) for an average of 36.3-24.0 days between January 1997 and December 1999. The final subjective efficacy of IPD (300 mg/day) in twenty evaluable patients were as follows: excellent, 50.0%; good, 40.0% ; and poor, 10.0%, with an efficacy rate of 90.0%. The final subjective effectiveness rates inclusive of excellent and good efficacy were 90.9% for the IPD® single administration group, and 88.9% for the combined administration (IPD®+concomitant drugs) group. No statistical differences in efficacy were noted between the two groups. Mild nausea appeared as an adverse effect in one patient (4.8%) in the IPD single administration group. It was speculated that the efficacy of IPD therapy for the allergy of the larynx is mainly attributable to suppression of chemical mediators derived from mast cells of the laryngeal mucosa or suppression of IL-4 or IL-5 production from The type cells.

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Voice Rehabilitation after Laryngectomy

[in Japanese]

2000 Volume 93 Issue 7 Pages 608-609
Published: July 01, 2000
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.93.608

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