Practica Oto-Rhino-Laryngologica

Chronic Cough in Otolaryngology

Kensei NAITO

2001 Volume 94 Issue 8 Pages 667-675
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.667

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Chronic cough without accurate pathological findings in the lower respiratory airway can present a difficult diagnostic dilemma. The most common causes, such as chronic bronchitis, asthma, postnasal drip, cough variant asthma, atopic cough, laryngeal allergy andgastroesophageal reflux, can usually be suspected on the basis of the history and physical examination and subsequently confirmed by appropriate diagnostic tests and responses to specific therapy. In otolaryngology, postnasal drip, laryngeal allergy and tracheobronchial foreign body are the primary causes of chronic cough and these clinical features are described in this review. However, when we examine patients complaining of chronic cough, we must take into account the possibility of severe conditions, such as lung cancer, bronchial tuberculosis, hypopharyngeal cancer, maxillary malignancy and mycosis.

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Scierotherapy of Hemangioma in the Larynx

[in Japanese], [in Japanese]

2001 Volume 94 Issue 8 Pages 676-677
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.676

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High Dose ATP or/and Steroid Therapy for Sudden Deafness

Shuichiro HAYASHI, Ryo AMESARA, Tomohiko FUJITA

2001 Volume 94 Issue 8 Pages 679-683
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.679

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Ninety-four patients with sudden deafness were treated with high dose ATP or/and steroids. Complete recovery was obtained in 44% of patients, definite improvement in 11%, slight improvement in 12%, and no improvement in 33%. Important prognostic factors were time between the onset and the beginning of initial treatment, age, configuration of the initial audiogram, severity of the initial hearing loss, and vertigo. No significant difference in curative effect was noted between these two methods, high dose ATP together with steroid, and high dose ATP alone. Furthermore, a curative effect in the first week was closely related to recovery. In conclusion, we suggest that if the curative effect in the first week is not in sufficient, it is important to select another method.

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A Case Report of Wegener's Granulomatosis with Ear Symptoms

Yoshiya ISHIDA, Yoshifumi Kobayashi, Nobuyuki BANDOH, Tatsuya HAYASHI, ...

2001 Volume 94 Issue 8 Pages 685-691
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.685

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Wegener's granulomatosis is necrotic granulomatosis angitis frequently starting with otolaryngological symptoms. We treated two patients with a history of otitis media with hearing loss. The laboratory results for both patients were positive for C-ANCA; one patients had typical pathologic appearance in the nasal mucous membrane, but the other had no typical pathologic signs. The patients were diagnosed with Wegener's granulomatosis based on the clinical, histological and laboratory findings, and predonisolone and azathioprine were administered.
The diagnosis and treatment of Wegener's granulomatosis with ear symptoms is also discussed.

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Medial High Jugular Bulb with Diverticulum; A Case Report

Masafumi TANIGUCHI, Taisuke Kobayashi, Kiyofumi GYO

2001 Volume 94 Issue 8 Pages 693-697
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.693

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Jugular bulb located high and medial in the petrous bone can be a cause of sensorineural hearing loss, tinnitus and vertigo. Here, we report a case of medial high jugular bulb with diverticulum. The patient was a 51-year-old woman who presented with bilataral hearing loss and tinnitus. The right ear showed mixed hearing loss due to eardrum perforation and the left ear showed complete sensorineural hearing loss. CT showed a left medial high jugular bulb with diverticulum that was compressing the cochlear and vestibular aqueducts. We speculated that sensorineural hearing loss in this patient was due to compression of the cochlear aqueduct by the medial high jugular bulb.

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Electoroneuronography (ENoG); Preoperative Facial Nerve Assessment for Parotid Gland Tumors

Katsura KAWATA, Hideyuki FUKUSHIMA, Hajime Nakamura, Yoshihiro TAMURA, ...

2001 Volume 94 Issue 8 Pages 699-704
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.699

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Parotid gland tumor are often associated with carcinomatous infiltration into facial nerves without overt manifestations of facial nerve palsy, which makes preoperative predictions of carcinomatous infiltration difficult. ENoG has been shown to be a useful approach to evaluate facial nerve degeneration. Here, we measured facial nerve function by performing ENoG preoperatively on patients with parotid gland tumors prior to investigate the usefulness of ENoG in preoperative examination of these tumors.
Subjects: Twenty healthy individuals without any history of facial nerve palsy and 18 patients with parotid gland tumors (13 with benign tumors and 5 with malignant tumors) but no overt facial nerve palsy.
Results: Mean ENoG values obtained for each groups were 103.5% (control), 82.2% (benign) and 48.1% (malignant). The mean ENoG values for the malignant group was significantly different compared to the other two groups (p<0.05). Differences in sizes or regions of tumors did not affect ENoG values significantly.
Conclusion: ENoG was useful for the preoperative evaluation of facial nerve function. We suggest that a 50% reduction or more in ENoG values may predict the malignancy of tumor and a high risk for carcinomatous infiltration into facial nerves without any manifestations of facial nerve palsy.

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Two Cases of Calcifying Epithelioma in the Periauricular Region

Eiji TAKEUCHI, Hiroya KITANO, Kazutomo KITJIMA

2001 Volume 94 Issue 8 Pages 705-709
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.705

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We report two cases of calcifying epithelioma, one in the preauricular region and the other in the infraauricular region. Calcifying epithelioma is a benign tumor originating from the hair matrix cells. It usually occurs in children and young adults. Calcifying epitheliomas are commonly observed on the face, neck and upper extremities. Most cases involve subcutaneous, solitary, firm nodules measuring 1 to 3cm in diameter. Despite these clinical characteristics, preoperative diagnosis based on clinical examination is sometimes difficult because of the various manifestations presented by the tumor. In particular, in the periauricular region it is occasionally difficult to differentiate the lesions from those involving the parotid gland, or from parotid gland tumors. For accurate diagnosis, it is necessary to carefully evaluate clinical findings together with radiography, sonography, CT, and MRI findings.

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A Case of Olfactory Neuroblastoma

Satoshi SENO, Hideyo SOGO, Takema SAKOTA, Yuko Saito, Hiroki IKEDA, Yo ...

2001 Volume 94 Issue 8 Pages 711-715
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.711

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A case of olfactory neuroblastoma is reported. A 71-year-old man visited our hospital exhibiting left nasal obstruction and purulent choanal drip on May 13 1998. Examination showed a large tumor in his left nasal cavity; the surface of it was smooth and bled easily. The patient did not have any visual acuity difficulties and the cervical lymphnodes were not swollen. The patient had undergone surgery for an olfactory neuroblastoma in 1979 in another hospital. CT scan revealed a large tumor in his left nasal cavity and maxillary sinus but which did not extend into the cranial space or eye socket. There was no bone defect. Based on the pathological findings, we made a diagnosis of recurrent olfactory neuroblastoma.
The patient was treated using combined therapy; preoperatively, chemotherapy (CBDA+CPA+VP-6) and radiation therapy were performed. Since 19 years previously, 40 Gy radiation therapy was used, we added a further 30 Gy radiation. Subsequently, the tumor was removed completely left lateral rhinotomy approach.
The patient is being followed up periodically and to date no recurrence of tumor has been observed. In conclusion, we suggest that long-term follow up is important since it has been previously reported that olfactory neuroblastoma can recur even after a long interval as in this case.

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Two Cases of Large Pituitary Adenomas Operated by Staged Endoscopic Surgery

Takayuki NAKAGAWA, Tadayoshi TAKASHIMA, Kenta TOMIYAMA

2001 Volume 94 Issue 8 Pages 717-721
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.717

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The advantages of endoscopic pituitary surgery include easy reoperation, and based on this, we performed planned staged operation in two cases of large pituitary adenomas extending to the suprasellar lesion using the endoscopic transsphenoidal approach via both nostrils. In the initial operation, the tumor contents were gently removed, but the tumor capsule in the extrasellar lesion remained intact to avoid perioperative injury to the surrounding organs. Four weeks later, the second operation was performed after confirmation of the site of the residual mass by magnetic resonance imaging. The residual mass had descended into the sellar floor and was easily resected with no operative complications. Although planned staged operation requires two operations, we suggest that it is a safe and efficient procedure for the removal of large pituitary tumors.

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A Clinical Study of Nasopharyngeal Cancer

Yoshifumi Kobayashi, Tatsuya HAYASHI, Masanobu IMADA, Satoshi NONAKA, ...

2001 Volume 94 Issue 8 Pages 723-728
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.723

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The outcomes of 40 cases of nasopharyngeal cancer (NPC), treated in our hospital between November 1976 and December 1998, were evaluated. Factors that appeared to influence prognosis were assessed by the Kaplan-Meier method. The ages of the patients ranged from 17 to 78 years. There were 28 males and 12 females.
The cumulative five-year survival rate for the whole study population was 45.1%. The UICC classification (1997) was used for disease staging. The percentages of patients survival after five-years were: 100% for stage I (5 case), 71.4% for stage 101B (9 cases), 11.4% for stage III (9 cases), 33.3% for stage IV A (3 cases), 53.6% for stage NB (7 cases), and 0% for stage IV C (3 cases). The histological type with the highest survival rate was keratinizing type which had a 33.3% (10 cases) survival rate. The anatomical sites of primary tumors with the survival rate were 54% for the posterior wall (25 cases) and 36% for the lateral wall (10 cases). The survival rate according to classification based on initial therapy were as follows: radiotherapy alone group, 49.4% (20 cases); combined radiotherapy and chemotherapy group, 34.4% (14 cases). Since the most frequent cases of death was distant metastasis (67%), we suggest that the prevention of distant metastasis is important.

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A Case of Rhinogenic Intracranial Abscess

Tomoya NAGATA, Mikio SUZUKI, Atsushi IKEDA, Tsuyoshi KITANISHI, Kazuto ...

2001 Volume 94 Issue 8 Pages 729-735
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.729

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We report a rare case of intracranial complication originating from the frontal sinusitis. The patient was a 32 year-old-male who initially presented with a high fever and anumb feeling in his head. A sudden onset of right upper limb dyskinesia appeared several days after the initial symptoms. Magnetic resonance imaging (MRI) was useful to reveal an epidural abscess in the frontal region of the head and a subdural abscess near the falx cerebri. These Lesions ware considered to arise from the direct extension of the frontal sinusitis via a posterior wall defect of the frontal sinus, and phlebitis of the diploic vein around the frontal sinus. The intracranial abscess and frontal sinusitis ware eliminated using Neurosurgical and Otolaryngological techniques.
Even with the development of antibiotics, this condition can still be fatal; thus, we suggest that it is important to increase physician's awareness of this condition.

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Investigation of Predictive Values as the Criteria for Indication of Uvulopalatopharyngoplasty

Nobuo Usui, Kazuhiro Kawano, Madoka ISHIBASI, Kazunari OKAMURA, Koichi ...

2001 Volume 94 Issue 8 Pages 737-741
Published: August 01, 2001
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.94.737

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Purpose: To determine whether preoperative physical examination, physiological examination, and MRI examination of the upper respiratory tract can yield predictive values for the indication of uvulopalatopharyngoplasty (UPPP).
Subjects and Methods: Thirty-seven patients who completed preoperative and 3-6 month-postoperative follow-up examinations, examination of nocturnal sleep and respiratory resistance via the nose and the mouth, and upper respiratory MRI examination were investigated.
Results: The AHI improvement rate was calculated using preoperative and postoperative AHI, and the correlation between the AHI improvement rate and the results of preoperative physical examination, physiological examination, and upper respiratory MRI examination was investigated. There was a significant positive correlation between the AuI improvement rate and the preoperative AHI (r=0.471, p=0.0033), body weight (r=0.496, p=0.0018), and BMI (r=0.438, p=0.0067). The sensitivity and specificity were 77% and 83%, respectively, if calculated with AHI=30; 84% and 83%, respectively, if calculated with weight=70kg; and 61% and 83%, respectively, if calculated with BMI=26 kg/m².
Conclusion: A higher AHI, weight, and BMI resulted in increased AHI improvement rates, and the predictive values for UPPP were considered to be AHI≥30, weight≥70kg, and BMI≥26kg/m².

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Lymphangioma of the Neck in an Adult; A Case Report

Toshiaki SUGITA, Eiji YUMOTO, Hisayoshi KISAKI, Tadahiko SAIKI

2001 Volume 94 Issue 8 Pages 743-749
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.743

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Cervical lymphangioma usually occurs in infants and children as a soft tumor, but it is rarely found in adults. We report a rare case of lymphangioma arising in the right lateral neck of a 44-year-old female. The patient presented with a soft and painless swelling in the right lateral neck. Ultrasound and MRI findings suggested a cystic mass inside the right sternocleidomastoid muscle and the tumor was completely resected under general anesthesia despite some adhesion with the internal jugular vein. Histopathological examination revealed lymphangioma. No recurrence has been noted to date.

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Clinical Evaluation of Combined Use of Azelastine Hydrochloride, Roxithromycin, Tofisopam and Saiboku-to for Throat Discomfort Unsuccessfully Treated by Previos Physicians

Mikikazu YAMAGIWA

2001 Volume 94 Issue 8 Pages 751-759
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.751

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Between 1997 and 1999 the author treated 100 patients (50 male and 50 female, aged from 15 to 76 years with a mean age of 56.2; 44 allergic and 56 non-allergic) with intractable throat discomfort that had not previously responded to medical treatment. Azelastine hydrochloride (anti-allergic agent, Azeptine° 2mg/day), roxithromycin (synthesized macrolide antibiotic, Rurid°300mg/day), tofisopam (a derivative of 2, 3-benzodiazepine effective for autonomic nerve dysfunction, Grandaxin°150mg/day) and Saiboku-to (Chinese herbal medicine for abnormal sensation and inflammation in the upper airway, Tsumura Saiboku-to Extract Granules° 7.5g/day) were administered in combination to the 44 allergic patients and the latter 3 medicines only to the 56 non-allergic patients for a total of 2 weeks.
The therapeutic effect of the combined medication was evaluated at the end of the first and second weeks of administration and one week after the termination of treatment. The medication was considered to be markedly effective when discomfort improved by 80% or more, moderately effective with a 50-79% improvement, slightly effective with a 20-49% improvement, and not effective if the improvement was less than 20%.
The medication was markedly effective in 31% and moderately effective in 35% of patients at the end of the first week; the corresponding figures were 37% and 34% at the end of the second week, and 38% and 30% one week after the termination of medication, respectively.
These findings indicate that the combined medication was effective in the therapy of patients with intractable throat discomfort.

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Off-vertical Axis Rotation; How to Do, How to Evaluate

[in Japanese]

2001 Volume 94 Issue 8 Pages 760-761
Published: August 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.760

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