Practica Oto-Rhino-Laryngologica

Electrical Diagnosis for Facial Palsy

Masaru AOYAGI

2002 Volume 95 Issue 10 Pages 985-995
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.985

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Electrical examinations for the diagnosis of facial palsies are reviewed. Because the recovery of nerve function is prescribed by the degree of wallerian degeneration and the degenerated nerve fibers are not responsive to stimulation, the examinations using electrical stimulation are important for the accurate prognostic diagnosis of facial palsy.
Because of its simplicity and convenience, the nerve excitability test (NET) is the most popular in clinical use. But its reliability is insufficient. Electroneurography (ENoG) is more reliable either than NET or the maximal stimulation test. However, when a facial nerve is stimulated peripheral to the injury site, the prognosis cannot be estimated correctly until the degenerations are completed in the stimulus site. Thus, NET and ENoG are not significant within 7-10 days after the onset for prognostic diagnosis.
Using transcranial magnetic stimulation (TMS), the facial nerve can be stimulated around the fundus of the internal auditory meatus, which is central to the injury site in most facial palsies. Patients having a good prognosis can be identified using TMS in the early stage of palsy. Though the examination technique developed by Saito et al. (1992) is a bit complicated, antidromic facial nerve-evoked potential provides accurate information about nerve degeneration in the early stage of palsy.
For bilateral facial palsy, the measurement of facial nerve conduction velocity is useful for the prognostic diagnosis (Tojima, 1988). The measurement of the distribution of facial nerve conduction velocity using Hopf's collision method (Saito, 1991) contributed to the analysis of the pathophysiology of Bell's pal-sy, which is thought to be a compression neuropathy.
Blink reflex is useful in the prognostic diagnosis and also in the estimation of synkinesis as a sequela of palsy. F-waves caused by neuronal recurrent discharge due to antidromic impulse have recently been used in the estimation of recovery of damaged nerves.

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Cochlear Implantation in a Case with InternalAuditory Meatus Malformation

[in Japanese], [in Japanese]

2002 Volume 95 Issue 10 Pages 996-997
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.996

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Acute Low-tone Sensorineural Hearing Loss

Yoshiharu KITANI, Hideyuki FUKUSHIMA, Hajime Nakamura, Yoshihiro TAMUR ...

2002 Volume 95 Issue 10 Pages 999-1004
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.999

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We retrospectively studied 131 patients (132 ears) with acute low-tone sensorineural hearing loss (ALHL) who were treated at our facility from April, 1997 through March, 2001. Their illnesses were characterized by 1) acute onset, 2) with chief complaints of ear fullness, tinnitus and hearing impairment, 3) without vertigo, and 4) hearing loss in the two lower frequencies (250 Hz and 500 Hz). We investigated the general clinical features, the audiometric diagnostic criteria in the two lower frequencies and the effectiveness of steroid therapy in the improvement of prognosis and recurrence ratio.
The results were as follows;
1) Patients consisted of 40 males (40 ears) and 91 females (92 ears). The female-male ratio was 2.3. The peak incidence was in their thirties for males and twenties and fifties for females.
2) About 95% of patients in the study registered at more than 50 dB in the two lower frequencies.
3) The hearing recovery rate was 79.8% (87/109).
4) The recurrence ratio was 24.8 % (27/109). Of 21 patients followed up, 14 recovered, 1 not changed and 6 were diagnosed with Meniere's disease.
5) There were no differences in hearing recovery ratio and recurrence ratio between patients with and without steroid therapy.

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A Familial Case of Engelmann Disease with Hearing Impairment

Isamu KUNIBE, Ken-ichiro NOMURA, Hayabusa NOZAWA, Akihiro KATADA, Masa ...

2002 Volume 95 Issue 10 Pages 1005-1009
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1005

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Engelmann's disease is an uncommon genetic disease characterized by symmetrical hyperostosis of the diaphysis of the long bone and skull base. A patient with this disease and concomitant hearing loss in the family are presented. The propositus was a 44-year-old man who complained of bilateral hearing loss and tinnitus but without leg pain. He had had mild conductive hearing loss in the right ear due to bony involvement of ossicle, and mild sensorineural hearing loss in the left ear due to acoustic nerve compression in the internal auditory canal. A 23-year-old woman in the same family had a 12-year history of severe bilateral leg pain. She also demonstrated complete deafness in the left ear due to acoustic nerve compression in the internal auditory canal.

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Disorder of the Central Vestibular System Demonstrating Impaired Visual Suppression of VOR

Yoshiko SHIOMI, Yousaku SHIOMI, Naoharu ODA, Mitsuko FUJIHARA

2002 Volume 95 Issue 10 Pages 1011-1016
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1011

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Three cases of central vertigo with impaired visual suppression (VS) of the vestibulo-ocular reflex (VOR) during manual sinusoidal rotation are presented. A 48-year-old woman consulted our clinic com-plaining of chronic vertigo for three years. There was no spontaneous nystagmus and routine equilibrium test did not demonstrate any abnormality, while VS of VOR was severely impaired. MRA demonstrated stenosis of the right vertebral artery. A 38-year-old man consulted our clinic due to acute vertigo persisting for one day. He showed left-beating spontaneous nystagmus without aural symptoms. Electronystagmography showed right canal paresis without remarkable findings suggesting central abnormality, while VS of VOR was severely impaired. MRI demonstrated a meningioma at the cerebello-pontine angle. A 58year-old man was referred to our clinic with a one-month history of dizziness. He did not show any spontaneous nystagmus and there were no abnormal neurological findings. The equilibrium test was normal except for impaired optokinetic nystagmus, and VS of VOR was impaired. MRI demonstrated a hematoma at the left cerebellar peduncle. VS of VOR was thought to be a useful parameter for determining the ne-cessity of further evaluation by MRI and MRA.

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The Effect of Canal Plugging Evaluated by Positional Nystagmus

Mamoru SUZUKI, Yasuo OGAWA, Koji OTSUKA, Hitoshi INOUE, Masato HIROI, ...

2002 Volume 95 Issue 10 Pages 1017-1020
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1017

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Clinical effect of a canal plugging procedure was evaluated by positional nystagmus findings. A 61-year-old woman had complained of positional vertigo for the past 8 years. Vertigo was exacerbated when her head position was with the right side down. The positional nystagmus varied at every examination. They were direction-changing geotropic, or apogeotropic nystagmus, direction-changing rotatory nystagmus etc. Other neurootological tests were negative. From the findings of nystagmus, combined lesions involving the utricle, horizontal and posterior semicircular canals were suspected. Since her response to physical therapy was minimum, canal plugging surgery to the right horizontal canal was indicated. After surgery, all types of nystagmus as well as vertigo disappeared, suggesting an inhibitory effect of canal plugging on the whole vestibular organ.

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A Case of Harada's Disease Exhibiting Impairment of Bilateral Vestibular Function

Kazuhiko TAKEUCHI, Takumi HAYASHI, Tian-qun YANG, Mayuko SAKAIDA, Haji ...

2002 Volume 95 Issue 10 Pages 1021-1024
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1021

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We report the case of a 42-year-old male with Harada's disease who showed impairment of bilateral, vestibular and cochlear function. He showed bilateral sensorineural hearing loss on an audiogram and canal paresis in Caloric response. The systemic administration of betamethasone was effective: his visual acuity and hearing level normalized and vertigo subsided.

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Otogenic Intracranial Complication; A Case of Bacterial Meningitis

Kyo YASUDA, Reiko Kuroda, Toshimitsu HASHIMOTO, Akira SASAKI, Hideichi ...

2002 Volume 95 Issue 10 Pages 1025-1029
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1025

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We report a case of otogenic intracranial complication. The patient was a 34-year-old female who complained of left otalgia and headache. She was hospitalized because of deterioration of her level of consciousness and high fever. On examination, her cerebrospinal fluid showed an elevated cell count. A bacterial culture of the otorrhea and cerebrospinal fluid found Streptococcus pneumoniae. A CT scan showed left acute otitis media and mastoiditis with paranasal sinusitis of the same side. This patient was successfully treated with intravenous antibiotic therapy without surgery. After she recovered, a CT scan with coronal sections showed bony defects and a thin bony wall in the left tympanic and mastoidal tegmina. This suggested that in this case the bacterial meningitis was secondary to acute otitis media and mastoiditis.
When headache and high fever persist in patients with otitis media, we should suspect intracranial complications.

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Three Cases of Traumatic Stenosis of the Nostril

Nobuhisa Ito, Michinari MURAOKA

2002 Volume 95 Issue 10 Pages 1031-1036
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1031

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Three cases of traumatic stenosis of the nostril were reported. In a 23-year-old male, the right nostril was obstructed by scar tissue. Deformity of the right ala was also seen. He was successfully treated by surgical enlargement of the stenosis using a nasolabial skin flap transplantation technique under local anesthesia. In a 37-year-old male, the right nostril became obstructed by scar tissue following traffic accident. He was treated by surgical enlargement of the stenosis using a nasolabial skin flap and composite graft transplantation technique under general anesthesia. In a 65-year-old male, the bilateral nares became obstructed by membraneous scar tissue. The left nostril was treated simply with surgical enlargement, while the right nostril was successfully enlarged using an island nasolabial skin flap transplantation technique under general anesthesia. In this case, rhinomanometry, which is an objective evaluation of nasal patency, showed obvious reduction of nasal resistance to airflow after the surgical repairs. In all cases, patients had shown nasal obstructions, but were able to breath comfortably through their nostrils after surgery. The stenoses have not recurred following skin flap transplantation in any of the three cases. The author concludes that skin flap transplantation is the most effective reconstruction method for defects after enlagement of traumatic stenosis of nostril.

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Carbon Dioxide Laser Vaporization of Turbinate for Allergic Rhinitis

Shun-ichi IMAMURA, Hideyuki HONDA

2002 Volume 95 Issue 10 Pages 1037-1044
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1037

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Carbon dioxide laser vaporization of turbinate has recently become accepted as a common treatment for allergic rhinitis. Usually, only a single irradiation is applied per outpatient clinic consultation to mini-mize trauma. However repeated irradiations on separate days are required to achieve an adequate effect. Therefore, we attempted a new method of vaporization and evaluated the outcome. To widely and deeply vaporize the inferior turbinate, irradiation was repeated three times in one session after removing the carbon coating from the previous irradiation under nasal endosopic observation. After the procedure, most patients experienced complete nasal obstruction for two or three days, but there was no intraoperative or postoperative bleeding. All patients had improvement of their chief complaints and were satisfied after a single treatment. Especially, 60% of the patients were completely released from refractory nasal obstruction.
Most patients were satisfied with the effects and the cost, compared with those treated by the usual methods. This method may be especially accepted by the patients with severe complaints, in particular nasal obstruction, but do not have enough time to make frequent visits to an outpatient clinic over a period of several weeks.

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A Case of Apocrine Carcinoma of the Eyelid with Parotid Gland Lymph Node Metastasis

Chieko YAMADA, Norikazu YAMAZAKI, Motoyasu HIRAO, Tomoko SHINTANI, Tet ...

2002 Volume 95 Issue 10 Pages 1045-1048
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1045

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Apocrine carcinoma of the eyelid is a rare neoplasm. We present a case of this carcinoma accompa-
nied by parotid gland lymph node metastasis. The primary tumor of the eyelid was resected and diagnosed as an idiopathic poorly differentiated carcinoma of the skin. After postoperative radiotherapy to the eyelid, a small mass was found in the parotid gland and diagnosed as lymph node metastasis of apocrine carcinoma from the eyelid tumor. With apocrine carcinoma, there is a high risk of lymph node metastasis. To treat this metastasis, we administered postoperative radiotherapy to the parotid gland and ipsilateral neck region.

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A Foreign Body in the Maxillary Sinus; A Case Report

Koji MIYATA, Tomoya NAGATA

2002 Volume 95 Issue 10 Pages 1049-1052
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1049

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We report a case of a foreign body in the maxillary sinus. The patient was a 25-year-old female who had been admitted in our hospital with hyperphagia and vomiting. A dentist incidentally found an abnormal shadow in the right maxillary sinus on X-ray examination, but the patient did not complain of any nasal symptoms. The foreign body in the maxillary sinus demonstrated a curvedshape, but we could not accurately identify the foreign body.
Caldwell-Luc procedure was performed and the foreign body was removed from the maxillary sinus without any complications. The foreign body was identified as gutta-percha which had been used as a root canal filling material. We thought that a foreign body was accidentally inserted into the maxillary sinus during dental treatment.

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A Case of Large Pharyngeal Hemangioma

Toshihiro NAGATO, Satoshi NONAKA, Masanobu IMADA, Akihiro KATADA, Nobu ...

2002 Volume 95 Issue 10 Pages 1053-1058
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1053

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Pharyngeal hemangioma is a comparatively rare tumor. Surgical removal, sclerotherapy and laser therapy are representative of the treatment modalities generally employed. We report a case of large pharyngeal hemangioma extending from the nasopharynx to the oropharynx.
The patient was a 19-year-old male complaining of hematemesis. We diagnosed large pharyngeal hemangioma and performed sclerotherapy using 5% monoethanolamine oleate under general anesthesia. Alter the sclerotherapy, the tumor decreased in volume immediately. However, one year later, the tumor increased its volume to that before the sclerotherapy. As an alternative therapy, we carried out laser therapy using KTP and YAG laser under general anesthesia. The tumor shrank immediately and has shown no tendency to increase its volume during the three years since laser therapy.
Although both therapies decreased the volume of hemangioma similarly, the effect of sclerothrapy did not even last for one year. As the effect of laser therapy lasted for more than three years, it is likely that laser therapy was more useful than sclerotherapy in this case.

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Therapy for Sleep Apnea Syndrome

-Comparison between nCPAP and MAS-

Keiju TSUBAKI, Kousuke ISHII, Kouichi ABE, Masanori YAMAMOTO, Masashi ...

2002 Volume 95 Issue 10 Pages 1059-1063
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1059

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Improvements in subjective symptoms, changes in the apnea index (AI), and complications were studied in patients with obstructive sleep apnea syndrome (OSAS) who were treated with nasal continuous positive airway pressure (nCPAP) or a mandibular advancement splint (MAS).
Subjects: The subjects consisted of 32 patients (30 males and 2 females) with habitual snoring and sleep apnea.
Methods: AI was measured using an apnea monitor (APNOMONITOR II®, Chest Co.). Sleep apnea was defined as the cessation of respiration for 10 seconds or longer during sleep. Complications, improvements in subjective symptoms and changes in AI were investigated during and after each treatment.
Results: Subjective symptoms improved in 24 of 25 patients undergoing nCPAP treatment. Mean-while, subjective symptoms disappeared or improved in all patients receiving MAS. AI improved in 21 of 25 patients with nCPAP and in all patients with MAS.
As complications of nCPAP, xerostomia was noted in 4 patients, breathing difficulty in 4 and recur-rent arousal in 3. In contrast, temporomandibular arthralgia was noted in only 3 patients with MAS.
Conclusion: The continuity rate of MAS was high and its efficacy was comparable to that of nCPAP in patients with OSAS.

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Large Benign Thyroid Tumor Suspected of Anaplastic Thyroid Carcinoma

Masaaki HIGASHINO, Ryo KAWATA, Tomoko YAMAGUCHI, Katsuhiro YOSHIMURA, ...

2002 Volume 95 Issue 10 Pages 1065-1069
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1065

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We reported large thyroid tumor in a 75-year old female who presented with cervical tumor. The patient first noticed the mass 30 years previously, however the mass had not enlarged. Then the tumor rapidly enlarged within one week with pain. On the initial examination in our hospital, the tumor was over 10 cm, reaching the submandibular gland. The tumor was diagnosed as thyroid malignant tumor by fine needle aspiration biopsy (FNA). The histological diagnosis suggested findings anaplastic carcinoma based on the present history, FNA findings and inflammatory response of blood examination. However, the tumor did not grow after administration and there was no accumulation on Ga scintigram. So we performed hemithyroidectomy alone after one week of administration, and the tumor was diagnosed as follicular adenoma with hematoma by intraoperative frozen section. We suggested that rapid enlargement of the tumor and inflammatory response was due to intratumoral hemorrhage, and misdiagnosis of FNA was due to a complicat

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Anterior Skull Base Surgery

Hajime ISHINAGA, Teruhiko HARADA, Takeshi SHIMIZU, Kazuhiko TAKEUCHI, ...

2002 Volume 95 Issue 10 Pages 1071-1074
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1071

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Anterior craniofacial resection is now recognized as one of the best treatment for nasal and paranasal tumors involving the cribriform plate. This approach allows for a more oncologically sound en bloc tumor removal. Here we report 6 cases of anterior skull base surgery for malignant neoplasms. The mean age was 54.0 years ranging from 30 to 70. There were 5 men and 1 woman. The pathological diagnoses were as follows: squamous cell carcinoma (4), adenocarcinoma (1), and malignant melanoma (1). Three patients required free tissue transfer and anterior skull base was reconstructed using a pericranial flap in 3 patients. Four patients are alive without disease, and two died. Major complications occurred in 1 of 6 patients and that patient developed a cerebellar hemorrhage. Infectious complications occurred in 2 patients. There were no perioperative deaths. We concluded that craniofacial resection is an effective surgical treatment for nasal and paranasal tumors.

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Three Cases of Inflammatory Myofibroblastic Tumor in the Head and Neck Region

Yoshifumi Kobayashi, Mitsuru YANAI, Miki TAKAHARA, Akihiro KATAYAMA, I ...

2002 Volume 95 Issue 10 Pages 1075-1081
Published: October 01, 2002
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1075

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Three cases of inflammatory myofibroblastic tumor (IMT) in the head and neck region are reported. Case 1 was an 80-year-old male diagnosed with IMT of the parotid gland which was treated with partial parotidectomy and submandibular neck dissection. Case 2 was a 63-year-old male diagnosed with IMT on the middle ear which was treated with radical operation on the middle ear. Case 3 was a 71-year-old male diagnosed with IMT of the nasal cavity which was treated with septectomy. All patients are still alive without any recurrence. In these rare diseases of the head and neck area, pathological diagnosis was dif-ficult to confirm from specimens. It is unresolved whether IMT is a true tumor or pseudotumor, so dif-ferentiation should be made the difference between IMT and other tumors or specific inflammation by im-munological or genetic methods.

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Impalement Injury Through the Chest to Forehead

Jin HOSHI, Shigehiro OWAKI, Mikio SUZUKI

2002 Volume 95 Issue 10 Pages 1083-1086
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1083

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Impalement injury is a penetrating and contusive wound with two distinct characteristics; stab and blunt trauma. We encountered a 52-year-old male with impalement injury by two iron rods through the chest to the neck, pharynx, paranasal sinus, orbita, and forehead. As the stakes damaged the bilateral optic nerve, he had lost vision at the initial visit. Computed tomographic examination of the head, neck, and chest was performed to evaluate the organs and degree of injury. Although the iron stakes caused artifacts on computed tomographic testing, the examination was still beneficial to detection the penetrating route and the degree of injury to various organs. Sufficient exposure of rods without causing additional vascular injury, repair of injured organs, exhaustive debridement and drainage were carried out. Fortunately, we could save the patient's life. The following therapeutic strategy for impalement injury was used: 1) injured organs, especially large vessels, should be assessed before surgical treatment; 2) impaled objects should be extricated after protection of large vessels; and 3) thorough debridement, wound drainage, and administration of tetanus toxoid and antibiotics are nessesary.

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Percutaneous Ethanol Injection Therapy (PEIT) in Head and Neck Lesion

[in Japanese]

2002 Volume 95 Issue 10 Pages 1088-1089
Published: October 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.1088

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