Practica Oto-Rhino-Laryngologica

The Diagnosis and Surgical Treatment of Sleep Apnea Syndrome

Nobuo Usui

2002 Volume 95 Issue 2 Pages 113-119
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.113

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Sleep apnea syndrome (SAS) is a serious disorder that occurs at a high incidence. Until 30 years ago, snoring was considered harmless to the individual, and only a social problem in its annoyance to others. However, since it was reported that snoring is the most common symptom associated with SAS, and that severe snoring and SAS, especially obstructive sleep apnea syndrome (OSAS), have effects on the morbidity and mortality of patients with cardiovascular disease, snoring and SAS have attracted a great deal of attention. In 1981, Fujita et al. reported a method of treating snoring and SAS by uvulopalatopharyngoplasty (UPPP). However, the rate of improvement by UPPP remained at about 50%, which caused misunderstanding of the role of surgery in OSAS. In 1981, Sullivan et al. reported the use of nasal continuous positive airway pressure (nCPAP), and this brought about a marked change in the concept of OSAS treatment. There is currently controversy about the diagnosis and treatment of OSAS, specifically, who should diagnose and treat the disorder, how to treat it, and how to assess the effects of treatment. Therefore, we reviewed our data on the diagnosis and treatment of OSAS, including several problems relating to surgical treatment.

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Arteriovenous Malformation in Head and Neck

[in Japanese], [in Japanese]

2002 Volume 95 Issue 2 Pages 120-121
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.120

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A Study of Therapy Used for 300 Patients with Sudden Deafness

-The Combination Effects in Grades 2-4-

Shinichiro Narita, Kazutoyo Kobayashi, Tomoko Shintani, Hideki Ogasawa ...

2002 Volume 95 Issue 2 Pages 123-129
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.123

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We investigated the therapy used in 300 patients with sudden deafness who were treated at Hakodate Municipal Hospital, Ebetsu Municipal Hospital, Obihiro Kousei Hospital and Nakamura Memorial Hospital in the period 1994-2000. The grades were 1, 2, 3 and 4 in approximately 22, 30, 35and14%, respectively. General improvement was achieved in 78% of the subjects (Grades1-4). The use of pentoxyfilline (n=25), oxygen under high pressure (OHP) (n=63) and lipo-prostaglandin E1 (lipo-PGE1) (n=27) resulted in significant (p<0.05) improvements in patients with sudden deafness (Grades2-4) when applied in combination with steroids, VB12 and Adenosinetriphosphate disodium. The improvement rate was 92, 86 and 100% in the pentoxyferin, OHP and lipo-PGEl groups, respectively.
These findings suggest that the improvement of blood flow in the inner ear may be very important in treating sudden deafhess.

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Vertigo Attacks after Drinking Alcohol; Report of a Case Recorded by Electronystagmography

Michiko Kachi, Tsutomu Nakashima

2002 Volume 95 Issue 2 Pages 131-134
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.131

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It is well known that nystagmus appears even in normal people after drinking alcohol, and this is called positional alcohol nystagmus (PAN). However, there have been few reports in which actual nystagmus was recorded after drinking alcohol in patients with inner ear diseases. Here we report a patient who developed vertigo after drinking, which was recorded on an electronystagmogram during the alcohol loading test.

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A Case of Immediate Type Traumatic Facial Nerve Palsy

Takaya Nashida, Kojiro Tsuki, Kyoko Kushida, Mieko Sone, Sadamu Takaya ...

2002 Volume 95 Issue 2 Pages 135-138
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.135

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Accurate diagnosis of early stage traumatic facial palsy is often difficult due to severe complications. In this paper, a case of traumatic facial palsy in a 5-year old male is presented. Left facial palsy was noticed following a head injury. As the facial palsy gradually progressed after the trauma, he was referred to our clinic, 3 days after the onset of palsy. Facial movement was evaluated based on the 40-point grading system. He showed 8/40 points, but a CT scan didn't depict any temporal bone fracture which might involve the facial canal. In spite of concentrative treatment, his facial movement score deteriorated to 4/40 points 5 days after the trauma. We performed decompression surgery 5 days after the onset of palsy. Bony fragment from a fracture involving the tympanic segment of the facial nerve impinged directly on the nerve. In this case, surgical exploration revealed a fracture which extended to the tympanic portion.
He had a good recovery of facial movement with a score of 32/40 points 8 months after surgery. This case shows that temporal bone fractures are not always revealed by CT and that early decompression of the facial nerve is recommended when facial palsy gradually gets worse following trauma.

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Topical Ear Treatment

-The Usefulness of Eardrops-

Satsuki Yasumura, Shin Aso, Hitomi Motoshima, Masahito Tsubota, Masats ...

2002 Volume 95 Issue 2 Pages 139-143
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.139

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The aim of this study was to investigate the usefulness of eardrop treatment in patients with otitis externa and media. The survey using a questionnaire revealed that OFLX and CMX were used in 78.1% of 228 patients who visited ENT doctors in Toyama between January and July, 2000. The clinical efficiency of the treatment was determined according to the criteria by Baba et al., which were based on changes of major symptoms after administration of eardrops. The rates of effectiveness were 81.8% in otitis externa, 98.1% in acute suppurative otitis media and 86.2% in chronic otitis media. The combined administration of topical and systemic antibiotics in chronic otitis media patients was less effective on symptoms than only topical administration. On the other hand, ear cleaning treatment of by ENT doctors such as washing, wiping and suctioning of aural discharge accompanied with topical eardrops was much more effective in reducing otorrhea than only eardrop treatment. Bacterial replacement after the topical administration of antibiotics was observed in only one patient who continued to use eardrops against the doctor's instruction. In conclusion, administration of eardrops was very useful and the combination of eardrops and ear cleaning by doctors was helpful to cure otitis externa and suppurative otitis media.

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The Efficacy of Nasopharyngeal Topical Treatment

Makoto Ito, Akiko Shirai, Tomokazu Yoshizaki, Toshiro Nishimura, Takak ...

2002 Volume 95 Issue 2 Pages 145-151
Published: February 01, 2002
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.95.145

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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 Haemophilus influenzae in children with respiratory tract infections has been reported in Japan. Therefore, we carried out clinical and bacteriological studies of topical treatment of the nasopharynx in patients with pediatric acute otitis media at 3 general hospitals and 6 clinics.
Between February and May 2000, 30 strains of Streptococcus pneumoniae and 19 strains of Haemophilus influenzae were isolated from the nasopharynx in 42 children with acute otitis media. Of the 30 Streptococcus pneumoniae, penicillin G resistant S. pneumoniae (PRSP) and penicillin G intermediately resistant S. pneumoniae (PISP) accounted for 55% and 10% of the total, respectively. On the other hand, 26% of the 19 Haemophilus influenzae were β-lactamase-negative ampicillin-resistant (BLNAR) strains.
The bacteriological efficacy of topical treatment of the nasopharynx combined with appropriate oral antimicrobial drugs in patients with PRSP, PISP and BLNAR was 57%, 50% and 60%, respectively. On the other hand, the bacteriological efficacy of only oral antimicrobial drugs in patients with PRSP, PISP and BLNAR was 20%, 43% and 63% respectvely. These results suggest that the success rate of the sterilization of pediatric nasopharynxes using a topical treatment combined with oral antimicrobial drugs is higher than treatments using only oral antimicrobial drugs.

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Efficacy of Treatment to Clean and Widen the Middle Nasal Meatus on Rhinosinusitis

Takechiyo Yamada, Hitoshi Saito, Shigeharu FUJIEDA, Shigehito MORI, Yu ...

2002 Volume 95 Issue 2 Pages 153-157
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.153

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Ventilation of the paranasal sinuses has been hypothesized to be a critical factor in curing rhinosinusitis, because blockage of the ventilating sinuses can lead to retention of nasal discharge or pus. In this report, we investigated the effect of treatment to clean and widen the middle nasal meatus in outpatients with rhinosinusitis. The outpatients were assigned to two groups: in the first group, cotton wool soaked with epinephrine was applied to the middle nasal meatus for 10minutes after cleaning the meatus at each consultation; in the second group, noepinephrine was used but the other conditions were the same. The treatment results were analyzed using X-rays, and subjective complaints via a the questionnaire survey, and nasal symptoms and X-rays scores were significantly better in the first group compared to the second group (p<0. 0001, p<0.005).

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A Case of Melanotic Oncocytic Metaplasia of the Nasopharynx

Yuji Imate, Norio SHIMIZU, Tomoko Nakano, Nobuchika ONO, Tetsuya TAHAR ...

2002 Volume 95 Issue 2 Pages 159-163
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.159

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We report a case of melanotic oncocytic metaplasia. The lesion was incidentally detected in the nasopharynx of a 60-year-old woman. Fiberscopic examination revealed small multiple brown-pigmented nodules at the pharyngeal openings of the auditory tube on both sides. Microscopically, the lesion showed the grandular pattern of melanin-containing oncocytes. The nodules on the left side, which were larger than those on the right side, were removed using forceps. Such a pigmented variant of benign oncoytic lesion is very rare.

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Primary Nasal and Paranasal Sinus Cysts in a Child

Kouji Deguchi, Kengo NISHIMOTO, Ikuyo MIYANOHARA, Shoji MATSUNE, Yuich ...

2002 Volume 95 Issue 2 Pages 165-170
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.165

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We report a rare case of primary nasal and paranasal sinus cysts. The patient was a 4 year-old female, whose chief complaint was right exophthalmus. Although CT and MRI were performed preoperatively, primary cyst was not diagnosed at that time. Taking malignant tumors into consideration, endoscopic endonasal sinus surgery was performed under general anesthesia. Intraoperatively, multiple cystic lesions containing mucous effusion were observed and were opened to be a mono-cavity. After 10 months' follow up no recurrence has been noted. To our knowledge, this is the first case report of primary and multiple paranasal sinus cysts in a child.

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A Case of Renal Cell Carcinoma, Metastasized to the Paranasal Sinuses

Tsunehisa Ohno, Mitsuharu Nonomura, Tatsuo Kikugawa

2002 Volume 95 Issue 2 Pages 171-174
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.171

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We report a case of renal cell carcinoma that metastasized to the paranasal sinuses. A 78-year-old male who had had a left nephrectomy 5 months before under the diagnosis of renal cell carcinoma, complained of epistaxis, nasal obstruction and visual disturbance. A CTscan demonstrated a tumor in the nasal cavity and paranasal sinuses. An open biopsy revealed that the histopathologic diagnosis was metastatic renal clear cell carcinoma (grade 2) to the paranasal sinuses. We performed radiation therapy (50 Gy) to the paranasal sinuses as conservative treatment. Currently, the tumor in the paranasal sinuses seems to be growing gradually.

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A Case of Large Vessel Type Intramasseteric Hemangioma

Masayuki SAKAMOTO, Nobuo Kitahara, Satoshi Asanuma

2002 Volume 95 Issue 2 Pages 175-179
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.175

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A 26-year-old man presented with a soft mass in the cheek that had been present since childhood. MRI revealed a fluid intense mass in the masseter muscle, where the tumor, thought to be a hemangioma, was acting to slow the flow of blood. Angiography showed some spots on the branches of the facial artery from the portal phase to the venous phase, which was considered to be the area of congestion. Histopathological study revealed that the tumor was a lymphangioma with sclerotic veins and lymphatic vessels. Phlebosclerosis was considered as the possible cause of congestion and increase in venous pressure, in which case veins and lymphatic vessels might have multiplied to produce an Intramasseteric hemangioma. The patient was free from disease after resection of the tumor along with a portion of the masseter muscle during a 2-year follow-up period. Since the large vessel type of intramuscular hemangioma increases passively, recurrence of the tumor after resection of sclerotic veins and arteries is rare.

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The Correlation between Obstructive Sleep Apnea Syndrome and Obesity

Kosei Takeda, Muneo Nakaya, Masatoshi Horiuchi, Tomoaki Kai

2002 Volume 95 Issue 2 Pages 181-184
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.181

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To investigate the correlation between obstructive sleep apnea syndrome (OSAS) and obesity, 71 OSAS patients whose sites of obstruction were diagnosed based on sleep nasendoscopy findings were studied. The patients were subdivided into three groups by body mass index (BMI) as follows: Group A, 24 patients with BMI less than 25 (kg/m₂); Group B, 19patients with BMI between 25 and 28; and Group C, 28 patients with BMI more than 28. Variables examined include the apnea index (AI), 4% O² desaturation index (DI), nadir SpO², and cephalometric data (SNA, SNB, PNS-U, MP-H, PAS). AT and cephalometric data were not correlated with BMI, but DI and nadir SpO² were mutually correlated with BMI. These data suggest that OSAS may be worsened by obesity. Of the 71 patients, 45 were treated with surgery based on sleep nasendoscopy findings, and 33 patients, AI, DI, and nadir SpO² were evaluated after surgery. There was a 77.4% and 72.7% improvement in the AT and DI respectively, but neither were correlated with BMI. The response rates were slightly better than previous reports. We believe that careful patient selection using sleep nasendoscopy data as well as avoiding surgery for extremely obese patients when possible may contribute to good results of surgical treatments.

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Cervical Osteophytes and Dysphagia

Yasuko Shibata, Harumi Arao, Noriyuki Yanagita

2002 Volume 95 Issue 2 Pages 185-189
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.185

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We report five cases of cervical osteophytes that caused dysphagia.
All cases were middle-aged or elderly male patients.
Four of the five cases with symptomatic cervical osteophytes underwent surgical resection of the osteophytes via a standard anterior approach. One of them (case 1) had symptomatic osteophytes of the cervical anterior longituidal ligament. We made a diagnosis of OALL (ossification of the anterior longitudinal ligament) and operated.
Dysphagia due to cervical osteophytes is usually treated conservatively, but surgical resection should be considerd in cases with severe dysphagia.

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Prophylactic Immunotherapy for Japanese Cedar Pollen-Sensitive Individuals

Yoshinori Nakai

2002 Volume 95 Issue 2 Pages 191-201
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.191

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This study was designed to investigate whether prophylactic immunotherapy for individuals sensitized to Japanese cedar pollen could prevent an outbreak of pollen-induced allergic rhinitis. A total of 13 non-atopic volunteers and 67 patients sensitized to Dermatophagoides farinae (D. farinae) and Japanese cedar pollen were enrolled in the study. Before enrollment in the study, all of the 67 patients had perennial nasal symptoms due to D. farinae, but no seasonal aggravation of nasal symptoms. 32 patients were treated with immunotherapy using standardized D. farinae extracts alone (control group), and the remaining 35 patients were treated with immunotherapy using the same D. farinae extracts and Japanese cedar pollen extracts (immunotherapy group). The following results were derived from the study:
1. Prophylactic immunotherapy significantly decreased incidences of the outbreak of seasonal allergic rhinitis due to pollen.
2. IL-4 synthesis during the pollen season by peripheral blood T cells stimulated with the cedar pollen allergen were enhanced in the control group, whereas IL-4 synthesis during the season was not enhanced in the immunotherapy group. In particular, IL-4 synthesis during the season did not differ between the non-atopic volunteers and the patients who were treated with prophylactic immunotherapy for more than 3 years.
In conclusion, prophylactic immunotherapy could prevent the outbreak of seasonal allergic rhinitis in those who had been sensitized to the pollen. Therefore, it is likely that prophylactic immunotherapy is a new method of decreasing the incidence of seasonal allergic rhinitis in Japan.

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Bakumondo-to Appears to Alleviate Radiation-Induced Mucositis in Early Laryngeal Carcinoma

Koichiro Kanaya, Yuji Imate, Tsuyoshi Takemoto, Koji Hasuike, Koichl W ...

2002 Volume 95 Issue 2 Pages 203-209
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.203

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PURPOSE: Tsumura Co.'s Bakumondo-to (TJ-29) is a Chinese herb medicine prescribed widely in Japan for bronchitis and laryngitis. It is well known that TJ-29 not only has a variety of effects including anti-inflammatory and antitussive properties, but also is capable of increasing salivary secretions. The purpose of this study is to examine whether TJ-29 can reduce mucosal toxicity caused by radiotherapy in patients with early laryngeal carcinoma.
METHODS AND MATERIALS: Between 1993 and 1999, 20 patients with primary early laryngeal carcinoma were treated by radiotherapy at Nagato General Hospital. All patients were treated with 2 Gy per fraction daily, 5 days a week. Eight patients formed the control group (no TJ-29) and 12 patients received TJ-29 throughout the radiation therapy. The severity of daily subjective symptoms such as hoarseness, xerostomia or pharyngoxerosis, cough, and sore throat were graded O to 3 according to descriptions on the clinical charts.
RESULTS: No statistically significant between-group differences were seen in subjective hoarseness, xerostomia or pharyngoxerosis, and cough. However the mean final grade of subjective sore throat was less severe in the TJ-29 group (p=0.023).
CONCLUSION: Despite the limited number of patients, this study suggests that TJ-29 was able to reduce the severity of mucositis induced by radiotherapy. Further intensive research is needed.

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Mystery of Meniere's Disease

[in Japanese]

2002 Volume 95 Issue 2 Pages 210-211
Published: February 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.210

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