Practica Oto-Rhino-Laryngologica

Diagnosis and Treatment of Ossicular Lesions

Tetsuo HIMI

2002 Volume 95 Issue 4 Pages 315-323
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.315

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This review focused on both the new diagnostic method for ossicular anomalies and the pathophysiology of otosclerosis and otosclerosis-related disorders.
First, this article demonstrated the advantages of virtual endoscopy imaging, and the application of 3D imaging for patients with ossicular anomalies. This technique may play an important role in preoperative planning and surgical training.
With regard to stapes surgery, recent knowledge of the clinical characteristics and temporal bone pathology in patients with otosclerosis-related diseases was described. The cause of both complications and residual conductive hearing loss after stapes surgery was also discussed by clinical investigations and by histopathologic study of temporal bone in patients with otosclerosis.

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Tortuous Common Carotid Artery with Thyroid Tumor; A Case Report

[in Japanese], [in Japanese]

2002 Volume 95 Issue 4 Pages 324-325
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.324

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Insertion of Ventilation Tube for Treatment of Recurrent Acute Otitis Media

Yumiko Maruyama, Makoto Ito, Mitsuru Furukawa

2002 Volume 95 Issue 4 Pages 327-336
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.327

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We inserted the ventilation tube into seven children for recurrent acute otitis media (rAOM), who could not recover from rAOM in spite of comprehensive treatments including myringotomies, oral or intravenous administration of antibiotics, and administration of immunoglobulin.
In order to select patients for the ventilation tube insertion, we followed the indications for surgery as below.
1) Recurring otitis media purulenta more than once a month
2) Inability to recover from rAOM in spite of comprehensive treatments including myringotomies and peroral or intravenous administration of adequate antibiotics
3) Ability to undergo general anesthesia.
The average observation times before and after surgery were 8.05 and 5.10 months. During these periods, the frequency of otitis media purulenta significantly decreased (t test, p<0.0001), from 1.72/30 days to 0.14/30 days on average. It was also proved statistically that the number of days of antibiotic administration and the frequency of fever showed a significant decrease after the operation as compared with before (p=0.0007, p=0.0188).
Ventilation tube insertion is thought to be one of the effective treatments for rAOM, and avoiding the overuse of antibiotics would prevent the increase of drug-fast bacteria such as penicillin resistant Streptococcas pneumoniae and ampicillin resistant Haemophilus influenzae both in number and in the level of resistance.

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A Study of Tympanoplasty in Elderly Patients and Questionnaire Survey

Tatsuhito OWA, Masaharu URA, Yutaka NODA, Yukio Nakamura

2002 Volume 95 Issue 4 Pages 337-343
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.337

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The outcome of tympanoplasty and following questionnaire survey in elderly patients older than 65 years was investigated. Fifty four ears of 40 patients with chronic otitis media (30 ears), middle ear cholesteatoma (13 ears), sequela of otitis media (9 ears) and others (2 ears) were operated at the Department of Otolaryngology, University of the Ryukyus School of Medicine. The success rate in terms of hearing improvement according to the criteria of Otological Society of Japan (2000) was 43.1% as a whole.
The group with chronic otitis media had better (67.9%) hearing improvement than that of cholesteatoma (7.7%) or sequela of otitis media (22.2%). Answers to a questionnaire survey were received from 21 patients. The results showed that not only the patients but also their families felt the hearing improvement and were satisfied with the operation. They mentioned hearing recovery and end to ear discharge as satisfactory points. For using hearing aids, it seemed that tympanoplasty was of benefit to some patients. There were no severe problems relating to general anesthesia or surgery during the clinical course. In spite of a lower success rate in hearing improvement, patients and their families had a good impression of the operation. In conclusion, tympanoplasty for elderly patients should be recommended for patient satisfaction as well as improvement in hearing ability.

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A Foreign Body in the Nasal Cavity; A Case Report

Yoshio HATAKEYAMA, Toshihiro YAMAMOTO, Yoshiyuki KITAOKU

2002 Volume 95 Issue 4 Pages 345-348
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.345

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Adult patients with an undiagnosed foreign body existing in the nasal cavity for a long period of time are rare. The patient was a 63-year-old female who had undergone an operation for sinus empyema at the age of 17 and who visited our outpatient clinic complaining of nasal bleeding and discharge and other indefinite symptoms. We treated her for about 8 years without any findings of a foreign body in her nasal cavity due to the absence of any remarkable signs on CT and fiberscope examinations. Finally, a foreign body covered with granulation tissue was found when an endoscopic operation to remove nasal polyps and granulation tissue was performed. The foreign body was a plastic stick that was partially covered with calcifications.

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Three Cases of Olfactory Neuroblastoma

Shigeki MOCHIGI, Tetsuya MURAKAWA, Manabu NAKANOBOH, Taichi FURUKAWA, ...

2002 Volume 95 Issue 4 Pages 349-353
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.349

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Olfactory neuroblastoma (esthesioneuroblastoma) is a rare carcinoma arising from the epithelium.
To date eighty cases have been reported in the Japanese literature, and we report here three cases of olfactory neuroblastoma.
Case 1, a 67-year-old male presented with a nosebleed and magnetic resonance imaging revealed a mass in the nasal cavity that infiltrated intracranially. Skull base surgery and craniofacial resection were performed, but the patient died of brain metastasis two and a half years later.
Case 2, a 45-year-old male presented with epistaxis and computed tomography revealed tumor invading the anterior cranialfossa. En bloc resection of the skull base was performed with subsequent radiotherapy chemotherapy (carboplatin). Neck dissection was required later for cervical metastasis but the patient is still alive six years after neck dissection.
Case 3, a 69-year-old female presented with nasal obstruction. The tumor was limited to the nasal cavity and surgical extirpation by lateral rhinotomy was performed. The patient is still alive two years postoperatively with no evidence of local recurrence or metastasis.

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Subcutaneous and Brain Abscesses Caused by Frontal Sinusitis

Yutaka HIGUCHI, Hideo Nakamura, Hiromi KONDOH, Masabumi OBATA, Sugata ...

2002 Volume 95 Issue 4 Pages 355-359
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.355

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The patient was 14-year-old boy who complained of progressive forehead swelling and persistent slight fever. A CT scan revealed subcutaneous abscess, brain abscess in the right frontal lobe and frontal sinusitis. The patient underwent a drainage operation at which time bone destruction was noted in the skull, and the subcutaneous abscess was observed to be continuous with the frontal sinus.
Three months after neurosurgery, forehead pain recurred again, and CT and MRI showed left pansinusitis including frontal sinusitis. Right extranasal frontal sinusectomy and maxillo-etmoidectomy was performed to prevent intracranial complication. Additionally a bony defect was noted in the posterior wall of the frontal sinus. In this patient we considered that the infection had directly spread to the brain and subcutaneous forehead through the bony defect in the wall of the frontal sinus.
In cases of rhinogenic intracranial complications, the frontal sinus is considered to be the most probable origin of infection. The mechanisms for the intracranial spread of infection from the frontal sinus and the importance of surgical treatment against frontal sinusitis are also discussed.

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Clinical Study of Patients with Postnasal Drip

Shinya TAKANO, Shinya INAMI, Hajime ARAMAKI

2002 Volume 95 Issue 4 Pages 361-364
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.361

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We analyzed the relationship between postnasal drip and the state of the nasal middle meatus in 394 patients with sinusitis.
There was a weak relationship between postnasal drip and the type of paranasal sinuses. Many of the patients with postnasal drip had bilateral contraction and obstruction of the meatus.

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A Case of Tongue Lipoma

Daisuke Kobayashi, Akinori KIDA, Susumu OGAWA, Ayako KAWAMOTO, Yuki YA ...

2002 Volume 95 Issue 4 Pages 365-370
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.365

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Lipoma can arise in any portion in the body where fat tissue is exist. However, lipoma in the oral cavity is rare and reported to occur only in 2-5% of benign tumor in the oral cavity in Japan. We treated a 66-year-old female with a lipoma of the tongue. Oral examination revealed a 27×23mm mass on the left edge of the tongue. The mass was firm on palpation. A T1 weighted axial MR image clearly showed a hyperintense mass with a small area of isointensity. The tumor was excised under general anesthesia. It was encapsulated and measured 50×30×25mm in size. The histopathologic diagnosis was lipoma with muscle components. A review of the Japanese literature showed 55 cases of lipoma of the tongue.

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A Case of Warthin's Tumors in the Bilateral Parotid Glands

Tadashi YOSHIDA, Nobuhiro HAKUBA, Hidemitsu Sato, Kiyofumi GYO

2002 Volume 95 Issue 4 Pages 371-375
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.371

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Tumors of the parotid gland usually arise unilaterally and multiple tumors in the bilateral parotid glands are very rare. In this paper, we present a case of multiple Warthin's tumors in the bilateral parotid glands and also discuss 27 cases of Warthin's tumors. A 50-year-old man with multiple tumors in simultaneous bilateral parotid was treated at our hospital. Preoperative MRI showed five tumors in the right parotid gland and two in the left. Surgical extirpations were done under general anesthesia first on the right parotid gland and then on the left 11 days later. Histological examination revealed that they were Warthin's tumors. We studied 27 cases of Warthin's tumors treated at our hospital during the last 25 years. No significant differences were found in age and sex between bilateral and unilateral cases, while the average number of tumors was 2.8 in the bilateral cases and 1.3 in the unilateral cases.

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Tonsillar Sarcoidosis; A Case Report

Kazuhiro YAMAMOTO, Masatoshi HIRAYAMA, Yoshiaki IGUCHI

2002 Volume 95 Issue 4 Pages 377-381
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.377

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We report a patient with tonsillar Sarcoidosis who was initially diagnosed with acute tonsillitis. A 49-year-old female, presented with complaints of sore throat and bilateral neck swellings. At the first examination, her tonsils were swollen and reddish colored. Bilateral neck lymph node swellings could also be palpated.
She was diagnosed as acute tonsillitis, and treated perorally with antibiotics (2 weeks). The tonsillar swelling, however, was not improved. Therefore we conducted a biopsy on her left tonsil and sarcoidosis was diagnosed.
The treatment was switched to peroral steroid medication and the symptons subsequently improved. The findings of concomitant acute inflammation and the location characterized this rare sarcoidosis case.

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A Case of Laryngeal Tuberculosis

Akiko HAGIWARA, Takekazu MISHIMA, Ichirou ANDOU, Makiko SEKI

2002 Volume 95 Issue 4 Pages 383-386
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.383

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Recently, laryngeal tuberculosis has been a rare disease. However, some individuals still develop tuberculosis even today, so careful attention should be paid to this diseae. In this paper, a case of laryngeal tuberculosis is reported. The patient was a 30-year-old female. She presented with a chief complaint of hoarseness, and had granulomatous changes in her bilateral false cords, vocal cords, and subglottic region. Diagnosis was established by the identification of Mycobacterium tuberculosis in the tissue sample. The glanulomatous lesion responded well to treatment with anti-tuberculous chemotherapy. We report the details of this patient together with a discussion of the relevant literature.

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Treatment of Subglottic Stenosis with Composite Nasal Septal Cartilage Graft

Akiko Tanaka, Tomoyuki HAJI, Hideaki MAEDA, Shinji TAKEBAYASHI, Nobuya ...

2002 Volume 95 Issue 4 Pages 387-394
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.387

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Four cases of severe subglottic stenosis are reported. The causes of stenosis were long time intubation in two cases, laryngeal injury in one case, and a scar caused by radiation in one case.
All cases were treated by two-stage laryngotracheal reconstruction. First, we made a laryngotracheal fissure, and removed the subglottic granulation or scar tissue. After about three month's observation, we reconstructed the anterior tracheal wall with a composite nasal septal cartilage graft (nasal septal cartilage with the unilateral mucoperichondrium) and covered the cartilage with an advanced cervical skin flap, reserving a small stoma for respiration. After three months observation, the stoma was closed in three of four patients. However, in one patient with laryngeal injury the stoma was required for respiration.
We consider that a composite nasal septal cartilage graft is suitable for the reconstruction of the anterior tracheal wall in adults because it is easy to obtain the graft, and because the transplantation and reconstruction of the anterior wall of the larynx and trachea with the composite nasal septal cartilage are both safe and relatively simple.

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Cell Proliferating Activity and p53 Protein Expression in Laryngeal Carcinoma

- Comparison with Regard to the Extent of Tumor Progression -

Makoto SHIRANE, Tomohito DATE, Tsutomu UEDA, Takamasa IMAI

2002 Volume 95 Issue 4 Pages 395-401
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.395

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The immunohistochemical expression of p53 protein and proliferating cell nuclear antigen (PCNA) and the number of argyrophilic nucleolar organizer regions (AgNORs) as well as the mean size of the nuclei were evaluated in seventy-five formalin-fixed, paraffin-embedded specimens from the untreated patients with laryngeal carcinoma. The primary tumors were classified into forty-seven cases of an early group of T1, T2 and twenty-eight cases in an advanced group of T3, T4 according to the extent of tumor progression. Comparison was made of the above-mentioned parameters between the two groups. The cell proliferating activity measured by PCNA and AgNORs and the coefficient of variation in the mean size of nuclei were significantly increased in the advanced group compared with the early group. However, no significant correlation in the expression of p53 protein was found between the early group and the advanced group. These results suggest that the proliferating activity which highly related to the malignancy of tumor cells increases with tumor growth and that damage in the p53 tumor suppressor gene is concerned more with the early stage of tumor genesis than with tumor growth. Comparison by the presence or absence of neck lymph node metastasis in the advanced group showed no significant difference in the proliferating activity, expression of p53 protein and mean size of nuclei.

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Refractory Cases in Laryngopharyngeal Reflux Disease (LPRD)

Takashi KATO, Yusuke WATANABE, Hiroshi MUTA, Yoshiharu SAKATA, Takeshi ...

2002 Volume 95 Issue 4 Pages 403-408
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.403

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Gastroesophageal reflux disease (GERD) which includes otorhinolaryngologic symptoms is called laryngopharyngeal reflux disease (LPRD). Recently, there are refractory cases of GERD and LPRD for which only a proton pump inhibitor (PPI) is effective. In Japan, it is reported that most refractory cases of GERD are aged females and negative cases of Helicobacter pylori (H. pylori).
Eight refractory cases of LPRD are reported. The male and female ratio was 1:1. The chief complaint was pharyngeal pain in 3 cases. Reflux esophagitis was found endoscopically in 4 cases and H. pylori was negative in all cases. Kyphorachitis was found in females and surgical treatment was performed in 1 case.
Refractory cases of LPRD were similar to those of GERD. In LPRD, refractory cases seen in aged females who respond only to PPI may require other modes of treatment.

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Enterocolitis Caused by Methicillin Resistant Staphylococcus Aureus (MRSA) after Bilateral Neck Dissection

Yuichiro YANAGI, Tetsuaki KUBOTA, Kazuo MATSUI, Yoshiyuki KADOKURA, Ha ...

2002 Volume 95 Issue 4 Pages 409-412
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.409

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The number of patients with postoperative enterocolitis caused by MRSA has been rapidly increasing since the use of antibiotic prophylaxis consisting of extended-spectrum cephems. We encountered a case of postoperative enterocolitis due to MRSA. The patient was an 26-year-old female who had bilateral cervical lymph node metastasis of tongue cancer; the enterocolitis appearred after we performed bilateral neck dissection. We used prophylactic antibiotics (FMOX) following the operation to prevent infection. Abdominal pain, high fever, and white watery diarrhea appeared seven days after the operation. MRSA was detected in her feces. Toxic shock syndrome toxin I (TSST-I) was induced by this MRSA. The patient was treated with oral vancomycin (2g/day), to which this MRSA showed sensitivity. The patient showed improvement in her symptoms, serum CRP level, and, leucocytosis after 12 days.

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Clinical Efficacy of Choto-san with Merislon and Serenal® on Tinnitus

Keiko NISHIOKA, Hisako MATSUOKA, Shigeko NISHIOKA, Mami YAMAMOTO, Naot ...

2002 Volume 95 Issue 4 Pages 413-420
Published: April 01, 2002
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.95.413

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Forty-two patients complaining of tinnitus were treated orally with Choto-san (a Chinese medicine), Betahistine Mesilate, and Oxazolam for one month. Overall effectiveness ratings: Twenty-four (57.1%) patients seemed to improve in tone volume, twenty-two (52.4%) in durability, and sixteen (38.1%) in worrying. Even in the early stage of this experiment, twenty-six percent of the subjects seemed to have a greater improvement in tinnitus than those treated with only one of the medicines. It is suggested that these medicines are promising in the treatment of tinnitus because there is a synergic effectiveness in their combination.

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Treatment of Chronic Sinusitis in Relation with Pathological Backgrounds

[in Japanese]

2002 Volume 95 Issue 4 Pages 422-423
Published: April 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.422

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