Practica Oto-Rhino-Laryngologica

The Role of the Otorhinolaryngologist in Treating Sleep-related Breathing Disorders

Shigeru Higami, Hiroya Kitano

2003 Volume 96 Issue 12 Pages 1025-1033
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1025

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Mass communications have seriously reported the dangers of Sleep Apnea Syndrome and this disease has become widely known among the general population. Extensive research into daytime sleepiness due to sleep-related breathing disorders had shown that this condition causes decreased work efficiency and contributes to traffic accidents. Moreover, the treatment expenses of high blood pressure, heart disease, and diabetes, which occur secondarily to sleep-related breathing disorders negatively influence the medical economy. However, the clinical level of sleep medicine in Japan is obviously behind that in North America, and progress should be accelerated for the benefit not only of the individual but also of the society. Otolaryngologists often encounter this disease and may perform surgical treatment, but recently, evaluation of the upper airway morphology has been considered essential for continuous positive airway pressure therapy and oral appliance. We think that the the role of the otolaryngologist will become increasingly important in treatings this disease, for each patient to be able to choose the optional treatment for their individual condition.

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Dehiscent Carotid Canal Incidentally Found by Otoscopic Observation

H. Sato

2003 Volume 96 Issue 12 Pages 1034-1035
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1034

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Psychotherapy for Psychogenic Hearing Loss

Michiko Ashitani, Chiyonori Ino

2003 Volume 96 Issue 12 Pages 1037-1043
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1037

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The cases of 31 patients with psychogenic hearing loss who visited us between 2000 and 2002 were reviewed.
The patient group included 9 males and 22 females. The age range was 6 to 14 years, with a mean age of 9.1 years. We classified the patients into three groups, Other-oriented group, Self-oriented group and Conflict group, based on psychological interview and tests. Then we reported sand play and psychological feature of each group.
In the Other-oriented group, the symptoms are considered to represent “protection” against the incursion of others, and it is desirable to cultivate a sense of identity in psychotherapy. In the Self-oriented group, the symptoms may mean “refusal” of others who attack them, and it is necessary to treat both the factor-problems and the secondary mental problems. In the Conflict group, the symptoms can be considered to represent “demand” for care, and it is desirable to encourage self-expression in receptive psychotherapy. The clinical presentation of psychogenic hearing loss varies, and individualized mental assistance is essential.

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Anti-viral Treatment for Three Cases of Sudden Onset Total Deafnesses

Tomohisa Hirai, Shinji Kimura, Mamoru Fujii

2003 Volume 96 Issue 12 Pages 1045-1048
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1045

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The efficacy of anti-viral teatment (acyclovir, γ-globulin) was assessed in the treatment of three patients with sudden onset total deafnesses. Two of the three patients showed slight improvement in hearing disorders, but the remaining patient showed no improvement. One of the three cases was suspected of having some relation to an infection by herpes simplex virus. A more effective protocol for sudden onset total deafnesses is needed.

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Two Cases of Amyloidosis of the External Auditory Canals

Naoki Ashimori, Yasuhiro Hayashi, Tomoyuki Hoshino

2003 Volume 96 Issue 12 Pages 1049-1054
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1049

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Amyloidosis is a relatively rare disease that is defined by extracellular deposition of amyloid. Although it causes disorders of various tissues and organs including the head and neck, little is known about the involvement of amyloid in external ear disorder. Here we report two case studies of amyloidosis in the external auditory canals. One patient was a 66-year-old female with ear itching. Multiple brownish nodules were seen in both ear canals. The other patient was a 46-year-old female with bilateral hearing loss. She had been receiving chronic hemodialysis treatment for 20 years. Her physical examination demonstrated brownish masses that occupied both ear canals and 30-dB conductive hearing loss in pure tone audiometry. The masses in both of her ears were excised to resolve the hearing impairment. Both patients' pathological findings for the ear masses were positively stained by Congo red, and they were diagnosed with amyloidosis. Immunohistochemical staining was performed in both cases. We identified the first case as localized cutaneous amyloidosis, and the second case as dialysis-related amyloidosis.

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Allergic Rhinitis in Sapporo

Etsuko Kanaizumi, Yukihiro Somekawa, Hironobu Yamaya, Atsushi Kondo, A ...

2003 Volume 96 Issue 12 Pages 1055-1061
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1055

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We reported 587 cases of allergic rhinitis in Sapporo General Railway Hospital between April 1995 and March 2000. Radioallergosorbent tests (RAST) were performed for diagnosis of allergic rhinitis.
RAST was positive for house dust (HD) in 75.0% of the patients, 71.8% for mite, 40.9% for white birch, 31.6% for grass, and 21.8% for mugwort.
It is known the most common pollinosis allergen in Sapporo was once grass pollen. However, it has been reported that birch pollinosis has been gradually increasing in Sapporo and neighboring areas recently.
In this study too, the most common pollinosis allergen was birch pollen. RAST was positive in 71% of all pollinosis patients.

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Clinical Statistics of Allergic Rhinitis Patients; The Patients Living in Farmland and Mountain Forest Regions

Keiko Nishioka, Mami Yamamoto, Hisako Matsuoka, Yumiko Ichihara, Mitsu ...

2003 Volume 96 Issue 12 Pages 1063-1070
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1063

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This study reports on a clinical and statistical examination of 628 outpatients who visited our medical department and were diagnosed with allergic rhinitis in the six years between 1996 and 2001. Among all patients, 46.5% suffered from nasal allergy with mites, 42.4% had Japanese cedar pollinosis, and 46.7% of patients had grass weed pollinosis. Grass weed pollinosis was most common and pollinosis tended to shift into a much older generation. With regard to patients with Japanese cedar pollinosis under the age of 19, there were significantly more male than female patients. Among grass weed pollinosis sufferers under age 29 also male patients outnumbered females. Japanese cedar pollinosis and grass weed pollinosis patients had serious grade symptoms significantly more commonly in environments where air pollution in the daytime was much worse than elsewhere, and it is worth noting that more than 50% of patients had lower airway symptoms.

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Vascular Leiomyoma of the Nasal Cavity

Kaori Enatsu, Kenji Takasaki, Shinya Jinnouchi, Takashige Nakata, Haru ...

2003 Volume 96 Issue 12 Pages 1071-1074
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1071

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A case of vascular leiomyoma in the nasal cavity is reported. A 74-year-old man with a complaint of recurrent right-side nasal bleeding visited our clinic, and a spherical tumor was found on his right-side inferior turbinate. The tumor was excised under general anesthesia, and histopathological examination revealed a vascular leiomyoma of the nasal cavity. The etiology, incidence, diagnostic imaging and treatment of this tumor are discussed.

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Argon Plasma Treatment for the Nasal Bleeding Caused by Hereditary Hemorrhagic Telangiectasia

Haruko Suzuki, Shun-ichi Imamura, Hideyuki Honda, Shin-ichi Usami

2003 Volume 96 Issue 12 Pages 1075-1080
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1075

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A 50-year-old man presented with recurrent epistaxis and iron-deficiency anemia. His mother and niece also experienced recurrent epistaxis, and his grandmother, an uncle and two aunts died from severe epistaxis. He had multiple telangiectasia in the nasal mucosa, soft and hard palate, lip, tongue and conjunctiva. He also had experienced hematomesis, and telangiectasia of the stomach was found by gastroendoscopy. He was diagnosed as hereditary hemorrhagic telangiectasia (HHT), because of his family history, recurrent epistaxis, and multiple telangiectasias. We tried various treatments, such as steroid collunarium to the nose, oral tranexamic acid and anti-inflammatory drugs for epistaxis, but it could not be controlled effectively, and severe daily epistaxis required blood transfusion. Thus, next we used argon plasma for irradiating telangiectasia of nasal cavity under endoscopic observation and obtained good control of the epistaxis. In this report, we present the clinical history and treatment results in this case, review the literature and summarize various treatments for recurrent epistaxis in HHT.

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A Chopstick as an Epipharyngeal Foreign Body in an Infant

Ryuhei Nozaki, Kojiro Tsuji, Hironori Takebayashi, Chihiro Hatta, Masa ...

2003 Volume 96 Issue 12 Pages 1081-1086
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1081

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Force injuries of the soft and hard palates often occur in children, who tend to hold pointed objects in the mouth. In most cases, the injury is superficial and heals uneventfully. However, there have been several cases in which the object penetrated deeply into the epipharynx and had to be removed surgically. In this paper, a chopstick as an epipharyngeal foreign body in an infant is presented. A 2-year-old infant was referred to our clinic due to oral bleeding caused by a chopstick. There was no apparent piece of the chopstick visible. However, CT and MRI demonstrated the remaining chopstick in the soft palate through epipharynx, and flexible fiberscopic examination demonstrated a further piece of chopstick in the epipharynx. It was removed under general anesthesia and he recovered without complications. In the case of infants, it is difficult to determine the site of pain, personal condition and situation of the accident. Determination of residual foreign body is thought to be difficult with only a quick inspection of the wound. Physicians must conduct a proper inspection quickly and take precautions, especially when the foreign body is not found. Imaging study (CT, MRI) was useful in this case of a foreign body involving a chopstick.

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Orbital Cellulitis Arising from Acute Frontal Sinusitis via Maxillary and Ethmoidal Sinusitis due to Odontogenic Infection

Mami Yamamoto, Keiko Nishioka

2003 Volume 96 Issue 12 Pages 1087-1090
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1087

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we report a case of a 55-year-old male who presented with orbital cellulitis as a complication of acute frontal sinusitis due to odontogenic infection. Computed Tomographic scans revealed orbital cellulitis in addition to unilateral opacification of all maxillary and frontal sinuses and only the frontal part of the ethmoid sinus. Surgical approach was required to treat the sinusitis and associated orbital cellulites, and bone destruction was found between the frontal sinus and the upper orbital wall. Cultures detected Streptococcus constellatus from all sites.
Odontogenic infections may spread to the orbit through several routes. In this case, the acute frontal sinusitis most likely occurred after disease of the ostiomeatal complex. The infection spread to the orbit through the ruptured hole between frontal sinus and the upper wall of the orbit. Treatment consisted of drainage and antibiotic medication as well as treatment of the causal dental infection.

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Endoscopic Removal of Ectopic Inverted Tooh

Naoko Morita, Shuji Fujita, Takeshi Morita, Masahiro Kikuchi, Tetsuya ...

2003 Volume 96 Issue 12 Pages 1091-1094
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1091

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We report two cases of ectopic inverted tooth, which were removed by endoscopic endonasal surgery. Case 1 was a 9-year-old boy who had no symptoms. A white mass was incidentally found in his right nasal cavity, and the tooth was removed easily with endoscopic endonasal approach. Case 2 was a woman who had recurrent episodes of right maxillary sinusitis. Imaging examination revealed that a tooth was buried in the posterior wall of the antrum. After creating a large middle meatal antrostomy by endoscopic endonasal approach, we could observe the tooth fixed firmly to the surrounding bone. We removed the tooth completely by drilling the surrounding bone with a curved burr. They are both doing well after operation. Recent improvement in instruments has made the endoscopic endonasal approach possible. This approach is useful for removing ectopic teeth because it is less invasive to the patient than a conventional approach.

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Clinical Analysis of Parotid Tumor

Ryoji Ishida, Hiroyuki Yamada, Sin-ichiro Nishii

2003 Volume 96 Issue 12 Pages 1095-1098
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1095

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We report a clinical study of 152 patients with parotid tumor treated in our hospital between 1993 and 2002. We treated parotid tumors according to frozen section analysis. When a tumor was diagnosed as benign by frozen section histological analysis, partial lobectomy was performed. For low grade malignant tumors, lobectomy preserving the facial nerve was performed. When a tumor was diagnosed as a high grade malignant tumor, total parotidectomy was performed.
The rate of accurate determination of malignancy was 98.7%, and the rates of correct histological diagnosis of malignant or benign tumor were 97.5% and 73.0% respectively. In patients with malignat tumors, 5-year survival was 69%, and this result was consistent with previous reports.
Our findings suggested that frozen section diagnosis is useful for evaluation of parotid tumors.

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Large Nasopalatine Duct Cyst; A Case Report

Tsunehisa Ohno, Kouzou Ohta, Nobuya Fujiki, Kazuyuki Ichimaru, Aiko Ta ...

2003 Volume 96 Issue 12 Pages 1099-1102
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1099

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We report a patient with a large nasopalatine duct cyst treated with the help of an oral appliance. A 72-year-old male complained of swelling in the anterior median part of the hard palate. Preoperative CT scan demonstrated a large cystic lesion with a large defect in the palatal bone, which deformed his nasal structure. The cyst was totally removed through a gingival approach. A large dead space left after removal of the cyst was healed in 15 weeks by pressing with an oral appliance.

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Intact-PTH Level after Surgery for Thyroid Cancer

Hideaki Tsuzuki, Shigeharu Fujieda, Masafumi Sakashita, Myungmi Oh, No ...

2003 Volume 96 Issue 12 Pages 1103-1108
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1103

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We determined the level of serum intact parathyroid hormone (intact-PTH) in 122 thyroid cancer patients after 6 postoperative months. Hemithyroidectomy was performed in 92 patients, subtotal thyroidectomy in 20 patients, and total thyroidectomy in 10 patients. The normal level of intact-PTH in patients who underwent hemithyroidectomy or subtotal thyroidectomy was kept without parathyroid autotransplantation. The level of intact PTH in 89 patients who underwent extirpation of regional lymph nodes was significantly higher than that in 22 with ipsilateral neck dissection or 11 with bilateral neck dissection. There were no clinical factors, such as gender, age, clinical stage, tumor size or pathological classification, showing correlation with the level of postoperative intact-PTH. In the entire series, postoperative permanent hypocalcemia occurred in 9 (7%) patients. Of these 9 patients, 8 had undergone total thyroidectomy and only 1 subtotal thyroidectomy. The strategy for preservation of parathyroid function during total thyroidectomy was determined as follows: 1) preservation of bilateral superior parathyroid gland, 2) preservation of 1 superior parathyroid gland and autotransplantation of at least the other 1 parathyroid gland, or 3) autotransplantation of 2 parathyroid glands.

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Pharmacotherapy for Pollinosis

K. Masuyama

2003 Volume 96 Issue 12 Pages 1110-1111
Published: December 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.1110

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