Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 96, Issue 3
Displaying 1-17 of 17 articles from this issue
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  • Functional Examination for Conductive Deafness without Perforation of the Tympanic Membrane
    Akira Hara
    2003 Volume 96 Issue 3 Pages 191-196
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.191
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    Functional otological examinations, including pure tone audiometry (PTA), impedance measurement of the tympanic membrane, tympanometry, liquid test (LT) and acoustic reflex test (AR), were reviewed to evaluate their accuracy in the diagnosis of conductive deafness without perforation of the tympanic membrane. PTA, impedance audiometry, tympanometry and CT did not contribute to the differential diagnosis of ossicular fixation and discontinuity. In contrast to these results, LT showed a significant difference between ossicular fixation and discontinuity, i. e., no improvement of bone conduction threshold at any frequency by filling the external auditory canal with fluid in 86.7% of the patients with ossicular discontinuity, and deterioration of bone conduction at 1000Hz in 92.5% of patients with ossicular fixation. A reversed pattern in the ipsilaterally stimulated AR was observed in 87.3% of conductive deafness patients examined. The amplitude of this artifact response was larger at higher frequency (2, 000Hz) in ossicular fixation and at lower frequency (500Hz) in ossicular discontinuity. These results were obtained in all patients showing the reversed pattern, without any exception. Therefore, we concluded that LT and AR are the most reliable examinations for the differential diagnosis between fixation and discontinuity of the ossicles.
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  • Diagnosis of Pediatric Otitis Media Using the Electric Flexible Scope and the Image Filing
    N. Kubo
    2003 Volume 96 Issue 3 Pages 198-199
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.198
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  • Radiation Therapy for Middle Ear Carcinoma; A Report of Three Cases
    Chisa Harada, Kazunori Sekine, Koichi Tamura, Koji Kimoto, Naoki Toda, ...
    2003 Volume 96 Issue 3 Pages 201-206
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.201
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    Three cases of middle ear carcinoma treated at our hospital are reported. All cases had histories of chronic otitis media or middle ear surgery. According to Stell's classification, staging was T3N0M0, T2N0M0 and T3N0M0, respectively. Because of advanced age or tumor extension around the carotid artery or the dura mater, irradiation, but not surgery, was indicated in all cases. Two of three cases also received Stereotactic Radiosurgery (SRS) to residual tumors. To date, both patients treated with SRS have survived for two years without recurrence. Another patient with a residual tumor with a volume beyond SRS indication died of disease one year after irradiation. We suggest that adding SRS therapy to irradiation is effective in the treatment of middle ear carcinoma.
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  • Two Pediatric Cases of Facial Palsy Caused by Intracranial Disease
    Shinji Takebayashi, Nobuya Yagi, Tatsuyuki Yamamoto, Ryusuke Hori, Ats ...
    2003 Volume 96 Issue 3 Pages 207-211
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.207
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    We report two pediatric cases of facial palsy caused by intracranial disease, and review 54 facial palsy patients under 12 years old who were admitted to Kurashiki Central Hospital between January 1991 and January 2002. Previously reported cases, congenital palsy patients and traumatic palsy patients were excluded from review.
    Case 1 was a 2-year-old girl, who was hospitalized due to left facial palsy. MRI revealed a well-enhanced mass both in the cerebellopontine (CP) angle and the spinal cord. The tumor in the spinal cord was pathologically diagnosed as an atypical teratoid-rhabdoid tumor, which probably caused metastasis from the CP angle to the spinal cord.
    Case 2 was a 5-year-old girl, who was admitted to the hospital with right facial palsy. At 3 years old, she developed right facial palsy but recovered one month later. At 4 years old, right arm and right leg palsy occurred, but recovered. MRI revealed arteriovenous malformation in the parietal lobe.
    Of 54 cases reviewed, 35 patients were diagnosed as having idiopathic palsy (Bell's palsy), 11 as having viral infection, 7 as having otogenic disorder, 1 as having neoplasm. We were able to follow 42 cases over a prolonged period. Of these 42 cases, 39 cases recovered, and 3 cases did not recover.
    Facial palsy in children is considered to have a good prognosis, but it may be the initial manifestation of a life-threatening disorder such as intracranial vascular malformation or neoplasm. When neurologic findings in addition to facial palsy are manifested or suspected, it is important to search for an intracranial lesion. MRI is a very useful method of evaluating intracranial disease.
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  • A Case of Mixed Hearing Loss Accompanied with Multiple Congenital Malformations
    Kazumasa Kondoh, Tadashi Kitahara, Tetsuo Morihana, Shin-ichi Okumura
    2003 Volume 96 Issue 3 Pages 213-217
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.213
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    We report a case of mixed hearing loss accompanied by multiple malformations in a 5-year-old male. His mother first suspected that her child had reduced hearing, when he was 5-years and 2-months-old. Nine months later, she brought her son for a hearing test. Audiometry showed a mild low frequency mixed hearing loss bilaterally.
    As a past history, he had a ventricular septal defect and hypoplasia of the bilateral big toes. Family history was noncontributory; there was no history of a similar illness in other family members or relatives.
    We peformed exploratory surgery. The round window niche was obscure and the circumferential bony wall of the cochlea was thin. So we abandoned the surgical attempt at hearing improvement.
    In the embryo, the differentiation period of each organ varies. Accordingly, we considered that some teratogenic factor may have had an effect on the embryo in the 5-6th weeks of viviparity when the differentiation period of the malformed organs overlapped each other.
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  • A Possible Mechanism of Otalgia Stemming from Temporomandibular Disorders
    Toshihiro Nakaniwa, Toshihiko Matsumoto, Takao Kishi
    2003 Volume 96 Issue 3 Pages 219-224
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.219
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    A study was conducted to investigate the relationship between otalgia and the condyle displacement stemming from temporomandibular disorders (TMDs). Twenty-eight female patients of similar ages with TMDs were enrolled and classified into two groups: 14 subjects without any ear symptoms and the others with otalgia. Peak pressure and impedance in the middle ear were evaluated, condyle displacement at P1-P5 was measured using axial radiograph projection and kinematic axis point displacement between preand post treatment was determined.
    The differences between the two groups were statistically analyzed by Mann-Whitney U-test and Wilcoxon signed-ranks test, and significant differences between two groups were noted for the following: side difference of the lateral shift of the condyle, vector of the centric slide analyzed at kinematic axis points, and middle ear peak pressure on the disorder side, and also stapedius reflex threshold level on the opposite side. These results suggest that in TMDs either the presence or absence of otalgia is significantly related to disorders of the middle ear pressure stemming from condyle displacement.
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  • CT Evaluation of Medial Protrusion of the Lamina Papyracea
    Kouichi Abe, Kousuke Ishii, Masanori Yamamoto, Keiju Tsubaki
    2003 Volume 96 Issue 3 Pages 225-230
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.225
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    The frequency, location and gender difference of the medial protrusion of the lamina papyracea toward the ethmoid sinus were evaluated in 522 patients who underwent CT of the paranasal sinus region at our institution between January 1999 and January 2002. The area of interest was the nose and paranasal sinuses in 295 patients, auditory organ in 190 patients and maxillofacial area in 37 patients. The lamina papyracea was clearly identified in all the patients. Patients with a past history of paranasal sinus surgery and those with injuries in the lamina papyracea were excluded from the study. The patients consisted of 283 males and 239 females aged between 6 and 94 years. Twenty-nine patients were younger than 20 years old. Axial slices were taken in most cases. Medial protrusion was judged to be positive in cases where the lamina papyracea evidently deviated toward the ethmoid sinus on CT and the CT value of the protruded area was identical to that of the orbital fat.
    Medial protrusion of the lamina papyracea was positive in 4 males and 2 females with a frequency of 1.15%. All the 6 patients were older than 20 years old. The protrusion was located in the anterior ethmoid in 2 patients, middle ethmoid in 3 patients and entire ethmoid area in 1 patient whose ethmoid sinuses were poorly developed. The protrusion was also located on the right side in 4 patients and on the left side in 2. Bilateral protrusion was not observed.
    It has been reported that the frequency of medial protrusion of the lamina papyracea is about 1%. CT is an essential examination before surgery of the nose and paranasal sinuses. It is important to preoperatively evaluate the anatomical relation of critical structures including the lamina papyracea.
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  • Maxillary Sinusitis Caused by Oral Implants
    Morito Kamada, Kaoru Shimazu, Hideaki Aoki, Akihiro Shiroyama, Daisuke ...
    2003 Volume 96 Issue 3 Pages 231-236
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.231
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    Dental implants are widely used for partially or fully edentulous patients, however, cases of maxillary sinusitis caused by dental implants have been reported.
    We treated 26 such patients in Osaka Dental University hospital from 1973 to 2001. A clinical analysis was performed in 27 cases, and the results were as follows:
    1. Of the 26 cases, 10 patients were males and 16 patients were females; the mean age was 54.5 years old.
    2. Type of implants: 19 patients received endosteal implants, 7 were fitted with subperiosteal implants and 1 got endodontic and endosteal implants.
    3. The period from implant insertion to symptoms of maxillary sinusitis: 7 patients (25.9%) had onset within a month and 9 patients had onset within a year (33.3%).
    4. Period from symptoms to diagnosis: 12 cases (44.4%) were diagnosed within a month and 20 cases (74.1%) were diagnosed within 6 months.
    5. To prevent maxillary sinusitis, investigation of the volume of maxillary bone is required, followed by choosing the proper surgery method and type of implants.
    6. It is important to quickly decide whether sinus surgery is necessary or not and to remove implants causing maxillary sinusitis if they perforate the maxillary sinuses.
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  • A Case of Malignant Myoepithelioma Arising in the Submandibular Gland
    Isao Uemaetomari, Keiji Tabuchi, Tetsuro Wada, Akira Hara, Jun Kusakar ...
    2003 Volume 96 Issue 3 Pages 237-243
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.237
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    Malignant myoepithelioma (MME) is a rare tumor of the salivary gland accountig for about 0.45% of all salivary gland tumors. An 81 year-old woman with a malignant myoepithelioma originating from the submandibular gland is reported. The patient had recurrent tumors 3 times, and was treated with irradiation against the locally recurrent lesions in the cervical lymph nodes and complete response was obtained. However, she subsequently suffered multiple metastases to the lung. Histologically, the tumor mainly consisted of plasmacytoid cells proliferating in an acinar fashion. Immunohistochemical investigation revealed the carcinoma cells were positive for S-100 protein, vimentin and keratin, and were slightly positive for α smooth muscle actin (αSMA). The carcinoma cells also had high positivity for p53 and MiB-1 (Ki-67).
    Thirty-five cases of MME had been reported in Japan. Although the therapeutic methods were different, younger patients tended to have a worse prognosis. High positivity for p53 and (or) MiB-1 (Ki-67) suggest a poor clinical outcome. Surgical excision is the mainstay of the therapy for MME, and radiation therapy for recurrent lesions and as a postoperative therapy of MME has been reported to be effective, although radiation therapy per se is still controversial.
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  • A Case of Sialodochitis Fibrinosa
    Sumihito Kinoshita, Yasuaki Sadanaga
    2003 Volume 96 Issue 3 Pages 245-247
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.245
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    We report a 25-year-old female with sialodochitis fibrinosa of the bilateral parotid glands. She had a history of nasal allergy. On microscopic examination of the white mucus plug taken from Stenon's duct, many eosinophils were seen.
    Increased IgE was shown by blood examination and Interleukin 5 in the saliva was increased slightly. A steroid agent was very effective for the symptoms.
    Sialodochitis fibrinosa was probably caused by an allergic factor.
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  • Study of Serum IL-6 and TNF-α Levels in Patients with Obstructive Sleep Apnea Syndrome
    Takeshi Kataoka, Fuyuki Enomoto, Ryutaku Kim, Hidenori Yokoi, Masato F ...
    2003 Volume 96 Issue 3 Pages 249-254
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.249
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    (Objectives) To assess changes in pre- and post-operative serum IL-6 and TNF-α levels in surgically-treated patients with a diagnosis of obstructive sleep apnea syndrome (OSAS).
    (Subjects and Methods) The study population comprised 27 patients who were surgically treated with a diagnosis of OSAS, 7 patients who had no OSAS and were surgically treated for non-OSAS disorders, and 4 healthy volunteers. Blood samples were collected from these groups of subjects prior to operation and around 7 days post-operation, and serum IL-6 and TNF-α levels were determined using ELISA kits.
    (Results) There was a significant difference in preoperative serum IL-6 levels between the OSAS group and the healthy volunteer group. Both the OSAS group and the non-OSAS group exhibited a significant increase in this parameter postoperatively, compared to their respective preoperative values. A significant difference in preoperative serum TNF-α value was observed between the OSAS group and the healthy volunteer group. The OSAS group displayed a significant decrease in serum TNF-α postoperatively as compared with the preoperative value. When compared in terms of apnea index, there was a significant difference in preoperative serum IL-6 level between the OSAS group and the healthy volunteer group. Postoperatively, a significant increase in this parameter was noted for the OSAS group, compared to the preoperative value. The preoperative serum TNF-α value differed significantly between the mild OSAS sub group and the healthy volunteer group. Following the operation, the severe OSAS subgroup showed a significantly lower TNF-α value than the preoperative value.
    (Conclusion) Our findings indicated differences in the trends of pre- and post-operative serum IL-6 and TNF-α levels in OSAS patients. The degree of surgical intervention might possibly account for the differences while inflammatory reactions associated with reperfusion of the ischemic region also appear likely to be involved.
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  • Hemangioma of the Root of Tongue Treated with Injection Sclerotherapy
    Kenichi Takano, Hiroshi Tsubota, Masato Hata, Hiroaki Mitsuzawa, Mitsu ...
    2003 Volume 96 Issue 3 Pages 255-260
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.255
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    Hemangiomas of the root of the tongue is rare. We report a case of a 54-year-old man who complained of hematemesis. Fiberscopy demonstrated a tumor with a red, almost smooth surface located at the root of the tongue.
    Injection sclerotherapy with monoethanolamine oleate was performed. Generally, injection sclerotherapy requires general anesthesia in patients with a large hemangioma because of pain. However, in order to change the head position during treatment, we performed it under local anesthesia.
    The authors suggest that injection sclerotherapy using monoethanolamine oleate is an easy, effective and safe thrapy for a hemangioma of the tongue root.
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  • A Case of Primary Tracheal Carcinoma
    Ryo Ota, Satoshi Nonaka, Isamu Kunibe, Masanobu Imada, Yasuaki Harabuc ...
    2003 Volume 96 Issue 3 Pages 261-265
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.261
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    The patient was a 58-year-old man who complained of persistent bloody sputum. He had a history of laryngeal squamous cell carcinoma 7 years ago and received 72Gy irradiation after vertical laryngectomy. Endoscopic and X-ray examination revealed a tumor mass in the left wall of the trachea 3cm inferior to the subglottic area, but no tumor mass in the larynx. Histological examination of biopsy specimens revealed squamous cell carcinoma. Total laryngectomy with tracheotomy was performed. After the surgery, he has been free from disease for two years. Tracheal carcinoma is relatively uncommon and is difficult to diagnose. To the best of our knowledge, tracheal carcinoma has been reported in 58 Japanese patients in the 5 years.
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  • The Sternocleidomastoid Muscle-Clavicle Myoosseous Flap as a Supportive Framework for Tracheal Reconstruction following Radical Resection
    Kazuhide Yoshida, Satoru Kodama, Masashi Suzuki, Goro Mogi
    2003 Volume 96 Issue 3 Pages 267-271
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.267
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    Although thyroid cancer is generally a relatively low grade malignancy, invasion to the surrounding tracheal, laryngeal or esophageal tissue does occur in patients. We were confronted with a case of thyroid cancer that had invaded the trachea, and radical resection was considered the only curative surgical procedure. Procedures designed for the repair of laryngotracheal defects vary, but they share the common goal of providing a stable airway while preserving normal phonation. We successfully reconstructed the patient's airway after wide resection of the cervical trachea using a sternocleidomastoid muscle-clavicle myoosseous flap as a supportive framework. This procedure may become a useful, safe and reliable method for tracheal reconstruction compared with end-to-end anastomosis following circumferential resection of the trachea.
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  • Effects of Pollenosis on the Lower Airway
    Mari Miyagi, Toshio Ookoshi, Madoka Kawano
    2003 Volume 96 Issue 3 Pages 273-279
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.273
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    Purpose: Effects of pollenosis on the lower airway were investigated in patients positive for specific nasal provocation test with Japanese cedar, cock's foot grass, and/or ragweed pollens.
    Subjects and Methods: The present study enrolled twenty-three, seven, and nine patients who were positive for Japanese cedar pollen provocation, sneezed in response to Japanese cedar pollen provocation, and were positive for cock's foot grass (7 patients) and ragweed (2 patients) pollen provocation, respectively, on nasal antigen provocation test, performed using antigen disks of Japanese cedar, cock's foot grass, and ragweed pollens at our allergy outpatient clinic between 1984 and 1990. These patients were examined by spirography with flow-volume curve recording.
    Results: The most remarkable changes were observed in the zone below V75 in patients who sneezed in response to Japanese cedar pollen provocation, at V50 in those positive for cock's foot grass/ragweed pollen provocation, and at V25 in those positive for Japanese cedar pollen provocation.
    Conclusion: The most severe effects of pollenosis on the lower airway were observed in patients who sneezed in response to Japanese cedar pollen provocation. Since these results indicate that pollenosis does influence the lower airway, treatment of the lower airway is thought to be needed whenever symptoms involving the lower airway appear.
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  • The Effect of Paroxetine on Tinnitus Refractory to Other Oral Administrations
    Keiichi Izuhara, Kenta Aoki, Toshimitsu Hayashi, Kenichi Ando, Masaya ...
    2003 Volume 96 Issue 3 Pages 281-288
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.281
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    Paroxetine is one of the Selective Serotonin Reuptake Inhibitors (SSRIs) that are efficacious on depression and anxiety. In order to examine the effect of Paroxetine on the subjective symptom of tinnitus, psychology and total improvement, it was internally given to eight tinnitus patients with nine affected ears who could not obtain sufficient relief by our usual internal treatments and whose progress we were able to observe for eight weeks. As a result, Paroxetine was effective in tinnitus that was refractory to other oral administrations. The total response rate was 56%, and furthermore, excluding tinnitus after sudden deafness the rate increased to 83%. No side effect was found. Some tinnitus patients showed a tendency of depression and anxiety. Since SDS (Self-rating Depression Scale) and STAI (State-Trait Anxiety Inventory) were improved in the cases where tinnitus was improved, Paroxetine seemed to have anti-depression and anti-anxiety effects in patients with tinnitus. Paroxetine is an effective treatment for tinnitus patients without sudden deafness and organic diseases after a proper psychological evaluation.
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  • The Availability of the Endoscope for the Nasal/Sinus Diseases
    M. Tamura
    2003 Volume 96 Issue 3 Pages 290-291
    Published: March 01, 2003
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.96.290
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