Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 97, Issue 11
Displaying 1-15 of 15 articles from this issue
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  • Diagnosis and Treatment of Conductive Hearing Loss with Transtympanic Endoscopy
    Seiji Kakehata, Hideichi Shinkawa
    2004 Volume 97 Issue 11 Pages 937-945
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.937
    JOURNAL FREE ACCESS
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    In conductive hearing loss with an intact ear drum, even though preoperative examinations including audiometry, tympanometry and CT scan are applied, exploratory tympanotomy is necessary to make an exact diagnosis of ossicular interruption and stapes fixation. In the exploratory tympanotomy, if an ossicular problem is detected during the procedure, it is usually followed by ossicular reconstruction surgery.
    Our current strategy for treatment of conductive hearing loss without tympanic membrane perforation is presented.
    The presurgical diagnosis is made in the outpatient clinic by transtympanic endoscopy through the circular and non-hemorrhagic perforation made by laser-assisted myringotomy (LAM). An endoscopic view of the ossicular chain through 30- or 70-degree angled tip endoscopes held immediately to the outer side of the perforation was obtained to diagnose conduction disturbance locus in conductive hearing loss cases. Precise preoperative diagnosis is useful for patient counseling, surgical indications and planning.
    When an ossicular interruption is diagnosed, endoscopic transtympanic tympanoplasty (ETT), a newly developed minimally invasive procedure, is planned. In the endoscopic visualization through the dry, circular myringotomy perforation using a 1.9mm diameter rigid angled endoscope, ossiculoplasty was performed by inserting a trimmed tragal cartilage through the myringotomy perforation. As opposed to conventional methods, this procedure does not require surgical exposure such as otosclerosis drilling and skin incision, and avoids the substantial risk of unnecessary injury to the chorda tympani. ETT for a disrupted ossicular chain is an adequate and minimally invasive procedure and should prove a useful surgical procedure in future endoscopic tympanoplasty.
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  • Endoscopic Orbital Decompression for Dysthyroid Orbitopathy
    M. Tamura
    2004 Volume 97 Issue 11 Pages 946-947
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.946
    JOURNAL FREE ACCESS
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  • A Case of Large Preauricular Epidermoid Cyst Expanded into the Skull Base
    Masayuki Kabeya, Toshiyuki Fujisaki, Katsuro Sato, Hajime Umezu, Masah ...
    2004 Volume 97 Issue 11 Pages 949-955
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.949
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    The patient was a 73-year-old male, complaining of progressive right otalgia and right facial palsy. A radical mastoidectomy on the right ear was performed, and the histopathological diagnosis was only granulous tissue. A small subcutaneous mass at the right preauricle appeared just after the operation, and an open biopsy was performed. The histopathological diagnosis was epidermoid cyst.
    MRI showed a high intensity area from the right preauricle to around the medial pterygoid muscle. The symptoms were not improved by the administration of antibiotics and drainage. CT and MRI after about two months revealed that the epidermoid cyst and its infection had expanded from the infratemporal fossa to the pterygopalatine fossa, but they were not detected as an apparent invading lesion of the skull base, so surgical treatment was selected. Although skull base surgery was performed, the cyst and its infection could not be extirpated completely, because they had expanded deeply into the skull base beyond the clivus, against preoperative assessment. Disturbances of the central nervous system appeared and gradually increased. Finally, the patient died of respiratory failure.
    We treated a rare case of preauricular epidermoid cyst invading the skull base. It was considered that the lesion was possibly more enlarged than was detected in the CT and MRI findings, due to the skull base infection.
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  • Perilymph Fistula Caused By Paracentesis: A Case Report
    Shingo Kakimoto, Masayuki Furukawa, Kouhei Kawamoto, Makoto Miyamoto, ...
    2004 Volume 97 Issue 11 Pages 957-961
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.957
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    A 39-year-old female was diagnosed with left acute otitis media and had paracentesis. Because she had continuous vertigo immediately after the paracentesis, she was sent to our hospital. At first she was treated with conservative therapy, but the severe hearing loss, dizziness and tinnitus worsened, so she underwent surgical exploration of the tympanic cavity 10 days after the onset. During the surgery, there was no dislocation of the ossicle, but perilymphatic leakage from the oval window was observed. The window membrane was repaired with temporal fascia and fat. Although her dizziness disappeared completely, her tinnitus persisted. However, the tinnitus disappeared with time and the hearing loss gradually recovered. This case was possibly a medical accident, but it is important to recognize that perilymph fistula is one of the complications of paracentesis, and when it occurs, it must be diagnosed accurately.
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  • Two Cases of Ectopic Inverted Tooth of the Nasal Cavity
    Naotaro Akiyama, Kenji Takasaki, Yasuo Osato, Haruo Takahashi
    2004 Volume 97 Issue 11 Pages 963-966
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.963
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    We report two cases of ectopic inverted tooth in the nasal cavity. Case 1 and 2 were an 8-year-old female with left epistaxis and a 10-year-old male with right epistaxis respectively. In both cases, computed tomography revealed that the attenuation of the mass was the same as that of the oral teeth. We removed the ectopic inverted tooth completely with endoscopy by an endonasal approach. We describe their clinical courses, and the etiology, diagnosis and management of the ectopic inverted tooth, with a review of the literature.
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  • A Case of Verrucous Carcinoma of the Tongue
    Masayuki Sakamoto, Yukiko Shinjo, Ryuzaburo Higo
    2004 Volume 97 Issue 11 Pages 967-970
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.967
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    We report a case of verrucous carcinoma of the tongue. A 73-year-old female noticed leukoplakia of the right edge of her tongue. As a hard mass appeared in that area, partial resection of the tongue was performed. Histopathological study revealed that the intraoperative specimen was epithelial hyperplasia with moderate dysplasia. The patient was carefully followed. About half of one year later, the hard tumor reappeared. Partial resection of the tongue was performed again, and this time, histopathological study revealed that the tumor was verrucous carcinoma.
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  • Primary Small Cell Carcinoma of the Oropharynx: A Case Report
    Tomofumi Okamiya, Tomoko Chiyoda, Masahiko Muroi, Nobuhiko Furuya
    2004 Volume 97 Issue 11 Pages 971-976
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.971
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    We report an extremely rare case of primary small cell carcinoma of the oropharynx.
    A 74-year-old male patient complaining of massive cervical tumor had a small uvular lesion. A biopsy of the uvular tumor and immunohistochemical analysis led to a histological diagnosis of small cell carcinoma. We diagnosed primary small cell carcinoma of the oropharynx and metastasis to the cervical lymph nodes since he had no chest lesion. He was treated with radiation therapy, because chemotherapy could not be used due to his bad general condition and several severe complications. Eventually, the patient died due to sepsis from a decubitus ulcer, in spite of the satisfactory clinical effect of the radiation therapy on the oropharyngeal primary lesion and the cervical tumor.
    Small cell carcinoma is a special neoplasm both pathologically and clinically. We should create a protocol for the treatment of laryngopharyngeal small cell carcinoma as a systemic disease.
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  • Hemangioma of the Epiglottis
    Reiko Hattori, Takeshi Shimizu, Alok Bhandari, Yuichi Majima
    2004 Volume 97 Issue 11 Pages 977-981
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.977
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    We describe a rare case of epiglottic hemangioma in 71-year-old female with dyspnea and abnormal sensation of the larynx. There was no associated history of hemoptysis. The lingual surface of the epiglottis was occupied by a whitish pink mass with a smooth surface. The preoperative diagnosis was an epiglottic cyst. Intraoperative direct laryngoscopy demonstrated that the mass arose from the right edge of the epiglottis. The tumor was resected by YAG laser with a blood loss of 350ml, mainly originating from the feeding artery of the mass. However, bleeding was well controlled with electrocoagulation. The pathological diagnosis was venous hemangioma
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  • Two Cases of Denture Foreign Body in the Esophagus in the Aged with Mental Disorder
    Satoshi Ohno, Makoto Miura, Kazuyuki Ichimaru
    2004 Volume 97 Issue 11 Pages 983-986
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.983
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    Two cases of denture foreign body in the esophagus were reported.
    A 74-year-old male with dementia due to Alzheimer's disease suddenly complained of dysphagia. A chest X-ray displayed a denture lodged in the esophagus, but the denture was not noticed at that time. Because he subsequently suffered from secondary aspiration pneumonia, he underwent tracheostomy and percutaneous endoscopic gastrostomy. After 3 years, by chance, the denture foreign body was detected by gastro-intestinal fiberscopy. His family did not consent to the removal of the foreign body.
    A 65-year-old male with mental retardation suddenly complained of dysphagia. A chest X-ray revealed a denture lodged in the esophagus the next day. The denture was removed under esophagoscopy with a Verda dilation laryngoscope without any complications.
    When the aged suddenly complain of dysphagia, presence of a foreign body in the esophagus should be ruled out, even if they are not aware of misswallowing foreign bodies.
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  • Two Cases of the Relapsing Polychondritis with Hoarseness and Dyspnea
    Rie Horie, Shinichi Sato, Tadahiko Matsunaga, Satoshi Ikegami
    2004 Volume 97 Issue 11 Pages 987-996
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.987
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    Relapsing polychondritis (RP) is a systemic disorder of unknown etiology characterized by inflammation of the cartilaginous structure. We had two cases of RP. The first patient (50 year-old woman) and the second patient (33 year-old woman) were admitted with hoarseness and dyspnea because of subsequently developing glottic and tracheal stenosis. These cases were diagnosed by criteria of RP or physical symptoms, biopsy and effects of steroid therapy. We analyzed clinical features, laboratory data, pathology, therapy and prognosis in 56 cases in the literature in Japan. The cases that were diagnosed and received steroid therapy within a year had good prognosis. It is necessary to follow up for at least a year, when steroidos are decreased and abandoned. It is also important that we do appropriate respiratory management because the upper airway stenosis can be fatal.
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  • Wegener's Granulomatosis with Otolaryngological Symptoms
    Yoshiya Ishida, Akihiro Katada, Kan Kishibe, Masanobu Imada, Tatsuya H ...
    2004 Volume 97 Issue 11 Pages 997-1005
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.997
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    Clinical features and treatment outcomes of 16 patients with Wegener's granulomatosis were evaluated retrospectively. The ages of the patients ranged from 28 to 81 years with a median age of 53 years. There were 7 males and 9 females. Thirteen patients had a nasal necrotic granuloma, 5 patients had a history of otitis media with hearing loss, 4 patients had an orbital invasion, and 2 patients had hypertrophic pachymeningitis. 12 patients had a localized type of Wegener's granulomatosis, the other 4 patients had lung lesions, and 2 patients had kidney lesions. The laboratory results of 7 patients were positive for C-ANCA, 7 patients had typical pathologic appearance in the nasal mucous membrane, but the other had no typical pathologic signs. These patients were diagnosed with Wegener's granulomatosis based on the clinical, histological and laboratory findings, and predonisolone was administered to all patients. We should pay attention to diagnosis of Wegener's granulomatosis, especially with a localized type of Wegener's granulomatosis with otolaryngological symptoms alone, without positive laboratory results for C-ANCA and typical pathologic appearance.
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  • Deep Neck Abscess: A Retrospective Review of 14 Cases
    Junichi Wakashima, Kazumasa Watanabe, Takayuki Kozawa
    2004 Volume 97 Issue 11 Pages 1007-1013
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.1007
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    This study was performed to review our experience of 14 patients with deep neck abscess. All of the patients underwent surgical drainage. We investigated the number of infected compartments in each case and the factors that influenced the outcome.
    The durations of the drainage and hospitalization of the patients with more than 8 infected compartments, more than 2 drainage operations, and tracheostomy were significantly long. The number of infected compartments was significantly correlated with the durations of the drainage and hospitalization.
    Therefore, the analysis of infected compartments by CT scan is most important in the treatment and prediction of the outcome for patients of deep neck abscess.
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  • Mediastinitis Extending from Deep Neck Infection: A Report of Two Cases
    Jun Watanabe, Masaru Kawasaki, Masayuki Kabeya, Kuniyuki Takahasi
    2004 Volume 97 Issue 11 Pages 1015-1020
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.1015
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    Mediastinitis extending from deep neck infection is a very severe disease. We report two cases of cervicomediastinal abscess that were both successfully treated with antibiotics, cervical drainage and transthoracic drainage.
    The first case was a 16-year-old man who had a left cervical abscess for which the origin of infection was left mandibular dental caries. Cervical drainage was first performed by a dentist and treated with antibiotics. However, the abscess remained and expanded to the mediastinum on CT scan. At the second operation, cervical drainage and transthoracic drainage was performed by a dentist and thoracic surgeons, but the cervical abscess did not disappear on CT scan. At the third operation, we performed total cervical drainage and the CT scan showed that the abscess had disappeared.
    The second case was a 57-year-old woman who had diabetes mellitus. The origin of infection was pharyngitis. The first CT showed a cervical abscess expanding from the upper neck to the mediastinum. We performed a cervical and transthoracic drainage operation with thoracic surgeons. After the operation, she was treated with antibiotics and insulin. Afterwards, the abscess was disappeared perfectly.
    Frequent CT scan is very useful in evaluating disease and can help determine the time for surgical treatment. Early and aggressive surgical drainage with collaboration by thoracic surgeons is also very important in severe cases, and will improve the chance of survival in patients with this disease.
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  • Use of Methylrosanilinium Chloride for a Post-operative MRSA-infected Wound: A Case Report
    Naoki Oishi, Yasuhiko Takei, Sekiko Kiyota, Haruna Yabe
    2004 Volume 97 Issue 11 Pages 1021-1025
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.1021
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    A 52-year-old male patient consulted our hospital with complaints of long lasting pain in the throat and swelling in the neck. Physical, pathological and X-ray examinations led to a diagnosis of carcinoma in the base of the tongue, which had already extended deeply into the tongue and epiglottis (oropharyngeal carcinoma, T4N2cM0). After chemoradiotherapy which did not successfully reduce the tumor, surgical removal of both the tongue and larynx, and reconstruction of the base of the oral cavity with a PM-MC flap were performed. Unfortunately, the operation was accompanied by a subcutaneous infection which occurred as a result of a surgical complication of a pharyngeal fistula. The germ culture examination revealed that the wound was infected with MRSA. Since povidone-iodine and general use of antibiotics were not effective in suppressing the inflammation, possibility arose for serious and critical complications such as MRSA pneumonia or rupture of a major neck artery. However, immediately after we started using methylrosanilinium chloride for the MRSA-infected wound, the inflammation began to disappear quickly without any serious side effect to surrounding tissue. We concluded that methylrosanilinium chloride was effective in the treatment of MRSA-infected wounds.
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  • The Mechanism of Symptoms Caused by Orbital Wall Fracture
    Y. Kase
    2004 Volume 97 Issue 11 Pages 1026-1027
    Published: November 01, 2004
    Released on J-STAGE: October 07, 2011
    DOIhttps://doi.org/10.5631/jibirin.97.1026
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