Practica Oto-Rhino-Laryngologica

Auditory Neuropathy

Clinical Concept, Audiological Features and Managements

Tetsuya Tono

2005 Volume 98 Issue 11 Pages 827-833
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.827

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Auditory neuropathy (AN) is characterized by preservation of cochlear outer hair cell function, as evidenced by the presence of otoacoustic emissions and/or measurable cochlear microphonics, when the ABR is absent. Possible sites of AN are the inner hair cells, the auditory nerve and synaptic juncture between inner hair cells and the dendritic processes of the spiral ganglion cells. Thus hearing loss in AN may not be clearly categorized as cochlear or retrocochlear deafness using the currently available auditory testing methods. AN is found in patients ranging in age from infants to adults and can be clinically classified into two types, postlingual (adult) and the prelingual (infant) types, according to the age of onset. Two typical AN cases from each type are presented to discuss appropriate clinical management including cochlear implants for these patients. Despite increasing evidence from overseas showing the potential benefit of cochlear implants in prelingual-type AN, caution should be exercised when considering cochlear implantation in the postlingual type. Promontory stimulation test is thought to be useful in order for predicting postoperative performance with cochlear implants in adult patients.

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Normal Swallow Response in the Younger and the Aged

S. Takagita, [in Japanese]

2005 Volume 98 Issue 11 Pages 834-835
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.834

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Inhibition of Tinnitus Obtained by Stimulation of the Mandibular Branch of the Facial Nerve

Isei Satoh

2005 Volume 98 Issue 11 Pages 837-846
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.837

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This study was performed to investigate the idea inhibition of tinnitus by blocking abnormal afferent impulses, which cause tinnitus in the cochlear nerve, from comparatively peripheral regions of the auditory tract. Frequent stimulations were given transcutaneously on the Ramus marginalis mandibular of the facial nerve in 91 cases of tinnitus who experienced noise within ear, and 30 cases who experienced noise in the head or who experienced noise in a region except the ear. Every one of these patients had suffered from an unpleasant feeling every day for more than 6 months. Results were as follows:
1. A subjective improvement was observed in 89.0% of patients with tinnitus, and not observed in 93.3% of patients who experienced noise in head.
2. Improvement in tests for the patients with tinnitus was demonstrated in 88.7% of cases by tinnitus masking carves, and in 67.8% of cases by loudness balance tests.
3. The subjective improvement of tinnitus obtained by frequent stimulations is experienced as not only a reduction of loudness, but sensuous changes such as the thinning or softening of sound, or the scattering of sound.
4. 81.1% of patients with tinnitus reported that their tinnitus returned to the previous level within 1 week after frequent stimulations.
5. By comparing the right side and the left side in 78.3% of patients with tinnitus in both sides, an improvement of tinnitus was observed after more than one week when frequent stimulation was given one time to 5 times within a week.
6. There were no problems caused by stimulation.

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A Large Primary Frontal Sinus Cyst with Intracranial Extension

Akihiro Sakai, Yumi Ueno, Michiaki Yokoyama, Noboru Yamanaka

2005 Volume 98 Issue 11 Pages 847-851
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.847

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We report a large primary frontal sinus cyst with intracranial extension. A 60-year-old man presented with swelling of the forehead. Magnetic resonance imaging and computed tomography showed a large frontal sinus cyst that exceeded the base of the skull in size and extended into the intracranial region; the frontal lobe was also pressed against. The cyst also developed into the orbit and pressed against the eye-ball. However, no symptoms indicated frontal lobe impairment, and diplopia was not recognized. Since there was a possibility that the dura mater might be damaged by opening the cyst, it was opened by an extranasal approach.

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Clinical Study of Nasal and Paranasal Sinus Mycosis

Toshifumi Hasegawa, Kazuo Kumoi

2005 Volume 98 Issue 11 Pages 853-859
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.853

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Fifty-four cases (18 males and 36 females) with nasal and paranasal sinus mycosis treated at Himeji Medical Center between 1992 and 2002 were reviewed. Patient ages ranged from 22 to 94 years with an average of 61.6 years. Hepatic disease was present in 12 cases and diabetes in 5 cases. The sinuses involved with mycosis were the maxillary sinus (32 cases), the maxillary and ethmoid sinuses (13 cases), the sphenoid sinus (5 cases), the ethmoid sinus (2 cases), the frontal sinus (1 case), and the nasal cavity (1 case). All cases demonstrated unilateral diseases. Twenty-three cases had symptoms associated with pain and 14 cases with bleeding.
CT scans of 53 cases showed high density areas in 52 cases (98.1%) and bony destructions in 4 cases (7.5%). CT scans of 45 cases of maxillary mycosis showed expansions of the lateral nasal wall in 33 cases (73.3%), widenings of the natural ostium in 24 cases (53.3%) and sinus wall thickenings in 39 cases (86.7%). MRI showed that 14 (70.0%) of 20 cases had changes in the intensity of the maxillary bone. Concerning anatomical variants, 24 cases (53.3%) had septal deviations and 16 cases (35.6%) had concha bullosas. The affected side was the wide side of the sinonasal tracts in 15 cases (33.3%) and the narrow side in 20 cases (44.4%).
All cases were diagnosed by pathological examinations, while fungus was detected in 4 (10.8%) of 37 cultures. Species of mycosis were aspergillus (49 cases), candida (2 cases) and mucor (1 case).
Radical antrotomy of sinuses was performed in 31 cases and endonasal sinus surgery in 16 cases. Forty-six of the cases treated surgically were cured, while there was one recurrence of the invasive type. After surgical treatment, patients were administered antifungal medications over 3 months and irrigations of saline over 6 months to prevent recurrences.

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Case of an Intraorbital Wooden Foreign Body Penetrating the Maxillary Sinus

Yuki Komabayashi, Masanobu Imada, Atsuyoshi Asahi, Hiroshi Osanai, Nob ...

2005 Volume 98 Issue 11 Pages 861-864
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.861

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A 62-year-old man suffered a penetrating injury to his left periorbital region with a wooden foreign body. He consulted an ophthalmologist and plastic surgeon. He was diagnosed with a conjunctival laceration and blowout fracture. His conjunctiva was consequently sutured. One month after injury, he consulted our clinic for diplopia. Severly limited trading in the upper and lower directions were observed.
Computed tomography (CT) and Magnetic resonance imaging (MRI) revealed an orbital floor fracture. When we performed an anterior orbitotomy, a 50mm long, 10mm wide wooden foreign body covered with granulation tissue in the orbit was found which had penetrated the maxillary sinus. It was removed from the orbit. In this case, wooden foreign body could not be identified preoperatively.

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Effectiveness of Oral Steroid Administration for Eosinophilic Sinusitis

Kousuke Yoshifuku, Shoji Matsune, Yuichi Kurono

2005 Volume 98 Issue 11 Pages 865-871
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.865

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Special attention has been recently paid to chronic sinusitis with marked eosinophilic infiltration given its resistance to conservative as well as surgical treatment. This pathology is now classified as eosinophilic sinusitis (ES). Several reports suggest that systemic steroid administration is effective and necessary as maintenance therapy after surgery. However, the optimal doses and duration of steroid therapy following surgery remain unknown. The present study was performed to examine the effectiveness of oral steroid therapy for ES after endoscopic sinus surgery (ESS). Two hundred and three patients with chronic sinusitis complicated with nasal polyps who underwent ESS in the ENT clinic of Kagoshima University Hospital from January 2000 to December 2003 were enrolled in the study. Biopsy of nasal polyp was performed prior to ESS, and ES was diagnosed by the histological findings of more than 60 eosinophils/field at the magnification of 200. ES cases were classified into two groups based on clinical records; one group was orally administered with steroid after ESS (SG), the other group did not receive steroid after ESS (NSG). Topical findings and laboratory data such as eosinophils and eosinophil cationic protein (ECP) within peripheral blood were compared between the SG and NSG groups. In the results, ES was observed in 30 out of 203 (15%) cases of sinusitis. ES was complicated with asthma in 63%, and with allergic rhinitis in 33%. Recurrence of nasal polyp was statistically less in SG than in NSG. Oral steroid administration was particularly effective in patients with both ES and asthma. Decreased nasal polyp recurrence rates were observed in patients with lower peripheral blood eosinophil counts and lower serum ECP levels. Those findings indicate that oral steroid therapy is effective to reduce recurrence in patients with ES by decreasing the number of activated eosinophils in peripheral blood.

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Primary Neuroendocrine Carcinoma of the Hypopharynx: A Case Report

Takumi Okuda, Katsuhiro Toyama, Noriaki Nagai, Atsushi Haruta

2005 Volume 98 Issue 11 Pages 873-879
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.873

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Primary neuroendocrine carcinoma of the hypopharynx is extremely rare.
A 72-year-old man complaining of sore throat and dyspnea was admitted to the university hospital. Tumors with a bleeding tendency were seen in both epipharynx and hypopharynx lesions. CT scanning revealed enhanced mass imaging in the sections of the epipharynx, hypopharynx and lymph nodes in the left cervical lesion. Based on the findings the stage was T4N2cM0. Pathological examinations after biopsy indicated a neuroendocrine carcinoma. Concurrent chemotherapy (CDDP/VP-16) and radiotherapy (45Gy) were carried out. Because neuroendocrine carcinoma and small cell lung carcinoma belonged to the same categorical neoplasm, the regimen of so called “EP therapy” for the small cell carcinoma in the lung was adopted. This therapy was highly effective, and the primary lesion was reduced in size. The patient is still alive 24 months after bilateral cervical lymph node metastasis, 9 months after the primary treatment.

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Post-Operative Pain in Tonsillectomy with the Harmonic Scalpel

Atsuhito Takahashi, Kazuhiko Shoji, Satoshi Ikegami, Shinji Suzuki, Yo ...

2005 Volume 98 Issue 11 Pages 881-885
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.881

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Tonsillectomy is one of the most common surgical procedures for otolaryngologists. Although tonsillectomy procedures are common, like any surgical procedure, there are post-operative complaints and complications. The aim of this retrospective study was to evaluate the pattern of post-operative pain in tonsillectomy using the harmonic scalpel (HS). 43 patients were entered into this study (13 men, 20 women, 10 children). The severity of pain was scored by the patient on a numerical rating scale (NRS). The assessment was performed in three groups (men, women, children). The mean scores in men and women had no statistical difference. But, children felt less pain than adults (men and women). The difference between the two groups was statistically significant. We confirmed that the level of pain is worse between day 2 and day 5 in some adults (42%), but the same trend was not found in children. We thought that the NRS was an useful tool to evaluate post-surgical pain.

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A Case Report of Schwannoma of the Larynx

Yoshimichi Yokoyama, Ken Akisada, Teruhito Aihara, Kazuyasu Fukuda, Ta ...

2005 Volume 98 Issue 11 Pages 887-890
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.887

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Schwannomas originating from Schwann cells are well capsulized benign tumors, and are not common in the larynx. In Japan, the first case was reported in 1948. Since then, only 73 cases have been reported to our knowledge. We describe a schwannoma of the larynx in a 60-year-old woman who had suffered from hoarseness for 40 years. The lesion was located in the right false cord of the larynx, and was found to be a submucosal tumor. It was removed by thyrotomy, and the diagnosis was confirmed pathologically. In this case, the mobility of the right vocal cord was impaired after surgery. Therefore, the possibility that the tumor originated in the recurrent laryngeal nerve branch is discussed.

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Nasopharyngeal Cancer Presented with Repeated Attacks of Syncope

Nobuhiko Seki, Katsufumi Hoki, Hiroshi Tsubota, Hideaki Shirasaki, Ats ...

2005 Volume 98 Issue 11 Pages 891-896
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.891

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The commonest initial symptom of nasopharyngeal cancer (NPC) is a neck mass, and the other common ones are otitis media with effusion, nasal obstruction, epistaxis, cerebral nerve palsy, and so on. Syncope is often seen in patients with head and neck tumour, but is mostly noted in cases of malignant tumour. To our knowledge, syncope as the presenting symptom of NPC is uncommon and only five cases have been reported. We report one case of nasopharyngeal cancer the initial symptom of which was recurrent syncope accompanied by strong facial pains.
A 59-year-old man complained of recurrent attacks of strong facial pains on the right side followed by syncope for about one year. He consulted a nearby doctor and was treated under the diagnosis of arrythmia. Computed tomography demonstrated multiple low density areas in the liver, which was a finding indicating a metastatic liver tumour. FDG-PET showed abnormal uptakes in the nasopharynx, bilateral upper neck and liver. Pathological study of the nasopharyngeal mucosa revealed in poorly differentiated squamous cell carcinoma. The patients was diagnosed with nasopharyngeal cancer T2bN2M1, stage IVC. Chemotherapy with cisplatin, 80mg/m² on day 1 and 5-Fluorouracil, 400mg/m² on days 2-5 and radiotherapy of 64Gy in 32 fractions were scheduled. FDG-PET performed about one month after treatment demonstrated no abnormal findings and the patients has been followed regularly.
The relevant literature shows that activation of the glossopharyngeal nerve (glossopharyngeal neuralgia) plays an important role in the pathophysiology of head and neck tumour-induced syncope.
Syncope as the presenting symptom of nasopharyngeal cancer is rare. In the case of syncope of unknown etiology, it is necessary to make an allowance for head and neck tumour.

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Two Cases of Small Cell Neuroendocrine Carcinoma in Head and Neck

Ichiro Tojima, Mikio Suzuki, Masakazu Hanamitsu, Hironori Sakurai, Tak ...

2005 Volume 98 Issue 11 Pages 897-902
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.897

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This report described two patients with small cell neuroendocrine carcinoma of the larynx (patient 1) and maxillary sinus (patient 2). Immunohistological examination was helpful for the diagnosis. Both patients had lymph node metastasis of the bilateral neck, but at the start of their treatment distant metastasis was not detected by conventional clinical examinations including systemic imaging examinations (computed tomography, magnetic resonance imaging, and radioisotope imaging). Patients responded to systemic chemotherapy with or without radiotherapy. Surgical treatment for the resultant primary tumor and lymph node metastasis was effective. However, after initial treatment, distant metastasis appeared in the brain (patient 1) and in the liver (patient 2). They died 16 months (patient 1) and 7 months (patient 2) after their initial diagnoses. Although chemoradiotherapy and surgical treatment was effective for the regional tumor, the treatment of distant metastasis was crucial for acquiring the long term survival.

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Diagnosis and Treatment of Olfactory Disturbance

T. Miwa

2005 Volume 98 Issue 11 Pages 904-905
Published: November 01, 2005
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.98.904

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