Practica Oto-Rhino-Laryngologica

How to Evaluate Mobility of the Auditory Ossicles during Middle Ear Surgery

Kiyofumi Gyo

2006 Volume 99 Issue 2 Pages 83-90
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.83

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The outcome of tympanoplasty depends on a variety of factors, such as middle ear disease, tubal function, surgical skill, and the type of ossicular reconstruction. The mobility of the auditory ossicles, especially the stapes, is thought to be one of the most critical factors affecting postoperative hearing. Most otologic surgeons assess ossicular mobility by placing an ear pick on the ossicle and moving it by hand. This maneuver provides only a rough estimate, and the results are subjective. This paper reviews the ossicular vibration testers developed for use during middle ear surgery.
In 1951, Zöllner reported an ossicular mobility tester called “Schallsonde”, but the device did not become popular because its clinical significance was not fully recognized at that time. In 1997, we developed an ossicular vibration tester utilizing a pair of ceramic elements. Although it provided important information on ossicular mobility, clinical assessment of the device revealed several intrinsic disadvantages. In 2001, Wada et al. introduced a revolutionary measuring system utilizing a single ceramic element and a micro-pressure sensor to evaluate stapes mobility. Recently, we developed a new ossicular mobility tester utilizing an electromagnetic driver and a piezoelectric sensor. The device is computer-controlled and overcomes most of the drawbacks of our previous system. The design, principles, and measuring procedures are reported.

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Cervical Lymph Node Metastasis from Pancreatic Carcinoma

N. Ueda, [in Japanese], [in Japanese]

2006 Volume 99 Issue 2 Pages 92-93
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.92

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A Case of X-linked Agammaglobulinemia with Recurrent Otitis Media Detected by Preoperative Test

Motoki Sekine, Masahiro Takahashi, Takahide Hamano, Kenji Okami, Masah ...

2006 Volume 99 Issue 2 Pages 95-100
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.95

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We report on a 4.5-year-old boy with X-linked agammaglobulinemia (XLA). He had experienced recurrent acute otitis media. Before treatment with ventilation tube insertion, ABO blood testing showed a discrepancy between forward and reverse groupings. Immunologic assays revealed panhypogammaglobulinemia and a nearly complete absence of circulating B cells. Since the patient showed a deficient expression of Bruton's tyrosine kinase (BTK) protein in monocytes and mutation in the BTK gene, he was diagnosed as having XLA. The patient then received intravenous immunoglobulin replacement therapy. Although congenital immunodeficiency diseases are not common, they must be considered in children who experience recurrent upper respiratory infections including otitis media. A discrepancy between forward and reverse groupings of ABO blood testing might be a diagnostic clue to XLA.

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Removal of Superglue (Cyanoacrylate) from the Ear Using Acetone

Yuki Wasano, Taro Sugimoto, Hirofumi Maehara, Ken Kitamura

2006 Volume 99 Issue 2 Pages 101-104
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.101

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The ability of superglue (cyanoacrylate) to bond instantly and strongly to skin presents special problems when inserted into the external auditory canal. We present a 9-month-old baby with superglue as a foreign body in her left ear. The superglue was successfully removed with acetone to debond it from the skin. The procedure was performed under local anesthesia without damaging either the meatal skin or tympanic membrane.
A literature review of similar cases is included.

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Maxillary Cancer which Caused Marked Systemic Inflammatory Reaction

Keigo Honda, Shinzo Tanaka, Masanao Kishimoto, Yoshihiro Tamura, Hisan ...

2006 Volume 99 Issue 2 Pages 105-110
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.105

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We report a case of maxillary cancer that caused a marked systemic inflammatory reaction including leukocytosis and high blood levels of C-reactive protein. The production of Granulocyte-colony stimulating factor (G-CSF) by tumor cells was demonstrated by immunohistochemical staining. Despite the reported poor prognosis of G-CSF producing tumors, chemoradiotherapy was highly effective and all of the inflammatory indexes settled to within normal limits. The patient is under close follow-up and has been in complete remission for eleven months after the completion of chemoradiotherapy.

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Early Stage Oral Cancer Patients with Occurrence of Distant Metastasis

Hideki Chijiwa, Youko Takane, Yoshihisa Ueda, Yoshimi Miyajima, Tadash ...

2006 Volume 99 Issue 2 Pages 111-114
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.111

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In general, the early stage of oral cancer shows a good prognosis. It is widely accepted that distant metastasis to distant organ does not occur without metastasis to the cervical lymph nodes. We encountered two cases of early oral cancer who developed distant metastasis to the lung without any evidence of metastasis to the neck lymph nodes. The first case was a 63-year-old woman diagnosed as having T1 oral cancer. Resection of the tumor was performed using a CO2 laser, but lung metastasis was detected five months later. Systemic chemotherapy with CDDP, 5-Fu was administered and complete response was obtained. The patient has not shown any sign of recurrence to date. The second case was a 48-year-old man who was diagnosed as having T1 oral cancer. Surgical removal of the tumor was performed with CO2 laser. Although the postoperative course of the primary site is uneventful, lung metastasis was detected only four months after. Combined systemic chemotherapy with TXT, CDDP and 5-Fu was administered along with hypo-fractionated stereotactic radiotherapy to the metastatic lung cancer. Partial response was obtained and at present, adjuvant chemotherapy with TS-1 is being continued. Histopathologic study of the resected primary tumor was again performed, and a vessel invasion or a skip cancer lesion was recognized. Minute histopathologic observation of the primary tumor as well as positive postoperative treatment against distant metastasis are now underway.

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Fish-Bone Foreign Body in Extra Pharyngeal Space: A Case Report

Shinpei Kada, Atsuhiro Yoshida, Masahiko Hayashi

2006 Volume 99 Issue 2 Pages 115-118
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.115

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A 66-year-old female patient presented with a history of sudden foreign-body sensation following the swallowing of a fish bone. Soft tissue X-rays could not show a foreign body in the neck. Computed axial tomography was done which showed a fish bone embedded in the extra pharyngeal space behind the left tonsil. Because the fish bone was located near the pharyngeal space and there were no inflammatory findings around the fish bone, we assumed that the fish bone could be removed by operating with a trans-oral approach. A left tonsillectomy was carried out and the fish bone was removed from the muscle tissue around the tonsil. Her foreign-body sensation was eliminated. To our knowledge, there have been 17 patients with extrapharyngeal fish bone foreign bodies. Among them, there were only 3 patients whose fish bones were removed by operating with a trans-oral approach. For trans-oral-removal, we suggest that inflammatory findings around the fish bone and accessibility are important considerations.

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A Case of Chlamydia Trachomatis Pharyngitis and Conjunctivitis Associated with Otitis Media with Effusion

Teruo Shiomori, Koichi Hashida, Nobusuke Hohchi, Tsuyoshi Shiraishi, T ...

2006 Volume 99 Issue 2 Pages 119-124
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.119

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Chlamydia trachomatis (C. trachomatis) infection is the commonest sexually transmitted disease that mostly occurs in the urogenital region. We herein report a case of pharyngitis and conjunctivitis caused by C. trachomatis associated with otitis media with effusion (OME). A 19-year-old lady presented with a 2-month history of earache, foreign body sensation of the throat and eye itching with discharge followed by bilateral hearing loss. On otolaryngological examinations, pharyngitis, OME and hypertrophic adenoid were pointed out. On ophthalmological examinations Chlamydia conjunctivitis was highly suspected. Serological tests showed raised levels of anti-C. trachomatis antibodies, and C. trachomatis was detected in the eye discharge and pharyngeal mucus by a DNA probe method. Pharyngitis and conjunctivitis ameliorated after the administration of oral antibiotics (clarithromycin), eye drops (levofloxacin) and oculentum (oxytetracycline). However, OME and hypertrophic adenoid persisted, and therefore, the patient eventually underwent tympanostomy tube insertion and adenotomy. C. trachomatis was detected in the resected adenoid tissue as well by a DNA probe method. Her postoperative clinical course was uneventful, and C. trachomatis detection by PCR was negative both in the tears and pharyngeal mucus. The diagnosis and treatment of Chlamydia infection in the head and neck were reviewed from the literature.

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Two Cases of Varicella Zoster Virus Infection of Pharynx and Larynx

Hitoshi Tsujie, Akihito Watanabe, Masanobu Taniguti

2006 Volume 99 Issue 2 Pages 125-127
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.125

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We report two cases of varicella zoster virus infection of the pharynx and larynx. The patients were a 69-year-old man who complained of sore throat and a 58-year old woman who complained of left otalgia. Both cases showed white erosive lesions on the hemilateral epiglottis and arytenoid as well as recurrent nerve palsy. Based on hemilaterality and recurrent nerve palsy, we supposed that these patients had varicella zoster virus infection and prescribed Acyclovir. Hematological examination showed a high titer of varicella zoster virus antibody. The male patient lost consciousness and was diagnosed as having meningitis. Both patients recovered by conservative therapy. Physical examination and antibody titer were useful for diagnosis of varicella zoster virus infection.

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Lymphocele after Neck Dissection: A Case Report

Soichi Yamaguchi, Kohei Sueno, Shuichiro Yada, Makoto Tanaka

2006 Volume 99 Issue 2 Pages 129-132
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.129

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We administered chemotherapy and radiotherapy treatment to a patient diagnosed as having laryngeal cancer. There after, total laryngectomy and left modified neck dissection were performed. The patient complained of swelling of the left cervical region one year and four months postoperatively and underwent follow-up examination. In left supraclavicular fossa, a hard mass measuring 33mm was palpated. Because SCC rose, we suspected metastatic lymph node enlargement and performed biopsy under local anesthesia for diagnosis. There were no malignant findings on histopathology. Because biopsied area became further enlarged on the fourth postoperative day, we diagnosed chylous stoma. Based on the course, lymphocele had apparently formed after neck dissection and chylous stoma subsequently developed. A case in which Lymphocele forms after neck dissection is extremely rare.

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Clinical Investigation of Obstructive Sleep Apnea Syndrome in Female Patients

Kikuo Sakamoto, Atsushi Kikuchi, Youko Takane, Tadashi Nakashima

2006 Volume 99 Issue 2 Pages 133-137
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.133

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Few papers have addressed gender differences in sleep apnea syndrome (SAS). We investigated the relation between SAS and gender. Five hundred and eighteen patients underwent polysomnography (PSG) at Kurume University Hospital between May 2002 and April 2004. In 386 patients (319 male, 67 female, average age of 50 years old) who fulfilled the criteria of SAS (apnea-hypopnea index ‹AHI›≥5), age, body mass index (BMI), AHI, abnormality of maxillo-facial form (maxilla, mandibular retrusion) and tonsil hypertrophy were examined. The AHI of males was higher than that of females (p=0.0553), but there was no difference in BMI. In regard to the maxillo-facial form and tonsil hypertrophy, abnormal findings were found in male patients, but there was no difference in mandibular retrusion. Forty-seven (70.1%) of the 67 female patients were in postmenopause. When data were compared between females in premenopause and postmenopause, BMI and AHI were significantly higher in premenopausal patients. In regard to the mandibular-facial form, postmenopausal females showed abnormality. On the other hand, tonsil hypertrophy was predominantly found in premenopausal females. In comparison to the number of SAS cases in male and female patients, there were fewer mandibular-facial form abnormalities in females. Therefore, the diagnosis of SAS in females is rather difficult unless PSG is done. In postmenopausal females, AHI was relatively high despite the fact that they were not obese. These results suggest that functional rather than qualitative changes are important for understanding the characteristics of SAS in postmenopausal females.

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Omissions of Medical Fees Covered by Health Insurance for Outpatients in Our Department

Toru Seo, Keiko Kashiba, Naoki Saka

2006 Volume 99 Issue 2 Pages 139-142
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.139

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Economic efficiency has recently been required even in public hospitals. Medical fees from health insurance account for most of the medical income of our hospital. Medical fees were counted in units of points, with one point equaling 10yen. However, it is unclear how many points are omitted in determining medical fees to be paid by health insurance. This study investigated the extent of such omissions.
The subjects were all outpatients who consulted the Department of Otolaryngology of Takarazuka Municipal Hospital between January 24 and 28, 2005. Following the completion of daily work, we examined the slip sheets actually used to calculate payments and determined the omissions. In our department, when a doctor completes the treatment and/or examination, the nurse checks the appropriate items in slip sheets.
Omissions were found on slip sheets for 40 of 372 patients (10.8%). Based on the total reward receipts (322, 988 points), 5298 points (1.6%) had been omitted. Omissions for balance tests, middle ear fiberscopy and laryngoscopy were particularly common.
The loss associated with this were estimated as about 2, 360, 000yen annually. The reason for omissions appeared to be the lack of presence of a nurse during treatment and/or examinations and poor knowledge of nurses about otolaryngological care.

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The Efficacy of Prophylactic Adminstration for the Treatment of Japanease Cedar or Japanese Cypress Pollinosis

Shuntaro Inagawa, Meiho Nakayama, Takako Kamazawa, Hiroshi Sunagawa, K ...

2006 Volume 99 Issue 2 Pages 143-150
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.143

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The clinical effect as well as the effect on quality of life (QOL) of ebastine were evaluated in Japanese ceder pollen allergy patients by comparing treatment before the start of pollen season and treatment after pollen had been scattered.
Seventy-seven cases could be evaluated for efficacy and safety and sixty-nine were assessed for QOL.
1) Based on the symptom score method, treatment before the pollen season showed a lower score than treatment at later time.
2) Based on the medication score method, there were no significant differences.
3) Assessment of QOL using JRQLQ showed a lower score indicating a higher QOL in patients cases treated before the start of the pollen season.
These findings suggest that prophylactic ebastine is useful for the treatment of Japanese ceder pollinosis, even when there was a small quantity of pollen.

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Clinical Study of Levofloxacin (LVFX) 400mg Orally in Two Divided Portions for Acute Exacerbation of Chronic Otitis Media and Chronic Sinusitis

Yo Kimura, Hidekazu Furuse, Shin-ichi Okazaki, Teruo Kiren, Tomoo Wata ...

2006 Volume 99 Issue 2 Pages 151-156
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.151

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Twenty-six adult cases of acute exacerbation of chronic otitis media (COM) and twenty cases of acute exacerbation of chronic sinusitis (CS) were treated by Levofloxacin (LVFX) 400mg a day in two divided portions. The clinical efficacy rates were 84.6% for COM and 85% for CS. Bacteriolgical therapeutic failures in treatment were observed in four COM and three CS patients. Adverse response and abnormal laboratory findings were not observed. LVFX was more effective when given at 400mg a day in two divided portions.

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The Management of Facial Palsy as a Complication in Ear Surgery

M. Sone

2006 Volume 99 Issue 2 Pages 158-159
Published: February 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.158

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