Practica Oto-Rhino-Laryngologica

Tympanoplasty in our Department

Treatment of the Posterior Meatal Wall

Tatsuyuki Banno, Shigeru Inafuku

2006 Volume 99 Issue 9 Pages 711-719
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.711

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Canal wall up tympanoplasty is considered an ideal method because of its effective preservation of the meatal morphology with early drying and aroidance of disorder in the mastoid cavity after surgery. However, since the posterior meatal wall is preserved in this method, a blind spot in the surgical field may result in a higher incidence of residual cholesteatoma than canal wall down tympanoplasty. There is a risk of retraction cholesteatoma recurrence in spaces of the reconstructed external auditory canal in patients in whom pneumatization in the mastoid wall down cavity has not been achieved. To solve these problems, the usefulness of mastoid obliteration tympanoplasty has been reported, and reconstruction of the posterior meatal wall using soft tissues has been also reported. In this study, we evaluated the problems of reconstructing the external auditory canal using soft materials based on the experience and out-comes of patients with cholesteatoma treated by this method since 1999 after the method was carefully evaluated.

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Parathyroid Adenoma Manifested by Recurrent Laryngeal Nerve Palsy

S. Nonaka, [in Japanese]

2006 Volume 99 Issue 9 Pages 720-721
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.720

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The Association between Obstructive Sleep Apnea Syndrome and Orthostatic Dysregulation

Naoharu Kitajima, Mamoru Suzuki

2006 Volume 99 Issue 9 Pages 723-730
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.723

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The purpose of this study was to investigate the association between sleep apnea syndrome (OSAS) and orthostatic dysregulation (OD). Okuni et al. (1984) studied OD using a questionnaire. Using their method, we investigated changes in symptoms after using nasal CPAP in 38 patients. Nasal CPAP was effective in 61% of cases. Abe et al. (1986) studied OD using a questionnaire and the Schellong test. Using these methods, we investigated changes in clinical symptoms and signs after using nasal CPAP in 17 patients. In addition, we examined stabilometry in these patients. In about 40% of patients that were diagnosed as having OD, clinical symptoms and signs improved after using nasal CPAP. The above results suggest that chronic sleep disorder caused by OSAS could lead to OD. Patients with OD might accompany OSAS, and treatment of OSAS could improve OD in these cases.

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Relapse of Acute Lymphocytic Leukemia with Involvement of the Posterior Cranial Fossa Presenting with Vertigo and Facial Palsy

Akiko Adachi, Toru Seo, Atushi Miyamoto, Akiko Yukimasa, Michiko Node, ...

2006 Volume 99 Issue 9 Pages 731-735
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.731

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A 15-year-old male complained of vertigo and was brought to our clinic on April 3, 2002. He showed rightward nystagmus with right fixation and rightward spontaneous nystagmus. Caloric test showed canal paresis of the left ear. Although there was a past history of acute lymphocytic leukemiam, he was in complete remission. Therefore, he was diagnosed as having vestibular neuritis of the left ear and treated with prednisolone. Balance problem improved for one week. However, he complained of recurrent dizziness on April 26, and left facial palsy on April 30. MRI showed enhancement in the posterior cranial fossa and cranial nerve (III, V, VI, VII, VIII, X nerve). He was diagnosed as having having relapsing leukemia with involvement of the central nervous system, and treated with intraspinal administration of methotrexate (MTX). Thereafter, dizziness and facial palsy were improved. In this case, lesion of the cranial nerve demonstrated on MRI differed from neurological symptoms. When patient having a past history of leukemia complain of vertigo, we must suspect relapse of leukemia, even if he/she was in complete remission.

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A Case of Hunt Syndrome with Generalized Herpes Zoster

Shin Yamanaka, Hirotaka Minami, Tatsuji Matsumoto

2006 Volume 99 Issue 9 Pages 737-741
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.737

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We report a case of Hunt syndrome with generalized Herpes Zoster in an adult woman. The patient was 85 years of age and had been a history of multiple myeloma treated by steroids and immunosuppressants. She was referred to our hospital by her primary care physician for right-sided facial and neck pain, otalgia and throat pain. The following day, swelling in the pharynx and the larynx worsened and required tracheostomy. We initiated administration of Aciclovir and intravenous immunoglobulin, which successfully avoided critical complications. Despite the treatment course, facial paralysis and sensorineural hearing loss persisted.

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Treatment of Tongue Cancer

Masayuki Shibayama, Masakazu Hanamitsu, Satoshi Sonoda, Takeshi Shimiz ...

2006 Volume 99 Issue 9 Pages 743-749
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.743

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We retrospectively reviewed 52 tongue cancer patients who received definitive treatment at Shiga University Hospital between January 1993 and August 2004.
In cases of T1and early T2 (early T2: ≤3cm), partial glossectomy was performed. Radical operation followed by reconstructive surgery was performed after pre-operative chemotherapy in cases of advanced T2 (advanced T2: >3cm), T3 and T4. Post-operative radiation was performed in some cases to prevent local and cervical recurrence.
The 5-year survival rates by the Kaplan-Meier method were 92% in stage I, 88% in stage II, 73% in stage III, 55% in stage IV, and 72% overall, respectively. The 5-year survival rates by the size in T2 cases were 90% in early T2 and 46% in advanced T2. Twelve cases were relapsed. Locoregional recurrence occurred in 11 patients (5 cases at the primary site, 6 in the neck), and distant metastasis in 4 patients. Long-term survivors after secondary treatment were 3 of 11 cases with recurrence at the primary site.
The results of salvage treatment for recurrent cases were discouraging. Adjuvant chemotherapy and post-operative radiotherapy are recommended for advanced tongue cancer.

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First Bite Syndrome after Dissection of Parapharyngeal Tumor

Hideyuki Nakagawa, Koichi Tamura, Koji Abe, Katsushi Miyazaki, Hironor ...

2006 Volume 99 Issue 9 Pages 751-757
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.751

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Two cases of first bite syndrome (FBS) were reported as a complication after surgery for parapharyngeal tumor. FBS is the development of pain in the parotid area associated with the first bite of food, especially the first meal of the day. In one case, pleomorphic adenoma of the left parotid gland extended into the parapharyngeal space. During resection, dissection around the external carotid artery was performed to mobilize the parotid tail and part of the parotid gland tissue was preserved. In the other case, acinic cell carcinoma of the left parapahryngeal space was resected. During resection, the external carotid artery was cut and most of the parotid gland was preserved. In both cases, sympathetic innervation of the parotid gland through the sympathetic plexus around the external carotid artery was lost without Homer's syndrome. It is possible that sympathectomy of the residual parotid gland is responsible for the development of FBS.

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A Case of Lemierre's Syndrome with the Necessity of Ligating the Internal Jugular Vein

Hisashi Ohtsuka, Koji Nishimura, Tetsuya Yokoyama, Kazuharu Yamazaki, ...

2006 Volume 99 Issue 9 Pages 759-762
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.759

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A 29-year-old man visited our hospital complaining of right neck pain and swelling following acute tonsillitis. Computed tomography (CT) showed dilation of the right jugular vein without computational enhancement and numerous small nodules in both lungs. These findings led us to diagnose Lemierre's syndrome. To avoid further embolism formation, he underwent ligation of the right jugular vein and subsequent postoperative anticoagulation therapy, resulting in elimination of the thrombus.

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A Case of Advanced Hypopharyngeal Carcinoma Successfully Treated with TS-1

Masako Uno, Teruhito Aihara, Suetaka Nishiike, Takeshi Akisada, Tamots ...

2006 Volume 99 Issue 9 Pages 763-766
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.763

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We report a case of advanced hypopharyngeal carcinoma that responded well to chemotherapy with TS-1, a novel oral anticancer agent of fluorinated pyrimidines. The patient was a 65-year-old man who underwent radiation therapy at 64.8Gy as first-line therapy. The treatment resulted partial response of the primary tumor, while the metastatic cervical lymph node did not show any change. After discharge, the patient received intermittent 80mg/day of oral TS-1 for 2 weeks of every 3 weeks. CT after 5 months demonstrated disappearance of the primary tumor and partial response in the metastatic lymph node. TS-1 administration still continus, and the patient has shown a good course. We considered that TS-1 is effective against the noncurable head and neck squamous cell carcinoma and allows the patient to maintenance satisfactory QOL.

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A Case of Polyostotoic Fibrous Dysplasia

Makoto Miyamoto, Masayuki Minamino, Satoshi Chikano, Masao Yagi, Toshi ...

2006 Volume 99 Issue 9 Pages 767-770
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.767

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We report a 47-year-old woman with polyostotic fibrous dysplasia. She complained of a painless swelling of the left cheek since she was two years old. A craniofacial CT examination showed sclerotic changes of the left maxilla, sphenoid and temporal bone. Bone scintigraphy showed high uptakes at not only these craniofacial bones but also thoracic vertebrae, rib, left humerus and pelvis. A biopsy of the left maxilla bone was performed, and a histopathological examination showed fibrous dysplasia. Therefore, we diagnosed her as having polyostotic fibrous dysplasia. At present, the left maxillary tumor has not progressed. We are continuing careful follow-up.

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The Usefulness of FDG-PET in Diagnosing Head and Neck Cancer

Report of Four Cases

Kazunori Matsuda, Yoshiaki Kitamura, Kazunori Sekine, Katsushi Miyazak ...

2006 Volume 99 Issue 9 Pages 771-780
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.771

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FDG-PET (2-[¹⁸F]fluoro-2-deoxy-D-glucose positron emission tomography) is clinically useful in detecting head and neck cancer providing accurate estimate of primary cancer and metastasis lymph node especially in cancers that are equivocal on conventional imaging. FDG-PET scan shows unknown primary cancer and metastatic lymph nodes that appear normal CT scan/or MRI. Furthmore, whole body FDG-PET makes it possible to simultaneously detect distant metastasis.
We reported 4 cases of head and neck cancer and showed the efficacy of 2-[¹⁸F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in the diagnosis of head and neck cancer. FDG-PET is highly useful for detecting previously unrecognized primary cancer with lymph node metastasis to the neck. FDG-PET also has a high potential for detecting neck lymph node metastasis, staging head and neck cancer and assessing its response to irradiation and chemotherapy. Finally, FDG-PET is useful for diagnosing recurrent or residual head and neck cancer and its distant metastasis.

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Clinical Usefulness of Nasal Mucus Specimen for Rapid Influenza Antigen Test

Yoshio Umeda

2006 Volume 99 Issue 9 Pages 781-787
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.781

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During the 2004-2005 influenza season, a clinical study was conducted to evaluate the utility of nasal mucus collected by nose blowing as a specimen for the rapid influenza antigen test. In this study, nasal swab specimens and nasal mucus specimens were respectively collected from 136 patients who were suspected of having influenza infection. The nasal specimens were collected by existing standard methods and nasal mucus specimens were collected by the method that patients themselves blew their own noses. Then, both specimens were tested with a rapid influenza antigen detection kit (QuickVue rapid SP influ) and the results were compared. These results were also compared with the results of a culture test, which was performed as a gold standard.
Out of 40 influenza patients (type A: 9; and type B: 31) who were diagnosed by the culture test, 7 nasal swab specimens were A positive (sensitivity: 77.8%) and 13 were B positive (sensitivity: 41.9%) and 7 nasal mucus specimens were A positive (sensitivity: 77.8%) and 18 were B positive (sensitivity: 58.1%) with the rapid test. On the other hand, out of 96 influenza negative patients, all specimens of both types showed negative results (specificity: 100%) with the rapid test.
These results indicate that nasal mucus specimens collected by patients blowing their own nose have an equal or superior performance (sensitivity and specificity) to existing nasal swab specimens for the influenza antigen rapid test. Considering the easier and safer sampling practice of the nasal mucus specimen, we concluded that nasal mucus specimens collected by nose blowing have a clinical usefulness in the rapid influenza antigen test.

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A Study of 8 Cases Undergoing Ligation of the External Carotid Artery in our Department

Ayako Furuya, Yoshihiro Yamada, Hitoshi Kikuchi, Tomoko Sugiuchi, Naoh ...

2006 Volume 99 Issue 9 Pages 789-793
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.789

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We have experienced 8 cases undergoing ligation of the external carotid artery in the past 8 years (1998-2005), and this is a report of our findings. Surgery was performed under general anesthesia. After confirming the furcation of the common carotid artery, the external carotid artery was identified from the bifurcation of the superior thyroid artery and then double ligation was performed between the lingual artery and superior thyroid artery. This technique was effective without complications in 6 cases for which it was thought to be indicated, but it was not effective in 2 cases for which it was not indicated. One case had Osler disease and the other had a cutaneous invasion of nasal cavity carcinoma. Both cases had a focus extending bilaterally, so ligation of the external carotid artery was not indicated.
The surgical technique poses no problem if the physician is an otorhinolaryngologist, and its effectiveness is considered high if the indication is certain. The advantage of this technique is that a surgeon can perform it as the occasion demands.

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A Recurrent Case of Spontaneous Mediastinal Emphysema

Kan Kishibe, Kazumi Yoshino, Tetsuji Wada, Naoki Kanai, Yasuaki Harabu ...

2006 Volume 99 Issue 9 Pages 795-800
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.795

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Spontaneous mediastinal emphysema is a rare condition that primarily occurs in young, thin, healthy adults. It is rare for cases of spontaneous mediastinal emphysema to recur. Recently, we experienced a recurrent case of spontaneous mediastinal emphysema. A 17-year-old boy came to our hospital complaining of chest pain and dyspnea. His chest computed tomography (CT) showed mediastinal emphysema with cervical emphysema. He was hospitalized and treated with bed rest and antibiotics to prevent infection. Mediastinal air resolved completely after 6 days of hospitalization. Seven weeks following the first episode of spontaneous mediastinal emphysema, the patient was readmitted with a second episode of cervical pain. He was hospitalized again and treated with bed rest and antibiotics to prevent infection. Mediastinal air resolved completely after 4 days of hospitalization. Recurrent spontaneous mediastinal emphysema has been documented only in our patient and 6 others in Japan.

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Flow-chart for Diagnosis of Conductive Deafness

K. Kumakawa

2006 Volume 99 Issue 9 Pages 802-803
Published: September 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.802

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