Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
Current issue
Displaying 1-13 of 13 articles from this issue
Editorial
  • Tomoya Ishida, Yoichiro Sugiyama
    2024 Volume 117 Issue 11 Pages 951-957
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    Swallowing is controlled by the neuronal circuitry in the brainstem through complex mechanisms involving coordinated sequential and patterned movements of swallowing-related muscles. Despite the complexity of the pathogenesis of swallowing impairments, patients with dysphagia should be treated based on the pathophysiology of the swallowing condition in individual patients. The pharyngeal stage of swallowing is triggered by visceral afferents in the larynx and pharynx and has sensorimotor feedback mechanisms which assist in the swallowing movements. Interferential current stimulation to the neck may help patients with dysphagia with delayed swallowing initiation. Laryngeal suspension surgery can help patients with impaired laryngeal excursion, while cricopharyngeal myotomy can help patients with incomplete opening of the esophageal inlet during pharyngeal swallowing. Rehabilitation and/or surgical intervention for dysphagia can be applied to patients with dysphagia and tailored to the functional disturbance of swallowing.

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Clinical color photographs
Original articles
  • Ryosuke Kitoh, Yutaka Takumi
    2024 Volume 117 Issue 11 Pages 961-969
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    Recently, intratympanic steroid injection (ITSI) has come to be widely used, especially as salvage treatment, for idiopathic sudden sensorineural hearing loss (iSSNHL). However, the optimal protocol for ITSI remains unclear.

    In this study, we investigated the relationship of the background characteristics of the patients and the method of ITSI with the effect of the latter on hearing improvement. We also examined the proportion of cases and factors related to the risk of development of tympanic membrane perforation as a complication of ITSI.

    The subjects of this study were 167 cases of iSSNHL treated by ITSI between 2007 and 2021.

    The background characteristics of the patients analyzed included the age, sex, affected side, presence/absence of underlying diabetes mellitus, hearing level on the affected side before treatment, and improvement with first-line treatment. In regard to the factors associated with the ITSI, the duration from onset of hearing loss to the start of ITSI, the number of injections, the average interval between injections, the injection site on the tympanic membrane, and the need for a ventilation hole were considered.

    When the effectiveness of salvage treatment was defined as a hearing improvement of 10 dB or more, the treatment was found to be effective in 80 out of 132 cases (57.6%). The interval from onset to the start of ITSI and age were identified as being statistically significantly associated with the efficacy of ITSI.

    The proportion of tympanic membrane perforation was 8.7% (13 out of 149 cases). The injection site (anterior inferior quadrant) on the tympanic membrane was the only factor that was identified as being statistically significantly associated with the risk of tympanic membrane perforation.

    In conclusion, differences in the method of ITSI within the scope of this study did not affect the efficacy of ITSI as a salvage treatment. The proportion of cases that developed tympanic membrane perforation was, however, slightly higher than in previous reports, so that it seems necessary to consider ways to reduce the proportion of cases developing tympanic membrane perforation, especially by modifying the site of injection on the tympanic membrane.

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  • Miki Tomura, Koji Abe, Hironori Akizuki, Keisuke Naito, Hitoshi Shono, ...
    2024 Volume 117 Issue 11 Pages 971-975
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    An aberrant internal carotid artery (ICA) in the middle ear is known to occur in about 1% of the population, whereas duplicated ICA with a collateral hypoplastic native ICA is rather rarer. We report the case of a 41-year-old woman who presented with hearing loss and a feeling of pulsation of the tympanic membrane on the right side. Computed tomography revealed a middle ear mass and absence of the bone plate separating the ICA from the middle ear, continuity of the mass with the horizonal petrous portion of the ICA, and enlargement of the inferior tympanic canaliculus. The duplicated ICA was confirmed by angiography. It is important to diagnose an aberrant ICA, in view of the risk of hemorrhagic complicating tympanotomy or middle ear surgery.

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  • Ayumi Shimamura, Shota Tanaka, Kaname Sakamoto, Akira Hayashi, Toshina ...
    2024 Volume 117 Issue 11 Pages 977-984
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    Eosinophilic otitis media is an intractable type of otitis media, and is often complicated by severe bronchial asthma and eosinophilic sinusitis.

    A 53-year-old man was diagnosed as having eosinophilic otitis media at the age of 40 years, but had discontinued follow-up visits for personal reasons. He subsequently received treatment from his primary care physician for asthma alone, including with benralizumab. In regard to the present medical history, he was urgently hospitalized for left otorrhea, swelling in front of the left ear, left facial pain, and left facial nerve paralysis, and MRSA (methicillin-resistant Staphylococcus aureus) was cultured from the ear discharge and blood. We administered antibiotic therapy and performed mastoidectomy, and diagnosed the patient as having poorly managed otitis media complicated by MRSA infection, which resulted in temporal muscle abscess formation and facial paralysis. The facial nerve paralysis was cured by postoperative steroid treatment, but the symptoms of eosinophilic otitis media persisted. In cases with multiple symptoms, it is important to make a definitive diagnosis based on the clinical findings and laboratory findings, so as to enable prompt therapeutic intervention.

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  • Ryo Kamitani, Hiroaki Yazama, Tasuku Watanabe, Kazunori Fujiwara
    2024 Volume 117 Issue 11 Pages 985-990
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    We report the case of an extremely obese patient (body mass index 70) who underwent surgical treatment for external auditory canal cancer. A 33-year-old man with hypertension and diabetes mellitus was referred to our department for evaluation and treatment of a mass lesion in the left external auditory canal. Tissue biopsy from the mass in the left external auditory canal revealed squamous cell carcinoma. Computed tomography and magnetic resonance imaging revealed poor contrast enhancement of the tumor and unclear tumor margins, and we diagnosed the patient as having squamous cell carcinoma of the left external auditory canal, cT1N0M0. However, considering the possibility of bone invasion by the tumor, we planned lateral temporal bone resection. During the period leading up to the surgery, the patient was encouraged to lose weight and was treated for diabetes mellitus to reduce the surgical risk. In addition, the patient had also been diagnosed as having and was undergoing treatment for sleep apnea. We simulated the surgical situation with anesthesiologists and surgical nurses to reduce the risk of perioperative complications. Lateral temporal bone resection and postoperative management were performed safely, and the patient was discharged 10 days after the surgery without significant complications. Postoperative histopathological examination revealed bone erosion in a part of the external auditory canal, and the tumor stage was revised as pT2N0M0. Negative surgical margins were confirmed, and we believed that the tumor had been resected completely.

    In extremely obese patients, evaluation of the true tumor margins on preoperative imaging studies is difficult, so that extremely careful surgical planning is required. In addition, careful perioperative management of the patient’s comorbidities is required, and cooperation with physicians from multiple specialties is important to prevent serious complications such as heart failure or respiratory failure.

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  • Kazuki Chiyonobu, Kazuyuki Kubo
    2024 Volume 117 Issue 11 Pages 991-996
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    Venous thrombosis occurs mostly in the veins of the lower extremities and is relatively rare in the neck veins. Thrombosis involving the neck veins most often affects the internal jugular veins. In particular, Lemierre syndrome is known to be a disease characterized by the occurrence of septic thrombotic internal jugular phlebitis, potentially leading to the spread of sepsis and formation of abscesses in distant organs. We encountered a very rare case of external jugular vein thrombosis complicating peritonsillitis, and report this case with a review of the literature.

    The patient was a 24-year-old woman who presented to us with a 2-day history of fever and sore throat, and gradually developed trismus. She visited her previous doctor who diagnosed her as having acute tonsilitis and referred her to our department for treatment. At the initial examination, swelling and redness of the bilateral palatine tonsils and swelling around the left tonsil were noted. We diagnosed the patient as having left peritonsillitis, and started the patient on treatment with antibiotics and betamethasone. Contrast-enhanced CT and neck ultrasound on day 2 of hospitalization revealed a thrombus in the left external jugular vein. In particular, cervical ultrasound showed some floating thrombi, and we started the patient on anticoagulant therapy and, heparin sodium administration. With these treatments, both the left peritonsillitis and the external jugular vein thrombosis resolved.

    There is no consensus regarding anticoagulant therapy and surgical treatment for venous thrombosis in the head and neck region. In this case, antibiotic treatment and anticoagulant therapy were able to control the infection and eliminate the thrombus, suggesting a good therapeutic effect.

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  • Tomoki Matsuda, Satoshi Yamada, Kotaro Morita, Daiki Mochizuki, Kazuta ...
    2024 Volume 117 Issue 11 Pages 997-1002
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    The Omicron variant of SARS-CoV-2 is often associated with upper respiratory tract infections such as laryngitis, rather than lower respiratory tract infections such as conventional pneumonia. In this case report, we describe a case of tracheotomy performed for laryngitis associated with COVID-19 in an immunosuppressed patient.

    A 44-year-old female who was in an immunosuppressed state as a result of receiving immunosuppressive medication after renal transplantation developed COVID-19. She had been diagnosed as having the infection 21 days before admission. Her symptoms initially subsided, but they flared up again and she was hospitalized because of a severe sore throat and difficulty in eating. The PCR test was positive on admission, but the judgment on the antigen quantification test was pending. Since some time had passed since the onset of the disease, we judged that there was no active infection. Laryngoscopy revealed crusts in the subglottis, which were partially removed, followed by nebulization treatment, but the crusts re-formed immediately. Therefore, we decided to perform a tracheotomy. A report antigen quantification test for COVID-19 was performed before the tracheotomy, which revealed increase of the antigen level. This suggested active COVID-19 infection. Discussions were held with the anesthesiologist to determine if it was possible to safely intubate the patient, and we finally performed tracheotomy under general anesthesia.

    There are 23 and 10 cases of laryngitis and epiglottitis caused by COVID-19 reported in the literature. Patients with epiglottitis required airway maintenance (p < 0.01). One patient with laryngitis, in whom crusting was observed in the subglottis, as in the present case, required airway maintenance. Thus, subglottic crusting may be a risk factor. In addition, in immunosuppressed patients developing COVID-19, active infection may persist for a long time and it is important to confirm infectivity by performing antigen quantification tests multiple times. In addition, methods for securing the airway should be well-discussed among healthcare providers.

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  • Yui Hongo, Yasuhide Okamoto, Ayako Okui, Shinsuke Funakoshi
    2024 Volume 117 Issue 11 Pages 1003-1009
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    Hyperammonemia is a serious side effect of 5-fluorouracil (5-FU), but there have been only a few reports of the side effect observed in patients with cancers in the head and neck region. In this report, we describe two cases of hyperammonemia caused by 5-FU administration. Case 1 was a 77-year-old man who received 5-FU + CBDCA (carboplatin) + radiotherapy for supraglottic carcinoma. On day 4 of treatment, he became unconscious and blood tests showed hyperammonemia, which was diagnosed as an adverse effect of 5-FU. 5-FU administration was discontinued, and amino acid preparations, lactulose, kanamycin, and high-dose replacement fluids were administered. Case 2 was a 66-year-old male who received TPF as induction chemotherapy for primary mesopharyngeal carcinoma of the right tonsil, followed by cervical dissection. On day 5 after administration, he became unconscious and blood tests showed hyperammonemia. Amino acid preparations, lactulose, and fluid infusions were administered. In both cases, the hyperammonemia and consciousness level improved after treatment. Possibility of hyperammonemia should be borne in mind in cases who develop impaired consciousness after administration of 5-FU.

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  • Aya Sakikawa, Isao Suzaki, Kei Sakikawa, Tatsuya Kitajima, Mio Takeuch ...
    2024 Volume 117 Issue 11 Pages 1011-1017
    Published: 2024
    Released on J-STAGE: November 01, 2024
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    Heerfordt syndrome is a rare phenotype of sarcoidosis characterized by uveitis, parotid swelling, facial nerve paralysis, and fever that accounts for less than 2% of all cases of sarcoidosis. A 56-year-old woman who had been diagnosed as having uveitis approximately four months earlier based on the presence of conjunctival hyperemia, ocular pain, and photophobia presented our department of otorhinolaryngology with right facial nerve paralysis. She had previously presented with various symptoms such as fever, arthralgia, edema and pain in both lower limbs and facial swelling. The degree of right facial nerve paralysis at her initial visit to our department was mild (score on the Yanagihara grading system, 22), and we treated with corticosteroids under the assumption of Bell’s palsy. However, she showed little improvement. Subsequently, histopathologic examination of a biopsy specimen obtained from the parotid gland showed nondesmoplastic epithelioid cell granulomas, which led to the diagnosis of sarcoidosis.

    Sarcoidosis is a systemic disease characterized histologically by the presence of nondesmoplastic epithelioid cell granulomas, and the most commonly affected organs are the hilar/mediastinal lymph nodes, lungs, eyes, heart, and skin. In patients presenting with facial nerve paralysis, which is a frequently encountered condition in daily clinical practice, the possibility of an underlying systemic disease, such as sarcoidosis, should be considered in patients showing an atypical course and heterogeneous manifestations other than facial nerve paralysis, as in the present case.

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  • Yuichiro Maeda, Masakazu Hamamoto, Yujiro Fukuda, Hironori Miyake, Nao ...
    2024 Volume 117 Issue 11 Pages 1019-1024
    Published: 2024
    Released on J-STAGE: November 01, 2024
    JOURNAL RESTRICTED ACCESS

    Leptomeningeal carcinomatosis is a condition that develops when a malignant tumor metastasizes to the subarachnoid space of the cerebrospinal cord, and carries a poor prognosis. In this report, we describe a case of leptomeningeal carcinomatosis in a patient with lung cancer that progressed rapidly with varied cranial nerve symptoms after the patient developed acute sensorineural hearing loss.

    A 65-year-old man diagnosed previously as having lung adenocarcinoma presented with the chief complaints of hearing loss and lightheadedness and was referred to us from our radiology department. We diagnosed the patient as having acute left sensorineural hearing loss and began treating him three days after his initial visit. He complained of worsening diplopia and dysphagia on the day after he was hospitalized. Contrast-enhanced cervicothoracic CT and head MRI revealed no abnormal findings. Five days after the initial visit, the ophthalmologist diagnosed left oculomotor nerve palsy as the cause of his diplopia. Six days after the initial examination, we performed a lumbar puncture and cerebrospinal fluid cytology. On the same day, we performed contrast-enhanced MRI of the head, which revealed contrast effects along the brainstem and cerebellum and bilateral internal auditory canals, and nodular lesions in both the cerebellar hemispheres. Taken together with the results of cerebrospinal fluid cytology, we suspected leptomeningeal carcinomatosis. Seven days after the initial examination, cerebrospinal fluid cytology showed class V: adenocarcinoma. The patient was then definitively diagnosed as having leptomeningeal metastasis from lung cancer and transferred to the respiratory surgery department on the same day.

    In a patient with a history of malignancy presenting with varied cranial nerve symptoms, it is necessary to promptly perform contrast-enhanced MRI of the head to rule out the possibility of leptomeningeal carcinomatosis.

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Secondary publication
  • Kazuhiro Kuroda, Tatsuaki Kuroda
    2024 Volume 117 Issue 11 Pages 1025-1031
    Published: 2024
    Released on J-STAGE: November 01, 2024
    JOURNAL RESTRICTED ACCESS

    The tympanoplasty technique reported by Yuasa, in which autologous tissue is fixed to the perforated tympanic membrane with fibrin glue, is widely used. This innovation has also led to the development of several simpler surgical methods using artificial materials and not involving the use of fibrin glue.

    We use a carbon dioxide laser device (OtoLAMTM: Lumenis Be Japan Co., Ltd.) for tympanoplasty to refresh the perforation margin of the tympanic membrane and a collagen sponge with silicone membrane (TERUDERMIS®: ALCARE Co., Ltd.) as a closure material for tympanoplasty.

    During the past 9 years 6 months, from June 2013 to end-November 2022, we have performed tympanic membrane perforation closure using this method in 231 ears. The closure rate was not high after a single operation (78/231, 33.8%), but improved significantly with multiple surgeries attempts (161/231, 69.7%).

    OtoLAMTM is used to refresh the perforation margin within a short time. By simply fixing TERUDERMIS® to the perforated area with a silicone membrane, the operation can be performed within a short time, without the need for autologous tissue collection. The advantage of this surgery is that it is simple and quick to perform, is economical because it does not involve the use of fibrin glue, and there is no possibility of blood infection and therefore no need to provide a detailed explanation to the patient.

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