This report describes a case of giant cell tumor of the soft tissue of the external auditory canal. The patient was a 49-year-old woman who had noticed that for the past three months, water had a tendency to collect easily in her right ear during bathing. At the time, a sometimes painful mass was palpable in her right external auditory canal, so she visited a nearby otolaryngology clinic. A right external auditory canal tumor was identified, and she was referred to our hospital for further diagnosis. At the time of the initial diagnosis, we palpated a smooth, elastic, and slightly soft mass located mainly on the right external auditory canal anterior wall. A computed tomography examination revealed a mass extending from the cartilaginous part of the right external auditory canal to the bony part. The entire mass was surgically removed under general anesthesia, and the specimen was examined histopathologically. The mass extended from the right external auditory canal floor to the anterior wall, so a second operation was performed to remove these structures, including the skin. A histopathological examination revealed multinucleate giant cells resembling osteoclasts with a core that was similar to mononuclear cells, and the lesion was diagnosed as a soft tissue giant cell tumor. Local recurrence has not been observed for 18 months since the surgeries. Most giant cell tumors of soft tissue develop in the limbs, but they may develop from any part of the body including the head and neck region. No significant differences according to age or sex are apparent. Surgery is the treatment of first choice. The existence of giant cell tumors originating from soft tissue was first described by Salm et al. in 1972.
We report a case of inner ear hemorrhage diagnosed using magnetic resonance imaging (MRI). An 80-year-old man complained of unilateral sudden hearing loss and severe vertigo. Pure tone audiometry showed scale-out for the right ear and 22.5 dB for the left ear. T1-weighted MRI showed a high intensity area without gadolinium enhancement in the right inner ear at 22 days after the onset of symptoms. T2-weighted MRI showed a signal in the right inner ear that was slightly lower than that of normal fluid. A follow-up MRI was performed 56 days after the onset of symptoms. The T1-weighted MRI reexamination showed a signal that was slightly lower than the previous MRI findings. The T2-weighted MRI reexamination showed a signal that was almost the same as that of normal fluid. Despite steroid therapy during the early stage after onset, no change in the hearing level occurred.
We report a case of inner ear intralabyrinthine schwannoma diagnosed using magnetic resonance imaging (MRI). A 60-year-old woman complained of a right hearing loss that had occurred suddenly 2 months earlier. Pure tone audiometry showed scale-out for the right ear and 11.3 dB for the left ear. T1-weighted MRI showed a slightly higher signal intensity than that of normal intralabyrinthine fluid in the vestibule and lateral semicircular canal. The lesion was strongly and sharply enhanced after the intravenous administration of gadolinium. A sharply delineated signal intensity loss was also seen for the same lesion on a T2-weighted MRI examination. A follow-up MRI examination performed 4 years later showed no changes from the initial images. Her hearing level also did not change, and she did not experience vertigo during the 4-year follow-up period.
We repaired a cerebrospinal fluid (CSF) leak in a 27-year-old woman who had undergone primary repair surgery for recurrent meningitis when she was 4 years old. Twenty-three years later, she once again developed meningitis after giving birth to her first child via a vaginal delivery. At presentation in our clinic, her pure tone audiometry showed left ear deafness. A temporal bone computed tomography examination showed an inner ear malformation in her left ear. Because a recurrence of the CSF leakage was suspected, we performed an exploratory tympanotomy on her left ear. We found a partial bony defect of the stapes foot plate, from which a CSF leak had occurred. We removed the stapes and filled the inner ear with small, alternating pieces of temporal muscle and cartilage through the vestibular window. The patient’s postoperative course was uneventful, and there have been no signs of recurrence as of 2 years after the operation.
Extramedullary plasmacytomas are rare plasma cell tumors that occur mainly in the head and neck region. We report a case of multiple extramedullary plasmacytomas arising on both sides of the nasal cavity and paranasal sinuses. A 78-year-old man with a history of left cheek pain was referred to our department. The physical findings revealed a reddish brown mass in the left nasal cavity. Computed tomography and magnetic resonance imaging revealed masses on both sides of the nasal cavity and paranasal sinuses, extending into the left orbital fossa and invading the left maxillary sinus. A nasal biopsy was performed, and the tumors were pathologically diagnosed as extramedullary plasmacytomas. The patient underwent CyborD chemotherapy (a combination therapy consisting of bortezomib, dexamethasone, and cyclophosphamide) as well as radiation therapy (46 Gy) to control the tumors. The tumors disappeared rapidly, and the treatment was considered to have been effective. No recurrences have occurred to date.
Actinomycosis is an inflammatory disease caused primarily by the genus Actinomyces which is comprised of Gram-positive, anaerobic, non-acid fast rod bacteria. About 40%–60% of actinomycosis cases occur in the head and neck region. However, actinomycosis is rarely reported in the nose and sinuses. We encountered a rare case of actinomycosis in the maxillary sinus complicated with a fungal infection. A 31-year-old man visited our hospital complaining of nasal discharge. The clinical diagnosis was fungal maxillary sinusitis. Endoscopic sinus surgery was performed under general anesthesia. A histopathological examination revealed the presence of Actinomyces and fungi. The postoperative course has been uneventful as of 9 months after the operation.
Odontogenic myxoma is a relatively rare benign tumor that accounts for 3%–5% of odontogenic tumors. Although benign, tumor enucleation or the scratch technique can easily result in local recurrence, and resection that includes a tumor-free circumferential margin is recommended.
Whereas with the grow maxillofacial in young people is related, and an extended operation is difficult, and only tumorectomy, scratch technique may be performed in the fact. Here, we report the use of a transcanine fossa approach and nasal endoscopic surgery to perform a segmental resection of the maxilla so as to remove an odontogenic myxoma. Previous literature on this topic is also discussed.
Malignant lymphoma is a disease that is often encountered in the field of otolaryngology.
Malignant lymphomas originating from the nasal cavity often manifest symptoms from the early stages, and early detection is possible. In the case of paranasal malignant lymphomas, on the other hand, subjective symptoms are usually lacking until the later stages of the disease. We encountered a case of malignant lymphoma in whom the initial presentation consisted of signs of suborbital neuropathy; we report this case herein, with some consideration of the literature. A 79-year-old female visited our hospital with the chief complaints of swelling of the left cheek. Biopsy led to the diagnosis of diffuse large B cell malignant lymphoma.
We report a case of subperiosteal orbital abscess and discuss the effectiveness of surgery. The patient was a 10-year-old boy who complained of a headache and swelling of the left eyelid. No eye movement disorders or visual field loss were recognized. Conservative treatment was performed, but the patient developed diplopia and exophthalmos without any improvement in his symptoms. Endoscopic paranasal sinus surgery was performed under general anesthesia, break orbital medial wall and drained out from the orbital abscess. The patient’s symptoms promptly improved after the operation.
Involvement of the cranial nerves during the reactivation of varicella zoster virus (VZV) is known as Ramsay Hunt syndrome (RHS) and can result in paralysis of the facial muscles (cranial nerve VII) and damage to the vestibulocochlear nerve (cranial nerve VIII) with the formation of cutaneous ear vesicles. The involvement of cranial nerves other than VII and VIII sometimes occurs during the reactivation of VZV and can result in paralysis of the soft palate or vocal cords, etc. These effects typically arise from the involvement of the glossopharyngeal nerve (cranial nerve IX) or the vagus nerve (cranial nerve X). Initial symptoms can include a sore throat, hoarseness, and dysphagia, and a physical examination may reveal vesicular eruptions over various parts of pharyngolaryngeal mucosa. A pharyngolaryngoscopic examination may reveal eruptions on a unilateral side of the pharyngeal, laryngeal or epiglottic mucosa, with paralysis of the vocal cords or salivary storage in a unilateral piriform fossa. Here, we report two cases of vocal cord paralysis caused by VZV reactivation: a case with RHS and paralysis of the vocal cords, and a case with dysphagia and paralysis of the vocal cords and a sore throat as the initial symptoms.
Retropharyngeal abscess typically occurs during childhood and is rarely encountered in adults. Recently, the incidence of this disease has been decreasing, probably as a result of the application of progressive antibacterial drug therapies and a decline in tuberculosis. In cases with serious retropharyngeal abscesses, however, dyspnea caused by airway stenosis can occur, and progression to the mediastinum can result in mediastinitis. To prevent disease progression, early and appropriate treatments are needed. Retropharyngeal abscess can produce different symptoms, including a sore throat, odynophagia, and posterior neck pains. These symptoms are regarded as typical initial symptoms, but some non-specific symptoms sometimes emerge initially. It is essential to diagnose the ones in imagese in CT and MRI to correct diagnosis finally. Retropharyngeal abscess is infrequently accompanied by cervical vertebra lesions, such as spondylitis or spinal epidural abscess. These accompanying diseases often present neurologically, as paralysis of the upper or lower extremities. Here, we present two cases of retropharyngeal abscess accompanied by spondylitis.
Infectious thrombophlebitis is a disease in which septic inflammation occurs in the venous wall, resulting in intravenous thrombus formation; it is often complicated by pulmonary emboli and metastatic abscesses that occur in association with bacteremia. Here, we report a case in which the spread of infection from left peritonsillitis was considered to result in infectious thrombophlebitis of the left internal jugular vein. The patient was a 51-year-old man who had received antibiotics (piperacillin and levofloxacin) from a local otolaryngologist for the treatment of acute tonsillitis 8 days prior to an examination at our department. After the initial visit, the patient took no further action and did not return for a second examination. On day 8 after the initial examination, the patient returned for a second examination because of an exacerbation of a pharyngeal pain, high fever, and advanced left neck swelling. That same day, the patient was referred to our department for an examination because of a suspected left deep neck abscess. Contrast-enhanced computed tomography revealed thrombophlebitis in the left internal jugular vein and its branches. We performed an emergency tracheostomy and neck incision for drainage. We then administered antibiotics and performed anticoagulant therapy. The infection subsequently subsided, and the left internal jugular vein thrombus disappeared. However, recanalization of the vein has not been observed. Lemierre’s syndrome is a form of infectious thrombophlebitis in which an upper respiratory infection leads to internal jugular vein thrombophlebitis and systemic septic emboli. Although rare, the incidence of Lemierre’s syndrome has increased in recent years, and the course is often fatal. The present case was atypical in that lesions were observed in the neck only. Nevertheless, despite the rarity of Lemierre’s syndrome, it must be considered when diagnosing patients with symptoms such as those described above.
Schwannoma is a benign tumor originating from Schwann cells in the neurilemma. A schwannoma can occur in any part of the body, but it is uncommon in the oral cavity. Here, we report a schwannoma that occurred on the hard palate. A 64-year-old man presented with a 1-month-history of a mass on the hard palate. The mass was completely extirpated under general anesthesia. A pathological diagnosis of schwannoma (Antoni type A) was made. We discuss schwannoma of the palate and provide a review of the relevant literature.
Lymphoepithelial carcinomas of the salivary gland represent a rare histological type of cancer. The patient was a 69-year-old woman who came to our hospital with a chief complaint of a painless mass in her right parotid region. The patient underwent surgical treatment. A histologic examination indicated a diagnosis of lymphoepithelial carcinoma of the right parotid gland. The patient did not wish to undergo additional treatment. The patient was disease-free at a 4-year follow-up examination.
Oncocytoma mainly occurs in the salivary glands, most commonly in the parotid glands. Oncocytoma is less than 1% of the total salivary gland tumor. Oncocytomas are characterized by the proliferation of oncocytes containing eosinophil granules. Oncocytomas commonly occur in women and have been reported in both the left and right parotid glands. Neck ultrasound, contrast computed tomography, and contrast magnetic resonance imaging are useful for diagnosis. However, preoperative diagnosis is difficult, and most oncocytomas are diagnosed pathologically using the resected specimen. The possibility of malignant transformation has been suggested, and surgical removal is common. Here, we report a case of an oncocytoma that occurred in a parotid gland.
Epithelial-myoepithelial carcinoma (EMC) is a rare malignant salivary gland neoplasm. EMC comprises less than 1% of all salivary gland neoplasms and occurs in the parotid gland in about 80% of cases. Since 1991, 8 cases of EMC of the submandibular gland have been reported. We treated one case of EMC that occurred in the submandibular gland. The patient was a 70-year-old man who had complained of a mass in the right submandibular region for a few years. The mass was removed, together with the right submandibular gland, under general anesthesia. Histologically, the tumor consisted of a proliferation of double-layered duct-like structures with two distinctive cell types. Positron emission tomography (PET) and upper gastrointestinal endoscopy examinations performed during the postoperative period revealed a squamous cell carcinoma of the esophagus with lymph node metastasis. Here, we discuss EMC of the submandibular gland and provide a review of the relevant literature.
Adult T-cell leukemia lymphoma (ATLL) is a T cell tumor that was first described in Japan by Takatsuki in 1975. ATLL is induced by human T-lymphotropic virus type 1 (HTLV-1) infection and is associated with a poor prognosis. Carriers who have been vertically infected with the virus through breastmilk may develop ATLL during adulthood, with a reported lifetime incidence of about 5%. The pathological abnormalities associated with ATLL include skin rash, splenohepatomegaly, lymph node swelling, and so on. Such cases are often diagnosed in the Departments of Internal Medicine and Dermatology. Although such lesions are rarely found in the ear, nose and throat region, we experienced a case of ATLL with lesions in the larynx and nasal cavity. A 45-year-old woman complained of odynophagia and hoarseness. On physical examination, granulomas and crust formations were observed in the anterior commissure and the nose. To obtain a definite diagnosis, we biopsied the lesions during laryngeal surgery. The pathological findings suggested an ATLL. The provirus was identified in a blood sample, and the diagnosis was confirmed. Because ATLL is associated with a poor prognosis, an early diagnosis is desirable.
We report a very rare case of adenosquamous carcinoma of the larynx. A 74-year-old man complained of dyspnea for two weeks. An examination using a flexible laryngoscope revealed a larger tumor in the left arytenoid region. First, we performed a tracheotomy, and resected the large tumor. The histological diagnosis was adenocarcinoma. We diagnosed the tumor as an adenocarcinoma of the larynx (T2N1M0, Stage III) and performed a total laryngectomy in combination with a left radical neck dissection and a right modified radical neck dissection. Finally, the histological diagnosis of the tumor was adenosquamous carcinoma. As dysplasia was observed in positive margin of the region of the primary tumor, we additionally performed postoperative irradiation. The patient has not experienced a relapse for more than 5 years.
We report a case of chondroid lipoma arising from the arytenoid. A 65-year-old man visited an otolaryngology clinic with a chief complaint of laryngopharyngeal discomfort. A flexible fiberscope examination showed a spherical mass covered by intact mucosa in the larynx, but the base of the lesion could not be identified. A computed tomography examination of the neck revealed a low-density, well-circumscribed solid mass lesion in the supraglottic area. Because intubation was difficult as a result of the mass, the mass was removed using laryngomicrosurgery after a tracheostomy. The mass, which had arisen from the left arytenoid region, was well isolated from its surroundings and was histologically diagnosed as a chondroid lipoma. A follow-up examination performed two months after hospital discharge found no evidence of recurrence. Chondroid lipoma is a variant of the typical benign lipoma and is characterized by a mixture of mature fat cells with chondromyxoid and/or hyalinized areas. Its cells contain vacuoles resembling lipoblasts or chondroblasts, and it usually arises in the proximal extremities or limb girdles of middle-aged women but rarely in the head and neck region, especially in the larynx.
Neurogenic tumors of the larynx are uncommon. We report a case of neurofibroma of the larynx. A 29-year-old man complaining of dyspnea and a sore throat as a result of type 1 neurofibromatosis (von Recklinghausen’s disease) was referred to our hospital. A laryngoscopic examination revealed a 28-mm smooth mass covered by mucosa on the left arytenoid; this mass was obstructing the airway. The tumor was completely resected using a transoral approach. The histopathological diagnosis was neurofibroma. No recurrences of the tumor were seen during a one-year follow-up period.
We report two cases of Ramsay Hunt syndrome with vocal cord palsy. Neither patient exhibited other nerve palsies. The serum antibody titers for varicella-zoster virus (VZV) were significantly elevated in both patients. Herpetic vesicles were present on the left epiglottis and arytenoid in both patients. Both patients also reported a loss of hearing, facial palsy, and vocal cord palsy. One patient was treated with steroid therapy and anti-viral therapy, and the functions of all the cranial nerves were completely restored. The other patient was treated with anti-viral therapy because of a hepatitis B carrier status, but the vocal cord palsy did not improve.
Forestier’s disease is an unexplained extensive ossification of the anterior longitudinal ligament running along the anterior aspect of the vertebral bodies, a condition also referred to as ankylosing spinal hyperostosis. In the field of otorhinolaryngology, it is known to be associated with the sensation of a foreign body in the pharynx and dysphagia and can manifest as hoarseness, difficulty breathing, and other symptoms. We conducted a clinical review of 6 cases of Forestier’s disease treated at our hospital and found that all 6 cases were elderly men; 3 of these men had dysphagia. No clear difference in the extent or thickness of the hyperostosis was seen between those with and those without dysphagia. Treatment included follow-up and/or medication in the 3 patients without dysphagia and dysphagia rehabilitation after an assessment of swallowing function using video fluorography in the remaining 3 patients with dysphagia. Surgery was also considered in one of the latter 3 patients but was not feasible because of comorbidities. Nevertheless, all 3 patients with dysphagia had a favorable clinical course with ongoing dysphagia rehabilitation. Forestier’s disease commonly affects the elderly and thus is likely to coexist with a decrease in swallowing function and other age-related conditions. Appropriate treatment options should be selected for individual cases based on an adequate patient assessment.
We investigated 273 patients who experienced sudden deafness and visited our hospital between 2004 and 2008. The patients received tapering courses of hydrocortisone with an initial dose of either 500 mg or 300 mg. The mean age was 51.2 years, with the largest numbers of patients in their 40s, 50s, 60s and 70s, respectively. The >60 years of age group had a significantly lower rate of treatment efficacy than the <60 years of age group. The complete recovery rates were 85.8% for grade 1, 45.1% for grade 2, 27.9% for grade 3, and 17.5% for grade 4. Once the patients’ hearing had stabilized, no significant differences in the effective rate of hearing were observed between patients who had received an initial hydrocortisone dose of 500 mg and those who had received an initial dose of 300 mg.
We reviewed data on 273 patients with sudden deafness who visited our hospital between 2004 and 2008. All the patients received tapering courses of hydrocortisone with an initial dose of either 500 mg or 300 mg. The mean age was 51.2 years. Forty-one patients (15.0%) had diabetes mellitus (DM). In the <60 years of age group, the initial grade of deafness was significantly higher for the patients with DM than for those without DM. In the >60 years of age group, no significant differences in the initial grade of deafness were seen between patients with and those without DM. In the <60 years of age group, the treatment efficacy rate was significantly lower for the patients with DM than for the patients without DM. In the >60 years of age group, no significant differences in treatment efficacy were seen between patients with and those without DM. Thus, a correlation between DM and sudden deafness was seen for patients <60 years of age.
Objectives: We reviewed a study of superselective intra-arterial and systemic chemoradiotherapy for the treatment of advanced and recurrent carcinomas of the external auditory canal and middle ear performed between 2002 and 2009 to evaluate the long-term survival and preservation of organ function after treatment.
Subjects and Methods: The patients averaged 64.7 years of age, ranging from 49 to 75 years. All patients underwent superselective intra-arterial docetaxel infusion and systemic cisplatin and 5-FU chemotherapy. During and following the chemotherapy, all the patients received radiotherapy at a dose ranging from 30 Gy to 70.2 Gy.
Results: The follow-up period ranged from 5 to 134 months (median, 60.2 months). No major complications were observed. The fresh three cases with stage IV disease and one case with a local recurrence after surgery, all achieved a CR. One case of residual disease after surgery had PR. One case with a neck recurrence had NC. One case with residual disease after surgery died of pneumonia five months after treatment. One patient died of disease at 15 months after treatment. Four other patients survived for over 47 months.
Conclusion: We concluded that this therapy is safe and is a useful treatment option for carcinomas of the external auditory canal and middle ear.
A total of 329 patients consulted our hospital with a main complaint of tinnitus between December 1, 2011, and April 31, 2014. We performed a retrospective statistical analysis of these 329 patients. There were 144 men (43.8%) and 185 women (56.2%). The patient age ranged from 7–92 years (average, 59.0 years). In age and the sex, a lot of 40 years old or more were recognized and, as for the 40 years old level, there were many men and was admitted and there were many women in the 50 years old level, the 60 years old level, the 70 years old level and was admitted. The tinnitus handicap inventory (THI) score was distributed approximately equally. But a lot of 10–39 points in particular of ranges were recognized. Many patients with slight hearing loss were recognized in the pure tone audiometry. The frequency of tinnitus had most 8 KHz and was 4 KHz next. We prescribed a lot of vitamin B12 preparation and ATP preparation and subsequently prescribed cerebral circulation improvement. The most commonly prescribed Kampo medicine was Chotosan, followed by Goshajinkigan. After explanation, hearing aid treatment and the sound therapy took effect, too. In this article, we introduced the action in outpatients specialized in the tinnitus in our hospital and gave an outline at a point of the tinnitus treatment. At first a thing corresponding to the carefulness is thought to be important tenaciously by one year from a half year while giving psychotherapy, sound therapy, Kampo therapy.
Allergic diseases, including pollinosis, have become a global public health issue. In Japan, the number of patients with allergic rhinitis has been increasing annually. According to practice guidelines for the management of allergic rhinitis in Japan, the prevalence of allergic rhinitis has increased by 10%, compared with ten years previously. In the present study, we examined 2276 patients (1206 men and 1070 women) between the ages of 1 and 85 years using the CAP-radioallergosorbent test with serum specific IgE antibodies at the Kawasaki Medical School’s Department of Otolaryngology between 2000 and 2014. The sensitization rates were as follows: cedar pollen, 58.1%; house dust mites, 47.6%; cypress pollen, 38.8%; and Dactylis glomerata, 29.8%. For house dust mites, cedar pollen, cypress pollen, and Dactylis glomerata, the percent positivity was highest in the group that was less than 20 years old, and the percent positivity decreased for older age groups. Thus, the incidence of allergy rhinitis has increased not only in adults, but also in children. For patients with allergic rhinitis, further investigation of the causative antigen is needed for treatment and diagnosis. Further epidemiological studies in various geographical regions are needed to clarify regional variations in the prevalence of allergy rhinitis.
The prevalence of allergic rhinitis has been increasing annually. Various allergens can cause allergic rhinitis. House dust mites and Dematophagoides farinae allergen are known to be major causes of allergic rhinitis. This study evaluated the sensitization to house dust mites and D. farinae allergen in 2276 patients who underwent serum-specific IgE antibody evaluations using the CAP-radioallergosorbent test at the Department of Otolaryngology, Kawasaki Medical School, between 2000 and 2014. The tests revealed sensitization to house dust mites in 1082 patients and to D. farinae allergen in 1045 patients. Large fluctuations in sensitization were not observed over the 15-year study period. The house dust mite-specific IgE value was lower than the D. farinae allergen-specific IgE value.
The prevalence of allergic rhinitis continues to increase year after year, and Asteraceae allergen is a major cause of allergic rhinitis. This study evaluated the sensitization to Asteraceae allergen in 2276 patients who underwent serum-specific IgE antibody evaluations using the CAP-radioallergosorbent test at the Department of Otolaryngology, Kawasaki Medical School, between 2000 and 2014. The test revealed sensitization to ragweed in 404 patients and to mugwort in 442 patients. Large fluctuations in sensitization were not observed over the 15-year study period. The prevalence of sensitization to ragweed and mugwort was highest among teenagers; no other significant differences were seen among other generations.
In recent years, the incidence of allergic diseases has been increasing, and allergic rhinitis is no exception. In particular, an increase in the incidence of Japanese cedar pollinosis and a decrease in the average age of onset have been noted. In the present study, we examined the allergic sensitization rate among children aged 15 years old or younger. The subjects consisted of 279 outpatients of our department who had complained of nasal symptoms and had undergone CAP-radioallergosorbent tests using serum-specific IgE antibodies between 2000 and 2014. The Dermatophagoides farinae sensitization rate was highest, with an incidence of 70.3%, while the Japanese cedar pollen (JCP) sensitization rate was 56.2%. When the sensitization rate was examined according to age group, the JCP sensitization rate was found to increase significantly for older age groups. This study further examined the association between the birth month and JCP sensitization, and a higher positive JCP sensitization rate was observed for children born before pollen dispersal (November to January), compared with children born in other months. Thus, an association between birth month and JCP sensitization was suggested. It has been pointed out that a perennial allergy (such as Dermatophagoides farinae sensitivity) can affect JCP allergy as an enhancing factor. Also, we found a significantly high JCP sensitization rate among children with Dermatophagoides farinae sensitization as well as an increase in duplicate sensitization with age. However, the results also revealed that even at older ages, a certain percentage of children still exhibited sensitization to Dermatophagoides farinae alone and that more children were becoming sensitized to JCP alone. Thus, the presence of a perennial allergy might not always influence JCP sensitization.
Background: The amount of cedar pollen influences the severity of symptoms of patients with cedar pollinosis. Therefore, it is important to determine how the amount of cedar pollen is associated with symptoms and quality of life (QOL).
Methods: The subjects were non-treated patients who had consulted our hospital during the cedar pollen-exposure season of 2015. The subjects were questioned about their symptoms and QOL using the Japanese Rhinoconjunctivitis Quality of Life Questionnaire (JRQLQ).
Results and Conclusion: The cedar pollen count in 2015 was relatively low. No significant difference in the symptom scores of the pre-season group and the post-onset treatment group was seen. The pre-season group had significantly better QOL scores, face scales, and sleep scales than the post-onset treatment group.
Objectives: To evaluate the surgical timing for chronic tonsillitis, peritonsillitis, and peritonsillar abscess.
Subjects and Methods: We report the clinicopathological features of 67 patients with tonsillitis and 113 patients with peritonsillitis and peritonsillar abscess. We examined the indications for a bilateral tonsillectomy in patients with chronic tonsillitis. We considered which surgical care we chose in puncture and incision and abscess tonsillectomy in a peritonsillar abscess.
Results: A bilateral tonsillectomy was necessary in patients with more than 4 episodes of tonsillitis. The hospital stay was significantly shorter for the puncture group than for the incision group about patients with peritonsillar abscess. For the reason, an incision might be necessary if sufficient drainage cannot be obtained using a puncture.
Conclusion: Accurate evaluations are needed for patients with chronic tonsillitis, and a quick response might be necessary to prevent airway obstruction in cases with peritonsillar abscess.
Objectives: We reviewed a study of superselective intra-arterial and systemic chemoradiotherapy for the treatment of advanced hypopharyngeal carcinoma conducted between 2000 and 2008 to evaluate the long-term survival and preservation of organ function after this treatment.
Subjects and Methods: The patients averaged 62.8 years of age, ranging from 42 to 78 years. Three had stage III disease and 25 had stage IV disease. All the patients underwent superselective intra-arterial docetaxel infusion and systemic cisplatin and 5-FU chemotherapy. During and following the chemotherapy, all the patients received radiotherapy. We determined the rates of laryngeal preservation and the need for a tracheotomy or gastrostomy, and we reviewed the videofluoroscopic examination, videoendoscopy, and capsaicin test results. We also conducted a questionnaire.
Results: No major complications were observed in this series. For patients with primary lesions, the CR rate was very high (96.4%). The overall 5-year survival rate was 36.4%. The cause-specific 5-year survival rate was 38.3%. The laryngeal preservation rate was very high (96.2%). The combined laryngeal preservation and 5-year survival rate was 36.4%. Videofluoroscopic examinations and videoendoscopy showed almost no changes in swallow function. Only six patients (21.4%) required a tracheotomy and five patients (17.9%) required a gastrostomy. Most of the patients were able to swallow after chemoradiation. The results of a questionnaire concerning voice and swallowing ability were mostly good. The capsaicin test showed no change before and after treatment.
Conclusion: We concluded that this therapy is safe and is as useful as other treatment modalities for long-term organ preservation and the maintenance of function.
Malignant lymphoma in the head and neck region, such as the tonsils and neck lymph nodes, is relatively common and often has a good outcome histological type, very different in many cases by the degree of progress. Biopsied from the salivary glands, which is also the same malignant lymphoma to obtain a definitive diagnosis. This time we were biopsy in our hospital, to obtain a definitive diagnosis, we report a retrospective study to patients who were treated in our hospital blood internal medicine. Malignant lymphoma 18 cases were salivary glands occur in the case to obtain a definitive diagnosis at the hospital our department in April 1985–August 2015 were examined in the subject. Hodgkin’s lymphoma was seen in 2 cases, while all the other cases were forms of non-Hodgkin’s lymphoma: 7 cases of diffuse large cell lymphoma, 7 cases of MALT lymphoma, and 2 cases of follicular lymphoma. Many of the B-cell cases were elderly patients, while the patients with Hodgkin’s lymphoma were under 20 years old.
A combination of docetaxel (DOC) therapy and radiotherapy was used to treat patients with T2N0 laryngeal carcinoma. Thirty-two patients with T2N0 laryngeal cancer received concurrent chemoradiotherapy (64.6–74 Gy) with weekly DOC (10 mg/m2). All the patients were male, and their average age was 66.3 years. All the patients achieved a complete response (CR). The overall survival rate, as determined using the Kaplan-Meier method, was 92.0%, and the disease-free survival rate was 92.2%. The local control rates were 88.0% for the glottis and 28.6% for the supraglottis and subglottis. Grade 3 or higher toxicities were seen in 4 patients. In conclusion, concurrent chemoradiotherapy with DOC is a feasible and effective treatment for glottic squamous cell carcinoma.
Laryngeal edema, which is mainly caused by acute epiglottitis, is often encountered by otolaryngologists. This disease sometimes leads to dyspnea as a result of airway stenosis. Especially in the poor symptoms of respiratory organization, laryngeal fiber findings sometimes gets severe to the contrary. In severe cases, otolaryngologists must decide whether special airway management, such as a tracheotomy, is needed. We retrospectively analyzed 80 cases of laryngeal edema (mainly caused by acute epiglottitis) that were hospitalized in our department between January 2010 and April 2015. Items such as patient age, sex, initial symptoms, smoking rates, underlying disease or airway management, and duration from first symptoms until consultation were included in the analysis. We divided the patients into Grades 1, 2, and 3 according to the laryngeal findings (degree of swelling of epiglottis or epiglottis arytenoid), and each of the above-mentioned items were analyzed for each grade.
Objectives: We reviewed a study of superselective intra-arterial and systemic chemotherapy for the treatment of recurrent glottis cancer after radiation performed between 2007 and 2009 to evaluate the long-term survival and preservation of organ function after treatment.
Subjects and Methods: The patients averaged 70.8 years of age, ranging from 59 to 82 years. One patient had stage Ib disease, three had stage II disease, and one had stage IV disease. All the patients underwent two cycles of superselective intra-arterial docetaxel (40 mg/m2) infusion and subsequently four cases underwent systemic cisplatin (50 mg/m2) and 5-FU (350 mg/m2) chemotherapy. The treatment effects and organ function were then observed during a long follow-up period.
Results: The observation period lasted for 8–102 months (average, 77.6 months). No major complications were observed. Three cases had a CR, one case had an NC, and one case had a PD. In the case with PD, histopathological examinations revealed the transformation of squamous cell carcinoma into spindle cell carcinoma. This patient died 8 months after treatment. Two cases required a total laryngectomy. One case subsequently underwent seven laser surgeries and a partial laryngectomy and eventually died. The swallow function remained almost unchanged in all the patients. The two CR cases were able to speak well after treatment.
Conclusion: We concluded that this therapy is safe and is as useful as other treatment modalities for long-term organ preservation and the maintenance of function.
Thirty-six tracheotomies were performed at general hospitals in a single city during a 7-year period between September 2009 and September 2016. The average patient age was 73.8 years old. These findings reflect Japan’s aging society. The underlying diseases varied, and the condition of the elderly patients was often serious at the time of their emergency conveyance to a hospital. Several cases were intubated. Otolaryngologists should be able to perform a tracheotomy safely.
Radiation therapy is frequently performed for patients with head and neck cancer. Dysgeusia, dry mouth, and mucositis are possible adverse events of radiation therapy, since the oral cavity and salivary glands are often within the irradiated area. These complications can become serious problems for head and neck cancer patients. Here, we examined improvements and the current state of xerostomia symptoms in head and neck cancer patients who have undergone radiation therapy.
PURPOSE: Boron neutron capture therapy (BNCT) is among the radiation treatments known to have a selective lethal effect on tumor cells. In this report, we summarize our clinical results for BNCT for the treatment of head and neck cancer at our institution.
METHODS: We started clinical studies for the treatment of head and neck cancer in 2003. Since then, we have completed the following four clinical studies: (1) an analysis of the accumulation of BPA in the tumor and surrounding normal tissue using an 18FBPA-PET study, (2) a BNCT clinical trial for recurrent head and neck cancer, (3) a BNCT clinical trial for head and neck melanoma, and (4) a BNCT clinical trial for newly diagnosed advanced head and neck cancer. All the patients provided consent, and the study was approved by the medical ethics committees of Kawasaki Medical School and Kyoto University. BNCT was performed in a single fraction using an epithermal beam at the Kyoto University Research Reactor and the Japan Research Reactor 4.
RESULTS: The 18FBPA-PET study showed no difference in the T/N ratio between an SCC and a non-SCC group. Overall, 83% of the patients had a T/N ratio of more than 2.5. The response rates were more than 80% for all the BNCT clinical studies. Although mild alopecia, xerostomia, and fatigue were observed in all the patients, no severe adverse effects of grade 3 or higher occurred in these patient series.
CONCLUSIONS: Our preliminary results demonstrated that BNCT is a potentially curative therapy for patients with head and neck cancer. The treatment does not cause any serious adverse effects and can be used regardless of whether the primary tumor has been previously treated.
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