Recently, a number of clinical studies on cell therapy have been reported and used in clinical practice for several intractable diseases. Inner ear cell therapy for sensorineural hearing loss also has been studied using some laboratory animals, although to date reports on successful hearing recovery have been few. Previously, we developed a novel rat model of acute sensorineural hearing loss due to fibrocyte dysfunction induced by a mitochondrial toxin and performed cell therapy with bone marrow mesenchymal stem cells (MSCs). In this study, we injected MSCs into the lateral semicircular canal; a number of these stem cells were then detected in the injured area in the lateral wall. Rats with transplanted MSCs in the lateral wall demonstrated a significantly higher hearing recovery ratio than the untreated controls. These results suggested that mesenchymal stem cell transplantation into the inner ear may be a promising therapy for patients with sensorineural hearing loss due to degeneration of cochlear fibrocytes. In this article, we review studies on inner ear cell therapy using some laboratory animals including rodents such as mice and rats, and primates such as cynomologus monkeys (Macaca fascicularis).
Paragangliomas are highly vascular, slow growing neoplasms that can occur within the temporal bone, as well as other sites in the head and neck. Preoperative angiography showed no feeding artery of the tumor in our case, but Zellenballen and hypervasularity were observed histologically. Tympanic paragangliomas confined to the middle ear cavity do not need preoperative embolization.
We investigated the effectiveness of Lipo-prostaglandin E1 (Lipo-PGE1) into patients with idiopathic sudden hearing loss. Thirty three patients were treated with steroids only (steroids group) and 40 patients were treated with steroids plus Lipo-PGE1 (steroids plus Lipo-PGE1 group). There was no significant difference in sex, age, initial hearing level, and period between the onset of the disease and the start of the treatment between the two groups. The rate of complete recovery and marked improvement was 45.4% in the steroids group and 65.0% in the steroids plus Lipo-PGE1 group at the final examination. There was no significant difference in the rate between the two groups. For patients under 60 years of age and those with vertigo in the steroids and Lipo-PGE1 group a significantly better outcome was seen in the rate of complete recovery and marked improvement. These results suggest that the Lipo-PGE1 may be effective as a concomitant drug with the steroids regardless of the age and hearing level of the patient for the treatment of idiopathic sudden hearing loss.
Mucoceles of the paranasal sinuses can grow progressively to compress the bony structure of the skull base, which eventually leads to intracranial extension. The management and follow-up such a case will be presented. A 54-years-old female had massive intracranial extension of the paranasal sinus mucocele. The initial symptom was left visual loss and headache. Diagnostic images revealed massive soft density of the frontal and ethmoid sinuses with a wide defect of the orbital bone and the base of the skull with the high intensity seen in both T1 and T2 signals. These findings suggested a fronto-orbital-ethmoid mucocele with extension of the skull base. The mucocele was safely marsupialized via the endonasal endoscopic approach. Although the dura of the skull base was extensively exposed, no cerebrospinal fluid leak or herniation occurred. There was no deviation of the brain substance in the CT or no cranial nerve deficit during a long-term follow-up. We believe that the endonasal endoscopic approach with the marsupialization technique is the most recommendable option for huge mucoceles because of the minimally invasive, safe and effective method.
Resection of the posterior nasal nerve is often performed in the patients with intractable and severe chronic rhinitis. However, massive nasal bleeding has been pointed out as a serious postoperative complication. We report here 3 patients with postoperative bleeding, who were successfully treated with prompt hemostasis. From the basis of the perioperative findings, the bleeding point was derived from the central part of the resected trunk or major branches of the sphenopalatine artery. It was concluded that careful attention should be paid during and after surgery involving resection of the posterior nasal nerve.
Invasive paranasal aspergillosis has been considered to have a poor prognosis. We report a case of orbital apex syndrome due to left ethmoid-sphenoid aspergillosis. A 76-year-old woman with untreated diabetes mellitus, presented with left visual disturbance, oculomotor nerve palsy, ptosis and orbital pain. CT and MRI showed cloudy images with defects of the bone wall in the left posterior ethmoidal sinus. The serological examination revealed aspergillus antigen (+) and high levels of β-D glucan. Therefore, we diagnosed paranasal aspergillosis, and administrated voriconazol preoperatively as an antifungal agent. The patient underwent left ethmoid-sphenoidectomy and biopsy via the endonasal approach. In the histopathologic examination, aspergillus was found around the optic nerve canal. At the present, continucus administration of voriconazol has improved the patient's ptosis and orbital pain, but not her visual disturbance. This case suggests that invasive paranasal aspergillosis has the possibility of visual loss and high mortality rate so that he needs early diagnosis and treatment.
The cause of the orbital blow-out fracture includes violence, sports (baseball and boxing, etc.), traffic accidents, falls, and so on. This fracture is usually the result of an object striking the eyeball with some force. We report herein on a very rare case of blow-out fracture caused by an airbag (SRS) deploying in a traffic accident, striking the driver in the face and resulting in the fracture. To investigate how an airbag can cause injury when it is deployed, both the mechanics of airbags and the associated wound mechanism were examined.
We evaluated the clinical effectiveness of a proton pump inhibitor (PPI), for patients complaining to throat discomfort, with an F scale and visual analogue scale (VAS) score. These patients had a high rate of symptoms of gastroesopharyngeal reflux and there was correlation with the F scale and VAS score before taking the PPI. Significant improvements were observed in both scores after the administration of the PPI, especially in the reflux symptoms. On the other hand, the dismotility symptoms were not significantly improved with the medication. We recognized the effectiveness of a PPI for foreign body sensation in the throat.
Pleomorphic adenoma is recognized as a common neoplasm of the salivary gland. More than 90% of pleomorphic adenomas originate from the parotid gland. On the other hand, the minor salivary gland of the hard palate as the origin shows a relatively low frequency. We report on the different clinical features of 2 cases of pleomorphic adenoma arising from the hard palate. The first case was a 65-year-old female. Although a fine needle aspiration biopsy (FNAB) showed suspected class V adenoid cystic carcinoma, there were no clinical findings on the diagnostic images or symptoms suggesting malignancy. The second case was a 34-year-old female whose FNAB showed a suspected class III pleomorphic adenoma, which was consistent with the final pathological diagnosis from the resected specimen. These findings suggest that FNAB is not a definitive finding, but one of the diagnostic tools to obtain full information.
Although the incidence of retropharyngeal abscesses has currently been markedly reduced, we still have to pay adequate attention to early diagnosis and treatment in order to prevent a serious situation. We experienced 6 adults patients with retropharyngeal abscess in the past 5 years. The characteristic features of the current trends of the retropharyngeal abscess were confirmed as follows, i) most patients were adulty in their middle age; ii) it frequently appeared to be secondary to an upper airway infection; iii) an immunosuppressive status such as diabetes mellitus, blood dialysis, et cetera were recognized as the underlying pathology; and iv) most pathogens were suggested to be normal flora, anaerobes, and enterobacteria.
We report two cases of cervical subcutaneous emphysema following dental treatment. Case 1: A 36-year-old female after dental extraction presented with swelling of the right cheek and submandibular region and pain. Sinus and cervical CT scan showed cervical and mediastinal subcutaneous emphysema. Case 2: A 35-year-old female complained of swelling of the right cheek and submandibular region and pain following laser operation on the gingiva. Cervical and mediastinal subcutaneous emphysema was found in CT scan. Both patients were treated with rest and drip antibiotics.
Adequate local anesthesia of the larynx and pharynx is required for reliable results of office-based procedures of laryngeal surgery. The conventional method to apply local anesthetic is to spray it topically into the oropharynx and the hypopharynx, followed by direct application to the larynx and the base of the tongue with cotton tip applicators. However, the topical procedures through the oral cavity are sometimes difficult to perform due to the laryngeal reflex. We developed a new apparatus consisting of a flexible air pump-powered spray nozzle to directly introduce the topical medication to the pharynx and the larynx via the nasal cavity. The fluid spread of the spray by the new flexible nozzle was almost consistent with that obtained by the conventional solid air pump-powered spray nozzle. The time from the beginning of the topical anesthesia to finish the surgery was 5 to 10 min, which was considerably shorten than the conventional method (15 to 25 min). The present apparatus for the local anesthesia is useful to obtain an accurate and safe procedure for office-based laryngeal surgery.
It is quite difficult to recognize sore throat and fever as the initial symptoms of neutropenia. Since neutropenia causes serious infection and critical shock, early diagnosis and effective treatment are required to achieve a good prognosis. We report a case of acute epiglottitis due to neutropenia. A 61-year-old female complained of sudden onset of fever and sore throat. Although she took antibiotics for a few days, dyspnea was observed and emergency tracheotomy was performed based on the diagnosis of acute epiglottitis. Laboratory data indicated neutropenia, which was thought to be caused by long-term administration of immunosuppressants and analgesics for treatment of rheumatoid arthritis. Immediate cessation of the above medicines together with administration of both granulocyte colony-stimulating factor and steroids resulted in improvement of the patient’s clinical symptoms and signs.
Fungal infections are known to be associated with immunocompromised patients. However, localized fungal infection of the larynx is extremely uncommon. We describe a case of glottic stenosis due to laryngeal candidiasis that occurred in a 56-year-old male patient with acute myelogenous leukemia and diabetes. Biopsy of the lesion enabled a diagnosis of laryngeal candidiasis and ruled out malignancies, tubeculosis and other diseases. Instillation and inhalant of antifungal agents managed to decrease the fungus mass but not improve the glottic stenosis. The patient’s glottic stenosis was intractable due to repeated proliferation of guranulation tissue or postoperative adhesion in the vocal cords in spite of three operations. The uncontrolled clinical course would suggest that acute myelogneous leukemia and diabetes cause delayed union in postoperative wounds.
A clinical study was conducted on 63 patients with laryngeal cancer treated in the Department of Otorhinolaryngology-head and neck surgery at the Hospital of Juntendo University since 2004. Their mean age was 67.0 years, and the male to female ratio was 20:1. Of the 63 patients, 18 had glotic cancer and 40 supraglotic cancer. Under the TNM classification, 29 were in stage I, 24 in stage II, 3 in stage III and 7 in stage IV. The two years local control rate in glotic and supraglotic cancer were 72.8% and 76.0%, respectively. The two years regression free survival rate in glotic and supraglotic cancer were 72.8% and 44.3%, respectively. According to this result, our treatment strategy was properly conceived, but some points required modification. In some of those patients with glotic cancer who received radiotherapy alone, local recurrence was noted. Adding some chemotherapy, including a cytotoxic agent or molecular target therapy, to radiation is required for improvement of the treatment result.
Langerhans cell histiocytosis (LCH) has been known to show a number of proliferating histiocytic cells that were similar in feature to Lanngerhans cells. LCH has been classified into three types, namely Single-System Single-Site (SS), Single-System Multi-Site (SM), and Multi-System Multi-Site (MM). A 9-month-old male infant with LCH (MM type) was treated in our hospital. Eruptions, the hard palate tumor and otorrhea were observed at the first examination. The CT scan showed destruction of the hard palate, maxillary sinus and temporal bone. We confirmed the diagnosis of LCH with a skin biopsy. The immunohistolgical findings showed a positive reaction for S-100 protein. Moreover, electromicoscopic observation identified Birbeck granules as one of the main characteristics of LCH. Our patient underwent chemotherapy according to the prtocol of the Japan LCH Study Group (JLSG, 1996). This therapy was able to treat the lesions of both bones and skin at 7 months after the JLSG chemotherapy of regimen.
Over the years, Mikulicz’s disease has been considered a subtype of Sjögren’s syndrome; but recent studies point out the involvement of IgG4, and this new concept classifies Mikulicz’s disease as a systemic IgG4-related plasmacytic disease, different from Sjögren’s syndrome. We experienced 2 cases (a 53 year old female and a 51 year old male) who presented with swollen lacrimal glands and submandibular glands. Their IgG4 concentrations in the serum were shown to be elevated and prominent IgG4 positive plasma cells were revealed on histopathological examinations. Since other lymphopoliferative diseases were ruled out, from these findings we diagnosed the patients as having Mikulicz’s disease. Treatment with systemic steroids proved effective and the patients showed no other systemic complications. Reports state that in the later stages, other complications such as autoimmune pancreatitis may occur, therefore regular follow up studies are essential.
Descending necrotizing mediastinitis (DNM) can be occasionally caused by cervical deep infection and has a high mortality rate. Therefore, strategies for treating DNM have reported the need for surgical management as well as full antibiotics administration. We experienced two cases of DNM with deep neck abscesses. Neck and chest computed tomographic (CT) imaging of our cases revealed typical signs of neck abscesses and gas formation in mediastinum. In case 1, a 57 year-old-male patient could be rescued by both transcervical mediastinal drainage and mediastinal drainage with thoracotomy. Case 2 (a 59 year-old-male) was managed with transcervical mediastinal drainage without thoracotomy due to poor pulmonary function. The patient died on the 37th postoperative day. From our own cases and other reports, we suggest that early diagnosis with chest CT, and aggressive mediastinal drainage with the addition of a thoracotomy would be essential to improve DNM.