To clarify the skull content contribution to vibratory bone stimuli transmission and to determine stimuli features, we compared auditory threshold and distortion product otoacoustic emission (DPOAE) using a bone vibrator placed at different head sites, including the eye. The best audiometric threshold and the highest DPOAE were with the vibrator either on the mastoid of the measured side or on the temple’s “ultrasound window”. Auditory threshold with the bone vibrator on the eye resembled those of the forehead and were about 10 dB higher than at the best sites. DPOAEs were clearly present when air-conducted stimuli were presented through an inserted earphone and with the bone vibrator on the eye, indicating that vibratory sound is transmitted through skull content to the inner ear. The intracranial vibratory stimuli transmission pathway thus plays a significant role, particularly at low frequencies, and possibly also when vibratory stimuli are applied to the skull bone.
Of the 26 cases of nonorganic hearing loss studied over the last 5 years, 19 cases were women and 7 were men. 18 had bilateral hearing loss and 8 had unilateral, mostly pure tone audiometry showing moderate “horizontal type” hearing loss, together with 2 of low tone hearing loss and 1 of high tone hearing loss. When pure tone hearing level and speech recognition threshold (SRT) were compared, SRT was lower than pure tone hearing level in 56% of ears. In self-recording audiometry by Bekesy, 54% of ears showed Jerger type V, unique in nonorganic hearing loss but not specific. Thresholds of click-evoked ABR and pure tone hearing level deviated among those with horizontal hearing loss, but ABR was not useful in detecting nonorganic low tone hearing loss. In all types of hearing impairment, especially in low tone hearing loss, auditory steady-state response (ASSR), a frequency specific response, was more useful than ABR in diagnosing nonorganic hearing loss.
We report a case of pediatric bilateral enlarged vestibular aqueduct (EVA) involving profound hearing loss and language delay. A boy born uneventfully had impaired reaction to sound, noted at 20 months. Auditory steady-state response and conditioned orientation response audiometry confirmed profound bilateral deafness. The child underwent speech therapy with hearing aids in both ears and was treated for secretory otitis media. Computed tomography (CT) showed bilateral vestibular aqueduct enlargement and incomplete cochlear partition. Magnetic resonance imaging (MRI) showed bilateral dilated endolymphatic sac. At 36 months, he underwent right-ear cochlear implant (Cochlear, Nucleus® freedomTM CI24RE). Mild perilymph and cerebrospinal fluid leakage occurred pulsatively following cochleostomy at the scala tympani. This was controlled by soft tissue packing. Intra-operative neural response telemetry (NRT) showed no evoked action potential at apical channels, but we successfully mapped cochlear implant for all channels and infant-toddler meaningful auditory integration scale (IT-MAIS) and meaningful use of speech scale (MUSS) improved.
Of studied 2,360 subjects with facial nerve disease between 1995 and 2009, 64% were diagnosed with Bell's palsy (BP), Ramsay Hunt syndrome (RHS) and Zoster sine herpete (ZSH). RSH and ZSH were less cumulatively curable than BP. Nerve palsy treatment results did not differ among the therapies. Among the 137 with bilateral and recurrent facial palsy, the age at first episode of those with bilateral recurrent palsy was younger than those with the bilateral alternative, ipsilateral recurrent, or bilateral simultaneous palsy. Women outnumbered men by three times among those with hemi facial spasm.
Functional and inner-ear hearing loss must be differentiated to diagnose functional hearing loss based only on the stapedius reflex (SR). We statistically compared values obtained by subtracting the pure-tone audiometry threshold from the SR threshold in those with functional or inner-ear hearing loss. At hearing of less than 60 dB HL, no significant difference was seen between those with functional and inner-ear hearing loss. At 70 dB HL or 80 dB HL, values were statistically lower in those with functional hearing loss than with inner-ear hearing loss (p<0.01). At 90 dB HL or more, the value was 0 or less in many with functional hearing loss. Evaluating hearing loss using the SR alone is therefore not possible in functional hearing loss at less than 60 dB HL. It is possible, however, to diagnose some cases of functional hearing loss at 70 dB HL or 80 dB HL and in many cases of functional hearing loss of 90 dB HL or more.
We evaluated the clinical application of Auditory Steady-State Response (ASSR) test as a measure of the hearing threshold of 63 children with hearing impairment and normal hearing. ASSR thresholds and hearing thresholds correlated highly at audiometric test frequencies of 500, 1000, 2000 and 4000 Hz. But, 51 of 407 ears showed discrepancy that differential score (DS) was over 30 dB. ASSR is very useful in estimating neonatal hearing threshold, but long-term follow-up is important in conditioned orientation response audiometry (COR) and behavioral observation.
We retrospectively analyzed long-term efficacy of multimodality therapy in 142 subjects with advanced maxillary sinus carcinoma between 1977 and 2010. Combined multimodality therapy based on Sato’s method consisted of intraarterial chemotherapy combined with radiotherapy and organ preservation surgery from 1977 to 1995, but results in 82 cases were unsatisfactory in T3 and T4 cases. To improve local control and survival, we refined combined therapy with weekly intraarterial carboplatin infusion combined with radiotherapy and radical extended surgery in 24 cases, raising cumulative cause-specific 5-year-survival rate to 100% in T3 and 56.7% in T4. Organ preservation decreased from that of combined multimodality therapy. To improve local control, survival and organ preservation in T4, we conducted superselective intraarterial cisplatin infusion combined with radiotherapy and organ preservation surgery in 36 cases, raising cumulative cause-specific 5-year-survival to 100% in T3 and 81.6% in T4. High organ preservation was also possible with all cases preserving ocular function. In conclusion, superselective intraarterial CDDP infusion combined with radiotherapy and organ preservation surgery is highly effective in treating advanced maxillary sinus carcinomas and improves prognosis and organ preservation.
In a pollen-season study of the clinical prophylactic effect in those with Japanese cedar allergy, we found that symptoms were less severe and quality of life (QOL) higher in those treated before rather than after pollen season started. These results indicate that prophylacsis is effective in treating Japanese cedar pollinosis.
We report 2 cases of relatively rare hematocele of the maxillary sinus in 14-year-old and 38-year-old men reporting nasal obstruction and epistaxis. Computed tomography (CT) showed isodensity maxillary sinus masses mimicking malignant tumors by destroying the bony wall. Masses were removed transmaxillarily and endonasally. Both were diagnosed histopathologically as hematocele.
Orbital blowout fracture causes include violence, sports, traffic accidents, and falls, with an object striking the eyeball with some force. Subjects numbered 30 studied clinically from 1986 to 2005. The prevalent symptom was double vision requiring surgical repair in 21 subjects. Recovery was related to surgical timings, underscoring the importance of early diagnosis and intervention.
We report a case of frontal sinus mucocele with repeated postoperative orbital complications. A 90-year-old woman with upper right eyelid swelling was diagnosed by computed tomography as having frontal sinus mucocele necessitating endoscopic sinus surgery (ESS). Despite successful surgery, orbital complications occurred 20 days, 1 month, 9 months, and 2 years and 9 months after surgery. They were alleviated each time by immediate antibiotic therapy. Elderly patients undergoing ESS thus require long-term postoperative follow-up.
We examined the relationship between vascular endothelial growth factor (VEGF) in nasal lavage and nasal symptom score in 39 subjects each with Japanese cedar pollinosis and grass pollinosis. VEGF concentration in nasal lavage was measured by ELISA. VEGF concentration in cedar pollinosis nasal lavage increased with nasal symptom exacerbation. We also studied the relationship between nasal symptom scores—sneezing, rhinorrhea, and nasal congestion—and VEGF concentration in nasal lavage in cedar pollinosis. VEGF concentration in nasal lavage correlated highly with nasal symptom severity. VEGF fluctuation in nasal lavage from those with grass pollinosis resembled that in Japanese cedar pollinosis. VEGF thus appears to play an important role in pollinosis pathogenesis.
We studied the role of pigment-epithelium-derived factor (PEDF) in allergic rhinitis pathogenesis. PEDF concentrations in nasal lavage from 54 subjects with Japanese cedar pollinosis measured by ELISA increased as nasal symptoms were exacerbated. The effect of PEDF on human umbilical vein endothelial cells (HUVEC) was examined and HUVEC proliferation was studied using BrdU assay and RT-PCR of c-fos. HUVEC apoptosis was also looked at using TUNNEL and Western blotting of creaved caspase 3. PEDF induced HUVEC proliferation by inhibiting HUVEC apoptosis at a low concentration. HUVEC apoptosis was induced by PFDF at a high concentration. Taken together, these results suggest that PEDF plays a key role in nasal allergy pathogenesis by regulating apoptosis and proliferating vascular endothelial cells.
We report a case of primary small cell carcinoma (SCC) of the paranasal sinus, which is a rare clinical entity, originating in the right ethmoid sinus. A 45-year-old woman seen for right nasal obstruction was found in anterior rhinoscopy to have a hemorrhagic tumor in the right nasal cavity. Computed tomography (CT) showed swelling of the right ethmoidal mucosa. Nasal tumor biopsy yielded a diagnosis of SCC. She was treated with irradiation and four courses of chemotherapy using cisplatin and etoposide. To evaluate the therapeutic effect, she underwent endoscopic sinus surgery, judged to be Grade 3. No recurrence has been seen in the 15 months since initial treatment.
Myoepithelioma is rare, accounting for ≤1% of salivary gland tumors. We report a case of myoepithelioma of the soft-palate. A 89-year-old woman treated 28 years earlier for palatal pleomorphic adenoma presented with an expanding soft-palate tumor and progressive dysphagia. We conducted minimum invasive surgery considering her age and condition. Histopathologically, the tumor consisted of small epithelioid cells and was diagnosed as recurrent myoepithioma based on a specimen from initial treatment. Immunohistochemical analysis showed positive reactions for α-SMA, vimentin, cytokeratin, and S-100 protein, and less than 5% reaction to Ki-67. No evidence of recurrence was seen 1 year after surgery.
Surgical resection of buccal mucosa carcinoma with cheek skin invasion frequently causes full-thickness cheek defects. This defect is usually corrected using reconstructive surgery with a free or pedicled flap. We report a case of squamous cell buccal mucosa carcinoma treating this defect through surgical reconstruction with a forehead flap. The three-step procedure was safe and minimally invasive. The subject was satisfied with functional and cosmetic outcome and skin color match.
Oral metastasis in renal cell carcinoma (RCC) is rare despite frequent RCC metastasis. We report two such exceptional cases. Case 1: A 71-year-old man seen for a tongue tumor had undergone bilateral radical nephrectomy for renal cell carcinoma and been diagnosed elsewhere with multiple bone, lung, and pancreatic metastasis. Tongue tumor biopsy pathologically indicated clear cell carcinoma, yielding a diagnosis of oral RCC metastasis. The man died of respiratory failure 3 months after diagnosis. Case 2: A 73-year-old man seen for a palatal tumor had undergone right radical nephrectomy for renal cell carcinoma. Palatal biopsy pathologically yielded a diagnosis of clear cell carcinoma, also yielding a final diagnosis of RCC metastasis. The tumor was reduced by arterial embolization.
The number of tonsillectomies, involving children has decreased and those involving adult dense peritonsillar adhesions has increased. Tonsil surgery is generally the first basic procedure an otolaryngologist learns and conducts alone. Since tonsil operations are numerous, the postoperative course is fairly constant, and the clinical path is easily applicable, otolaryngologists must master this basic procedure as a minimum for general hospital surgery and otolaryngology department management. While serious complications rare, we report the case of an 18-year-old woman who developed a pulmonary embolism the morning after bilateral tonsillectomy. We conducted an aggregate analysis of tonsil surgeries by otolaryngologists and the incidence of postoperative complications.
We evaluated eating and swallowing disorder in 45 subjects—29 men and 16 women aged 70 to 87 years old—treated for oral cancer between 1998 and 2007. The cases included 37 with tongue cancer, four with inferior gingival cancer, two with buccal mucosa cancer, and one with cancer of the oral floor. Of the 45, 33 underwent primary and 12 secondary treatment. The incidence of eating and swallowing disorder and that of aspiration pneumonia were evaluated. Eating and swallowing disorder occurred in 19 of 45 (42.2%) patients. On comparison of patients with the presence or absence of eating and swallowing disorder, the group receiving surgery alone comprised about 70% of those without eating and swallowing disorder, but only 10% of those with eating and swallowing disorder. Patients undergoing radiotherapy and Chemoradiotherapy were more than 4-fold more likely to have eating and swallowing disorder. Aspiration pneumonia occurred in 15 of 45 (33.3%) overall and in 19 (78.9%) with eating and swallowing disorder, mainly late in radiotherapy or chemoradiotherapy and after surgery. Logistic regression analysis confirmed that factors influencing aspiration pneumonia onset were T value, tracheostomy, and opioid administration.
Piriform sinus fistula is congenital anomaly, mostly occurring on the left side. We report a case of a 9-year-old boy suffering cryptogenic cervical abscess formation seven times before it was finally resolved. Referred in December 2001 for a suspected pirifom sinus fistula, his diagonosis was confirmed by pharyngoesophagography. The fistula was completely resected using a cervical approach, after which the fistula disappeared and has not recurred in the 6 years since surgery.
Posterior reversible encephalopathy syndrome (PRES) features headache, seizures, abnormal mental state, altered visual perception, and hypertension. While rare, it has become increasingly identifiable with clinicoradiological processes in cancer associated with cytotoxic and immunosuppressive agents. Such processes include vasogenic edema mainly involving the white matter of the parietooccipital lobes. PRES is reversible when adequately managed. Failure to quickly recognize it may, however, result in profound, permanent central nervous system dysfunction or death. We reported a 48-year-old woman with advanced hypopharyngeal cancer who developed PRES after total pharyngolaryngoesophagectomy. Her condition gradually improved and she recovered completely without neurological deficit 46 days after PRES onset.
The lack of definitive symptoms makes nasopharyngeal cancer difficult to diagnose early. Anatomically, nasopharyngeal cancer surgery is also very difficult. Nasopharyngeal cancer is classified histologically as undifferentiated or poorly differentiated, and is sensitive to radiotherapy and chemotherapy. The alternative chemoradiation protocol we developed cosists of 2-day CDDP (50 mg/m2/day), 5-day 5FU (800 mg/m2/day), and radiotherapy of 66 Gy in 36 fractions. Using this protocol, we have treated 9 subjects. Full-course three-cycle chemotherapy has been done in 89. Overall 5-year survival and disease-specific cumulative 5-year survival were both 100.0%, with 5-year disease-free survival 71.1%. Recurrence involved a neck lymph node in one subject and distant metastases in two. This treatment thus appears very useful, despite severe mucositis in 66.6% making long-term oral intake difficult and requiring long-term hospitalization. The next goal is thus reducing the incidence of mucositis complications.
A 17-year-old man with severe sore throat and poor oral intake admitted for intractable tonsillitis had sore throat ameliorated, but vomiting, nausea and cerebellar ataxia occurred on day 5 after admission. Laboratary examination showed that EBV (VCA) IgM was positive and EBV nuclear antigen (EBNA) was negative, yielding a diagnosis of acute cerebellitis with initial EBV infection. Methylprednisolone pulse therapy ameliorated subjective symptoms a month after onset, optokinetic nystagmus test results did not improve. We found the equilibrium function test very useful in evaluating latent cerebellar disorder.
Despite the reduction antibiotics have made in retropharyngeal abscess because of development in antibiotics, this condition must be rapidly diagnosed and adequately treated due to its potential lethality. We report a case of retropharyngeal abscess extending from the radix linguae to the mediastinum secondary to pyogenic spondylitis. A 70-year-old woman with untreated diabetes mellitus and administered steroid hormones for myalgia had potentially lethal multifocal abcesses, including spinal epidural and retroperitoneal lesions. Following emergency surgical drainage and the care of specialists, she recovered and was discharged without sequelae, paralysis, or dysphagia. Early surgical drainage is effective in ameliorating severe retropharyngeal abscess, for which early rehabilitation and swallowing training is important.
Arytenoid adduction is used in treating unilateral vocal cord paralysis. In 7 subjects with breathy hoarseness due to such paralysis undergoing arytenoid adduction from 2006 to 2008, preoperative mean maximum phonation time (MPT) of 4.6 ± 1.3 increased to 13.4 ± 1.7 postoperatively. Hoarseness was ameliorated in all subjects. These results indicate that arytenoid adduction is effective in treating unilateral laryngeal paralysis.
We report a rare case of laryngeal fibrosarcoma developing 6.5 years after laryngeal cancer radiotherapy. A 70-year-old man undergoing radiotherapy at 66 Gy in 2001 then developed granuloma. Repeated biopsy found no lesional malignancy. Total laryngectomy was conducted in 2008. Postoperative pathology showed the lesion to be fibrosarcoma. The man eventually died of pulmonary and hepatic metastases. We present the case with a review of the literature.
We retrospectively reviewed charts of 80 subjects with parotid gland tumors 44 men (55.0%) and 36 women (45.0%) aged 17-84 years (average age: 55.6) in the 7 years from April 2003 to March 2010. Benign tumors were diagnosed in 68 cases (85.0%) and malignant in 12 cases (11.7%). Of malignants, 8 patients (9.6%) were diagnosed as epithelial, including 2 of acinic cell carcinoma and epitherial-myoepithelial carcinoma, and 4 nonepithelial diagnosed as malignant lymphoma. The most frequent benign tumor was polymorphic adenoma in 36 (45.0%) followed by Warthin’s tumor in 20 (25.0%). The postoperative complications were facial nerve paralysis in 26 (31.0%), salivary fistula in 3 (3.7%), and Frey’s syndrome in 2 (2.4%).
Sialolithiasis refers to calculi forming where saliva is produced, with over 90% occuring in the submandibular gland. When saliva stagnates due to sialolithiasis, swelling develops and eating becomes painful. Symptoms are severe in the acute stage, but an asymptomatic state may persist. A 19-year-old woman with right submandibular sialolithiasis detected while she was in primary school developed an abscess that was not ameliorated in conservative treatment. An intraoral attempt to remove calculi released only pus. Despite temporary improvement, Wharton's duct was obstructed 2 months postoperatively, with impaired saliva outflow causing acute submandibular swelling. Computed tomography (CT) showed a huge mucosal cyst in the oral floor. The mandibular gland and cyst were removed by external incision.
IgG4-related sclerosing disease, including Mikulicz’s disease, is systemic, with IgG4-positive plasma cells appearing in internal organs body-wide. Sclerosing salivary glanditis such as Mikulicz’s disease and Kuttner’s tumor, autoimmune pancreatitis, primary sclerosing cholangitis, and retroperitoneal fibrosis are assumed to be phenotypes of IgG4-related sclerosing disease. Some cases of autoimmune pancreatitis complicated by malignant tumor have been reported, but few in the head and neck field. We detail a case of IgG4-related sclerosing disease complicated by salivary duct carcinoma.
A 64-year-old man seen elsewhere for recurrent bloody sputum was found in computed tomography (CT) to have a 2 cm thyroid tumor invading the trachea but no recurrent nerve palsy. Fine-needle aspiration biopsy showed papillary carcinoma of the thyroid gland. He was scheduled for total thyroidectomy and tracheal reconstruction. On admission, he reported dyspnea on exercise. The tumor grew rapidly invading the cricoid cartilage. Suspected anaplastic carcinoma was not seen. Total thyroidectomy and laryngectomy yielded a pathological diagnosis of poorly differentiated carcinoma as defined in General Rules for the Designation of Thyroid Cancer by the Japanese Society of Thyroid Surgery. Poorly differentiated carcinoma of the thyroid is a new pathological concept that we report with a review of the literature.
We report four cases of carotid body tumors (CBTs) in which tumors were removed surgically in two and the internal carotid artery (ICA) preserved in one. In the other, the ICA had to be replaced by the saphenous vein. The remaining two subjects died of multiple bone metastasis. These results emphasize the unpredictable nature of CBT and their malignancy potential, which warrants complete tumor resection and long-term postoperative follow-up.
We report a case of cat scratch disease (CSD) with neck lymphadenopathy. A 23-year-old woman reporting a painless left upper neck mass showed no inflammatory sign. Positron emission tomography (PET) showed fluorodeoxyglucose (FDG) accumulation in the neck suggesting malignant lymphoma. Biopsy of a resected lymph node histopathologically indicated granulomatous lymphadenitis with a suppurative granuloma. Serological indirect fluorescent antibody (IFA) findings showed elevated Barthonella henselae IgM antibody, yielding a definitive diagnosis of CSD. Serological testing for Barthonella species is important in diagnosing this zoonotic infection.
A 40-year-old service station attendant knocked unconscious when a car tire blew out and brought unconscious to the emergency room by ambulance was found in computed tomography (CT) to have no brain injury or hemorrhage. With 3 cm of his lower lip lacerated, the man’s oral cavity was filled with blood and his soft palate and uvula were swollen. Regaining consciousness, he reported strong pain on swallowing. Autoscopy showed a laceration from the epipharynx to the mesopharynx. Neck CT confirmed aerodermectasia, necessitating emergency surgery. With reference to the we discuss the diagnosis referencing the literature.
The relatively common thyroglossal duct cyst, or median cervical cyst, develops from residual thyroglossal duct tissue, generally comprise normal thyroid tissue1), so carcinoma development is rare at 1.9% (Livolsi, et al.)1), 1.7% (Keelig, et al.)2), or 1.6% (Nagamine, et al.)3). Since the Nonaka report4), only 66 cases of carcinoma development from thyroglossal duct remnant, including ours, have been reported.
We report 3 cases of anaplastic thyroid carcinoma occurring between 1995 and 2009 and all featuring an enlarged anterior cervical mass. The first case involved a 76-year-old woman whose clinical imaging findings strongly suggested thyroid gland malignancy, necessitating total thyroidectomy, neck dissection, and tracheostomy. The pathological diagnosis was anaplastic thyroid carcinoma. Despite postoperative chemoradiotherapy, she died of cervical lymph node and lung metastasis 5 months after diagnosis. Cases 2 and 3 involved a 63-year-old woman and a 47-year-old man diagnosed with anaplastic thyroid carcinoma based on fine-needle aspiration cytology findings. Both underwent total thyroidectomy, neck dissection, and tracheostomy and postoperative chemoradiotherapy but the second subject died 7 months after diagnosis due to multiple lung metastasis and the third subject 4 months after due to multiple lung and liver metastasis. Successfully treating those with anaplastic thyroid carcinoma requires timely diagnosis and appropriate treatment based on accurately evaluating the subject background.