Festschrift for Professor Yukio Watanabe In Honor of His Retirement as Chairman of the Department of Otorhinolaryngology, University of Toyama
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Hajime Nakagawa, Seiichi Takeda, Yukio Watanabe
2012 Volume 134 Pages
1-7
Published: 2012
Released on J-STAGE: July 22, 2012
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The electronic medical records system has spread in Japan since 1999. However, characteristic features specific to the otolaryngological clinic have not been reflected in the development of the electronic medical record. Therefore, we developed cutting-edge tools for otolaryngological clinic use through cooperation between the otolaryngological clinic and medical informatics staff. The results of audiological tests stored in the filing system can be displayed on the electronic medical record monitor through a URL link set up by the medical informatics staff to the audiological file server developed by the otolaryngological staff. Liquid crystal pen-tablets are also utilized in approximately 40.7% of all otolaryngological clinics to allow illustration of physical findings. These results suggest that both research into and the introduction of an electronic medical record suitable for use in the otolaryngological clinic have resulted in great success.
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Seiichi Takeda, Hajime Nakagawa, Yumi Nishijima, Michiro Fujisaka, Mak ...
2012 Volume 134 Pages
8-13
Published: 2012
Released on J-STAGE: July 22, 2012
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We have developed a filing system for hearing test results in collaboration with the electronic medical records of Toyama University Hospital. The hearing test includes pure tone audiometry, play audiometry, tympanometry, auditory brain-stem response, otoacoustic emissions, and electrocochleography. Operation of our system started in March, 2009, and to date, total data on 13000 tests has been compiled. With our filing system, useful information on hearing test results can be available at any terminal of the on-line electronic medical records system in our university hospital. Further support is necessary to establish more stable operation in the future.
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Naoki Ohashi
2012 Volume 134 Pages
14-17
Published: 2012
Released on J-STAGE: July 22, 2012
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The relation between the nystagmus in the supine position and the affected side in patients with horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is studied because nystagmus is frequently observed in the supine position before the patient assumes the supine right-ear-down and left-ear-down positions. Thirty patients with HC-BPPV were examined using electronystagmography (ENG) in the supine, supine right-ear-down and supine left-ear-down positions, and the relation between the direction of nystagmus in the supine position and the affected side was studied. The direction of nystagmus in the supine position was consistent with the affected side in 11 of 18 (61%) patients with cupulolithiasis and in 7 of 12 (58%) patients with canalithiasis. ENG findings in HC-BPPV patients with cupulolithiasis suggested that the cupula is oriented laterally in the HC. Other ENG findings in HC-BPPV patients with canalithiasis suggested that otoconia are located in the medial position of the HC. These findings are helpful to infer the affected side in the patient with HC-BPPV by observation of the nystagmus in the supine position before placing the patient in the supine right/left-ear-positions.
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Masatsugu Asai, Naoko Ueda, Yukio Watanabe
2012 Volume 134 Pages
18-27
Published: 2012
Released on J-STAGE: July 22, 2012
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Features of patients with unilateral vestibular disorders were evaluated from the standpoint of lateral sway with stabilometry. The patient group comprised 165 patients in whom air caloric stimulation revealed right ear canal paresis (CP) in 86 and left ear CP in 76 patients. The control group comprised 89 healthy subjects. Subjects stood on the stabilometer with both feet close together in eyes-open and eyes-closed conditions for 1 minute each. We analyzed results of sway pattern on the statokinesigram, mean position of center of foot pressure (COP), vector of velocity, and power spectrum under the eyes-closed condition. The most frequent pattern on the statokinesigram in both groups was the centripetal pattern. Lateral sway pattern was observed in 25% of patients in the patient group and 17% of the control group subjects. Mean positions of COP in the patient group shifted slightly to the right side irrespective of the side with CP. However, positions in the control group shifted slightly to the left side. The vector of velocity indicated that lateral sway was greater than forward-backward sway in both groups. Differences in velocity between the CP side and healthy side in the patient group were not statistically significant. In power spectral analysis, frequency range under 12.5 Hz was divided into 8 categories. The “power ratio” (ratio of summated power in each category to total power) was calculated. The power ratio below 0.125 Hz in the patient group was significantly lower than that of the control group. In contrast, the power ratio between 0.25 to 0.5 Hz in the patient group was significantly higher than that of the control group. We found moderate differences in lateral sway on stabilometry between the patient and control groups. However, these differences were not sufficiently apparent to allow patients to be distinguished from healthy subjects.
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Hideo Shojaku, Michiro Fujisaka, Masayuki Ishida, Yukio Watanabe, Hisa ...
2012 Volume 134 Pages
28-33
Published: 2012
Released on J-STAGE: July 22, 2012
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A 10-time-scale mockup of the semicircular canal located in a 1.5-time-scale mockup of the head was developed to quantify the biomechanical response of canalith during the two types of the canalith repositioning procedure (CRP). During steps 1 and 2 of the original CRP reported by Epley, all ten particles in the posterior semicircular canal were relocated from the distal limb of the canal. During steps 3 and 4, all particles passed the zenith of the canal curvature to enter the common crux and progress away toward the utricle. During step 3 of the modified CRP reported by Radtke et al., 4 of 10 particles still remained in the distal limb of the canal because the angle of head extension appears to be smaller than that of the original CRP. During step 4 of the modified CRP, 6 particles reached the utricle, whereas the 4 remaining particles moved backward to the ampulla of the canal. According to the experiment with our mockup, modified CRP could not accomplish complete removal of the particles from the canal as well as the original CRP could. Another mechanism, such as the type of shaking and loosening treatment offered by the Semont Liberatory Maneuver, should be involved to explain the clinical efficacy of the modified CRP.
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Yoshikazu Igarashi
2012 Volume 134 Pages
34-39
Published: 2012
Released on J-STAGE: July 22, 2012
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Transcanal and transtympanic otosurgeries were performed with ridged endoscopes (2.7-mm caliber, 11-cm length, 0° and 30° viewing angles), 3CCD zoom camera system with 90° beam splitter, and curved microsurgical instruments. The endoscope and microsurgical instruments were introduced directly into the external ear canal without using the otoscope. From April 2005 to November 2008, we performed tympanostomy tube placement in 120 ears, myringoplasty in 56 ears, congenital cholesteatoma extraction in 1 ear, perilymph fistula closure in 6 ears, and stapes surgery in 3 ears by endoscopically guided procedure. The close-up wide view displayed on the video monitor avoided blind operation even in cases of a narrow and/or curved external ear canal and enabled improvement of understanding of middle ear anatomy and of surgical information sharing by the surgical staff. Transtympanic middle ear surgery was performed through a tympanostomy fenestration, which was then immediately closed with areolar tissue and fibrin glue. This minimally invasive technique provided excellent visualization of middle ear structures, i.e., the I-S joint, stapes, stapedial muscle tendon, round window niche, horizontal portion of the facial nerve, and the tympanic sinus. This technique offers the advantages of no need for canal wall drilling, minimal interference by the chorda tympanic nerve, and no need for postoperative packing, and it allows for short-term patient hospitalization. The success of endoscopically guided otosurgery depends on having appropriate equipment and skills training.
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Hiroshi Kimura, Hideo Shojaku, Masatsugu Asai, Michiro Fujisaka, Hiroa ...
2012 Volume 134 Pages
40-43
Published: 2012
Released on J-STAGE: July 22, 2012
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We investigated 33 patients with collagen disease and related diseases following complaints of otorhinolaryngological symptoms. These 33 patients initially, complained of otorhinolaryngological symptoms, that were later found to be symptoms of collagen disease and related diseases. Twelve collagen diseases and related diseases were diagnosed. Primary Sjögren’s syndrome was definitively diagnosed in 19 patients. Two patients had Sjögren’s syndrome and rheumatoid arthritis, 1 had Sjögren’s syndrome and systemic sclerosis, and 2 had relapsing polychondritis. Temporal arteritis, atypical Cogan syndrome, adult-onset Still’s disease, Wegener’s granulomatosis, Behçet’s disease, systemic sclerosis only, systemic lupus erythematosus, sarcoidosis, and mixed connective tissue disease were diagnosed in 1 patient each. An average of 4.1 patients were diagnosed annually as having collagen disease and related diseases. The proportion of these patients diagnosed with collagen disease and related diseases following complaints of otorhinolaryngological symptoms was 0.3% annually in new outpatients. The most frequent clinical symptom was xerostomia, found in 17 of the 33 patients. All 17 of these patients with xerostomia were diagnosed as having Sjögren’s syndrome, suggesting that the otolaryngologist should carefully examine patients with xerostomia. When a patient was diagnosed as having Sjögren’s syndrome, the otolaryngologist consulted with a collagen disease specialist. Although the patients with temporal arteritis, atypical Cogan syndrome, or adult-onset Still’s disease, presented with high fever and severe otorhinolaryngological symptoms, the actual local otorhinolaryngological findings were mild. Therefore, patients with continuous high fever and severe otorhinolaryngological symptoms in spite of slight local abnormal otorhinolaryngological findings should be considered to have collagen disease or related diseases. Otolaryngologists should be familiar with otorhinolaryngological disturbances associated with collagen disease and related diseases.
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Michiro Fujisaka, Makiko Junicho, Hideo Shojaku, Seiichi Takeda, Yumi ...
2012 Volume 134 Pages
44-46
Published: 2012
Released on J-STAGE: July 22, 2012
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We investigated the efficacy of tinnitus retraining therapy (TRT) in our department. The subjects comprised 20 patients with chronic tinnitus. Seven of the 20 patients discontinued TRT, but in the remaining 13 patients, symptoms of tinnitus improved in 11 (84.6%) patients. The tinnitus handicap inventory score before treatment was higher in the patients with improvement of tinnitus (70.8/100) than in the patients with no change in tinnitus (41.2/100).
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Masahito Tsubota, Hajime Nakagawa, Yukio Watanabe
2012 Volume 134 Pages
47-52
Published: 2012
Released on J-STAGE: July 22, 2012
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We report two cases of cerebellar infarction with dizziness and hearing loss. Case 1: A 72-year-old woman visited our hospital because of dizziness, right hearing loss and right tinnitus. Neuro-otological examination showed spontaneous and positional left-beating nystagmus. Audiography tracing showed sensorineural right ear hearing loss. We diagnosed right sudden deafness with vertigo and administered steroid, ATP, nicotinic acid and vitamin B12 in our hospital. During the treatment, symptom of ataxia was observed. MRI showed a cerebellar infarction in the AICA territory, so the patient was diagnosed with AICA syndrome. Dizziness and hearing loss were improved by both antithrombotic therapy and steroid treatment. Case 2: An 85-year-old man visited our hospital because of dizziness, right tinnitus, facial numbness and temporal pain. Neuro-otological examination did not show clear nystagmus. Audiography tracing showed sensorineural right ear hearing loss. MRI showed a cerebellar infarction in the AICA territory, so the patient was diagnosed with AICA syndrome and admitted to the neurosurgery department. The patient was administered a free radical scavenger, antithrombotic drug and vitamin B products, and his symptoms improved with treatment. Occasionally, it is difficult to distinguish AICA syndrome from inner ear disease, so the clinician must take careful notice of findings from past history, neurological signs and findings of nystagmus.
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Hiroshi Nishida, Michiro Fujisaka, Yukio Watabae
2012 Volume 134 Pages
53-57
Published: 2012
Released on J-STAGE: July 22, 2012
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We encountered a case of acute otitis media caused by non-tuberculous mycobacterial infection. A 13-year-old girl presented with right ear pain and discharge lasting for 1 week despite treatment with a standard antibiotic. Physical examination revealed a small perforation of the right tympanic membrane and swollen external ear canal mucosa. Ear computed tomography showed a soft tissue shadow occupying the right middle ear and the mastoid cavity. Audiometry revealed right sensory hearing loss.
She received treatment with eardrops (OFLX), administration of antibiotic (intravenous PIPC 2.0 g/day) and steroid (intravenous dexamethasone sodium phosphate tapering from 6.0 mg/day). Right ear pain, discharge and hearing loss improved. Initial otorrhea cultures yielded non-tuberculous mycobacteria (
Mycobacterium fortuitum). After treatment, her symptoms resolved, and she has remained well without evidence of reinfection.
On the basis of our experience with this patient, we recommend conservative management (for example, antibiotic administration) for the initial treatment of cases of acute otitis media caused by non-tuberculous mycobacteria.
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Yuji Kanazawa, Hideo Shojaku, Yukio Watanabe
2012 Volume 134 Pages
58-62
Published: 2012
Released on J-STAGE: July 22, 2012
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We report a case of glomus tympanicum tumor. A 65-year-old woman seen for right ear pain was found to have a dull red mass behind her right eardrum on otoscopic examination. The tumor was diagnosed as a glomus tympanicum tumor by computed tomography (CT) and magnetic resonance imaging (MRI). Preoperative angiographic findings revealed that this tumor was fed by the middle meningeal artery, which we embolized, and by more than one artery. The tumor was completely removed by transcanal tympanoplasty with only a small amount of bleeding. Bipolar coagulation can coagulate blood vessels and offers better visualization of the surgical field.
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Satsuki Yasumura
2012 Volume 134 Pages
63-65
Published: 2012
Released on J-STAGE: July 22, 2012
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Nasal nebulizer has been recognized useful treatment for a long while since 1958. We experienced a case of anaphylactic shock after nasal nebulizer contained cefmenoxime hydrochloride (CMX) and Rinderon.
A 58-year-old female had cutaneous symptoms (itching, flush), cardiovascular symptoms (pulse weakening, hypotension), respiratory symptoms (rough breathing, dyspnea), digestive symptoms (vomit, incontinence of anus) and neurological symptom (consciousness loss) after nasal nebulizer. When she has had mild symptoms about anaphylactic reaction before this episode, internal medical doctor had diagnosed that symptoms were suspected neurally mediated syncope.
We are recognizing anew difficulty of a precise judgment and speedily handling in face of anaphylactic shock, in spite of understanding possibility of anaphylaxis for antibiotics.
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Katsuichi Akaogi, Hiromasa Takakura
2012 Volume 134 Pages
66-69
Published: 2012
Released on J-STAGE: July 22, 2012
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Eruption of a tooth into the nasal cavity is a rare clinical entity. We report the case of a 38-year-old man patient with cacosmia and nasal obstruction. A white mass was visually detected on examination as being an inverted tooth in the right nasal cavity. The tooth was diagnosed as a supernumerary tooth by a dentist. We extracted the tooth easily from the nasal cavity with the patient under general anesthesia. After the operation, the patient’s course went well and the symptoms of cacosmia and nasal obstruction have disappeared.
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Hirohiko Tachino, Satsuki Yasumura, Hideo Shojaku, Hiroshi Nishida, Yu ...
2012 Volume 134 Pages
70-75
Published: 2012
Released on J-STAGE: July 22, 2012
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We report a case of sinonasal rhabdomyosarcoma in an elderly 74-year-old man who complained of double vision and exophthalmos of the left eye. Computed tomography of the paranasal sinus confirmed findings of opacification of the left maxillary and ethmoidal sinuses extending into the orbit. Immunohistochemical examination of the excised tissue of the sinonasal tumor revealed the alveolar type of the rhabdomyosarcoma. Partial remission of the tumor was acquired in response to standard chemoradiotherapy for the rhabdomyosarcoma. However, the patient died due to multiple metastases 16 months after the onset of the disease. Sinonasal rhabdomyosarcoma with a high proliferative index (immunoexpression of MIB-1) has a poor prognosis.
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Hiromasa Takakura, Hideo Shojaku, Michiro Fujisaka, Yukio Watanabe
2012 Volume 134 Pages
76-80
Published: 2012
Released on J-STAGE: July 22, 2012
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Eagle’s syndrome is characterized by craniofacial or cervical pain due to an elongated styloid process or calcified stylohyoid ligament. We report a case of Eagle’s syndrome with stylohyoid ligament ossification, clinically mimicking a fishbone foreign body. The patient was a 61-year-old woman who complained of sore throat around her right tonsil after she got a fishbone stuck in her throat. She was diagnosed as having a fishbone foreign body in the right tonsil from CT scan findings and underwent right tonsillectomy in another hospital. However, her sore throat and the linear calcification within the right tonsillar bed on CT scan remained. She was thus diagnosed as having Eagle’s syndrome with 3D-CT in our hospital.
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Motoyoshi Maruyama, Masatsugu Asai, Yukio Watanabe
2012 Volume 134 Pages
81-83
Published: 2012
Released on J-STAGE: July 22, 2012
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We experienced a case in which it was not possible to perform Ejnell’s operation under direct laryngoscope, but it was possible with use of the Airway Scope. The Airway Scope was developed to facilitate tracheal intubation and was designed based on an anatomical shape that allows insertion with the head in a natural position. If apparatus are developed in the future that can be guided by this device, the Airway Scope may become a quite useful tool in the treatment of laryngeal disease.
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Hideharu Abe, Katsuichi Akaogi, Yukio Watanabe
2012 Volume 134 Pages
84-87
Published: 2012
Released on J-STAGE: July 22, 2012
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Acute longus colli calcific tendinitis is induced by inflammation of the longus colli tendon following deposition of calcified particles and causes acute neck pain, stiffness, and dysphagia. It can heal spontaneously within 1-2 weeks, but many cases are treated with powerful antibiotic drugs because these symptoms and swelling of the soft tissue in the retropharyngeal area along with laboratory evidence of elevated inflammatory reaction in the blood mimic the response to retropharyngeal abscess. To distinguish this tendonitis from retropharyngeal abscess, detection of calcification anterior to the axis (C2) by computed tomography (CT) is very important.
We report a case of a 51-year-old woman initially suspected of having retropharyngeal abscess by magnetic resonance imaging (MRI) alone, but by using CT, we confirmed the presence of calcification.
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Hiroaki Fushiki, Hideharu Abe, Masayuki Ishida, Motoyoshi Maruyama, Ke ...
2012 Volume 134 Pages
88-95
Published: 2012
Released on J-STAGE: July 22, 2012
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This study is a retrospective review of the clinical records of patients operated on for parapharyngeal space (PPS) tumors. Between April 2005 to September 2011, 8 patients (2 men, 6 women, mean age 61.3 years) with primary PPS tumors underwent surgical resections by the same operating team. Different surgical approaches were used according to the type of lesion, exact location, and size: transcervical in 3 patients, transcervical-transparotid in 4 patients, and transparotid in 1 patient. Mandibulotomy was performed in 3 patients (mandibular swing in 1, subcutaneous mandibular splitting in 2). The PPS tumors were all successfully removed with no significant perioperative complications. One patient presented with Frey syndrome 1 year later. Histological examination of the resected tumors showed 6 salivary gland tumors and 2 schwannomas. Of the 6 salivary gland tumors, 2 were malignant.
Our experience in the treatment of PPS tumors confirms the importance of preoperative assessment before every surgical resection in order to plan surgical treatment with a safe approach and which reduces aesthetic/functional damage. Intraoperative monitoring of multiple cranial nerves using NIM nerve monitoring systems is useful in the identification and preservation of neurological function in schwannoma.
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Masayuki Ishida, Hiroaki Fushiki, Motoyoshi Maruyama, Kenji Kobayashi, ...
2012 Volume 134 Pages
96-100
Published: 2012
Released on J-STAGE: July 22, 2012
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We experienced severe complications such as dysphagia and aspiration pneumonia following CyberKnife treatment of a persistent lesion following radical irradiation and lesion recurrence in 3 patients. We performed CyberKnife treatment for recurrence of a lesion at the base of the tongue after chemoradiotherapy for the same locus (case 3), for a cervical lymph node remaining after chemoradiotherapy for tongue cancer (case 5), and for recurrence of a soft palate lesion after chemoradiotherapy for oropharyngeal cancer (case 6). Following CyberKnife treatment, these three patients suffered from dysphagia and aspiration pneumonia for about 2 weeks comparatively early during the postoperative stage and experienced an unpleasant postoperative course.
No authors have reported severe adverse events following CyberKnife treatment. However, additional investigation of therapeutic indications by accumulating cases and focussing on the appearance of early- and late-stage adverse events would appear necessary.
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Kenji Kobayashi, Akira Naruse, Hiroshi Hara, Akihito Nakanishi, Hiroak ...
2012 Volume 134 Pages
101-104
Published: 2012
Released on J-STAGE: July 22, 2012
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Polymorphous low-grade adenocarcinoma (PLGA) is a low-grade malignant neoplasm usually arising in the minor salivary glands. We report a case of PLGA arising from the parotid gland. A 47-year-old man was admitted with a complaint of a tumor at the left post auricular region of 2-years duration. The tumor was removed surgically, and histopathological examination revealed PLGA. Clinicopathology of PLGA of the major salivary glands is discussed.
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