Selected Papers Vol. 106 No. 1-6
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Mieko Yoshioka, Yasushi Naito
2013 Volume 137 Pages
2-3
Published: 2013
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Sensorineural hearing loss (SNHL) due to congenital cytomegalovirus (CMV) infection can either be present at birth or develop later in life. We report a 3 years 7 months old boy who gradually developed speech until 3 years of age, but later showed no responses to verbal stimuli.
He was first referred to our clinic for the evaluation of motor delay at 9 months of age and was found to have left hemiparesis. Brain MRI revealed polymicrogyria in the right frontal region. Epileptic seizures began at the age of 13 months. Verbal development was assessed annually using intellectual function testing. He responded to his name at 9 months of age, and imitated words and pointed to objects when asked at 21 months. He could speak several words at 34 months of age. However, around 3 years of age, he stopped saying meaningful words. Audiologic evaluation revealed severe SNHL at 3 years 7 months old. There was no family history of hearing loss, past medical history of ototoxic medications or bacterial meningitis, or craniofacial/auditory anomalies, as possible factors related to the hearing loss. At the age of 7 years 5 months, examination of a dried umbilical cord specimen revealed the presence of CMV DNA. Thus, this patient was diagnosed as having delayed-onset SNHL with asymptomatic congenital CMV infection.
A prospective study is necessary for early detection of delayed-onset SNHL in patients with asymptomatic congenital CMV infection. Testing for the presence of CMV DNA in neonatal urine is performed in cases in which pregnant women are seronegative for CMV-IgG antibody or seropositive for CMV-IgM antibody during the first trimester of pregnancy. Infants diagnosed as having congenital CMV infection are evaluated by a newborn hearing screening test, head CT, ophthalmologic evaluations, and intellectual function testing. Follow-up hearing assessments are performed by both the auditory brainstem response and behavioral audiometry.
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Eiji Kondo, Ikuji Kawata, Tsukasa Takaishi, Ritsuko Abe, Yoji Hori, Ma ...
2013 Volume 137 Pages
4-5
Published: 2013
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In order to clarify the role of arteriosclerosis in the development of and recovery from sudden deafness, we evaluated arteriosclerosis in patients with sudden deafness, using pulse wave velocity (PWV) as a marker. Arteriosclerosis was observed in 69% of the sudden deafness patients and the initial hearing level in the patients with arteriosclerosis was worse than those without arteriosclerosis. After treatment with a steroid and lipid microsphere-incorporated prostaglandin E
1 (lipo-PGE
1), the recovery rate of the patients with arteriosclerosis was significantly lower than those without arteriosclerosis. These findings suggest that arteriosclerosis is an exacerbating condition and a poor prognostic factor in patients with sudden deafness. On the other hand, PWV in the patients with arteriosclerosis who recovered tended to decrease after the treatment, suggesting that the circulation-improving effect of lipo-PGE
1 may contribute to the recovery of the hearing loss related to arteriosclerosis.
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Kiyoshi Hiruma, Ryoko Watanabe
2013 Volume 137 Pages
6-7
Published: 2013
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We report herein on 5 cases of the transient type of apogeotropic direction-changing positional nystagmus. The pathophysiological mechanism behind this disorder is thought to be a canalolithiasis with the debris within the anterior part of the horizontal semicircular canal of an affected ear. In our cases, however, a transformation from an apogeotropic direction-changing positional nystagmus into a geotropic one was not observed before nystagmus completely disappeared. We therefore speculate that the free floating otoconia was located in the ampulla region on the utricle (vestibular) side. Therefore, rolling (yaw rotation) and FPP (Forced Prolonged Position) are considered to be an effective maneuver.
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Kazutomo Niwa, Ryo Ikoma
2013 Volume 137 Pages
8-9
Published: 2013
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A 32-year-old woman was admitted for acute vertigo with posterior cervical pain. It was suspected that an inner ear disorder was causing the vertigo because the patient had no neurological symptoms other than left-beating nystagmus and difficulty in standing, and computed tomography (CT) of the brain showed no abnormality. However she was diagnosed as having Wallenberg syndrome, because magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed a vertebral artery dissection, which can cause posterior cervical pain.
Although vertigo is often caused by an inner ear disease, a cerebrovascular disease should be considered in the differential diagnosis of vertigo, even in a case of a young adult. In many cases, patients with cerebrovascular disease have some neurological symptoms, but some of them have minimal symptoms, especially at the initial visit. When the diagnosis is uncertain, MRI and MRA are useful.
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Kiyoko Fujimori, Naoki Saka, Toru Seo, Shigeto Ota, Masafumi Sakagami
2013 Volume 137 Pages
10-11
Published: 2013
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Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal was first described by Minor et al. in 1998, and was named superior canal dehiscence syndrome (SCDS). A 27-year-old man presented with dizziness and oscillopsia induced by loud sounds. A pure-tone audiogram showed right conductive hearing loss at low tone frequencies with hypersensitivity to bone-conducted sound at low frequencies. Vestibular evoked myogenic potentials (VEMP) testing demonstrated large amplitudes in the right ear. A high-resolution computed tomography scan of the temporal bones revealed a dehiscence of bone overlying the superior canal. The image showing dehiscence was taken at an angle approximately 45° to the sagittal plane, in close parallel alignment with the superior semicircular canal. Based on these findings, SCDS was suspected as the cause of the dizziness.
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Mitsuo Sato, Mie Miyashita, Kazuya Saito, Michio Isono, Kyoichi Terao, ...
2013 Volume 137 Pages
12-13
Published: 2013
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We report herein on a case of reimplantation of a cochlear implant (CI) necessitated by cholesteatoma formation. Although the cholesteatoma had partly invaded the tympanic sinus, the round window niche, and the cochlea, a canal wall down mastoidectomy and expansion of the cochleostomy were useful to remove the cholesteatoma completely. In the replacement with a CI24RECA model we were able to reinsert all electrodes into the cochlea without resistance, and then the results of the neural response telemetry (NRT) were entirely positive. There were no postoperative complications. The postoperative speech perception improved compared with the preoperative findings. About a month after the operation, the patient suffered from otitis media with effusion, but it was cured without puncture and ventilation tube placement in a few weeks. At present there has been no reccurence. In agreement with previous reports, we think that CI reimplantation is an effective and relatively safe procedure.
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Risa Masuda, Akiko Katoh, Toyoaki Ohbuchi, Nobusuke Hohchi, Koichi Has ...
2013 Volume 137 Pages
14-15
Published: 2013
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Endolympathic sac tumor is a rare temporal bone neoplasm, and is considered to be a low-grade adenocarcinoma. Despite its slow growth and low incidence of association with distant metastasis, this tumor often shows aggressive local bone destruction. Herein, we report a rare case.
A 52-year-old man with Down syndrome presented with a 6-month history of hemifacial palsy. The initial examination revealed left-sided complete facial nerve palsy. Analysis of the auditory brain stem response indicated deafness on the affected side. The patient had no vertigo or nystagmus. Computed tomography revealed a well-defined osteolytic soft tissue lesion in the left petrous bone. The lesion was seen as a high intensity on both T1- and T2-weighted magnetic resonance images, and showed heterogeneous gadolinium enhancement. The labyrinth was destroyed, and the internal acoustic meatus was indistinguishable. Under a tentative diagnosis of cholesterol glanuloma, transmastoid biopsy was performed. The histopathological diagnosis was endolymphatic sac tumor. The patient eventually underwent removal of the tumor via a trans-middle cranial fossa approach following preoperative arterial embolization. His postoperative clinical course was uneventful, and he was discharged 19 days after the surgery. Although the facial nerve palsy or hearing loss did not recover, no evidence of tumor recurrence has been seen over a postoperative follow-up period of 32 months. A bibliographic review of the clinical/histopathological characteristics, diagnosis and treatement of endolymphatic sac tumor is presented.
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Atsushi Imai, Katsuyoshi Suzuki, Sho Morita
2013 Volume 137 Pages
16-17
Published: 2013
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A 65-year-old man working near metallic fences during a thunderstorm was struck by lightning. He lost consciousness and experienced a dermal burn on the right side of his body (10% total body surface area). Even though he did not complain about any hearing problems after the event, we found that his tympanic membrane was ruptured. After 34 days, the perforation of the tympanic membrane spontaneously healed without any further problems. Otologic problems tend to be missed because of the priority given to other critical emergency problems. Lightning could cause many issues such as auditory problems, vestibular disorders and facial paralysis, so it is important to recognize that a patient who is struck by lightning should undergo a complete otolaryngological evaluation right away.
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Yoshifumi Takahashi
2013 Volume 137 Pages
18-19
Published: 2013
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We analyzed 203 children with ages ranging from 0-14 yr. (134 children visited our clinic complaining of ear pain and/or ear fullness. Sixty-nine children visited with acute upper respiratory infection and showed ear redness and/or fluid collection in their tympanic cavities.). One hundred and forty-nine of them showed redness of pharynx, and strawberry tongue, and then were tested with a rapid strep test. One hundred and twenty-four children were proved to be infected by group A β-hemolytic streptococcus (GABS). We should pay attention if patients with otitis media are suffering from GABS at the time when GABS is prevalent. Forty children positive for the rapid strep test showed no signs of otitis media, even though they complained of ear pain and/or ear fullness. One hundred and fifty-nine children with apparent symptom in their tympanic membrane and/or tympanic cavity were classified according to the severity due to the “Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media (AOM) in Children”. Infection with GABS did not significantly affect the severity of otitis media. The effect of AMPC and/or CDTR-PI on their otitis media showed no significant difference between patients with and without GABS.
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Ayako Ito, Hitome Kobayashi, Ryuzaburo Higo, Harumi Suzaki
2013 Volume 137 Pages
20-21
Published: 2013
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Only a few cases of malignant melanoma of the middle ear have been reported in the literature to date. We report herein on a case of malignant melanoma in a 76 years old female with right facial palsy and hearing loss in her right ear. An otoscopic examination revealed a black right tympanic membrane. Computed tomography imaging showed a dense mass of soft tissue, filling the right tympanum and the right mastoid cavity, and invading the middle skull base. The diagnosis of malignant melanoma was confirmed on excisional biopsy of the tumor in the right mastoid cavity. We used a CyberKnife system as a palliative procedure, because the disease was considered as being inoperable. The treatment achieved stable disease (SD) status for 6 months. After 6 months metastases were detected in her sacral bone and liver. Although the patient died 11 months after the first examination, she suffered from nothing more than facial palsy and hearing loss until she died. Our case indicates that CyberKnife therapy could be feasible for controlling a patient’s QOL concomitantly with treating malignant melanoma of the middle ear.
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Nozomu Tamaki, Hiroyuki Enomoto, Midori Hayama, Ai Yoshitomi, Takahide ...
2013 Volume 137 Pages
22-23
Published: 2013
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Objectives: To assess the efficacy of myringotomy for mild or severe acute otitis media cases conducted in our department and examine search backgrounds of these cases.
Methods: We studied 72 cases (117 ears) in which we carried out a myringotomy.
Results: The following results were obtained.
1. The frequency of detection of PISP in this study was greater than that in a 2007 National surveillance.
2. The treatment of mild acute otitis media cases with high dose AMPC, high dose CFPN-PI or AMPC/CVA (14:1) was effective. As a result, the cases of myringotomy in our department decreased from 44 cases in 2010 to 14 cases in 2011.
3. The efficacy rate 3 weeks after myringotomy was 91.7%, which is higher than that of other reports. On the other hand, the recurrence rate was 40.3%, which required treatments.
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Yasuko Okado, Hitomi Higuchi, Takafumi Yamano, Takashi Nakagawa
2013 Volume 137 Pages
24-25
Published: 2013
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We investigated the length of hospital stay of 256 patients who underwent otologic surgeries after introduction of the in-house protocol (group A) at the Department of Otorhinolaryngology & Head and Neck Surgery of Fukuoka University Hospital from September 2007 to August 2010, and compared it with that of 110 patients who underwent similar surgeries from January 2005 to August 2007, prior to the introduction of the protocol (group B). The average length of hospital stay of patients of group A who underwent Canal Wall Down Tympanomastoidectomy was significantly shorter than that of group B who underwent the same surgery. However, for patients who underwent conductive system reconstruction without eardrum repair, much slighter benefit was derived from use of the protocol in terms of reducing the length of hospital stay. These findings suggest that the protocol is selectively useful for reducing the overall length of hospital stay, but may require revisions for some types of surgical procedures.
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Junichi Wakashima
2013 Volume 137 Pages
26-27
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We studied 186 ears in 109 children aged 0-12 years with otitis media with effusion (OME) and recurrent acute otitis media who underwent the insertion of a short-term ventilation tube (Shepard Grommet tube) at Tomakomai ENT clinic between 2008 and 2011. The average age at the time of insertion was 3.3 years, and general anesthesia was required for 2 out of 302 ventilation tube insertions. The tubes were removed after an average of 227 days. Sequelae from indwelling tubes included otorrhea (18.2%), and obstruction (12.9%). No perforation, adhesion and cholesteatoma was occurred after tube extraction. In children aged 2 or over, the recurrence rate of OME requiring a second ventilation tube insertion was significantly higher in the group without chronic sinusitis during intubation than in the group with chronic sinusitis. The cure rate for otitis media was significantly higher in the group intubated for 5 months or longer, compared with the group intubated for less than 5 months.
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Hiroaki Shimogori, Kazuma Sugahara, Hiroshi Yamashita
2013 Volume 137 Pages
28-29
Published: 2013
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We report two pediatric cases of suspected congenital cholesteatoma which the lesions spontaneously disappeared during the follow-up period. In case 1, a 3-year-old boy was examined by his local otolaryngologist because of an ear wax plug. In case 2, a 4-year-old girl was examined by her local otolaryngologist because of acute otitis media. In each case, a small whitish mass was found behind the ipsilateral anterior-superior-quadrant of the tympanic membrane, and the cases were referred to our hospital for further investigation. The children did not exhibit hearing loss or bone destruction in the middle ear. In both cases, the whitish mass gradually decreased in size during the follow-up period and disappeared under otomicroscopic examination. On the temporal bone CT images, a soft tissue mass anterior to the manubrium of the malleus also gradually decreased in size and disappeared. Based on these two cases, a “wait and watch” approach should be considered for patients with congenital cholesteatoma who do not exhibit hearing loss or bone destruction in the middle ear.
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Makoto Chiba, Tsukasa Ito, Tomoo Watanabe, Toshinori Kubota, Nobuo Oht ...
2013 Volume 137 Pages
30-31
Published: 2013
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Langerhans cell histiocytosis (LCH) involves the proliferation and accumulation of Langerhans cells at various sites and presents with various symptoms, depending on the organ or organs invaded.
A 2-year-old boy with LCH was treated at our hospital. Fever, head rash, bilateral chronic otorrhea unresponsive to antibiotics, and left exophthalmos were observed at our first examination. The CT scan showed destruction of the skull bone, zygomatic bone and vertebrae, and masses within these lesions. No bony defect was detectable in the middle ear, but a mass was present in the external auditory meatus. Skull X-rays revealed characteristic “punched-out” lesions. We confirmed the diagnosis of LCH with a biopsy of the head mass and the external auditory meatus mass. Immunohistology revealed positive staining of the lesional cells with CD1a and Langerin (CD207). The final diagnosis was multisystem LCH (MS-LCH). The child was placed on the chemotherapeutic regimen recommended by the Histiocyte Society.
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Noriko Kobayashi, Akira Hagiwara, Nobutoshi Funato, Shigeto Itani, Mam ...
2013 Volume 137 Pages
32-33
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A 50-year-old man was referred to our hospital with epistaxis from the right nostril. His left nostril had been packed with several pieces of gauze for a long time. Acute liver and kidney failure made control of the epistaxis difficult. Toxic shock syndrome (TSS) is associated with complications such as multiple organ failure or shock due to exotoxins, such as toxic shock syndrome toxin-1 (TSST-1), produced by
Staphylococcus aureus. Definitive diagnosis of TSS is difficult, because the diagnostic criteria of the Centers for Disease Control and Prevention (CDC) are stringent. Although our present patient did not fulfill the diagnostic criteria, TSS was strongly suspected. TSS after sinus surgery has been frequently reported. Few studies have been published about TSS caused by gauze packing for epistaxis. It is necessary to be borne in mind the possibility of TSS not only after surgery, but also after gauze packing for epistaxis.
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Kazuhiko Minami, Susumu Sakamoto, Kazunari Nishimura, Kazuyuki Ichimar ...
2013 Volume 137 Pages
34-35
Published: 2013
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The nasopalatine duct cyst is one of the nonodontogenic epithelial cysts and it arises from the epithelial remnants of the nasopalatine duct of the fetus. It occurs in approximately 2% of all maxillary cysts.
A 44-year-old man presented with asymptomatic swelling of the hard palate. Nasal endoscopy showed the elevation of the floor of the nasal cavities. CT and MRI images confirmed these findings, revealing a midline cystic mass of the maxilla, extending superiorly along the nasal septum and the floor of the nasal cavity, with a maximum diameter of 2.8 cm. The cyst was endoscopically opened to the bilateral nasal cavity under general anesthesia. The patient had no postoperative complications and showed no evidence of either stenosis of the opening or infection in the cavity at 6 months after surgery.
Few cases of the dilation of the cyst to the nasal cavity have been reported, but this technique is familiar to otolaryngologists and considered as an effective treatment.
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—A Clinical Study of 140 Cases Treated in a Clinic—
Masayuki Furukawa
2013 Volume 137 Pages
36-37
Published: 2013
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Laser surgery of the inferior turbinate has been considered a simple and effective surgical treatment with a low complication rate and has been used widely by many ENT surgeons including those in private clinics throughout Japan. In the present study, we assessed the clinical efficacy of carbon dioxide laser treatment in a private clinic. Treatments were performed on an outpatient basis in up to three consecutive sessions under local anesthesia. The outcome was evaluated with daily nasal symptom reports and patient interviews according to the Practical Guidelines for the Management of Allergic Rhinitis in Japan, 2009. Six months after treatment, almost all the nasal symptoms and total severity had remarkably improved in most patients. We also examined unsuccessful cases of laser surgery and discussed our results.
Laser surgery of the inferior turbinate is a minor surgical procedure with high efficacy and minimal postoperative morbidity. More cases and a longer follow-up are necessary to provide longer-term results.
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Miki Shino, Atsuko Furuta, Toshimitsu Komatsuzaki, Taisuke Hamasaki, S ...
2013 Volume 137 Pages
38-39
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The aim of this study is to analyze clinical features of young patients with olfactory disorders. The number of pediatric patients with olfactory dysfunction is low, and only a few studies have examined the characteristics of such patients and evaluated the results of their treatment. In this study, we compared the clinical characteristics of olfactory dysfunction in young and adult patients.
Patients 19 years of age or younger who consulted the Department of Otorhinolaryngology at Showa University Hospital from 2000 to 2009 complaining of olfactory disorders, were investigated retrospectively. Olfactory functions were examined based on T&T olfactometry.
A total of 39 patients were identified. The mean age was 14.5 years. Twenty-one patients were male and 18 patients were female. The common causes of olfactory disorders were congenital dysosmia (28.2%), chronic rhinosinusitis (20.5%) and dysosmia after head trauma (17.9%). The average recognition threshold was 4.91 and the average detection threshold was 4.37 in T&T olfactometry. After treatment, re-examinations were performed in 17 patients. The average recognition threshold was 4.04 and the average detection threshold was 2.54. Five patients showed improvement of olfactory functions, but 12 patients showed no improvement.
Young patients with olfactory dysfunction represented only 1.7% of all patients who visited the Special Outpatient Clinic for Olfactory Dysfunction. Compared with adult patients, young patients more frequently had congenital or post-traumatic olfactory dysfunction, and less frequently had post-common cold and no drug-induced olfactory dysfunction.
The improvement rate of olfactory dysfunction was 39.1% in young patients and young patients with olfactory dysfunction due to sinusitis showed the highest rate of improvement. No significant difference in the improvement rate was observed between the young and adult patients.
It was difficult to perceive olfactory dysfunction in young children, and their parents tended to notice it and bring their children to the outpatient clinic.
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—Evaluation Using VAS and QOL Questionnaire—
Makoto Yasuda, Takemitsu Hama, Yoko Haenuki, Kotaro Okamoto, Shigeyuki ...
2013 Volume 137 Pages
40-41
Published: 2013
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Initial drug therapy is effective in Japanese cedar pollinosis. However, some patients cannot take medications because they are ineffective, undesirable or have serious side effects. These patients choose treatments such as immunotherapy or surgical intervention. Although allergic rhinitis is not lethal, it can decrease the quality of life (QOL) with sudden short-term aggravation, such as that caused by Japanese cedar pollinosis. To assess allergic rhinitis therapy objectively, we studied the difference in the effects of subcutaneous immunotherapy (SCIT) and initial drug therapy using a visual analogue scale (VAS) to assess symptoms and a QOL questionnaire. This study enrolled patients who were examined during the cedar pollen season in 2011 and divided them into three groups: the immunotherapy, initial drug therapy, and after onset groups. The results showed that SCIT had marked effects on symptoms such as sneezing, nasal discharge, eye itching, and lacrimation via an antihistaminic action and improved the QOL, including daily life, outdoor activities, and spiritual life during the pollen season. Due to its efficacy for both treatment of the symptoms and improvement of the QOL of our patients, we plan to continue to promote SCIT.
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—An Allergen Challenge Chamber Study—
Takahiro Ichihara, Tetsuya Terada, Kanako Fujii, Ayumi Yuki, Ryo Kawat ...
2013 Volume 137 Pages
42-43
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Fluticasone furoate (FF) is a potent topical glucocorticoid for the treatment of allergic rhinitis (AR). We studied the effect of FF on subjects with seasonal allergic rhinitis using an allergen challenge chamber (ACC). The investigation was conducted in 35 patients suffering from Japanese cedar pollinosis through a randomized parallel-group trial. We compared the nasal and ocular symptom scores between the control subjects and the treatment group. There were no statistical differences in background factors between the two groups. The aim of this study was to assess the efficacy of FF in the ACC.
FF showed consistent attenuation of AR symptoms. A seven-day treatment course of intranasal FF given once-daily before the allergen exposure caused a statistically-significant reduction of some objective symptoms of AR including associated eye findings. In regard to subjective responses to eye manifestations, however, statistical significance for the treatment-control comparison was not be attained. The positive effects obtained by this study suggested that FF could be efficacious as a once daily steroid before the pollen allergy season. This means that FF could also be used for the initial drug of choice for the treatment of AR resulting from pollinosis along with oral anti-allergic agents.
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Tatsuya Fujii, Masakazu Goda, Kazunori Matsuda, Katsushi Miyazaki, Kaz ...
2013 Volume 137 Pages
44-45
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Frey’s syndrome is a complication associated with parotid tumor operation. We report herein on a 70-year-old man who developed Frey’s syndrome after fracturing his mandibular condyle. Although he underwent manipulative reduction, but not an operation, it is suggested that the dislocated condyle injured the auriculotemporal nerve, resulting in the development of Frey’s syndrome. A careful and long-term follow-up is needed for early diagnosis of Frey’s syndrome in patients with mandibular condyle fractures.
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Kenji Noda, Satoru Kodama, Hideaki Mabuchi, Kanako Noda, Masashi Suzuk ...
2013 Volume 137 Pages
46-47
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Invasive fungal sinusitis is considered to have a poor prognosis. We report herein on a case of invasive fungal sinusitis successfully treated with endoscopic sinus surgery (ESS) but which relapsed 4 months after surgery. A 65-year-old man presenting with left cheek pain was found on computed tomography to have a heterogeneously enhanced mass in the anterior wall of the maxillary sinus and bone defects. We suspected a malignant tumor and performed diagnostic ESS. Fungus and necrotic mucosa were observed in the posterior wall of the maxillary sinus while necrotic mucosa and bone destruction were observed in the anterior wall. Endoscopic findings indicated a diagnosis of invasive fungal sinusitis and the patient underwent removal of the mucosa of the maxillary sinus with a modified endoscopic medial maxillectomy. Pathology confirmed invasive fungal sinusitis and
Aspergillus fumigatus was detected on bacterial testing. The patient’s left cheek pain disappeared after surgery and micafungin was systemically administered for one month. However, follow-up CT at 4 months after surgery revealed recurrence in the orbit. Voriconazole was systemically administered and ESS was performed to confirm the diagnosis. Since we suspected that the fungus had invaded the lateral aspect of the maxillary bone, a total maxillectomy was performed, followed by systematic administration of voriconazole for 2 months. The patient was free from recurrence at the one-year follow up. This case suggests that, depending on the clinical course, aggressive surgery such as a total maxillectomy might be required for invasive fungal sinusitis.
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Seiichiro Makihara, Ayako Takeuchi, Miki Yamamoto, Kazunori Senoo, Sei ...
2013 Volume 137 Pages
48-49
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We report a case of invasive fungal sphenoiditis with nasal septal abscess. We drained the septal abscess and performed endoscopic transnasal sphenoidotomy. The patient suffered from permanent saddle deformity of the nasal dorsum. Bacteriological cultures of the septal abscess fluid revealed
Aspergillus flavus. Therapy with voriconazole failed because of resistance of the fungus, however, successful control of the symptoms was finally obtained by therapy with micafungin and itraconazole based on the minimum inhibitory concentration data.
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Shigeki Kawamura
2013 Volume 137 Pages
50-51
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Despite the concept of eosinophilic sinusitis becoming accepted widely in recent years, the diagnostic criteria remain unclear and definitive diagnosis requires histological proof of eosinophilic infiltration. Since it is not feasible for private otolaryngologists to sample tissue from deep within the paranasal sinuses, we examined if there might be another useful methods to establish the diagnosis of eosinophilic sinusitis before commencing treatment. In 43 cases of sinusitis (17 cases of eosinophilic sinusitis and 26 cases of non-eosinophilic sinusitis) of adult-onset, bilateral multiple polyps, and smell disturbance, we found significantly increased numbers of circulating eosinophils, high E/M values, and a high incidence of a prominence of the ethmoidal sinus on plain X-rays. The sensitivity, specificity, and accuracy of a blood eosinophil count of greater than 462 and prominence of the ethmoidal sinus on a plain x-ray of the sinuses for the diagnosis of eosinophilic sinusitis were 69.2%, 100%, and 88.2%, respectively. On the basis of these results, we propose that private otolaryngologists can also diagnose eosinophilic sinusitis based on history and medical examination, blood tests, and plain radiographs of the sinuses.
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Takumi Kumai, Miki Takahara, Saeko Yoshida, Toshihiro Nagato, Tatsuya ...
2013 Volume 137 Pages
52-53
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Renal cell carcinoma (RCC) occasionally metastasizes to a variety of regions including bone and liver, but nasal and paranasal sinal metastases are rare. No standard treatment currently exists, because of the small number of cases, so treatment varies for each patient. Sorafenib is a novel small molecular inhibitor of several kinases for malignancy, especially for RCC and hepatocellular carcinoma. We report herein on a case of nasal and paranasal metastatic RCC treated with VEGF targeted therapy (sorafenib) and radiotherapy.
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Takashi Taniyama, Tomonori Sugiyama, Mamika Araki, Kouhei Fukukita, Hi ...
2013 Volume 137 Pages
54-55
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Between 2001 and 2010, we treated 34 cases of paranasal sinus cysts with orbital symptoms. The subjects were 20 men and 14 women, aged 15 to 88 years (mean: 60.5 years). The paranasal sinus cysts were located in the frontal sinus in 15 cases, anterior ethmoid sinus in 12 cases, posterior ethmoid sinus in 8 cases, sphenoid sinus in 5 cases, and maxillary sinus in 2 cases. The symptoms included diplopia (9 cases), exophthalmos (8 cases), eyelid swelling (7 cases), visual disturbance (5 cases), orbital pain (4 cases), orbital discomfort (2 cases), and epiphora (2 cases). The cysts were postoperative in 24 cases and primary in 8 cases. Most patients tended to visit departments other than the department of otolaryngology, with only 5 patients initially visiting the department of otolaryngology. While the symptoms improved in 32 cases, little improvement was seen in 2 cases. Both of these latter symptoms 2 cases presented with visual disturbance. Therefore, early diagnosis and prompt treatment are essential for cases presenting with visual disturbance, as the symptoms may not respond satisfactorily to treatment if the treatment is delayed. Therefore, it is important for doctors in departments other than the department of otolaryngology also to be aware about this condition.
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—Comparison Pleomorphic Adenoma and Warthin’s Tumor—
Norio Suzuki, Ryo Kawata, Koutetsu Lee, Shuji Nishikawa, Shinpei Ichih ...
2013 Volume 137 Pages
56-
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We studied 11 cases of basal cell adenoma (BCA) of the parotid gland in which surgery had been performed in the past 12 years to investigate the clinical and pathological characteristics and to compare the diagnosis/treatment of BCA with those of Warthin’s tumor (WT) and pleomorphic adenoma (PA). Among 358 patients with benign tumors of the parotid gland who underwent surgery, 11 had BCA. All of these tumors showed a benign pattern on US, CT and MRI. The accuracy of fine needle aspiration biopsy (FNA) for diagnosis of BCA was slightly lower than for PA. Most PA and BCA lesions developed in the upper part of the parotid gland. Considering the gender difference and tumor site, it is necessary to differentiate BCA from PA rather than from WT. There were no significant differences in the duration of surgery, the blood loss, and the incidence of transient facial paralysis between surgical resection of BCA and surgery for PA or WT. BCA is the third most common of the benign parotid tumors, following WT and PA, although its incidence is low. When PA and WT are ruled out by FNA after a tentative diagnosis of benign tumor has been made based on imaging findings, BCA should be considered.
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Ryusuke Hori, Kazuhiko Shoji, Kiyomi Hamaguchi, Yusuke Okanoue, Shinta ...
2013 Volume 137 Pages
58-59
Published: 2013
Released on J-STAGE: March 25, 2014
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In children and adolescents under 20 years of age, tumors of the parotid gland are relatively rare. Six such patients with parotid tumors were treated at Tenri Hospital between 1997 and 2011. There were 5 males and 1 female and the mean age was 12 years. Histologically, pleomorphic adenoma was observed in 5 patients, and rhabdomyosarcoma in 1 patient. Surgery was performed for the 5 pleomorphic adenomas. There were no significant differences in the operating time and intra-operative blood loss among these 5 cases and 144 adult cases. In the case of rhabdomyosarcoma, the 4-year-old patient underwent a total parotidectomy. According to the Intergroup Rhabdomyosarcoma Study-IV, which was mostly used for the treatment of rhabdomyosarcoma, chemotherapy using vincristine, dactinomycin, and cyclophosphamide was performed as a postoperative treatment. Our patient is currently alive without local recurrence or distant metastasis.
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Akira Shimizu, Hiroyuki Ito, Ryoji Tokashiki, Tomoyuki Yoshida
2013 Volume 137 Pages
60-61
Published: 2013
Released on J-STAGE: March 25, 2014
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We report herein on a case of recurrent parotid gland acinic cell carcinoma that underwent CyberKnife treatment. The carcinoma had extended into the skull base and induced heavy headaches, which were treated with morphine. Following surgery with the CyberKnife, the headaches rapidly diminished, and morphine was no longer required. CT scanning showed reduction of the tumor, and the patient’s quality of life improved. Twenty four months after CyberKnife treatment, the tumor on this site has not recurred. The CyberKnife approach is acceptable for local control in the treatment of recurrent acinic cell carcinoma.
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Ninpei Yamaguchi, Kenichi Kaneko, Kotaro Ishimaru, Haruo Takahashi, Ma ...
2013 Volume 137 Pages
62-63
Published: 2013
Released on J-STAGE: March 25, 2014
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Extraskeletal Ewing’s sarcoma (EES) is a rare disease that is one of the Ewing’s sarcoma family of tumors (ESFT). Adult cases of ESFT often arise from extraskeletal sites. We herein describe a case of EES originating from the left oral floor. A 37-year-old man had a 3-month history of a painless mass in the left oral floor. The mass had enlarged without adhesion to the mandible. The patient underwent removal of the mass at a previous hospital. The postoperative diagnosis was Ewing’s sarcoma. The surgical margin was histologically positive, and thereafter the patient was admitted to our hospital. Contrast enhanced MRI and PET/CT demonstrated no residual tumor. The patient received a full course of chemotherapy (VDCA-IE therapy) with surgery. We performed oral floor partial excision following four preoperative chemotherapy courses. Histologically there was no residual tumor. The patient received a 13-course chemotherapy regimen after the operation. One year and seven months have passed from initial diagnosis without any signs of either local recurrence or distant metastasis.
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Yukihiro Hiraga, Junichi Kou
2013 Volume 137 Pages
64-65
Published: 2013
Released on J-STAGE: March 25, 2014
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Thirty-seven cases of major salivary gland carcinomas, treated in our hospital during the past 16 years from July 1995 to June 2011, were studied and reviewed histopathologically and statistically. They comprised 27 cases with parotid carcinomas and 10 cases with submandibular carcinomas. Thirty-five patients had undergone surgery, followed by chemotherapy in 7 patients and radiation therapy in 20. Because of the advanced ages of two patients in their 90’s with submandibular carcinoma, they were treated with radiation alone. The mean age of the group was 62.1 years. There was no difference based on sex and the side of occurrence. The mean duration of the complaint was 33.6 months, and the mean tumor diameter was 34.6 mm. The results of cytological examinations from 35 cases with fine-needle aspiration biopsy delivered a sensitivity of 62.9% and a false-negative rate of 37.1%.
Histopathological findings revealed the numbers of carcinoma ex pleomorphic adenoma as the greatest in all cases, salivary duct carcinoma in parotid carcinomas and also carcinoma ex pleomorphic adenoma in submandibular carcinomas. The mean operation time was 171.7 minutes and the mean intraoperative blood loss was 125.5 ml. In both parameters there was a statistically significant correlation. The complication with the highest postoperative rate was facial nerve palsy (37%). The 5-year cause-specific survival rate (CSS) was 78.5% in all cases, and 80.7% in parotid carcinomas and 72.9% in submandibular carcinomas, although these latter rates were without statistical significance. On the other hand according to the classifications of the stage of the cancer, the 5-year CSSs were 100% for Stage I, 80% for Stage II, 50% for Stage III, and 71.2% for Stage IV. Furthermore patients with parotid carcinomas with facial nerve palsy at the first time of diagnosis or in the category of the high malignancy group revealed significantly bleaker survival rates than those without.
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Marie Kubota, Kyoko Chujo, Ryuji Yasumatsu
2013 Volume 137 Pages
66-67
Published: 2013
Released on J-STAGE: March 25, 2014
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IgG4-related disease (Mikulicz disease) was first reported by Mikulicz in 1892 in a case of a man with bilateral swelling of the lachrymal, parotid, and submandibular glands. However, since Morgan and Castleman examined the pathological features of what they called Mikulicz disease in the 1950s, Mikulicz disease’s been considered as a part of Sjögren’s syndrome. In 2000, Tsubota et al. reported the difference in salivary gland destruction patterns between Mikulicz disease and Sjögren’s syndrome, and explained the clinical differences of each disease. In 2004, Yamamoto et al. reported that the serum IgG4 level is extremely elevated in Mikulicz disease patients. The concept of a systemic IgG4-related syndrome came with the recognition of autoimmune pancreatitis, in which Hamano et al. reported in 2001 that the serum IgG4 level was elevated. Since that time, Mikulicz disease has been considered as a part of a systemic IgG4-related syndrome.
We report herein on the case of a man who came to our institute in 2001 with bilateral swelling of the submandibular glands. We initially suspected malignant lymphoma and some other diseases, but during the long course of more investigations and follow-up, we finally diagnosed the condition as IgG4-related disease (Mikulicz disease).
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Noriko Kobayashi, Akira Shimizu, Kouichi Kitamura, Hiroyuki Ito, Mamor ...
2013 Volume 137 Pages
68-69
Published: 2013
Released on J-STAGE: March 25, 2014
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The present study analyzed 58 patients with submandibular gland tumors treated from April 1988 to March 2008 at the Department of Otorhinolaryngology of Tokyo Medical University Hospital. Forty six tumors were benign and were all pleomorphic adenoma. Twelve tumors were malignant. Six of the malignant tumors were adenoid cystic carcinoma.
The two patients with the malignant tumors had tenderness as a clinical sign. Even if the tumor was small, we should regard tenderness as a malignant sign.
Surgical complications were found in 36.2%, comprising facial nerve paralysis, dysgeusia and numbness of the tongue. Facial nerve paralysis which developed in the benign tumors was temporary. Permanent paralysis was noted in 33.3% in the malignant tumors.
Some of the tumors with low malignancy recurred or developed distant metastasis. Our findings suggest that we cannot control even low malignancy tumors with surgery alone and we need strict follow-up after surgery.
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Naokazu Fujii, Tetsuya Monden, Kenichirou Kawaguchi, Masako Terasaki, ...
2013 Volume 137 Pages
70-71
Published: 2013
Released on J-STAGE: March 25, 2014
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We encountered 2 patients who were tentatively diagnosed as having intestinal Behcet’s disease during treatment for refractory oral/pharyngeal ulcers, and 1 patient with Crohn’s disease. Case 1 was an 83-year-old male. Among the primary symptoms of Behcet’s disease, recurrent ulcers of the oral mucosa and vulval ulcer were observed. As an accessory symptom, digestive lesions were detected. A tentative diagnosis of intestinal Behcet’s disease was made according to the diagnostic criteria established by the Ministry of Health, Labour and Welfare. Case 2 was an 81-year-old female. Emergency surgery for two perforations in the small intestine was performed, but the patient died. Among primary symptoms of Behcet’s disease, recurrent ulcers of the oral mucosa was noted. As an accessory symptom, digestive lesions were detected, leading to a tentative diagnosis of intestinal Behcet’s disease. Case 3 was a 22-year-old male. Endoscopy of the large intestine revealed digestive lesions and stones, suggesting Crohn’s disease. In all patients, the initial symptoms were oral/pharyngeal ulcers, and digestive lesions appeared. The maximum interval from onset until diagnosis was 8 months.
Intestinal Behcet’s and Crohn’s diseases are difficult to differentiate from oral/pharyngeal mucosal lesions. Endoscopy of the digestive tract may be useful.
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Yu Saito, Yasuo Ogawa, Taro Inagaki, Masaaki Shimizu, Kunihiko Tokashi ...
2013 Volume 137 Pages
72-73
Published: 2013
Released on J-STAGE: March 25, 2014
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A 70-year-old man was referred to our hospital with the chief complaint of painful and intractable erosions of the oral mucosa. We performed radiation therapy for tongue cancer in March 2000. Then, in February 2001, neck dissection was performed for left cervical lymphadenopathy. No recurrence of the tumor was noted thereafter. In June 2011, the patient visited a nearby hospital with some bleeding sores in the mouth. As no improvement was noted with the usual treatment, oral bacterial pharyngitis was suspected and the patient was referred to our hospital. After admission, we performed biopsy suspecting recurrence of squamous cell carcinoma, however, no evidence of cancer recurrence was detected. Thereafter, skin biopsy and the test for anti-desmoglein antibody confirmed the diagnosis of pemphigus vulgaris. Patients with pemphigus vulgaris can present with mucosal lesions as the only initial symptom. For refractory oral, pharyngeal and laryngeal lesions, it is important to bear in mind the possibility of pemphigus vulgaris in the differential diagnosis. The test for anti-desmoglein antibody is highly specific, and useful as a minimally invasive test for the diagnosis and treatment of pemphigus vulgaris. Our present case exemplifies the usefulness of this test.
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Takashi Keira, Ryoukichi Imai, Atsushi Kondo, Makoto Kurose, Tetsuo Hi ...
2013 Volume 137 Pages
74-75
Published: 2013
Released on J-STAGE: March 25, 2014
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Tonsillar metastasis from lung cancer is a rare event.
We present herein on the unusual case of a 52-year-old man who developed metastasis to the left palatine tonsil from a large-cell neuroendocrine carcinoma.
He was treated with chemotherapy, resulting in complete remission.
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Yoshihiko Nakata, Ken Ishijima, Hiroaki Sato
2013 Volume 137 Pages
76-
Published: 2013
Released on J-STAGE: March 25, 2014
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Ligature of the external carotid artery (LECA) is a very effective method of choice in patients with excessive post-tonsillectomy hemorrhage. We report herein on the case of a 25-year-old man who underwent LECA for an excessive post-tonsillectomy hemorrhage. His tonsillectomy had been performed under general anesthesia for habitual angina seven days previously. One morning abrupt and excessive bleeding occurred and the patient went into shock. Immediate LECA was performed under general anesthesia. The bleeding was stopped rapidly and a blood transfusion was performed. The patient was discharged 16 days after the LECA without any severe complications.
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Shuhei Takiguchi, Yukiomi Kushihashi, Yoshiyuki Kyo, Yoshihiro Yamada, ...
2013 Volume 137 Pages
78-79
Published: 2013
Released on J-STAGE: March 25, 2014
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Marfan’s syndrome is a genetic disorder of the connective tissue. One of the most serious complications associated with Marfan’s syndrome is aortic dissection, which is often fatal, even when rapidly treated. We report a case of Marfan’s syndrome with acute aortic dissection presenting with pharyngeal pain.
The patient was a 41-year-old woman who presented with a one-week history of pharyngeal pain and slight fever. Although no abnormal findings were detected on physical examination of the pharyngolarynx, contrast-enhanced CT revealed acute aortic dissection and a funnel chest. Subsequently, we diagnosed the patient as a case of Marfan’s syndrome with acute aortic dissection.
Unexplained pharyngeal pain could be referred pain associated with cardiovascular disease.
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Atsuo Takeichi, Hidetaka Iwasaki, Hironori Akizuki, Ryo Kanamura, Nori ...
2013 Volume 137 Pages
80-81
Published: 2013
Released on J-STAGE: March 25, 2014
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We report three patients with tetanus who complained of dysphagia. All cases showed trismus, however, physical, serological and endoscopic examinations revealed not abnormalities. Under the diagnosis of tetanus, intravenous penicillin was administered to all three cases, which resulted in the disappearance of trismus, although one case showed a brief episode of generalized convulsion. The diagnosis of tetanus should be suspected in patients complaining of dysphagia who are found to have trismus, but no accompanying endoscopic findings.
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Takafumi Yamano, Satoru Ohba, Toshifumi Sakata
2013 Volume 137 Pages
82-83
Published: 2013
Released on J-STAGE: March 25, 2014
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We performed an analysis of the characteristics of and tendency towards snoring in children, using lateral X-ray imaging of the head following examination of cephalometric roentgenography and a clinical examination. As for surgical indications, based on our experience, we suggest that treatment such as tonsillectomy or adenotomy has been effective for pediatric patients complaining of snoring and sleep breathing disorders. We found that cephalometric analysis was not useful for children although it is useful for adults.
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Kentaro Mori, Satoshi Iwasaki, Yutaka Takumi, Takehiko Naito, Hideaki ...
2013 Volume 137 Pages
84-85
Published: 2013
Released on J-STAGE: March 25, 2014
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Children with Down Syndrome (DS) have many predisposing factors for the obstructive sleep apnea syndrome (OSAS), and removal of the tonsils and adenoids is the first-line treatment of airway obstruction and sleep apnea in children with DS. On the other hand, it is known that despite tonsillectomy and adenoidectomy, obstructive sleep apnea persists in 30-50% of children with DS. We investigate herein 4 patients who underwent tonsillectomy and adenoidectomy between January 2008 and December 2010. To evaluate the causes of OSAS in children with DS, we performed a comparative study of the degree of tonsillar hypertrophy, hypertrophy of adenoids, macroglossia, body weight, obesity, body mass index, oxygen saturation, apnea hypopnea index, period of operation, and the Mallampati test. Snoring and apnea improved in 2 cases (50%) after the operation, but OSAS remained in two cases (50%). Persistent sleep apnea in children with DS has multiple causes which include macroglossia, glossoptosis, enlarged lingual tonsils, hypopharyngeal collapse, and central sleep apnea. It is important to identify and characterize these potential causes.
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Saeko Yoshida, Miki Takahara, Toshihiro Nagato, Tatsuya Hayashi, Yasua ...
2013 Volume 137 Pages
86-87
Published: 2013
Released on J-STAGE: March 25, 2014
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Autoinflammatory diseases are characterized by seemingly unprovoked episodes of inflammation, without high-titer autoantibodies or antigen-spcific T cells. The periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a non-hereditary autoinflammatory syndrome characterized by periodic episodes of these conditions. It usually manifests itself in early childhood, especially before 5 years of age, and lasts several years. Its etiology is unknown, but in a recent study, the efficacy of tonsillectomy was suggested in the PFAPA syndrome. In one of our cases, a 4-year-old boy diagnosed clinically with the PFAPA syndrome, tonsillectomy proved effective. The tonsil is deeply associated with the etiology of autoinflammatory disorders in PFAPA syndrome. These data suggest the possibility that PFAPA may be a new member of the tonsillar focal diseases.
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Yuko Shimotatara, Toshikazu Shimane, Taisuke Nakamura, Takatoshi Tokud ...
2013 Volume 137 Pages
88-89
Published: 2013
Released on J-STAGE: March 25, 2014
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The Actinomyces, a resident flora in the oral cavity, can form a mass in the head and neck region that is often difficult to distinguish from a malignant tumor. This report describes a case of actinomycosis in a 65-year-old man who underwent concurrent chemoradiotherapy, left cervical lymph node dissection, laryngopharyngoesophagectomy, and esophageal reconstruction with the pectoralis major muscle for treatment of hypopharyngeal carcinoma. He subsequently developed a suspicious mass at the pharyngeal stump that was difficult to distinguish from recurrent carcinoma. After two biopsies, treatment with a penicillin antibiotic, and strict follow-up, the mass disappeared 38 weeks after the start of antibiotic treatment. Antibiotic treatment was subsequently discontinued and no recurrence has been detected to date.
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Masaki Hayashi, Muneki Hotomi, Noboru Yamanaka
2013 Volume 137 Pages
90-91
Published: 2013
Released on J-STAGE: March 25, 2014
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It has been reported that macrolides and some quinolones have an immunomodulatory effect and show synergy in their antimicrobial activity. Garenoxacin (GRNX), a recently developed fluoroquinolone, has been reported to show strong antimicrobial activity against respiratory pathogens such as
Streptococcus pneumoniae and
Haemophilus influenzae and high treatment efficacy for acute infectious diseases of the upper and lower respiratory tracts. To study the immunomodulatory effects of GRNX, we investigated its influence on interleukin-8 (IL-8), one of the products of proinflammatory cytokines, in human tonsillar lymphocytes stimulated with lipopolysaccharides (LPS). Palatine tonsils were obtained from patients with recurrent tonsillitis (n=12) and with hypertrophic tonsils (n=8). The tonsillar lymphocytes were stimulated with LPS (25 μg/ml) and were incubated with GRNX (5, 10, 15, 30 μg/ml) for 48 hours. IL-8 production of the treated lymphocytes was then measured with an ELISA. The IL-8 production of tonsillar lymphocytes was significantly suppressed by GRNX in the recurrent tonsillitis group, but not in the hypertrophic tonsil group. In conclusion, it is strongly suggested that GRNX has immunomodulatory effects on tonsillar lymphocytes with repeated episodes of infection through the suppression of IL-8 production. Thus GRNX has synergistic anti-inflammatory effects with its anti-bacterial properties, which is a favorable characteristic in the treatment of upper respiratory tract infections.
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Kohei Nishida, Tetsu Takeo
2013 Volume 137 Pages
92-93
Published: 2013
Released on J-STAGE: March 25, 2014
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We report herein on a rare case of spindle cell carcinoma in the laryngeal arytenoids. A 60-year-old man presented at our hospital with dyspnea. We performed an emergency tracheostomy to maintain his airway. A biopsy led to the diagnosis of a low specialization type of malignant tumor such as a sarcoma. We performed a total laryngectomy. Postoperative pathologic examination revealed that the greater part of this tumor was composed of spindle-shaped atypical cells and squamous cell carcinoma at an advanced stage, pT3N0M0, so that the final diagnosis was spindle cell carcinoma. We performed postoperative therapy, radiation therapy and chemotherapy with doxorubicin and ifosfamide. Postoperatively the patient has been doing well for 18 months without any sign of recurrence or metastasis. There is as yet no established chemotherapy regimen, so we need to share our experiences regarding chemotherapy for spindle cell carcinomas.
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Kousuke Yoshifuku, Junichirou Ohhori, Keiichi Miyashita, Yuichi Kurono
2013 Volume 137 Pages
94-95
Published: 2013
Released on J-STAGE: March 25, 2014
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Acute epiglottitis is a life-threatening infectious disease. Severe swelling of the epiglottis, arytenoids, or aryepiglottic fold is known to cause dyspnea and unless adequate treatment is delivered rapidly, the patient may suffocate. Therefore, early diagnosis and treatment are mandatory. We investigated the clinical features of patients with acute epiglottitis treated in our department and discussed the indications for airway management in such patients. In total 144 patients (90 males and 54 females ranging in age from 16-85 years) with acute epiglottitis were enrolled in the study. All patients were treated at Kagoshima University Hospital between October, 1999 and March, 2012. Airway management was required in 19 patients (13.2%) and the clinical characteristics of those subjects were compared with patients in whom airway management was not performed. Those findings suggest that when abnormal findings of the glottis were observed or the glottis findings could not be observed, airway management should be considered. Our results indicated that patients who needed airway management had severe dyspnea, more rapid and progressive aggravation of clinical findings and more severe swelling of the aryepiglottic folds compared to patients who did not require airway management.
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Masashi Okazaki, Takanari Goto, Kazuhiro Kawaguchi, Yutaka Suzuki
2013 Volume 137 Pages
96-97
Published: 2013
Released on J-STAGE: March 25, 2014
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Mycosis fungoides (MF) is the most common type of cutaneous malignant T-cell lymphoma, but reports of MF in the head and neck region are rare. We report herein on a case we experienced in which MF invaded the larynx and pharynx.
An 80-year-old man, who was seeing his dermatologist, visited a local hospital complaining of dysphagia, where a lesion in the epiglottis on the right aryepiglottic folds was discovered, and the patient was referred to our hospital for further examination. A biopsy of the area of interest confirmed the presence of MF and the patient was immediately sent for radiation therapy. Three months thereafter, an elevated MF lesion appeared on the posterior part of the tongue, so the patient underwent additional radiation therapy of the entire pharynx. Since no recurrence was seen 12 months after the end of the treatment regimen in our department, radiotherapy for potentially malignant lesions of the larynx and pharynx is suggested as a valid approach.
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Seiichi Nakano, Hironori Akizuki, Hidetaka Iwasaki, Satoko Yamashita, ...
2013 Volume 137 Pages
98-99
Published: 2013
Released on J-STAGE: March 25, 2014
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We report herein on a case of laryngocele with recurrent infection. A 48-year-old male complained of hoarseness and swelling of the left side of his neck. The endoscopic and CT scan examinations demonstrated the combined type of laryngocele that had expanded through the thyrohyoid membrane and had swollen up both medially and laterally in a dumbbell-like shape. To avoid the risk of laryngeal stenosis with the enlarged laryngocele infected by bacteria, in addition to intravenous infusion of an anti-bacterial drug, purulent discharge was drained from the infected laryngocele with a puncture needle. Because infection of the laryngocele was recurrent, it was surgically removed via an external neck approach under general anesthesia without any prophylactic tracheotomy. The laryngocele may be translated from a saccular cyst that had developed after the obstruction of communication between the laryngeal ventricle and the laryngeal saccule.
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Masashi Ogami, Shigeki Tsuchihashi, Satomi Moriyama, Michiaki Yokoyama
2013 Volume 137 Pages
100-101
Published: 2013
Released on J-STAGE: March 25, 2014
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A retrospective study was conducted to evaluate the clinical outcomes of 59 patients with laryngeal cancer treated at our department between 2001 and 2012 using our institution’s treatment protocol. The mean age of the patients, comprising 56 males and 3 females, was 70 years.
According to the TNM staging system, 39 cases (66.1%) were classified as having early-stage disease, and 20 (33.9%) as having advanced-stage disease. The treatment for early T stage laryngeal cancer at our insititution is radiation therapy at a total radiation dose of 60Gy. The patients with advanced-stage disease are treated by total laryngectomy with preoperative and postoperative radiation. The 5-year overall survival rate was 82.2% overall, being 92.4%, 100%, 72.9%, and 0% in patients with stage I, II, III, and IV disease, respectively. The disease-specific 5-year survival rate was 88.2% overall, being 100%, 83.3%, and 0% in patients with stage I/II, III, and IV disease, respectively. The preservation rate of the larynx was 85.3% in the T1 cases, but substantially lower (45.5%) in the T2 cases.
According to these results, our treatment protocol needs to be improved, particularly for patients with T2 and stage IV disease. Because the preservation rate of the larynx in the T2 cases was lower, we plan to introduce a new protocol involving the use of S-1 instead of 5-FU to improve the preservation rate of the larynx, or increase the total dose of radiation. Furthermore, we propose to add adjuvant systemic chemotherapy to the stage IV treatment protocol to improve the survival rate, because the high rate of distant metastasis was the main reason for the unsatisfactory results in patients with stage IV disease.
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