Author’s Translation Vol. 107 No. 1–6
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Yoshihiro Chiba, Toshiyuki Kokatsu, Nobuhiko Oridate
2014 年 140 巻 p.
2-3
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Hypertrophic pachymeningitis (HP) is a rare disease and patients with HP present with headache and multiple cranial nerve palsy. We report herein on a case of HP with hearing loss and facial palsy. A 61-year-old woman presented with headache, right hearing loss, right facial palsy and numbness of the right chin. She was first diagnosed as having severe acute otitis media. Most of the symptoms persisted after treatment with antibiotics and corticosteroids. Ga-DTPA-enhanced magnetic resonance imaging (MRI) revealed diffuse thickening of the dura mater consistent with HP. HP is caused by several diseases such as infection, collagen disease, vasculitis syndrome, IgG4 related disease, and metastatic cancer. In this case, HP was caused by metastatic rectal cancer to the cranial bone and dura mater. The facial palsy and chin numbness improved after the chemoradiotherapy, whereas hearing loss did not. HP should be taken into consideration when multiple cranial nerve palsy are observed. Ga-DTPA-enhanced MRI is useful in the diagnosis of HP.
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Naoki Saka, Shigeto Ota, Toru Seo, Masafumi Sakagami
2014 年 140 巻 p.
4-5
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We investigated the clinical characteristics of 63 patients aged under 15 years who visited the neuro-otological clinic in Hyogo College of Medicine over the last 10 years. These patients accounted for 1.9% of all patients during the period, and there were 31 boys and 32 girls. The predominant diagnosis was orthostatic dysregulation in 12 patients (19.0%), psychogenic vertigo in 8 patients (12.7%), and Ménière’s disease in 5 patients (7.9%). The ratio of diseases with a peripheral origin was lower in children than in adults. Thirty-four patients (54.0%) were referred from other otorhinolaryngology clinics and 12 patients (19.0%) from mainly pediatric clinics. Abnormal results were found in 29.3% of patients on pure tone audiometry and 26.2% on caloric testing. These results suggest that both examinations were useful and should be performed in pediatric patients.
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Tsuyoshi Umehara, Katsura Hakamada, Yuki Yamaguchi, Yoshihiro Noda, Ka ...
2014 年 140 巻 p.
6-7
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Sarcoidosis is an inflammatory multisystem disorder of unknown cause and neurosarcoidosis is a form of sarcoidosis that affects the nervous system, seen in approximately 5-7% of patients with systemic sarcoidosis. This report describes a case of neurosarcoidosis in a 69-year-old woman who suffered from vertigo and bilateral sensorineural hearing loss. Routine chest X-ray showed a pulmonary hilar lesion in the left lung. A chest CT for close inspection revealed left hilar and mediastinal lymphadenopathy, leading to broncho-alveolar-lavage (BAL) with a biopsy. Although the biopsy was negative, the BAL studies were strongly positive for lymphocytosis and a high CD4/CD8 ratio. In addition, the ACE level was high in the serum test. The patient was therefore given a possible diagnosis of neurosarcoidosis. High dose intravenous methylprednisolone pulse therapy was administrated for three courses and then tapered to the maintenance dosage. Vertigo and bilateral hearing loss were dramatically improved after the pulse therapy, but left high frequency hearing loss did not change. In this case, an inner ear disorder was suspected for the source of these symptoms with neuro-otological examinations and brain MRI finding which showed no abnormal lesion. Neurosarcoidosis must be considered when evaluating patients with atypical hearing loss and vestibulopathy.
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Kousuke Furukawa, Suguru Matsumoto, Futoshi Watanabe
2014 年 140 巻 p.
8-9
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Imaging diagnosis using magnetic resonance imaging (MRI) is indispensable for the diagnosis of acute cerebrovascular disturbances. Diffusion-weight imaging (DWI) MRI, in particular, has improved the diagnostic accuracy in acute ischemic stroke. However, some patients with acute stroke show no abnormal signals on DWI, despite the presence of an infarction. We present herein on a case of a hyperacute large ischemic stroke that was not detected on the initial DWI. A 85-year-old female with acute vertigo and vomiting was admitted to our hospital. In the neuro-otological examination, she had evoked direction fixed horizontal gaze and left-sided positional nystagmus. DWI examined within 2 hours after onset showed no ischemic findings. Twelve hours after onset, she developed consciousness disturbance and follow-up DWI demonstrated a large infarction on the brainstem, cerebellum and cerebrum.
False-negative findings demonstrated on DWI are sometimes observed in the case of brainstem or cerebellar infarction. Careful observation of neurological findings and follow-up MR imaging are useful for closer investigation of false-negative findings in the patients with suspected as having suffered an ischemic stroke.
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Mitsuo Sato, Takaaki Kobayashi, Kazuya Saito, Takao Imai, Katsumi Doi
2014 年 140 巻 p.
10-11
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
In this study, we report on a patient who had superior canal dehiscence and was treated by resurfacing the defect via the transmastoid approach. An 80-year-old male patient had the chief complaint of vertigo when he touched his left porus acusticus externus. As leftward nystagmus was induced by change in middle ear pressure and the existence of superior canal dehiscence was confirmed with computed tomographic scans (CT) of the temporal bones, we suspected an idiopathic labyrinthine fistula similar to the superior canal dehiscence syndrome (SCDS). At first, he was treated with medication, but as his vertigo was getting worse, he underwent surgery. A wide mastoidectomy was performed identifying the middle fossa dura. The superior semicircular canal was exposed together with the angle between the superior semicircular canal and the middle fossa bone. A bone pate was insinuated down the dehiscent canal. After the operation, no nystagmus was induced by change in the middle ear pressure and the patient did not feel any vertigo. When we anticipate the possibility of a transmastoid approach to a defect of superior canal based on preoperative CT findings, we should select this approach because the approach can avoid the more invasive middle fossa craniotomy.
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Ai Suzuki, Kazumasa Suzuki, Takashi Hatano, Yoshifumi Fujita, Yoshiaki ...
2014 年 140 巻 p.
12-13
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
There have been recent reports that autoimmune inner ear disease (AIED) has been found in some cases of refractory hearing loss such as idiopathic bilateral sensorineural hearing loss. McCabe first reported that patients with AIED responded to immunosuppressive therapy. Corticosteroid therapy alone is effective in the early phase of AIED, but becomes ineffective in a repeated series and immunosuppressive therapy is recommended in such cases. We experienced a case of idiopathic bilateral sensorineural hearing loss in which corticosteroid therapy was not effective after the recurrence and immunosuppressive therapy was applied, although the presence of the inner ear autoantibodies was not tested. In this case, the immunosuppressive therapy seemed effective for preventing the progression of the hearing loss and for improving the speech discrimination scores. This therapeutic strategy may be indicated in some cases of idiopathic bilateral sensorineural hearing loss which have proved refractory to corticosteroid therapy.
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Noboru Yamanaka, Rinya Sugita, Yutaka Fujimaki, Yosuke Kamide, Yoshifu ...
2014 年 140 巻 p.
14-15
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
A multi-center study was conducted in 8 otolaryngological clinics in Japan to obtain the clinical usefulness of
Streptococcus pneumoniae antigen detection kit for the management of acute otitis media (AOM). Children with acute otitis media who visited the clinics in this group study were categorized in terms of severity based on the Clinical Practice Guidelines for Pediatric Acute Otitis Media (2009 Edition), and patients with moderate or severe AOM were given diagnostic tests with
S. pneumoniae kit (HS kit). The treatment strategy was decided by each clinic in accordance with its clinic-specific criteria. Study results from clinics that made decisions based on the current treatment guidelines (non-HS group) and in reference to the test kit results (HS group) were stratified and post analysis was performed. The usefulness of the HS kit was evaluated based on the rate of concordance with cultivation tests, the clinical course and the impression of the attending doctors regarding the usefulness. The performance of the kit in comparison to cultivation tests showed a sensitivity of 78.2% and specificity of 89.9%. The results demonstrated that in 127 of 155 subjects (81.9%) the HS kit was “extremely useful” or “useful” in identifying the infecting organism, selecting appropriate antibacterial agents, or in giving the information to explain to patients’ guardians about the management of AOM. In HS kit-positive cases, the HS group and non-HS group judged that the kits were “extremely useful” or “useful” in 97% and in 90%, respectively. On the study of reasons on judging the HS kit as useful, the HS group indicated that the kit was useful in identifying the infecting organism, selecting appropriate antibacterial agents, and in giving the information to explain to patients’ guardians about the management of AOM. On the other hand, the non-HS group considered the kit as useful mainly in identifying the infecting organism.
Based on these results, the implementation of a rapid diagnostic method using
S.pneumoniae kit was confirmed as highly useful for the management of AOM.
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Haruo Hirakawa, Yasuyuki Nishi, Taisuke Watanabe, Makoto Tada, Takahir ...
2014 年 140 巻 p.
16-17
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We report herein on a case of recurrent cerebrospinal fluid (CSF) leakage from the different bony defects of the tegmen of the middle ear caused by habitual Valsalva’s maneuver at about a seven-year interval. A 47-year-old man consulted the otorhinolaryngological department of the NHO Kure Medical Center complaining of left ear fullness. Three weeks before he had caught a cold and had repeated Valsalva’s maneuver to reduce the ear fullness. Two weeks previously he recognized watery rhinorrhea just after he heard sound of air in the left ear. A week previously he had consulted an ENT clinic and middle ear effusion of the left ear was discovered. The patient was referred to our department as possibly having recurrent CSF-middle ear ef fusion, for he had had a past history of CSF-middle ear effusion about 7 years previously. At that time the first surgery was performed to treat the CSF. The surgery revealed a bony defect in the mastoid tegmen and the defect had been closed with cortical bone, bone paste, and periosteum. Three weeks after the consultation the second surgery was performed. The surgery revealed another bony defect in the epitympanic tegmen and no defect in the mastoid tegmen. The defect was closed in the same way as the first surgery. Detailed questioning revealed that the patient had had a habit of performing Valsalva’s maneuver before the first onset. We suspect that continual or intermittent positive pressure to the middle ear due to habitual Valsalva’s maneuver may cause the thinning or the disappearance of the bony wall of the middle ear.
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Takafumi Yamano, Toshifumi Sakata, Takashi Nakagawa
2014 年 140 巻 p.
18-19
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Objectives: To perform ventilation tube therapy for chronic otitis media with effusion in children, to investigate how the incidences of recurrence and tympanic membrane perforation varied with duration of placement, and to determine the most appropriate duration of placement.
Methods: Using a questionnaire survey in clinics after follow-up, we studied 119 ears 74 children with chronic otitis media with effusion, undergoing ventilation tube therapy between January 2007 and December 2012.
Results: The duration of tympanostomy tube placement was 444 days on average, and recurrence was seen in 5 cases. There was no significant difference in the rate of improvement between patients undergoing adenoidectomy and with no adenoidectomy.
Conclusion: It was thought that 500 days or more were desirable for tube placement and that an a denoidectomy should be undertaken concomitantly wherever possible. A future study should be designed to examine the long term effect. Our results suggested that a high risk of the recurrence was associated with congenital anomaly or retraction within one year after the insertion.
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Yasuhiro Tanaka, Tsuyoshi Yoshimura, Ayako Masuda, Hisashi Kessoku, Sa ...
2014 年 140 巻 p.
20-21
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We performed revision tympanoplasty on 10 patients with recurrent cholesteatoma in the past two years between May 2011 and April 2013. Four of 10 patients with recurrent cholesteatoma were operated on using a canal wall down tympanoplasty with soft-wall reconstruction as the initial surgery. We report herein on two representative cases of recurrent cholesteatoma in whom a canal wall down tympanoplasty with soft-wall reconstruction was initially performed. In the first case, an 11-year-old female child had repeated mucopurulent otorrhea from her left ear one year after the second planned staged tympanoplasty. The canal wall down tympanoplasty with soft-wall reconstruction was performed as second surgery. Otoscopic finding revealed recurrent cholesteatoma from the attic to a part of the mastoid cavity, protruding through the scutum and posterior wall defect. CT of the temporal bone showed soft tissue from the attic to the mastoid cavity with a bone defect of scutum and posterior canal wall. We diagnosed recurrent cholesteatoma after the canal wall down tympanoplasty with soft-wall reconstruction, and performed revision surgery. In the second case, a 10-year-old male child was suffering from purulent otorrhea from his right ear approximately one year after a canal wall down tympanoplasty with soft-wall reconstruction. Otoscopic finding revealed recurrent cholesteatoma that had eroded the scutum to invade the attic. The bone defect extended from the attic to more than half of the posterior canal wall. CT showed soft tissue from the attic to the mastoid cavity with a balloon-like retraction of the posterior canal wall. Finally we performed revision surgery for a recurrent cholesteatoma which had occurred after soft-wall reconstruction of the posterior canal wall. We consider that the soft-wall reconstruction for the purpose of simplifying the surgical procedure should be avoided. We had better preserve the posterior canal wall as much as possible when operating on children. Furthermore, when operating on children the long-term prognoses must always be considered.
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Noboru Yamanaka, Mitsuko Suetake, Michio Tomiyama, Rinya Sugita, Shige ...
2014 年 140 巻 p.
22-23
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We evaluated whether an outcome could be predicted using a scoring system 3 days after initiating drug administration in the treatment of acute otitis media (AOM). On the post-marketing clinical research of tebipenem pivoxil, we evaluated the associations among the scores at the initiation of drug administration, the variation of the scores from the baseline to 2–4 days afterward, and the judgment of the attending physician (cure/failure) within 3 days after completion or cancellation of the dosage. Compared to patients in whom simple AOM was cured (cure group), the redness scores of the eardrum were significantly higher (
P=0.003) at the first visit, a smaller change of the severity scores (
P=0.049) and a larger increase of the otorrhea scores were noted (
P=0.049) in patients in whom simple AOM was not cured (failure group). In patients with recurrent/persistent otitis media, a tendency similar to that found in simple AOM was observed. According to the variations of the scores for severity or for the tympanic membrane, the patients were classified as having Effectiveness Index (EI) A (decrease of scores >50%) and EI-B (decrease of scores <50%); thus, all patients in the failure group were classified as EI-B. These results suggest that the clinical response to antibiotic therapy for AOM can be predicted to some extent based on whether the patient is EI-A or EI-B at 2–4 days after initiating drug administration. Specifically, the results allowed a change in the treatment method: after measuring the score at 2–4 days after initiating drug administration, patients classified as EI-A would continue to receive the same treatment, whereas in those classified as EI-B a change in the antimicrobial agent should be considered. In other words, the decision of effectiveness based on the variations of the scores was useful to determine the treatment strategy for patients with AOM.
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Akira Horinaka, Tadahiko Wada, Takao Yoshida, Yuta Inoue, Akihiko Fuji ...
2014 年 140 巻 p.
24-25
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We report herein on the 20th case in Japan of a carcinoid tumor observed in the middle ear. The patient was a 71-year-old man who was first seen in our hospital in November 2012 for tinnitus of 3 years’ duration. On otoscopic examination, a white mass was observed through the tympanic membrane. The computed tomography demonstrated a tumor like lesion with no evidence of bone destruction. We first performed a probe tympanotomy and pathologically the lesion was diagnosed as a carcinoid tumor of the middle ear. We subsequently performed a tympanoplasty and completely removed the tumor. Recently, somatostatin receptor imaging has become available to detect metastasis or recurrence of carcinoid tumors. We think somatostatin receptor imaging may be appropriate for assessing carcinoid tumors of the middle ear.
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Takashi Taniyama, Tomonori Sugiyama, Mamika Araki, Kouhei Fukukita, Hi ...
2014 年 140 巻 p.
26-27
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Eosinophilic otitis media is characterized by otorrhea of the glue state with infiltration of many eosinophils in otorrhea, most patients present with intractable otitis media accompanied by bronchial asthma and sinusitis. Between 2003 and 2010, we diagnosed 7 patients as having eosinophilic otitis media and studied their clinical course which is presented herein. We treated 1 case surgically (case 7) and treated 6 cases conservatively. The clinical course of the case which was treated surgically is good at present in respect of the aspect of the eardrum and hearing ability progress. Hearing ability got worse in 2 cases among the 6 cases treated conservatively and in 1 case we could not perform systemic administration of steroids because of the patient’s medical disease. Eosinophilic otitis media is considered as intractable otitis media, but our experience suggested that we can prevent advance of hearing loss as much as possible in those cases where we can grasp the condition of the disease exactly and treat patients appropriately according to their morbidity.
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Junko Kusano, Norio Yamamoto, Harukazu Hiraumi, Tatsunori Sakamoto, Ju ...
2014 年 140 巻 p.
28-29
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
A 28-year-old man presented with progressive right hearing loss from a year previously. He had suffered from left hearing loss since his junior high school days. He received medication from other clinic but his symptom was not improved. He visited Kyoto University hospital when he was 27 years old. He had right mixed hearing impairment with 51.7 dB of air conduction hearing level, 20 dB of air-bone gap, and no stapedial muscle reflex. Blue sclera was noted and the patient had a history of osteogenesis imperfecta with several instances of bone fractures. CT scan showed demineralization in the bilateral cochleae and vestibules. We made the diagnosis of van der Hoeve Syndrome based on these clinical symptoms, signs, and examinations. A small fenestration stapedectomy was attempted in his right ear but the footplate was fractured. A partial stapedectomy was performed with removal of the posterior half of the footplate. The averaged improvement for air conduction hearing level was 31.7 dB and the air-bone gap was 10 dB even two years after the surgery. This case suggests that stapedectomy for van der Hoeve syndrome is useful if it is carefully performed.
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—A Review of 23 Cases with Severe Complications Including Fatal Cases—
Haruo Hirakawa, Yasuyuki Nishi, Taisuke Watanabe, Makoto Tada, Atsushi ...
2014 年 140 巻 p.
30-31
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
A 66-year-old man consulted our clinic complaining of fullness in both ears during hospitalization for pyogenic spondylitis at the Department of Internal Medicine in our hospital. He had been diagnosed as having myasthenia gravis 13 years previously and had been suffering from nephritic syndrome and steroidogenic psychosis for eight years. We applied transnasal tympanic inflation using a eustachian catheter (catheter inflation) because otitis media with effusion was observed in both ears. Nothing unusual was observed at the first application except the insufflation to both ears sounded stenotic. However, cervical and mediastinal emphysema suddenly developed at the second application. The patient’s general condition and state of consciousness were not affected just after the onset. Fortunately he recovered during an eight-day observation period with no additional treatment, for antibiotics had already been prescribed for pyogenic spondylitis. How to prevent and how to deal with complications are also discussed in a review of 23 cases with severe complications including fatal cases since 1985 in Japan.
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Hiroki Onishi, Mika Takahashi, Koji Abe, Noriaki Takeda
2014 年 140 巻 p.
32-33
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We report herein on a 19-year-old female with Langerhans cell histiocytosis (LCH) of the temporal bone. She complained of right ear fullness and showed conductive hearing loss of the right ear. CT imaging showed a tumor in the temporal bone and multiple nodules in the lung, and LCH was diagnosed by biopsy of the temporal bone tumor. After a series of remission-induction therapy of B1, but not A and maintenance therapy of B2 and C on the basis of the JLSG-02 protocol of the Japan LCH Study Group, LCH lesions in both organs disappeared and the defect of the temporal bone was replaced with new bone formation.
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Shigeto Itani, Sachie Kawaguchi, Nobuhiro Nishiyama, Atsushi Kawano, M ...
2014 年 140 巻 p.
34-35
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We evaluated the postoperative hearing results of 33 patients who underwent a type IV tympanoplasty between January 2001 and March 2010 at Tokyo Medical University Hospital.
A total of 33 ears in 18 male and 15 female patients were studied with ages ranging from 8 to 77 years. The patients were followed up for at least 6 months after surgery. The surgical techniques were Type IV-c in 32 ears, and IV-i in 1 ear.
In the case of a non-inflammatory disease, such as malformation of the middle ear, traumatic lesion of the ossicular chain and congenital cholesteatoma, successful hearing results were attained in 92.9% of the patients. In the case of an inflammatory disease, such as acquired cholesteatoma and otitis media, successful hearing results were attained in 36.8%.
The success rate was 87.5%, when an autograft cartilage was used for an ossiculoplasty and 43.8%, when bone was used.
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Noboru Yamanaka, Akihiro Uchizono, Yoshifumi Uno, Keiko Kanesada, Shoi ...
2014 年 140 巻 p.
36-37
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We evaluated the risk factors for refractory otitis media in children and factors related to the clinical efficacy of antimicrobial treatment using tebipenem pivoxil (TBPM-PI). Multivariate logistic regression analysis revealed that “group living” (adjusted odds ratio; 6.2, 95%CI; 1.6-24.7,
P=0.010), “age under 2 years old” (adjusted odds ratio; 4.2, 95%CI; 1.5-11.3,
P=0.005), and “concomitant rhinosinusitis” (adjusted odds ratio; 2.9, 95%CI; 1.1-8.1,
P=0.039) were significant risk factors for refractory otitis media. In 96 cases of acute otitis media (AOM) with the risk factors of refractoriness, TBPM-PI showed clinical efficacies with 100% for patients with one of the three risk factors and with 85% for patients with two or more of the risk factors. Multivariate logistic regression analysis revealed that “concomitant rhinosinusitis” (adjusted odds ratio; 4.4, 95%CI; 1.5-13.1,
P=0.008) was a significant factor related with the poor clinical efficacy of TBPM-PI treatment for AOM.
Based on the results clinicians providing medical care for pediatric AOM should keep the risk factors of refractoriness in mind when selecting an appropriate treatment strategy.
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Fumiko Kuboshima, Shin-ichi Kanemaru, Toshiki Maetani, Yoshihiro Tamur ...
2014 年 140 巻 p.
38-39
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We reported herein on a case of bilateral epidural abscesses caused by subacute otitis media and mastoiditis.
The patient was 61-year-old male with untreated diabetes mellitus. He complained of left retroauricular swelling, otorrhea and otalgia. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed bilateral epidural abscesses. Craniosurgical drainage was performed. After the operation, he was treated with intravenous antibiotics.
Although otogenic intracranial complications are rare, they can still represent a serious condition. It is important to examine the head MRI findings, and to treat such conditions in the early stages of the disease.
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Chiaki Suzuki, Noboru Yamanaka
2014 年 140 巻 p.
40-41
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Objective: To compare the clinical characteristics of bilateral acute otitis media (BAOM) with unilateral acute otitis media (UAOM) in children and to find risk factors of refractory otitis media.
Patients and Methods: Four hundred and sixty-six children aged 0 to 14 years old (median age; 1 year old) with AOM were enrolled during January 2010 and June 2011.
Diagnosis of acute otitis media, the severity classification by clinical/ontological scores, and treatments were based on Clinical Practical Guidelines for Acute Otitis Media in Children in Japan 2009. Refractory acute otitis media (RAOM) was designated as recurrent acute otitis media with more than 3 episodes in 6 months or more than 4 episodes in 12 months and/or persistent otitis media with a prolonged course of otitis media more than 3 weeks after the treatment. A multivariate logistic regression analysis was used to estimate the risk of BAOM and UAOM presenting with RAOM.
Results: One hundred and thirty-seven (29.4%) patients were diagnosed as having RAOM. Two hundred and seventy-eight (60%) patients were diagnosed as having BAOM, 45.3% of whom had RAOM, whereas 11 (5.9%) of 188 patients with UAOM showed a refractory clinical course. One hundred and fifty-four (33%) patients were under 2 years of age and 71.3% of them had RAOM. The odds ratio for BAOM patients (compared with UAOM patients) to present with RAOM was 8.7 (95% confidence interval; 4.4-17.1). The odds ratio for patients under 2 years of age (compared with patients aged 2 or over) to present with RAOM was 7.1 (95% confidence interval; 4.4-11.8).
Conclusions: BAOM patients and UAOM patients aged under 2 years of age were significantly associated with an intractable clinical course, and simultaneous occurrence of otitis media and an age under 2 years were apparent risk factors for refractory otitis media.
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Takayuki Ota, Kazuo Matsui, Koichi Kure, Wataru Kubota, Yoshihiko Esu, ...
2014 年 140 巻 p.
42-43
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
When the ear canal often gets exposed to cold water, it leads to the formation of a state called external auditory canal exostoses. This condition is known as surfer’s ear because it is commonly seen among surfers. We experienced seven cases of surfer’s ear from March 2008 to October 2012. All these patients were males with more than 15 years’ experience of surfing. These patients consistently complained of having ear-fullness and hearing loss. In all of these cases, a surgical approach was adopted and performed. The posterior ear incision with a trans-canal approach was chosen for all the cases. It might appear to be difficult to approach an anterior elevated exostoses in the wall of the external auditory canal via this approach, but drilling the external auditory canal in a conical shape from the posterior wall could enlarge the access very appropriately.
The method provides a wide field of view and enough space for surgical techniques; therefore it could decrease the risk of sensory hearing loss due to surgical damage.
The post surgical results of the canal formation demonstrated successful enlargement with a good shape in all the cases we have experienced.
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Takashi Nasu, Toshinori Kubota, Naoto Yoshizaki
2014 年 140 巻 p.
44-45
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We report herein on a patient with a bulky nevus cell nevus in the external auditory canal. A 43-year-old woman had a feeling of fullness in the right ear and noticed a tumor in the right external auditory canal. When the patient was first seen, a pedunculated mass lesion located at the base of the entrance to her right external auditory canal was found. As its appearance was skin-colored, it was difficult for us to make a diagnosis of nevus cell nevus at first view. It was diagnosed as a dermal nevus by a dermatologist at our hospital. We decided on the course of treatment after receiving advice from a dermatologist, and removed it surgically. Dermal nevi should be resected because of their potential for malignant change for cases and locations in which careful observation is difficult, such as in the external auditory canal.
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Kayoko Hattori, Takeshi Morita, Nobuya Fujiki, Kosaku Yamada, Takatosh ...
2014 年 140 巻 p.
46-47
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
The solitary fibrous tumor (SFT) is a rare neoplastic entity which typically originates from the pleura and other serosal tissues, and infrequently arises in the head and neck region. A 26-year-old female, who complained of nasal obstruction, was referred to us for a tumor in the left nasal cavity. A contrast-enhanced computed tomography scan showed a heterogeneously enhanced mass. The pathological findings of this hemorrhagic tumor on the first biopsy were compatible with a nasal polyp; however, the specimen on rebiopsy revealed a spindle cell neoplasm which was immunohistologically positive for CD34 and bcl-2, leading to the diagnosis of SFT. The tumor was endoscopically resected, the pathologic finding of which was identical to the preoperative diagnosis. The patient showed no evidence of recurrence four years after the operation. Immunohistological staining is essential for the diagnosis of SFT, as HE staining alone is insufficient to dif ferentiate it from other tumors.
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Mayu Uneno, Makoto Yasuda, Yoko Muto, Mayumi Kusumoto, Jungen Koimizu, ...
2014 年 140 巻 p.
48-49
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Pyogenic granuloma is a benign tumor that involves the skin and mucosa. It often occurs during pregnancy and the most frequent symptoms are nasal bleeding. The author encountered a case of pyogenic granuloma of the nasal cavity which was resected via the midfacial degloving approach.
A 31-year-old woman, 2 months after delivery of a baby, presented with spontaneous left-sided epistaxis and swelling of the bridge of the nose that had started 1 month previously. Physical examination demonstrated a white and dark-red mass that filled her left nasal cavity. The histological findings showed pyogenic granuloma. We determined to resect the mass because it remained 2 months after delivery without spontaneous re gression.
We chose the midfacial degloving approach to gain access to regions of the midface without external incisions. The entire successful resection was possible with this approach, and there has not been any recurrence for 1 year postoperatively. The cosmetic results were excellent and the patient was satisfied. No significant complications were seen.
The midfacial degloving technique can be considered as a valuable procedure with low morbidity and excellent cosmetic outcome. It may be a viable procedure for pyogenic granuloma of the nasal cavity.
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Hideaki Tsuzuki, Kenzo Tsuzuki
2014 年 140 巻 p.
50-51
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
OBJECTIVES: Argon plasma coagulation (APC), performed as an outpatient procedure, is used to treat severe allergic rhinitis (AR) that is unresponsive to drug therapy. The purpose of this study was to determine the therapeutic effects of APC on patients with perennial AR (PAR) or seasonal AR (pollinosis), and to confirm complications after APC.
METHODS: We performed bilateral APC under local anesthesia on 387 patients with PAR or Japanese cedar pollinosis at our clinic between November 2007 and August 2012. Postoperative changes in nasal symptoms including sneezing, nasal discharge and nasal obstruction, and intranasal findings were evaluated using a visual analogue scale (VAS) and the nasal grading score respectively, according to the Practical Guidelines for the Management of Allergic Rhinitis in Japan in 2013.
RESULTS: In patients with PAR, the mean VAS scores of nasal symptoms improved in 6 months after APC. The severity of RAST scores to house dust, cauterized level, and nasal septum deviation did not show significant influence on the improvement of nasal obstruction after APC. In patients with pollinosis, the mean VAS score of nasal symptoms showed an improvement of 40-60% for one season after APC. Our data also indicated that the most proper time for APC in seasonal AR was for 2 months before the pollen dispersion. As regards to major postoperative complications, atrophy of the inferior turbinate (8%) and epistaxis (3%) were observed. The patients more than 40 years old and/or with RAST scores less than class 3 to house dust were found as significant high risk factors of inferior turbinate atrophy after APC.
CONCLUSIONS: These results indicated that the APC is a useful treatment for patients with AR.
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Kohei Kawamoto, Shigeki Kawamura, Mikiya Asako, Koichi Tomoda
2014 年 140 巻 p.
52-53
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Septoplasty is one of the frequently performed surgical procedures among nasal surgeries. Sometimes suture of the mucosa of the nasal septum is necessary and useful to prevent mucoperichondrial flap perforation or hematoma. Because the mucoperichondrial flap has little tension once peeled from the septum, suturing is not technically easy. We used a Maniceps
® Septum Stitch, a semiautomatic suturing device, for nasal surgery. This system was originally developed as laparoscopic suture system and was modified for nasal surgery. The system comprises a pair of forceps: a straight needle is set on a needle holder which can pass the suture through the target tissue with one motion (closing and reopening the forceps). The semiautomatic suturing system is useful to not only for suturing of the nasal septum, but also for suture medialization of the middle turbinate to the septum in endoscopic sinus surgery.
When using the Maniceps
® Septum Stitch in the deep nasal cavity, sometimes a needle mounted at the tip of the forceps can accidentally damage the mucosa. In order to prevent such damage, we put a magnet at the side of the tip which can hold the needle parallel to the forceps. This ingenious little addition makes it easier to handle the system in the deep nasal cavity. We report herein on the practical usefulness of this semiautomatic suturing device in the nasal surgery along with the presentation of some cases, and conclude that the system makes suturing techniques in the nasal cavity easier to some extent.
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Hiroshi Hyakusoku, Yasuhiro Arai, Tatsu Kuwahara, Kae Sawakuma, Daisuk ...
2014 年 140 巻 p.
54-55
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Orbital infection mainly develops as a complication of sinusitis, and often disturbs the functions of the eye by raising orbital pressure due to abscess formation. We herein report on a case of an intraorbital abscess in the upper-lateral part of the orbit following acute sinusitis occurred in a 59-year-old male. At presentation, the sinusitis itself had already been improved and the abscess did not have contact with frontal or the ethmoid sinuses. A quick and correct diagnosis of sinusitis followed by orbital infection is essential. An urgent surgical drainage along with an adequate use of antibiotics is required to preserve the eyesight.
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Hiroyuki Harada, Shogo Shinohara, Yuji Kanazawa, Keizo Fujiwara, Masah ...
2014 年 140 巻 p.
56-57
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Postoperative sinus cysts are known to be slow growing and it normally takes 15 to 25 years for them to become symptomatic. We report herein on an extraordinary case with frontal sinus cysts developing and ballooning intracranially 1 year after endoscopic sinus surgery. A 26-year-old male underwent bilateral endoscopic sinus surgery under the diagnosis of eosinophilic chronic sinusitis. The postoperative follow up CT in 5 months revealed recurrent polyps in the nasal cavity and thickened mucosa in every sinus, as a nature of eosinophilic chronic sinusitis. One year postoperatively, CT and MRI imaging showed that large bilateral frontal sinus cysts had eroded the posterior wall of the frontal sinuses, widely extended into the anterior cranial fossa and compressed the left frontal lobe. Interestingly, the patient did not complain of any symptoms, central nervous system deficits, headaches or head heaviness though the cysts developed in the rather short period of seven months. In order to widely open the cysts and to observe the condition of the frontal sinus, we employed a modified Lothrop procedure with small extranasal control holes. The content of the cysts was a serous and clear effusion and differed from the known content of postoperative cysts which is ordinary a dark color mucous with high viscosity. The patient has not demonstrated any relapse of his frontal sinus cysts for 1 year and 8 months after the surgery. Our case is an extremely rare condition of frontal sinus cysts because of the speed of their development, the extraordinary contents of the cysts and the lack of symptoms. To the best of our knowledge, and despite an extensive search, no other such a case has ever been reported in the literature. The mechanisms of the development of these cysts are unknown but supposed to be partially due to the cause of the sinusitis itself, eosinophil infiltration.
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Kana Lee, Kunihiko Makino, Takeshi Kondo
2014 年 140 巻 p.
58-59
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Meningiomas account for 10-15% of all intracranial tumors, but less than 1-2% of them extend extracranially. They are benign tumors that originate in the meningothelial cells of the arachnoid granulations overlying the convexity of the brain and the skull base. We herein report on a case of meningioma that extended into the nasal cavity from the cavernous sinus, treated with surgical excision after Gamma-Knife irradiation. With the use of the Gamma-Knife procedure, the tumor was resected with less bleeding. In addition, Gamma-Knife irradiation increases the granulation that blocks the leakage of cerebrospinal if there are bone defects.
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Katsuya Fushimi, Kenzo Tsuzuki, Yusuke Kojima, Naoki Saka, Yasuo Mishi ...
2014 年 140 巻 p.
60-61
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We report herein on two patients with severe epistaxis from the sphenoid sinus resulting in an unfortunate clinical course. A 67-year-old man presenting with severe epistaxis and headache was taken by an ambulance to our hospital. Epistaxis-impaired hemostasis from the sphenoid sinus was observed. The blood examination showed a high inflammatory reaction. Blepharoptosis, dysarthria, and disorientation occurred afterwards. Head magnetic resonance imaging (MRI) demonstrated a left internal carotid artery pseudoaneurysm projecting into the left sphenoid sinus. Endovascular coil embolization of the internal carotid artery to avoid serious hemorrhage was urgently performed after obtaining sufficient informed consent. Although hemostasis was maintained, extensive cerebral infarction occurred after the embolization. Finally the patient died from aspiration pneumonia 5 months after embolization.
A 71-year-old man with epistaxis was transported by an ambulance to our hospital. He had a history of surgery and radiation therapy for chordoma. Pulsatile bleeding was observed from the remaining portion of the tumor in the posterior part of sphenoid sinus. He died of serious epistaxis with impaired consciousness after resuscitation attempt following cardiopulmonary arrest.
In case of epistaxis from the sphenoid sinus, we should suspect that the internal carotid artery may be involved in the bleeding. A detailed medical history should be obtained, especially any neurosurgical interventions and/or radiation therapy for head and neck tumors. We should check the other symptoms such as cranial nerve symptoms. A blood examination also provides important information. Imaging, especially computed tomography (CT) and MRI, should be performed to check for any lesions surrounding the sphenoid sinus.
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Hiroshi Kimura, Hideo Shojaku
2014 年 140 巻 p.
62-63
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We investigated the test results from 73 patients who were diagnosed based on the Japanese revised criteria for the diagnosis of Sjögren’s syndrome (SjS). When a patient showed 2 positive results, he was diagnosed as having SjS. Twenty-six of 73 patients were definitively diagnosed as having SjS. Eleven patients had one positive test result only. Thirty-six had three negative results. The histopathologic test was performed on 11 patients, and all 11 had positive results. The oral test was performed on 23 patients, and positive results were obtained for 18. The ocular test was performed on 15 patients, and positive results were detected in 9. The serologic test was performed on 26 patients, and 14 patients showed positive results. In the combinations of the serologic test and the oral test, 9 patients were diagnosed as having SjS. In the combinations of the oral test and the histopathologic test, 7 patients were positively diagnosed. In the serologic test and the ocular test, 4 were positively diagnosed. In the ocular test and the histopathologic test, 3 were positively diagnosed. In the oral test and the ocular test, 2 were positively diagnosed. In the serologic test and the histopathologic test, 1 patient was positively diagnosed. When the patient showed a positive result on the first serologic test, one of the residual tests certainly showed a positive result. This study suggested a patient was definitively diagnosed as having SjS when the first serologic test showed a positive result. The predictive value positive (PVP) of the serologic test and the histopathologic test were both 100%. The PVP of the ocular test was 81.8% and that of the oral test was 66.7%. The PVP of the oral test was statistically different from that of the serologic and histopathologic tests. Our results strongly suggest that the diagnostic capability using the serologic test and the histopathologic test were superior to the oral test.
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Nimpei Yamaguchi, Kenichi Kaneko, Haruo Takahashi, Naoe Kinoshita
2014 年 140 巻 p.
64-65
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Hemangiopericytomas (HPCs) are a rare vascular tumor arising from mesenchymal cells. We herein describe a 26-year-old man with an oropharyngeal HPC, who had a 3-month history of dysglossia and noticed a painless mass in the oropharynx. Contrast enhanced CT demonstrated an oropharyngeal tumor with a high vascularity. Preoperative biopsy of the tumor was insufficient because the tumor had high vascularity. The patient underwent transoral removal of the mass after embolization and sclerosing therapy. Postoperative diagnosis was an HPC. Eleven months have passed from the operation without any signs of either local recurrence or distant metastasis.
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Ray Motohashi, Kiyoaki Tsukahara, Kazuhiro Nakamura, Minoru Endo, Hiro ...
2014 年 140 巻 p.
66-67
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Tonsillectomy is a basic surgical procedure commonly carried out at many institutions. The most conventional procedure includes the palatine arch incision, the tonsillar capsule separation and tonsil removal using a snare. However, different institutions adopt various refinements in the procedure. Also, with advances in medical instruments, electrosurgical devices and other types of hot-knife are now used in addition to cold-knives such as scalpels and other knives used for incision. Under the current situation, instruction to residents is sometimes hampered due to the narrowness of the surgical view because it is not easy for residents and consultants to share the same view. It is also difficult for the consultant to check the residents’ work in detail. As refinements adopted at our institution, we use a hot-knife to suppress hemorrhage and an Angle Wider to ensure an adequate view and to protect the corners of the mouth. We also use an operating microscope so that the consultant and resident may have the same surgical view for easy and accurate instruction. In the present study, we compared the cold-knife and hot-knife procedures in tonsillectomies conducted by residents in their first year of training in our department. The refinement of the procedure adopted by our institution allowed easy instruction, decreased operation time, suppressed hemorrhage and reduced hospitalization days.
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Tomoaki Mori, Toshikazu Shimane, Hidenori Kanai, Yukiomi Kushihashi, M ...
2014 年 140 巻 p.
68-69
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We report herein on a case of hemangioma of the hypopharynx. A 72-year-old male was referred to our department with a tumor of the hypopharynx, discovered on gastrofiberoscopy. We diagnosed this tumor as a hemangioma. Excising hemangiomas carries the risk of severe bleeding, so photocoagulation with a KTP laser was performed for this patient. The tumor disappeared following photocoagulation with the KTP laser, and our results suggested that the KTP laser could be effective for the treatment of hemangiomas in the hypopharynx. Manufacture of this laser was however stopped in Japan in 2008, therefore some consideration is required to find an alternative system to the KTP laser.
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Narihisa Suzuki, Masato Fujioka, Yasutomo Araki, Hiroyuki Ozawa, Mitsu ...
2014 年 140 巻 p.
70-71
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
IgG4-related inflammatory diseases, including autoimmune pancreatitis and Mikulicz syndrome, have become known to physicians as new clinical entities, especially over the past few years. We would like to present a case of IgG4-related oropharyngolaryngitis. We encountered a 80-year-old male with a severe and intractable inflammation distributed exclusively in the hypopharynx and laryngeal surface of the epiglottis. The patient did not spontaneously recover and the disease was resistant to antibiotics and NSAIDs that were administered for 4 weeks. Frequent fiberscope inspections and punch biopsies failed to provide a diagnosis, and were followed by a detailed examination under laryngomicrosurgery, with multiple tissue samplings under general anesthesia. The samples revealed proliferative, non-malignant inflammatory lesions and the pathology showed IgG4-related symptoms; indicated by all of the criteria including blood and local IgG4 elevation being met. Symptoms were quickly suppressed by a week of steroid infusion drips, followed by a gradual tapering of oral steroids in accordance with a regimen for autoimmune pancreatitis. For many years, ENT physicians have often used corticosteroids empirically for atypical pharyngitis, but usage of steroids on conditions with uncertain criteria has always been criticized. This is, as far as we know, the first report of oropharyngolaryngitis to be associated with IgG4-related symptoms. The case is thought-provoking in that some of those recurrent atypical oropharyngolaryngitis cases might be explained in accordance with this information. Moreover, the results suggest that the serum IgG4 level might be a predictive marker for the requirement of corticosteroids administration.
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Takehiro Kobari, Yukio Nomoto, Yasuhiro Tada, Koichi Omori
2014 年 140 巻 p.
72-73
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
A 24-year-old male with severe sore throat, poor oral intake and pharyngolaryngeal edema was referred to our hospital. After making a diagnosis of infectious mononucleosis based on the laboratory data and a physical examination, we started to treat the patient without antibiotics. Following intravenous drip infusion and inhalation therapy, the symptoms ameliorated. However, the pain in the left side of the pharynx again deteriorated, and swelling of the left soft palate developed. We diagnosed the patient as having a secondary peritonsillar abscess. The pus was drained with an incision of the left lateral wall of the pharynx and the symptoms improved. There are various kinds of reports related to complications of infectious mononucleosis, however a case of peritonsillar abscess is rare. Although antibiotic medication for infectious mononucleosis is not generally recommended, we must examine the prescription of antibiotics carefully depending on each case, considering the possibility of aggravation of bacterial infection as secondary abscess formation following infectious mononucleosis.
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Hiromi Nagano, Hiroyuki Iuchi, Tomohiro Jimura, Masaki Kawabata, Yuich ...
2014 年 140 巻 p.
74
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
The symptoms of adult T-cell leukemia (ATL) appear owing to an adult-T-cell-leukemia virus (humanT-cell leukemia virus type I: HTLV-1).
A 91-year-old woman presented to the ENT service with a one-month history of hoarseness and an abnormal sensation of the throat. Inspection of the oral cavity revealed the presence of a tumor in the oropharynx. On endoscopic examination, the tumor extended from the nasopharynx to the oropharynx. A positron emission tomography/computed tomography (PET/CT) scan showed multiple accumulation throughout the body other than Waldeyer’s Ring. Histological analysis showed a variety of cells, which stained positive for CD3, CD4, CD8, and CD25, and negative to CD20.
Taking those findings into consideration, we diagnosed the patient as having adult T-cell leukemia-lymphoma (lymphoma type).
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Ken-ichi Hisamatsu, Itsuhiro Kudou, Tomoyuki Takane, Kiyoshi Makiyama
2014 年 140 巻 p.
76-77
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Objectives and Methods: Twenty four severe obstructive sleep apnea syndrome (OSAS) patients, 35 sleep disordered breathing (SDB) patients with excessive daytime sleepiness, and 74 simple snorers underwent coblation-assisted uvulopalatopharyngoplasty (cobUPPP) under local anesthesia. Polysomnography (PSG) events, snoring, QOL (SF-36 v2) and excessive daytime sleepiness on the Epworth sleepiness scale (ESS) were assessed 3 months after the operation. The overall assessment criteria of the operative effectiveness on OSAS were proposed using subjective symptoms and PSG events. Informed consent was obtained in writing from all participants prior to cobUPPP.
Results: AI (
P<0.0001), AHI (
P<0.0001), ODI (
P<0.0001), minimum SpO
2 (
P=0.028), SpO
2<90% (
P=0.008) and the arousal index (
P=0.001) were significantly ameliorated. Excessive daytime sleepiness was ameliorated in 34/35 cases and bothering snoring was improved, based on visual analog scale scoring, in 54/55 cases. Treatment of OSAS was assessed as highly effective in 11/24, 9/24 effective and 4/24 ineffective. Transient discomfort of the pharynx was an occasional complaint.
Conclusion: cobUPPP was effective for severe OSAS without significant complications and could be very useful to manage excessive daytime sleepiness and socially unacceptable snoring.
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Kenichi Mori, Masami Ohnishi, Hiroki Takahashi, Yuzuru Sakaida
2014 年 140 巻 p.
78-79
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We report herein on a rare case of double primary malignant tumors composed of squamous cell carcinoma of thelarynx and malignant lymphoma. The patient was a 60-year-old man with the chief complaints of swelling on the right side of his neck and hoarseness. Endoscopic examination demonstrated a massive tumor on the right supraglottic tissue. The accumulation of fluorodeoxyglucose was seen in the larynx, the cervical lymph nodes, the spleen, and the intraperitoneal lymph nodes. Supraglottic squamous cell carcinoma of the larynx (T4aN2bM1) was diagnosed. Two courses of chemotherapy was first performed, and the intraperitoneal lesion almost disappeared on PET-CT. After the third course of chemotherapy, concurrent chemoradio-therapy was administered. As a result, the right supuraglottic tumor had completely disappeared. However, an intraperitoneal lymph node had developed. The patient underwent laparotomy, and the histopathological diagnosis was diffuse large B-cell lymphoma. The patient was treated with R-CHOP. There was no recurrence of laryngeal carcinoma observed for 9 months until he died of malignant lymphoma.
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Taiji Kawasaki, Koichiro Wasano, Noriomi Suzuki, Yoshihiro Watanabe
2014 年 140 巻 p.
80-81
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We report herein on a case of mumps associated with laryngeal edema. The patient was an 18-year-old man who was referred by a nearby doctor with complaints of dyspnea and swelling of the submandibular and parotid glands. We suspected that the patient was suffering from mumps associated with laryngeal edema. The patient was hospitalized and started on treatment with intravenous steroids. Because the laryngeal edema did not improve with this treatment approach, a tracheostomy was performed. The diagnosis of mumps was confirmed by the elevated serum antibody titers. There have been about 15 reports of mumps associated with laryngeal edema especially from Japan. It is essential to examine the airway by laryngoscopy in case of mumps with swelling of the submandibular and parotid glands.
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Yukiomi Kushihashi, Hidenori Kanai, Tomoaki Mori, Masako Terasaki
2014 年 140 巻 p.
82-83
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Actinomycosis is an inflammatory disease by the
Actinomyces Sp. which is an anaerobic bacterium with a Gram-positive bacillus. The
Actinomyces is an intraoral indigenous bacterium, and it is has been reported that actinomycosis often develops within the head and neck region, but reports on epiglottal actinomycosis are rare. We therefore report herein on one case of epiglottis actinomycosis which we experienced. A 49-year-old man was suffering from pharyngalgia. The patient apparently consulted a nearby otorhinolaryngologist for a diagnosis regarding the symptoms of a common cold. He was referred to our hospital, where on arrival he was found to have hoarseness, but without dyspnea. Laryngoscopy revealed significant swelling of the epiglottis and we judged that immediate hospitalization was necessary. After hospitalization, no change was seen in either the epiglottal swelling or the inflammatory reaction, and we first considered that a neoplastic change had occurred in the epiglottis following hospitalization. Having failed to reach a diagnosis following CT, MRI and PET/CT imaging, we performed a biopsy of the epiglottis under the general anesthesia. The result of the pathological examination revealed granulation tissue of the epiglottis caused by actinomycosis. We started oral treatment with AMPC (1500mg/day). The patient recovered on the 140th day after starting treatment. In the examination of any epiglottal tumor actinomycosis should be considered in the differential diagnosis.
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Koji Asakura, Tomo Honma, Takashi Keira, Tomonori Nagaya, Tetsuo Himi
2014 年 140 巻 p.
84-85
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
The treatment results of 33 cases with laryngeal granuloma (contact granuloma, 31 cases and intubation granuloma, 2 cases) were evaluated. Five of six operated cases with contact granuloma showed post-operative recurrence. Following acid suppression therapy (proton pump inhibitor, H2-blocker, and Rikkunshito) at bed time and nocturnal anti-reflux precautions, 25 of 30 cases with contact granuloma, and both 2 cases with intubation granuloma, showed resolution of their granuloma. The resolution occurred within 6 months in 76%, and within 1 year in 92% of cases with contact granuloma (between 2 weeks and 144 weeks, mean, 26.6 weeks).
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Sayaka Sakane, Hiroyuki Enomoto, Nozomu Tamaki, Nobuhiko Oridate
2014 年 140 巻 p.
86-87
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
We experienced four cases of laryngeal paralysis associated with reactivation of the varicella-zoster virus (VZV). In all cases, the titers of the EIA antibody (IgG) were markedly increased. All patients were treated with an anti-viral agent and steroid. After treatment, there were no residual signs of the disease in all cases. In cases of unilateral cranial nerve palsy in which vesicles are either present or absent, herpes zoster should be considered and early treatment with anti-viral agent and steroid should be performed.
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Rui Sano, Atsushi Ando, Michihiro Masaki
2014 年 140 巻 p.
88-89
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
During the period from January 2003 to September 2013, 45 patients (44 males and 1 female, mean age 65 years) were diagnosed as having laryngeal carcinoma at Chubu Rosai hospital. We reviewed the clinical charts of these patients and investigated the treatment outcome and prognostic factor of laryngeal carcinoma. The clinical stage at initial presentation was stage I in 23 patients, stage II in 10 patients, stage III in 6 patients, and stage IV in 6 patients. As initial treatments, operation, radiotherapy (RT), chemoradiotherapy and chemotherapy were done for 7, 28, 9 and 1 patients, respectively. Five-year overall survival rates (OS) and disease-specific survival rates (DSS) for all laryngeal carcinoma patients were 65.4% and 79.0%, respectively. OS and DSS for 34 patients with glottic carcinoma were 71.4% and 84.7%, respectively. OS and DSS for 11 patients with supraglottic carcinoma were 40.0% and 53.3%, respectively. Both the OS and DSS for the glottic carcinoma were significantly higher than those for the supraglottic carcinoma (
P=0.011, 0.017). The OS rates for all laryngeal carcinoma patients with stage I, II, III and IV were 92.3%, 40.0%, 33.3% and 40.0%, respectively. The ratio of laryngeal preservation was 71%. Twelve patients died due to laryngeal carcinoma in 6 patients, second primary carcinomas in 3 patients, and other causes in 3 patients. The OS for the patients with stages II and III were poor. Three patients with stage II died of other causes. Two patients with stage III, one of whom rejected surgery, and the other of whom had inoperable general condition, died of laryngeal carcinoma. Therefore the treatment for laryngeal carcinoma was possibly proper. All five patients with normal cord mobility with T2 glottic carcinoma who underwent RT are currently alive with no recurrence. RT may therefore be effective for T2 glottic carcinoma with normal cord mobility.
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Hirotaka Shinomiya
2014 年 140 巻 p.
90-91
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Posterior reversible encephalopathy syndrome (PRES) was first codified as a single named syndrome in a 1996 case series by Hinchey et al. PRES was described as a clinical syndrome of insidious onset of headache, confusion, visual changes and seizures, which was associated with neuroimaging findings of posterior cerebral white matter edema. Hypertensive disorders, renal disease and immunosuppressive therapies so on are risk factors for this disorder. There are few reports of PRES caused by hypercalcemia. We report herein on a rare case of PRES in normotensive patient with hypercalcemia as a complication of an endstage oral cancer.
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Hiroyuki Harada, Shogo Shinohara, Keizo Fujiwara, Masahiro Kikuchi, Yu ...
2014 年 140 巻 p.
92-93
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Collision tumors are rare entities that consist of multiple neoplasms of distinct origin found in a single anatomic location. Several papers have mentioned collision tumors with two different malignancies in the head and neck. We report herein on a case with triple collision tumors in pathological neck dissection-lymph nodes. A 58-year-old male underwent a total laryngectomy and bilateral neck dissection under the diagnosis of supraglottic squamous cell carcinoma cT4aN2cM0. The dissection of the central compartment (level VI) with subtotal thyroidectomy was simultaneously undertaken due to the subglottic extension of the primary tumor. Histopathological examination revealed metastases of papillary thyroid carcinoma in the right lymph nodes, level III to V, in the left at level II, III and VI as well as metastases of squamous cell carcinomas in the right and left at level III and level II, respectively. Moreover small lymphocytic lymphoma cells were found to have infiltrated the lymph nodes bilaterally at level II to IV. Histology of the right level III, specimen revealed that these 3 kinds of tumor had collided in one lymph node. Multiple micropapillary carcinomas (4 mm maximum diameter) were also detected in the resected thyroid specimen. After the pathological report, we reviewed the preoperative FDG-PET/CT and found that only the existence of SCC showed an high accumulation of FDG on PET/CT. Considering the prognoses of each malignancy, postoperative radiation for squamous cell carcinoma was performed because lymphovascular invasions were pathologically seen at the primary site. It was decided to place the thyroid cancer and small lymphocytic lymphoma under observation without additional therapeutic intervention because the former was considered to be an incidental microcarcinoma and the latter was an indolent type lymphoma.
To our knowledge, this is the first reported case of triple collision tumors in one cervical lymph node.
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Toshiya Kimura, Tohru Sogami, Akifumi Mizukoshi, Tsunehisa Ohno, Hisan ...
2014 年 140 巻 p.
94-95
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
A case of branchiogenic carcinoma is reported herein. The patient was a 59-year-old female who noticed a mass on the left neck and visited our hospital. CT and echography revealed a cystic lesion, and PET disclosed multiple abnormal accumulations on the bilateral cervical lymph nodes and pharynx. First of all, we suspected the tumor as being a malignant lymphoma or metastatic carcinoma. We resected the tumor under general anesthesia for biopsy. The histopathological diagnosis was squamous cell carcinoma arising from a branchiogenic cyst. We examined the whole body and added the biopsies of the epipharynx, palatine and lingual tonsils which revealed no malignancy and no other primary lesions existed. The tumor was therefore diagnosed as a branchiogenic carcinoma. Bilateral radical neck dissection, and postoperative chemotherapy and radiotherapy were performed. The patient has survived until the time of writing for 30 months without recurrence.
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Takafumi Nagatomo, Keiichi Ichimura
2014 年 140 巻 p.
96-97
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
Hypoglossal schwannomas are extremely rare tumors especially in the submandibular space. They are sometimes difficult to diagnose as schwannomas before surgery. A 42-year-old male presented with a painless submandibular swelling. After various examinations, we diagnosed the swelling as a pleomorphic adenoma originating in the submandibular gland. Surgical excision was planned. During the operation, the tumor was proved to be of hypoglossal nerve origin. We performed subcapsular tumor resection with mild postoperative nerve paralysis. The patient was observed for 6 months. Hypoglossal dysfunction gradually improved. Schwannoma is a rare tumor but should be considered as one of the conditions in differential diagnosis of any masses located in the submandibular space.
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Rieko Sagawa, Isao Uemaetomari, Kei Ashizawa, Shuho Tanaka, Tetsuro Wa ...
2014 年 140 巻 p.
98-99
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
The thyroid gland is usually located in the anterior neck region between the second and fourth tracheal cartilages. An ectopic thyroid refers to the presence of thyroid tissue in other locations. Its reported prevalence is 1 per 100,000-300,000 people and 1 per 4,000-8,000 patients with thyroid diseases.
This report describes the case of a 51-year-old woman with an ectopic thyroid in the form of a large mass on the base of the tongue with repeated hematemesis. To reduce the bleeding, embolization of the main feeding artery was performed before surgical intervention. As a result, the surgery was successfully performed via the intraoral approach without much bleeding. Thus, embolization before surgical treatment for an ectopic thyroid on the base of the tongue was demonstrated to be an effective therapeutic strategy.
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Tsuyoshi Takemoto, Kenji Takeno
2014 年 140 巻 p.
100-101
発行日: 2014年
公開日: 2014/11/19
ジャーナル
オープンアクセス
The basaloid cell carcinoma is a rare variant of squamous cell carcinoma, that was recognized by the World Health Organization (WHO) in 1991. The prognosis is remarkably poor because of distant metastasis, but an effective therapy has not yet been established. Basaloid cell carcinoma of the hypopharynx is uncommon and only limited studies have been reported in the literature. We present herein on a case of basaloid cell carcinoma which occurred in the hypopharynx. A 58-year-old male presented our department because of an incidentally detected hypopharyngeal tumor. The tumor was resected transorally, and was diagnosed as basaloid cell carcinoma. We conducted post-operative chemoradiation.
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