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Men-dar Wu, Shigeru Inafuku, Taeko Kusumi, Meiho Nakayama, Hiromichi I ...
2000 Volume 2000 Issue Supplement104 Pages
1-6
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Drug-ototoxicity due to transtympanic infusion of electrolyzed strong acid solution (ESAS) was studied electrophysiologically by auditory brainstem response (ABR) and morphologically by scanning electron microscopy (SEM) of inner ear. After undergoing pre-treatment ABRs in response to tone pips at 8 kHz and 16 kHz, eight guinea pigs were divided into the following two groups: group A (5 animals, in which ESAS was applied into tympanic cavities bilaterally once a day for five successive days) and group B (3 animals, in which instead of ESAS, physiological saline solution (PSS) was applied under the same conditions as a normal control). Post-treatment ABRs were measured 24 hours after the transtympanic infusion of ESAS or PSS, and all animals were sacrificed and the inner ears were removed for the examination of SEM.
The results showed that there was no obvious morphological change of the sensory hairs in the organ of Corti, the macula and the ampulla following the transtympanic application of ESAS. Although among the group A, there was a slight elevation of ABR thresholds to be seen in 4 animals after the administration of ESAS, presumably it seems to be caused by the transitorily non-specific lesion of the tympanic membrane but not inner ear. Our findings suggest that ESAS might be considered as a useful and low-ototoxic disinfectant for the otologic treatment.
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Tsuyoshi Matsumoto, Taeko Kusumi, Men-dar Wu, Meiho Nakayama, Shigeru ...
2000 Volume 2000 Issue Supplement104 Pages
7-12
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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It is well known that dysfunction of the eustachian tube can cause retraction of the ear drum, and resultant cholesteatoma. In this study, we investigated retrospectively the relationship between reccurence of middle ear cholesteatoma and eustachian tube function.
From 1993 to 1996,81 cholesteotoma patients (83 ears) received intact canal wall tympanoplasty in the Department of Otolaryngology at Aichi Medical University. Before surgery, we evaluated their eustachian tube function by sonotubometry and tubotympano aerodynamic graphy (TTAG).
They were divided into four groups based upon the presence of a normal or dysfunctional eustachian tube and whether or not they received anterior tympanotomy. The rate of recurrence was lowest in the group who had normal function of the eustachian tube and previous anterior tympanotomy. In contrast, recurrence was most in the group who had a dysfunctional eustachian tube and did not receive anterior tympanotomy.
These results indicate that aeration of the middle ear is a significant factor in preventing recurrence of cholesteatoma.
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Shigeru Inafuku, Hiromichi Ishigami, Tatsuyuki Banno, Meiho Nakayama
2000 Volume 2000 Issue Supplement104 Pages
13-17
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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We reported 6 surgically-treated cases of middle ear cholesteatoma associated with Down's syndrome. The following points were considered to be important during surgery for such cases: 1)the canal-wall-up technique using a postauricular incision was superior to the canal-wall-down technique,2) the incision should be closed using the buried suture technique and 3) a fascial graft should be fixed by fibrin glue without a gauze tamponade. These points should be considered to facilitate postoperative treatment in the patients who are uncooperative.
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Shigeru Inafuku, Meiho Nakayama, Hiromichi Ishigami, Kei Sato, Ichio I ...
2000 Volume 2000 Issue Supplement104 Pages
18-22
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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A 17-year-old female with bilateral conductive hearing loss since childhood is reported. During exprolatory tympanotomy, the cause of conductive hearing loss was found to be ossification of the stapedial tendon attaching to a monopodal stapes.
The hearing in the left ear improved after cutting the ossified stapedial tendon. However, the hearing in the right ear did not improve because of a failure in cutting the severely ossified stapedial tendon. Ossified stapedial tendon should be kept in mind during diagnosing conductive hearing loss of unknown origin which started in childhood. Carefully procedures should be done when cutting a severely ossified stapedial tendon.
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Yukihiko Saitoh, Shigeru Inafuku, Tatsuyuki Banno, Men-dar Wu, Meiho N ...
2000 Volume 2000 Issue Supplement104 Pages
23-31
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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The approach for meatoplaty of surfer's ear is well reported using a postaural incision. Because tympanomeatal skin is easily damaged through this approach, we opted to perform an endaural incision in 3 cases of surfer's ear in patients who visited the Department of Otorhinolaryngology at Aichi Medical University. The tympanomeatal skin was detached, osteoplasty performed, and the skin was reattached using fibrin glue. No skin defect was found after the surgery in all three cases. Endaural incision is useful for preserving the tympanomeatal skin during meatoplaty.
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Tessei Kuruma, Shigeru Inafuku, Meiho Nakayama, Men-dar Wu, Hiromichi ...
2000 Volume 2000 Issue Supplement104 Pages
32-36
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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In Japan, otosclerosis is a relatively rare disease compared to the incidence in Caucasians. In this paper we report two sisters,53 and 49 years old, who have otosclerosis.
These patients consulted Aichi Medical University complaining of bilateral tinnitus and hearing loss, and were diagnosed as otosclerosis. The older sister had a hearing level of 56 dBHL in the right ear, and 49 dBHL in the left with combined hearing impairment in the low frequency range. The younger sister had a hearing level of 96 dBHL in the right, and 73 dBHL in the left with combined hearing impairment in the high frequency range. Radiographic examination showed no specific findings.
Bilateral stapedotomy was performed in the ears of both patients. Intraoperative findings revealed otosclerosis with sclerotic changes of the stapes. The superstructure of stapes in the left ear of the younger sister showed sclerotic changes histopathologically. Abnormal vascularity, thought to be the stapedial artery, was revealed through the foramen obliteration in the older sister. Both patients had unilateral hearing recovery postoperatively.
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Atsushi Nakano, Shigeru Inafuku, Men-der Wu, Meiho Nakayama, Hiromichi ...
2000 Volume 2000 Issue Supplement104 Pages
37-41
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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We report a patient with traumatic perilymphatic fistula caused by an earpick. Exploratory tympanotomy was performed via endoaural incision. The patient was found to have a dislocated stapes in the vestibule. The stapes was removed, and no perilymphatic leakage from the oval window was seen. Jugular pressure was also performed with no lymphatic leakage. We then injected physiological salt solution at 37°C into the oval window. Lastly, stapes surgery was perfomed and a piece of fascia was placed over the perforation in the tympanic membrane using fibrin glue. The patient's operation was performed 3 days after trauma and improvement of vertigo and hearing (sensory and air-bone gap) was obtained after surgery.
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Shigeru Tsujimoto, Meiho Nakayama, Shigeru Inafuku, Hiromichi Ishigami
2000 Volume 2000 Issue Supplement104 Pages
42-52
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Screening audiometry, measuring right and left hearing at 1 and 4 kHz is a legally required part of the screening health examination for workers in Japan. The goals of this study are to analyze the reliability of screening audiometry, and to define a method for detecting auditory disturbances utilizing these results.
We collected audiometry data in both a silent office room and in a sound-proof room utilizing the screening audiometry test and a fundamental audiometry, and then compared the results. The results coincided in more than 90% of the cases, which may suggest screening audiometry is highly reliable. In addition, we selected cases suspected of having hearing loss by the presence of three or more positive findings on four tests (right 1 and 4 kHz, and left 1 and 4 kHz examination). We found more than 90% of cases had some kind of middle or inner ear disease.
Screening audiometry is useful for detecting auditory diseases and may possibly contribute to preventing workers' hearing disturbances.
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Shigeru Tsujimoto, Meiho Nakayama, Shigeru Inafuku, Hiromichi Ishigami
2000 Volume 2000 Issue Supplement104 Pages
53-60
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Screening audiometry, measuring right and left hearing at 1 and 4 kHz, is a legally required part of the screening health examination for many workers in Japan. A large amount of data comes from this first screening, and there is some disagreement about how to select which patients with positive findings require secondary screening. In this study we performed four tests (right 1 and 4 kHz, and left 1 and 4 kHz examination) in 2820 workers, and divided these results into four groups. Group 1 patients had one positive finding and included 427 workers. Group 2 patients had two positive findings and included 265 workers. Group 3 had three positive findings and 73 workers. And group 4 had four positive findings and 22 workers. In our previous study, we reported that 90% of the cases in groups 3 and 4 had some kind of ear disease. Therefore, the patients who were sent on for secondary screening were from group 3 and 4, as well as a smaller subset from group 2. The number of workers in group 2 who had positive findings in bilateral 4 kHz testing numbered 109, while the remaining patients had positive findings on only one 1 kHz test and numbered 156. Because the patients with defects in the 4 kHz range included many patients with presbyacusis and noise-induced hearing loss, which do not require immediate treatment, we focused on the 156workers who had at least one positive finding in the 1 kHz range. Therefore, the total number of workers sent to secondary screening was 251; including the 156 workers from group 2, and all those from groups 3 and 4.197 of the 251 workers were then sent to secondary screening examination in a sound-proof room.104 workers showed some hearing disturbance while 93 workers had normal hearing. This method of screening may possibly reduce the number of workers who require secondary screening, and subsequently decrease the time required and financial burden.
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Ryu Tanemura, Meiho Nakayama, Shigeru Inafuku, Hiromichi Ishigami
2000 Volume 2000 Issue Supplement104 Pages
61-64
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Vogt-Koyanagi-Harada disease has been described as an autoimmune disease which targets melanocytes and causes visual disturbance. In addition, it causes auditory and equilibrium disorders occasionally. In this study, we report a case of Harada's disease with sensorineural hearing loss.
A 51-year-old male visited Aichi Medical University complaining of visual and hearing disturbances. An audiogram demonstrated moderate sensorineural hearing loss bilaterally. Visual and auditory acuity improved after administration of steroids. The hearing disturbance in this case may have been caused by an autoimmune reaction to melanocytes in the inner ear, similar to the previously reported phenomenon in the eye.
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Keiji Matsuzaki, Meiho Nakayama, Men-dar Wu, Shigeru Inafuku, Hiromich ...
2000 Volume 2000 Issue Supplement104 Pages
65-69
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Purpose: The CMI (Cornell Medical Index) is a self survey method used to study a patient's physical and mental status. In this study, we investigated what might affect dizzy patients physically and mentally by analyzing the CMI.
Targets and methods: We randomly selected 100 cases (35 male,65 females) from 722 patients who complained of dizziness and visited the Department of Otorhinolaryngology at Aichi Medical University from January 1,1996 to December 31,1997. These patients were given the CMI and the results were analyzed.
Results: The mental score was significantly more positive than the physical score in many cases, especially in the 50-59 year old patients. In the physical score, most patients complained of stiff muscles in the neck or back.
Conclusion: From the results of the CMI, we found that many dizzy patients have some kind of mental or physical problem besides dizziness. These results emphasize the importance of treating the whole patient, and not just focusing on the dizziness.
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Meiho Nakayama, Men-dar Wu, Shigeru Inafuku, Hiromichi Ishigami
2000 Volume 2000 Issue Supplement104 Pages
70-74
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Typical spontaneous nystagmus associated with Meniere's disease has been known to have a characteristic pattern consisting of horizontal, or horizontal and rotatory nystagmus beating toward the unaffected ear during the acute phase of the attack, followed by a reversal of the nystagmus direction as the patient recovers. However, different types of nystagmus were observed occasionally in some Meniere's disease patients by our experiments. The goal of this study is to investigate the character of nystagmus and to determine if there is atypical nystagmus in Meniere's disease. The positional nystagmus of forty-six Meniere's disease patients who visited the Department of Otolaryngology, Facility of Medicine, Aichi Medical University, was investigated retrospectively.
The results were as follows: 1) Spontaneous nystagmus was observed in thirty-five patients (76%) on their first visit to the hospital.2) There was no significant difference between the groups when observing the nystagmus beating toward the affected ear and the unaffected ear.3) Benign paroxysmal positional vertigo (BPPV) was observed in five patients while down beat nystagmus was revealed in four patients during their visits to the hospital.4) No evidence of central disturbance, when examined by CT and MRI, was observed in the four patients combined with down beat nystagmus.
As many scientists agree, endolymphatic hydrops in the inner ear was attempted to explain the etiology of Meniere's disease. The endolymphatic hydrops may cause debris in the inner ear and induce the BPPV which was observed in this study. Generally, the down beat nystagmus was only observed in the central origin. However, it can be also revealed when bilateral peripheral disfunction happens. The down beat nystagmus reported in this study may indicate bilateral Meniere's disease. In comparison with the typical nystagmus, we suggest there is atypical nystagmus in the Meniere's disease.
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Meiho Nakayama, Akira Nakamura, Shigeru Inafuku, Hiromichi Ishigami
2000 Volume 2000 Issue Supplement104 Pages
75-80
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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It is difficult to treat patients with long term dizziness. Many of these patients complain of headache, stiff neck, and eye strain in addition to the dizzy sensation. We evaluated the efficacy of a therapeutic method combining anesthetization and acupuncture to the treatment of headache, stiff neck, and eye strain in patients with long term dizziness.
Forty-one patients with long term dizziness were injected with 0.5% lidocain into acupuncture points BL10 and GB20, which are known to be effective for the treatment of vertigo, tinnitus, and releasing muscle tension in the head, neck and back. It is our hypothesis that the lidocaine may benefit in the acute setting and in augmenting the long term efficacy of the accupuncture.
This method improved the dizzy sensation in 50% of patients, stiff neck in 90% of patients, headache or eyestrain in 80% of patients. Because the vestibulospinal reflex, equilibrium disturbances may cause compensatory strain on the neck and back muscles resulting in complications, such as stiff neck, in these patients. By alleviating these strain symptoms in this patient population, the treatment's effect was to improve their dizzy sensation as well.
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Takako Okumura, Masaaki Sumiya, Meiho Nakayama, Shigeru Inafuku, Hirom ...
2000 Volume 2000 Issue Supplement104 Pages
81-84
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Anterior inferior cerebellar artery (AICA) syndrome has been reported in elder followed by cerebral infarction, however, it is rarely found in young adult. In this study, we reported a case of AICA syndrome associated with nephrotic syndrome in a 19-year-old male. The patient suffered. with left hemiparesis, agnosia, loss of activity, anasarca and left hypacusis after diarrhea and appetite loss, and was diagnosed cerebral infarction in the territory of the anterior choroidal artery by MRI. The symptoms were improved once after medical treatment, however, vertigo and left hearing loss evoked on the 20th day after the first attack. Right horizontal beating nystagmus, no response of left ABR, and ataxia of eye tracking test in ENG were revealed. Although the territory of the AICA had no evidence of ischemic finding in MRI, MR-angiography showed an occlusion of the AICA. Neurotological examination was significantly useful for diagnose in this case.
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Kiyoko Kimata, Tomoya Kohriyama, Shigeru Inafuku, Meiho Nakayama, Hiro ...
2000 Volume 2000 Issue Supplement104 Pages
85-89
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Hemangioma in the nasal cavity is rarely reported. We report a case of a 50 year old female who visited the Department of Otorhinolaryngology at Nagoya Memorial Hospital complaining of nasal bleeding.
Although we did a biopsy before the surgery, we could not confirm that the tumor was a hemangioma because a large part of the tumor only showed necrosis on pathology. Malignancy was suspected before surgery, and the surgery was done for pathologic confirmation, and possible removal of the tumor. Fortunately, there was little bleeding during the surgery and the pathologic diagnosis showed hemangioma. In general, we must be very cautious with surgery of hemangiomas because of the risk of severe bleeding.
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Kazutoshi Katoh, Shigeru Inafuku, Meiho Nakayama, Hiromichi Ishigami
2000 Volume 2000 Issue Supplement104 Pages
90-93
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Osteoma has been well reported in the area of rhinology, however, most cases are in the paranasal sinus and rarely occur in the nasal cavity. We experienced a case of osteoma found in nasal cavity, that originated in the middle turbinate.
The patient a 31-year-old female who suffered from nasal obstruction and dacryocystitis, visited us in January 1999. On February 9,1999, the osteoma (45.7×30.2 mm) was removed along with the middle turbinate. This was followed by dacryocystorhinostomy under general anesthesia. There has not been any recurrence after one year of observation.
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Tatsuyuki Banno, Meiho Nakayama, Shigeru Inafuku, Hiromichi Ishigami, ...
2000 Volume 2000 Issue Supplement104 Pages
94-100
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Uvulopalatopharyngoplasty (UPPP) was first reported as a useful treatment for obstructive sleep apnea syndrome (OSAS) patients by Fujita in 1981. Because it is a relatively recent procedure, there have not been many long-term follow-up studies on the results of this surgery. We investigated.42 patients who were diagnosed with OSAS in Aichi Medical University from 1993 to 1998.34 cases (81%) had more than a 50% improvement of respiratory distress index (RDI) after surgery. In long term observation, the number of patients with more than 50% improvement of RDI decreased to 14 cases (73%) at 6 months, and 7 cases (57%) at 24 months after the surgery. UPPP is useful in OSAS patients, however the effect of the surgery may decrease over time. This may be because of re-narrowing by post-operative scarring or may be related to an increase in the patient's weight.
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Tohko Momose, Takao Kamimura, Naoya Shiraki, Meiho Nakayama, Shigeru I ...
2000 Volume 2000 Issue Supplement104 Pages
101-105
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Nonclostridial gas phlegmon is often found in patients with diabetes, and may occasionally cause severe infections. We reported a case of severe nonclostridial gas phlegmon in the neck.
A 58-year-old male with a history of diabetes visited Aichi Medical University complaining of erythema, swelling, and warmth in his neck as well as dysphagia. Epiglottitis was noted endoscopically, and a gas phlegmon in the neck and chest were diagnosed on CT scan. The patient received a tracheotomy and antibiotics immediately. A mediastinal abscess occurred in the fifth day, and an incision for drainage was performed. From the abcess were cultured γ-streptococci and peptostreptococcus. Symptoms improved by the tenth day. Nonclostridial gas phlegmon responds poorly to antibiotics, so cases of deep neck clostridium infection require early surgical treatment and good diabetic control.
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Shuntaro Inagawa, Men-dar Wu, Ayako Usui, Kaoru Suzuki, Tatsuaki Sato, ...
2000 Volume 2000 Issue Supplement104 Pages
106-109
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Tumors in the parapharyngeal space are rarely found and comprise only 0.5% of tumors in the head and neck area. Most surgeons remove such tumors through skin incisions, however long incisions in the head and neck area may cause cosmetic problems. We performed surgery on a 25year-old female with a Schwannoma in the parapharyngeal space through an oral incision, and succeeded in removing the entire tumor. MRI, MRA and CT scan were useful for analyzing the size and area of the tumor before surgery. Although an oral approach is more difficult than a skin incision for removing tumors in the parapharyngeal space without supplementary damage, such an approach will help the patient cosmetically.
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Naomi Matsumoto, Meiho Nakayama, Shigeru Inafuku, Hiromichi Ishigami
2000 Volume 2000 Issue Supplement104 Pages
110-113
Published: October 31, 2000
Released on J-STAGE: November 27, 2012
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Forestier disease is a skeletal pathology that sometimes affects the head and neck as a consequence of hyperostotic involvement of the cervical spine. We report a case of a 60-year-old male who visited our hospital with progressive difficulty in swallowing solids. The radiographic findings were essential in the recognition of this disease. Lateral cervical spine roentgenograms revealed a bridge formation that almost resembled candle-wax dripping from C
4-5 to C
5-6along the anterior cervical spine. The barium swallow esophagogram demonstrated narrowing of the esophagus at the level of the hypopharynx that associated with a calcification of the anterior longitudinal ligament. The pathogenesis of dysphagia was thought to be not only mechanical compression but also a secondary chemical stimulation of digestive fluids and fibrosis.
This study suggested that Forestier disease with severe dysphagia may sometimes require surgical treatment and that it is important to distinguish this disease from other disorders of the cervical spine.
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