Our choice of surgery for acquired middle ear cholesteatoma is based on two fundamental principles : 1) the physiological morphology and function should be preserved to the maximum extent possible postoperatively, i.e., the posterior wall of the external auditory meatus and mucosa of the middle ear cavity should be well preserved; 2) the surgical procedure is selected based on the extent of invasion and the morbidity associated with the cholesteatoma, including the status of the remaining mucosa of the middle ear cavity.
The subjects registered for this study, which was conducted to collect evidence to establish the standards for selection of the surgical procedure, were patients who had undergone initial surgery for cholesteatoma of the pars flaccid type at our department during the 15-year period from 1988 to 2003. The postoperative recurrent rate and improvement of hearing were analyzed in these. The standards for selection of the surgical procedure according to the morbid condition were established in 1996, based in particular, on the postoperative recurrent rate of cholesteatoma during the 8-year period from 1988 to 1995. The 15-year period from 1988 to 2003 was divided into the former half (8-year period) and the latter half (7-year period), with 1996 as the cutoff year. The recurrent rate (after one-stage conservative surgery for the posterior wall, i.e., canal wall-up) and improvement of hearing were compared between these two periods.
The recurrent rate was distinctly lower following surgery during the latter period. The hearing was favorably improved for both periods. The results suggest improved surgical skills, decreased severity of inflammation, and the validity of the standards established in 1996 for selection of the surgical procedure.

View full abstract

We report a case of auricular herpes zoster accompanied by multifarious neural symptoms. A 62-year-old woman with paralysis of the right soft palate, dysphagia, and atrophy of the right sternocleidomastoid muscle arising from herpes zoster of the right auricle was found in brain MRI to have no abnomal findings, leading to a diagnosis of Vernet syndrome attendant on varicella-zoser virus infection. Paralysis of the facial nerve and vestibular nerve disorder became evident later, yielding a diagnosis of Vernet syndrome attendant on Ramsay Hunt syndrome of the complete type. We speculate that the disease developed from reactivation of viruses hidden in the facial and patellar ganglions and in the vestibular, aberrant, and glossopharyngeal ganglions, causing inflammation to spread via nerve anastomosis.

View full abstract

A 39-year-old man with obstructive sleep apnea due to bilateral abductor vocal cord paralysis is presented. He had impaired vocal fold abduction but had no neurological abnormality. During sleep high-pitched snoring and apnea were observed. Despite management of nasal continuous positive airway pressure therapy (nCPAP) with 14 cmH₂O pressure, severe esophageal negative pressure up to -50 cmH₂O remained. In order to reduce laryngeal obstruction, he underwent unilateral arytenoidectomy using microdebrider with direct laryngoscope. After arytenoidectomy, his nocturnal breathing improved markedly under nCPAP with 11 cmH₂O pressure and negative esophageal pressure was reduced to 20% of that previously. As this case indicates, careful examination of the upper aerodigestive tract is essential in treating obstructive sleep apnea

View full abstract

Continuous positive nasal airway pressure (n-CPAP) is now the treatment of choice in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). We reported a case of OSAHS exhibiting a patulous Eustachian tube only in n-CPAP. A 58-year-old man was diagnosed with severe sleep apnea syndrome and started on use n-CPAP, experienced aural fullness immediately afterword. Examination showed audiometry and the eardrum to be normal Eustachian tube functional inspection showed potential eustachian tube dysfunction. We concluded that the patulous Eustachian tube was caused by excessive of n-CPAP adversely affecting the middle ear and the auditory tube function.

View full abstract

Levofloxacin (LVFX), a new quinolone antibiotic has postantibiotic effect (PAE), so its activity depends on its concentration in infected tissue. LVFX is usually administered at a dose of 300 mg divided into 3 times a day, but trials of LVFX at 400 mg divided into twice a day in patients with acute upper respiratory infectious disease and pneumonia have been reported. We divided 50 patients with acute tonsillitis into two groups : those administered LVFX at 400 mg divided into twice a day and those given 300 mg divided into 3 times a day. x², t, and Wilcoxon tests were used for statistical analysis to assess clinical utility. A level of p <0.05 was considered significant. Good clinical efficacy and safety were obtained in the group administered 400 mg divided twice a day, but no significant difference was seen between the 2 groups. This group also showed superior dosage compliance.

View full abstract

Nocturnal polysomnography (n-PSG) was conducted and evaluated in a 3-year-old boy with Apert syndrome and sleep apnea before and after adenoidectomy and cleft-palate surgery. The preoperative, apnea hypopnea index (AHI) was 20.2 times/hr, deep sleep 33.4%, and REM sleep 32.4%. Postoperatively, AHI was 13.6/hr, deep sleep 30.2%, and REM sleep 14.7%. Although apnea improved, hypopnea remained. Sleep disorder in this case was considered due to upper jaw low formation causing soft tissue abnormalities.

View full abstract