JIBI INKOKA TEMBO
Online ISSN : 1883-6429
Print ISSN : 0386-9687
ISSN-L : 0386-9687
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Volume 58, Issue 2
Displaying 1-9 of 9 articles from this issue
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FEATURE ARTICLE
ORIGINAL PAPERS
  • COCHLEAR IMPLANTATION AFTER MENINGITIS IN ADULTS
    Jun Ikeya, Atsushi Kawano, Akira Hagiwara, Nobuhiro Nishiyama, Sachie ...
    2015 Volume 58 Issue 2 Pages 75-83
    Published: April 15, 2015
    Released on J-STAGE: April 15, 2016
    DOIhttps://doi.org/10.11453/orltokyo.58.2_75
    JOURNAL FREE ACCESS
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    Introduction: In patients who have had meningitis, application of cochlear implants can be difficult due to fibrosis or ossification of the inner ear. Insertion of an electrode may be complicated by a non-patent cochlear lumen due to new bone formation.
    Objective: The purposes of this study were to identify the outcomes of cochlear implantation in patients with profound hearing loss caused by meningitis and to compare the outcomes in those with and without cochlear osteogenesis.
    Methods: Among 390 adult patients who received cochlear implants between 1985 and 2013, 27 patients with a history of meningitis received 30 cochlear implants. The backgrounds of the patients and the outcomes during and after the operation were investigated. Speech performance was evaluated with threshold and Japanese speech perception tests.
    Results: The age at which the patients contracted meningitis ranged from 0.9 to 66 years, and the age at implantation ranged from 23 to 68 years. The causative factors were bacterial in 14 cases, abacterial in one case, viral in two cases, and unknown in 10 cases. The cochleae were ossified in five cases, fibrotic in five cases, and normal in 20 cases. The electrodes were fully inserted in all but two cases. The average threshold with a cochlear implant was 36.5dB, and speech perception of Japanese words and sentences was 32.0% and 46.1%, respectively.
    Conclusions: Patients with postmeningitic deafness benefit significantly from cochlear implantation. However, the audiologic outcomes are difficult to predict in some cases, particularly in the presence of ossification.
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  • COCHLEAR IMPLANTATION IN PATIENTS ON HEMODIALYSIS
    Nobuhiro Nishiyama, Atushi Kawano, Akira Hagiwara, Sachie Kawaguchi, J ...
    2015 Volume 58 Issue 2 Pages 84-90
    Published: April 15, 2015
    Released on J-STAGE: April 15, 2016
    DOIhttps://doi.org/10.11453/orltokyo.58.2_84
    JOURNAL FREE ACCESS
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    　The number of elderly patients with systemic diseases, even those needing cochlear implantation, is increasing. One example is patients with end-stage renal disease requiring maintenance hemodialysis therapy. We report five cases of cochlear implantation carried out in patients receiving maintenance hemodialysis therapy for chronic renal failure. The surgeries were conducted at the Tokyo Medical University Hospital, Tokyo, Japan. The patients consisted of four males and one female, with ranging in age from 30～57 years. The duration of the hearing impairment before the cochlear implantations varied from 1 to 45 years. The postoperative clinical courses of the patients were followed up for 5～14 years, by the end of which three of the patients died and the remaining two survived. Three of the patients received CI22M and two received CI24M. One of the patients underwent renal transplantation three years after the cochlear implantation. In fact, to the best of our knowledge, this is the second reported case of cochlear implantation carried out prior to renal transplantation that was performed subsequently.
    　There were no critical problems in the perioperative period or during postoperative auditory rehabilitation. However, an electrode slip-out was confirmed six years later in one patient, which was restored by re-implantation.
    　Thus, neither hemodialysis nor renal transplantation serves as an impediment to cochlear implantation and auditory rehabilitation. As the duration of the deafness was long, our patients used their cochlear implants with the help of visual information. Most of them enjoyed the benefits of cochlear implantation as part of the total communication skills.
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  • TWO CASES OF EXTRANODAL NK/T-CELL LYMPHOMA, NASAL TYPE (ENKL)
    Kentaro Matsuura, Chiaki Arai, Hiroshi Osafune, Eiji Shimura, Hideo Ed ...
    2015 Volume 58 Issue 2 Pages 91-98
    Published: April 15, 2015
    Released on J-STAGE: April 15, 2016
    DOIhttps://doi.org/10.11453/orltokyo.58.2_91
    JOURNAL FREE ACCESS
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    　Extranodal NK/T-cell lymphoma, nasal type (ENKL), is a disease that mainly develops in the nasal cavity and or pharynx. Patients with ENKL do not manifest specific symptoms and often present with nasal obstruction and/or nasal bleeding. Therefore, the disease is often difficult to diagnose in clinical practice.
    　We report two cases of ENKL that we encountered recentry. The first patient was a 45-year-old man who presented with nasal obstruction. His nasal septum was hard, and many scabs adherent to the nasal mucosa were observed. We performed some examinations for example, histological diagnosis, however, no abnormalities were found. We decided to follow up the patient. Eight months after his first visit to our hospital, his rhinostenosis was getting worse. A tumor was found in his nasal cavity at neighborhood medical clinical. Therefore, he was referred to our hospital again and diagnosed as having ENKL (clinical stage IE, NK-IPI group1). He was administered chemotherapy, his response to which was judged as CR.
    　The second patient was a 49-year-old woman. She presented with worsening nasal obstruction and nasal bleeding and was referred by a neighborhood clinic to our hospital for nasal surgery. Her nasal cavity looked normal at first glance, however, careful examination revealed that her nasal mucosa was slightly hardened and hemorrhagic. CT revealed evidence of sinusitis. ESS was performed and biopsy specimens were obtained from multiple sites of the nose. Based on the findings, the patient was diagnosed as having ENKL (clinical stage IE, NK-IPI group1). She received chemotherapy, and showed improvement (CR). However, 5 months later, her general condition deteriorated and she died soon thereafter. The complete remission rate in patients with localized ENKL is higher than 50%. However, advanced ENKL is associated with a poor prognosis.
    　Therefore, this disease must be diagnosed early and treated promptly.
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  • A CASE OF EPIDURAL ABSCESS DUE TO SPHENOID SINUSITIS WHO PRESENTED WITH UNCONSCIOUSNESS
    Kyoko Shirai, Koji Otsuka, Yasuo Ogawa, Sachie Kawaguchi, Nayuta Namio ...
    2015 Volume 58 Issue 2 Pages 99-105
    Published: April 15, 2015
    Released on J-STAGE: April 15, 2016
    DOIhttps://doi.org/10.11453/orltokyo.58.2_99
    JOURNAL FREE ACCESS
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    　Introduction: Although rhinogenic intracranial complications are rare because of the early diagnosis of sinusitis and widespread use of antibiotic treatment, they often become serious if left untreated. Herein, we report the case of a 75-year-old woman who presented with altered consciousness, and was diagnosed as having an intracranial epidural abscess and encephalitis secondary to isolated sphenoid sinusitis.
    　Case: She was admitted to the internal medicine department because of altered consciousness. On day 7 after the admission, endoscopic sinus surgery (ESS) was performed for the sphenoid sinusitis, which was the primary focus of infection, and pus escaped from the opening. The epidural abscess disappeared without brain surgery, however, 19 days later, encephalitis was diagnosed by brain MRI. Persistence of the impaired consciousness was considered to be because of the encephalitis secondary to the epidural abscess. Following treatment with antibiotics, the patient's conscious level gradually improved.
    　Discussion: Intracranial complications of sphenoid sinusitis can be treated by appropriate antibiotics and surgical drainage of the primary focus of infection. Isolated sphenoid sinusitis can progress silently to severe intracranial complications in the absence of the typical symptoms of sinusitis, because of the anatomical features of the sphenoid sinus. The diagnosis of intracranial complications requires a high index of suspicion and confirmation by imaging. Surgical treatment of the focus of infection in the sinuses should be performed at an early stage, when intracranial complications may be diagnosed.
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