Foreign bodies in the respiratory tract, diagnosed at otolaryngology outpatient clinics are, often easily removable. However, it is sometimes necessary to remove the foreign bodies under general anesthesia. We searched cases of foreign bodies in the field of otolaryngology that needed removal under general anesthesia. We found 1536 patients with foreign bodies in the external auditory canal, nasal cavity, pharynx and larynx registered over the past 10 years at our hospital, and in 13 of these cases, the foreign body was removed under general anesthesia. The 13 patients included 10 infant cases and 3 adult cases, and in all the infant cases, removal under general anesthesia was necessitated by the difficulty in removal because of infant movements; on the other hand, in all the adult cases, the foreign bodies were swallowed partial dentures. Sometimes, swallowed partial dentures pose serious problems. It is necessary to make judgments about the state of the denture, best method for removal, etc, before removal, because removal sometimes entails complications. In addition, there are often some risk factors, such as elderly age, presence of dementia, cerebral infarction, schizophrenia, etc. It is important for all medical staff and caregivers to consider these risk factors to prevent swallowing of denture.
Despite the advances in imaging examinations and antibiotic treatment, brain abscess is still encountered occasionally as one of the most life-threatening complications of otologic diseases. In children and elderly people, and patients with developmental disorders, the symptoms are sometimes non-specific, which can lead to delayed recognition and treatment. We report the case of a patient with developmental disorder who presented with a cerebellar abscess complicating cholesteatoma.
A 21-year-old man with developmental disorder was admitted to our hospital with a more than 2 weeks' history of fever, anorexia, consciousness disturbance and gait disturbance. Head computed tomography (CT) revealed abscess formation in the right cerebellum. Brain abscess drainage and decompression craniotomy were performed by neurosurgeons, and the patient was referred to us for identification of the underlying cause. The right ear was filled with purulent otorrhea, the tympanic membrane was cloudy, and white exudates were observed. CT examination of the middle ear revealed a soft-tissue density area filling the right tympanum and mastoid, extending to the middle cranial fossa and to the sigmoid sinus. These findings suggested that the cerebellar abscess was secondary to spread of infection from right middle ear cholesteatoma.
On the 10th day of hospitalization, right canal wall-down tympanoplasty was performed. Thereafter, treatment with antibiotics was initiated with improvement of the general condition of the patient by 9 months after the surgery.
We report a patient who was diagnosed as having IgG4-related disease after a surgery for chronic sinusitis.
A 66-year-old male patient presented to our hospital with nasal obstruction, left facial pain, and hyposmia. We found swelling of the nasal mucosa, purulent nasal discharge, and easy bleeding; based on these and the findings of CT, we diagnosed the patient as having chronic sinusitis. No improvement was observed with conservative management, therefore, we performed an operation. Very easy bleeding and significant swelling of the mucosa were seen. After surgery, much erosion and crusting were observed. During the follow-up, a plain x-ray of the chest revealed an abnormal opacity. Further investigations revealed a high serum level of IgG4 and taking these results into consideration with the findings of histopathological examination of the nasal mucosa, the patient was diagnosed as having IgG4-related disease. As the patient complained of ocular and oral dryness, he was started on treatment with oral prednisolone at the dose of 30mg/day, which has now been tapered to 15mg/day. Until now, about 20 months after the operation, the patient has shown no evidence of relapse.
Movie encoding conditions suitable for presentation were investigated. Short clips of the surgical scenes with rapid movement or only with slow movement were prepared from surgical videos from otologic microscopic surgeries and endoscopic sinus surgeries. Each clip was encoded at the 1,920×1,080 resolutions at 29.97 frames per second with the H.264 codec to various bit rates, and saved as MP4 movies. Subjective evaluation by projecting the encoded clips using a LCD projector showed that the encoding of 6Mbps was satisfactory for all clips, and 3Mbps was acceptable for clips of slow movements.