Acute otitis media is one of most common diseases in otolaryngology clinic. We retrospectively reviewed cases of inner ear disorders caused by acute otitis. This included 12 ears of 11 patients who had acute otitis media with an elevated bone conduction hearing threshold. All patients were hospitalized between April 2008 and June 2014. The median age was 35.5 years, with a range of 13 to 63. We divided hearing prognosis into complete recovery, marked improvement, improvement, and no recovery. The patients complained of otalgia, hearing loss, and headache. They were treated with ear drum incision, antibiotic therapy, and steroids intravenous injection. Hearing prognosis was not correlated with days from the onset or those of ear drum incision. Three cases had vertigo and 6 cases had nystagmus. Most of these patients showed elevated hearing threshold. The treatment results were complete recovery in 8, improvement in 3 and no recovery in one case. The overall hearing improvement rate was 72.7%. All of the cases with poor hearing prognosis had nystagmus. It was suggested that the presence of nystagmus resulted in a poor hearing prognosis. We recommended early hearing test including bone conduction threshold for patients who had complained of vertigo, tinnitus and severe hearing loss. We should be aware of an elevated bone conduction threshold associated with acute otitis media.
Between January 2007 and April 2013, tympanoplasty for chronic otitis media in children was performed in 65 ears at Kansai Electric Power Hospital and Osaka Red Cross Hospital, and postoperative tympanic membrane perforation was successfully closed in 53 ears (81.5%). This percentage was significantly lower than that in adult cases. In some cases of postoperative perforation, the transplanted temporal fascia showed- engraftment, and then perforation develops during the clinical course. There are various factors that could possibly be responsible for this re-perforation. We histologically examined the strength of the temporal fascia as a material for myringoplasty. Necrotic tissue and inflammatory cell infiltration were observed in some parts. It was considered that the weak temporal fascia in children might be responsible for postoperative tympanic membrane re-perforation.
Cartilage has been popular for treating tympanoplasty in Europe, particularly in Germany. However, use of this material has been uncommon among Japanese surgeons. In our department, 41 cases with adhesive otitis media were treated using palisade cartilage tympanoplasty between 2006 and 2011, and 48 cases were treated by tympanoplasty using one plate of thinly sliced cartilage between 2009 and 2012. In this study, we compared surgical results between these techniques. Postoperative hearing success rate was 61% in the palisade group and 67% in the thinly sliced group, according to the 2010 criteria of the Japan Otology Society. In the palisade group, postoperative air-bone gap was 11–20 dB in 18 cases (50%), 21–30 dB in 12 cases (33%), and >30 dB in 6 cases (17%). In the thinly sliced cartilage group, postoperative air-bone gap was 10 dB in 8 cases (18%), 11–20 dB in 14 cases (32%), 21–30 dB was in 16 cases (37%), and >30 dB in 5 cases (12%). These rates did not significantly differ between the two techniques. Successful hearing results were obtained in 6 cases (86%) of type I, 10 cases (59%) of modified type III, and 6 cases (50%) modified type IV in the palisade group. In the thinly sliced cartilage group, successful hearing results were obtained in 6 cases (67%) of type I, 12 cases (60%) of modified type III, and 11 cases (79%) of modified type IV. Hearing improvement after surgery was not related to the ossicular reconstruction. Total number of reoperations during follow-up was 1 case (4%) for the palisade group and 4 cases (11%) for thinly sliced cartilage group (Kaplan-Meier method). This rate did not differ significantly between techniques. These results suggest that cartilage tympanoplasty for adhesive otitis media is superior to other surgical techniques despite the different surgical procedure.
The purpose of this study was to evaluate the postoperative outcome after tympanoplasty using a survival analysis method, and also to identify prognostic factors which influence the clinical results, using a multivariate Cox proportional hazards regression analysis based on the above survival analysis. This study was performed on 246 cases of pars flaccida cholesteatoma which were treated with canal wall reconstructed tympanoplasty type IIIi-M and type IIIc from 1991 to 2012. The follow-up period of all the subject patients was more than one-year and the median follow-up period was 4.5 years. The disease-free successful cases were defined as the cases in which patients did not undergo either re-operation with recurrent and residual cholesteatoma nor revision operation due to other problems, and maintained good hearing outcome. Based on the criteria set by the Japan Otological Society (2010), the cases that satisfied the following are evaluated as good hearing results; (a) a successful case in which preoperative bone conduction was used, and (b) a case in which the postoperative air-bone gap was within 20dB after tympanoplasty for chronic otitis media. The results of survival analysis were shown for each of (a) and (b). The results are as follows: 1. The five-year survival rate of successful case was (a) 80.3% and (b) 83.4%, and the 10-year survival rate was (a) 64.7% and (b) 72.9%. Furthermore, the 5-year recurrence rate of cholesteatoma was 5.2%, and its 10-year rate and 15-year rates were 8.2% and 15.6% respectively. And also, about the residual recurrence rate of cholesteatoma, 5-year rate was 1%, 10-year rate was 5.3%, and 15-year rate was 9.2%. 2. Results of the Cox proportional hazards regression analysis have revealed that “middle ear effusion” “atelectatic ear” and “otorrhea as of surgery” were significant unfavorable factors for the recurrence of cholesteatoma. Moreover, “wide localization of cholesteatoma in middle ear” was also recognized as a significant prognostic factor for the residual recurrence of cholesteatoma.
We evaluated improvement of pneumatization using temporal bone computed tomography (CT) in the chronic otitis media cholesteatoma cases which were firstly treated by canal wall up tympanoplasty (CWU) and evaluated correlation among pneumatization-associated factors such as formation of pneumatic space, improvement of hearing acuity, and recurrence. The present study includes total 82 ears. Ages of the subjectss are between 4 and 74 years old. Pneumatization was assessed and classified into 4 groups (no pneumatization = 0; pneumatization to middle tympanic cavity = 1; pneumatization to upper tympanic cavity = 2; and pneumatization to mastoid antrum = 3) as previously described in Kakizaki, et al. (2007). Besides, the subjects were classified into 3 groups by their ages (15 or under; 16 to 35; and 36 and more). The subjects of 15 aged or under showed significantly improved pneumatization. The subjects with pneumatization to mastoid antrum showed significantly improved hearing acuities. Thus, our result suggests that the mucosa of tympanic cavity, which mediates conduction, is almost fully restored in the cases with pneumatization to mastoid antrum, which resulted in the significantly improved hearing acuities.
Disruption of the ossicular chain by ear pick injury is a cause of conductive or mixed hearing loss. We report two cases treated surgically 25 years or more after such long-standing ear pick injury. Both patients had previously complained of symptoms other than hearing loss, and eventually consulted us with complaints of hearing disturbances and tinnitus. Review of their medical histories suggested disruption of the ossicular chain by ear pick injury. The situation of ear pick injury in both patients was considered by the presence of an eardrum scar and ossicular chain lesion. A lesion in the stapes was present in Case 1 but not in Case 2. Both cases exhibited a positive stapedial reflex. A review of 38 previously published cases revealed that those treated surgically within one month of injury were frequently associated with vestibular disturbances, and more likely to exhibit perilymphatic fistula. Most cases had lesions of the stapes (70%) and 6 cases (22%) did not exhibit any other ossicular lesions.
We reported a rare case of an aberrant internal carotid artery running in the tympanic cavity. The patient was a 59-year-old female with otitis media effusion. Her chief complaint was bilateral fullness of ear. During myringotomy of the right ear, a profuse aural bleeding occurred. The bleeding was controlled by packing tightly with tampons. A CT scan revealed the aberrant internal carotid artery in the tympanic cavity. In the case of a massive bleeding during the ear treatment, we should pack tightly to stop bleeding without flustered.
The characteristic symptoms of tuberculous otitis media (TOM) are refractory otorrhea and hearing loss. However, these symptoms are nonspecific manifestations with respect to other diseases such as nonspecific chronic otitis media, cholesteatoma. Therefore, the diagnosis of TOM is not simple, and is typically delayed. But, an early diagnosis and treatment of TOM can prevent complications such as facial paralysis or irreversible hearing loss. The diagnosis of TOM is made if a specimen from the middle ear reveals the presence of acid fast bacilli, grows Mycobacterium tuberculosis (M.Tb) on a culture, and/or is positive for polymerase chain reaction for M.Tb. However false-negative reactions can occur with these tuberculin tests. Until recently, the tuberculin skin test was the only test for detecting latent tuberculosis infection. In response, Interferon-Gamma Release Assays (IGRAs) have been developed. 2 tests are included in IGRAs, one is the QuantiFERON (QFT)-TB-2G and the other test is the T-SPOT.TB. The tuberculin skin test uses a relatively crude mix of antigen from M.Tb, so false-positive reactions or false-negative reactions can occur with tuberculin tests. But both IGRAs use more specific M.Tb antigens - ESAT-6 and CFP-10. Therefore, the specificity of IGRAs is higher than the tuberculin skin test. Of course, IGRAs cannot distinguish an active infection from a latent infection. However, if the result of IGRAs is positive, we can perform tests for M.Tb promptly.
Children with not only severe, but mild to moderate hearing loss, require a hearing aid. However, there has been no nationwide welfare system. Early intervention, including fitting hearing aids should be performed in children with mild to moderate hearing loss to learn language and to develop communication skills. From September 2013, a subsidy system for hearing aid purchase for children with mild to moderate hearing loss was introduced in Tokyo. Twenty-seven children have applied for this system in our hospital in Tokyo. Sixteen children were newly fitted with hearing aids and eleven children replaced old ones. Before this system started, hearing aids had to be purchased at the parent's expense. Therefore economic problems were one of the reasons that some children could not have a hearing aid. Using this subsidy, eight children were able to receive financial aid and started using hearing aids. This was a long-awaited support for children and their families. In children with mild to moderate hearing loss and their families, sometimes the problems caused by hearing loss and the need for a hearing aid are difficult to understand. Therefore, the interval from diagnosis to fitting with a hearing aid tends to be longer than that for cases of severe hearing loss. However, after this system began, this interval has become shorter. This subsidy system is effective, thus we need to develop it further.
A retrospective five years' review was conducted in 71 patients (110 impaired hearing ears and 23 patients with vertigo) who considered to have steroid unresponsive autoimmune inner ear disease (AIED) and all patients were positive for antibody for a 68kDa bovine inner ear antigen. Pure tone average (PTA), speech discrimination score (SDS) and the maximal slow phase velocity of the caloric nystagmus (Max. spv) were used as objective measure of outcome. The patients were treated with cyclophosphamide (CPM). At the end of study, 37 of 110 impaired ears (34%) improved, 62 ears (56%) stabilized and 11 ears (10%) worsened in PTA. Recurrence hearing loss was seen in 50 patients (79 impaired ears). PTA of the patients demonstrated with those normal recoveries and marked recovery was significantly low level as compared with those patients who resulted in better, stable and worsened hearing. The SDS of the patients with positive response to therapy was significantly high as compared with those of unresponsive to therapy. Patients with rotatory vertigo and floating vertigo were significantly recovered. 15 out of 17 patients with vertigo showed bilateral impairment of vestibular function whose Max. spv before CPM therapy were bilaterally under 20°/sec. Max. spv of post CPM therapy significantly improved as compared with those of pre CPM therapy. In conclusion, intermittent low dose of CPM therapy for five years to patients with steroid unresponsive AIED maintained the same improvement with the result of previous study and showed significant improvement in Max. spv, though 50 patients (79 impaired ears) had reacted in five years.
We studied 169 inpatients (65 male and 104 female) with vertigo and/or dizziness in Joetsu General Hospital from October 2009 to March 2013. The age distribution showed a peak in the sixties. The most frequent diagnosis was vestibular neuritis (34%), followed by Meniere's disease (17%), sudden deafness (9%), and benign paroxysmal positional vertigo (5%). There were three cases (2%) of brainstem/cerebellar infarction. The average length of hospitalization was 9.05±8.07 days. Positive findings in simple examination, such as spontaneous/ gazed/positional nystagmus, head -shaking nystagmus, head impulse test, were seen in 78.7% of patients. Among the 54 cases with spontaneous nystagmus, the average length of hospitalization was shorter in patients with negative head impulse test than in those with positive head impulse test.
Since the fall of 2004, I have had the good fortune to study abroad in 3 European countries and the United States. During 1 year and 3 months, I could learn various acoustic neuroma surgeries. In the first visit Marseille University, I met Professor Jacques Magnan who becomes my former teacher of my life. The big reason why I pursued a career as a lateral skull base surgeon is because I thought “I must somehow return the favor to him.” I returned to Japan with a specific goal in mind and then tried to put into practice what I have learned, but I came up against numerous hurdles. I have been trodden a thorny path in these 10 years, however, with a lot of collaboration from domestic and foreign leaders and colleagues, I could continue working up to the present day. It is nothing special to become a lateral skull base surgeon. However, you need to make efforts to learn various knowledge and skill. Also you need strong determination further. Lateral skull base surgery is boundary domain between otology and neurosurgery, from now on, a team surgery by both sides must become mainstream. A future theme will be “hearing regaining (regeneration)”, so there is no doubt that the importance of existence of otologists and otoneurosurgeons will increase.