Tachibana T, Orita Y, Makino T
… +6 more, Ogawara Y, Matsuyama Y, Shimizu A, Nakada M, Marunaka H, Nishizaki K
Nihon Jibiinkoka Gakkai Kaiho
· 2016 Jun · PMID 30010279
Vocal process granulomas are mainly associated with vocal abuse, gastroesophageal reflux disease (GERD), or endotracheal intubation. In the present study, we evaluate the prognostic factors and the usefulness of a gradin...Vocal process granulomas are mainly associated with vocal abuse, gastroesophageal reflux disease (GERD), or endotracheal intubation. In the present study, we evaluate the prognostic factors and the usefulness of a grading system in 64 patients with vocal process granulomas. We classified the granuloma which limited the vocal process of the arytenoid cartilage as grade I, and which originated from the vocal process but extended beyond the vocal process of the arytenoid cartilage as grade II, according to the grading system proposed by Wang CP, et al. First, we treated this disease with conservative treatments including a proton pump inhibitor, steroid inhalation, or voice therapy. Surgical treatment was reserved for failures of conservative treatments or when the diagnosis was in doubt. The overall post-surgical recurrence rate was 65.7%, and it was significantly higher in male than female patients, and in younger than older patients. The overall remission rate was 79.7%. A multivariate analysis revealed that Grade II was a significantly poor prognostic factor and the patients with BMI ≥23 or Age <60 had a tendency to have a poor remission rate. The grading system is useful for anticipating the prognosis in cases of vocal process granuloma.
The usefulness of the micro CT scanner system SKYSCAN1176 was evaluated for the study of the guinea pig cochlea. Each slice of the section was 9 μm and we were able to identify each ossicles, modiolus, upper, middle, and...The usefulness of the micro CT scanner system SKYSCAN1176 was evaluated for the study of the guinea pig cochlea. Each slice of the section was 9 μm and we were able to identify each ossicles, modiolus, upper, middle, and basal turn of the cochlea. This scanner enables us to observe inner ear structure repeatedly in vivo.
We retrospectively analyzed 54 patients who died of head and neck squamous cell caricinoma regarding the process and duration of cachexia using the modified Glasgow Prognostic Score (mGPS). The patients were classified a...We retrospectively analyzed 54 patients who died of head and neck squamous cell caricinoma regarding the process and duration of cachexia using the modified Glasgow Prognostic Score (mGPS). The patients were classified as having cachexia when the serum albumin level was less than 3.5 mg/dL and the C-reactive protein (CRP) level was more than 0.5 mg/dL. The number of patients with cachexia was eight (8%) at the first visit and 50 (93%) at the time of death. In the 50 patients, the median and average time of having cachexia was 59 and 95 days, respectively. Thirty-two of the 50 patients (64%) died within three months after the presence of cachexia was confirmed. In this study, the time of having cachexia was so short, then the policy of care should be converted from aggressive into supportive in patients classified as having cachexia. mGPS would be an accurate assessment tool for cachexia and ascertain the end stage of head and neck cancer patients.
In recent years, human papillomavirus (HPV)-positive oropharyngeal carcinomas have been increasing. The first manifestation of these tumors is frequently as cystic metastasis to cervical lymph nodes that may precede reco...In recent years, human papillomavirus (HPV)-positive oropharyngeal carcinomas have been increasing. The first manifestation of these tumors is frequently as cystic metastasis to cervical lymph nodes that may precede recognition of the primary tumor, so, they often result in misdiagnosis as branchial cleft cysts. We report a case of cystic cervical lymph node metastasis of HPV-positive tonsil cancer. The patient was a 70-years-old man who noticed a mass on his left neck. The tumor was large and soft, and it was diagnosed as benign in fine-needle aspiration cytology. We diagnosed the tumor as a branchial cleft cyst and undertook surgery. The histopathological diagnosis was squamous cell carcinoma arising from a branchiogenic cyst. However, because it did not satisfy the diagnostic criteria, we diagnosed the tumor as an unknown primary tumor. One year later, left tonsil cancer was suspected based on PET-CT imaging and a left tonsillectomy was undertaken, whereafter tonsil cancer was found. In p16 immunostaining, it was positive in both cystic mass and tonsil. The cervical mass was cystic lymph node metastasis of HPV-positive tonsil cancer. It is important to investigate the oropharynx, when we found cystic cervical mass, because HPV-positive oropharyngeal carcinoma frequently results in cystic neck metastasis.
Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitides (AAVs) include microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA), the inc...Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitides (AAVs) include microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA), the incidences of which are reported to be increasing in Japan. We reviewed the clinical records of 20 cases with systemic AAVs (five cases with MPA, nine cases with GPA, and six cases with EGPA), who visited our otolaryngology department with otological symptoms from 2004 to 2014, and compared the otological characteristics among the diseases. Otologic symptoms appeared as an initial symptom(s) in 40% of MPA cases, 56% of GPA cases, and 83% of EGPA cases. GPA and EGPA cases showed a variety of symptoms such as otalgia, otorrhea, hearing loss, ear fullness, tinnitus and dizziness, while MPA cases showed only hearing loss and ear fullness, but otalgia or otorrhea. AAVs and otitis media associated with ANCA vasculitis (OMAAV) are usually diagnosed shortly after the appearance of otological symptoms in GPA cases, while the final diagnosis is delayed in EGPA cases. Furthermore, the diagnosis of OMAAV was made after the diagnosis of AAV in most cases of EGPA. More than half of MPA cases did not meet the diagnostic. criteria for OMAAV. It is noteworthy that in a significant number of AAV patients with ear disease, otological symptoms are supposed to appear as an initial symptom(s). Therefore, otolaryngologists have a major role to achieve early diagnosis of AAV. The patients with adult-onset inflammation of the middle ear, inner ear or both should undergo careful examinations, and they should be closely followed even if the diagnosis is uncertain.
Middle ear implants (MEIs) such as the Vibrant Soundbridge (VSB) are attractive and alternative treatments for patients with conductive, sensorineural, and mixed hearing loss who do not benefit from, or who choose not to...Middle ear implants (MEIs) such as the Vibrant Soundbridge (VSB) are attractive and alternative treatments for patients with conductive, sensorineural, and mixed hearing loss who do not benefit from, or who choose not to wear, conventional hearing aids (HAs). Recent studies suggest that MEIs can provide better improvements in functional gain, speech perception, and quality of life than HAs, although there are certain risks associated with the surgery which should be taken into consideration, including facial nerve or chorda tympanic nerve damage, dysfunctions of the middle and inner ears, and future device failure/explantation. In Japan, a multi-center clinical trial of VSB was conducted between 2011-2014. A round window vibroplasty via the transmastoid approach was adopted in the protocol. The bony lip overhanging the round window membrane (RWM) was extensively but very carefully drilled to introduce the Floating Mass Transducer (FMT). Perichondrium sheets were used to stabilize the FMT onto the RWM. According to the audiological criteria, the upper limit of bone conduction should be 45 dB, 50 dB, and 65 dB from 500 Hz to 4, 000 Hz. Twenty-five patients underwent the surgery so far at 13 different medical centers. The age at the surgery was between 26-79 years old, and there were 15 males and 10 females. The cause of conductive or mixed hearing loss was middle ear diseases in 23 cases and congenital aural atresia in two cases. The data concerning on the effectiveness and safety of VSB was collected before the surgery and 20 weeks after the surgery. Significant improvements of free-field Pure Tone Audiogram (PTA) from 250 Hz to 8, 000 Hz were confirmed (p < 0.001). Hearing gain up to 40 dB was achieved in the 1, 000 Hz to 4, 000 Hz range. No deterioration in either air conduction or bone conduction at PTA was noted at 20 weeks after the surgery. Monosyllable speech perception in both quiet and noisy conditions improved significantly (p < 0.001). The speech discrimination score in both quiet and noisy conditions improved significantly too (p < 0.001). In the future, it is likely that there will be an increasing population even in Japan that will meet the criteria for MEIs such as VSB. However, the long-term efficacy and safety of these devices should be established.
In 2009, we introduced percutaneous dilational tracheotomy (PDT) in otolaryngology residency training. PDT was performed in 21 cases and five residents had an opportunity to learn PDT. No major complications occurred. De...In 2009, we introduced percutaneous dilational tracheotomy (PDT) in otolaryngology residency training. PDT was performed in 21 cases and five residents had an opportunity to learn PDT. No major complications occurred. Decannulation was achieved in 17 of the 18 cases, excluding 3 mortalities. All residents felt that their knowledge of PDT had advanced. Introduction of PDT has great significance in otolaryngology residency training.
Herein, we report a case of drug-induced Stevens Johnson syndrome. (SJS). A 56-year old female visited our hospital complaining of right cheek pain. Local examination revealed that the right ostium of the maxillary sinus...Herein, we report a case of drug-induced Stevens Johnson syndrome. (SJS). A 56-year old female visited our hospital complaining of right cheek pain. Local examination revealed that the right ostium of the maxillary sinus was open and that the maxillary sinus mucosa was invaded by tumor. Biopsy revealed a histopathological diagnosis of squamous cell carcinoma. We therefore diagnosed the patient as a case of maxillary sinus carcinoma (T3N0M0) based on the CT, MRI and FDG-PET findings. During chemoradiotherapy for maxillary sinus cancer, the patient developed oral mucosal inflammation of progressively worsening severity; we initially thought that the symptom was a side effect of the treatment; however, several days later, skin lesions appeared throughout the body. We consulted a dermatologist, who suspected SJS. The patient was initiated on high-dose steroid therapy (steroid pulse therapy), and the symptoms improved. Because of SJS is a fatal drug eruption, early diagnosis and prompt treatment are important. In patients receiving chemoradiotherapy showing severe oral mucosal inflammation outside the irradiation area or oral mucosal inflammation associated with skin lesions throughout the body, it is necessary to bear in mind the possibility of SJS.
UNLABELLED: Sublingual immunotherapy (SLIT) for Japanese cedar pollinosis is effective, however, caution must be exercised against allergen-specific adverse events (AEs) during SLIT. PURPOSE: The purpose of this study wa...UNLABELLED: Sublingual immunotherapy (SLIT) for Japanese cedar pollinosis is effective, however, caution must be exercised against allergen-specific adverse events (AEs) during SLIT. PURPOSE: The purpose of this study was to clarify the AEs of SLIT in a large cohort of patients with Japanese cedar pollinosis. METHODS: We conducted a detailed survey, by both questionnaires and direct interviews, of 207 patients receiving SLIT at our clinic. RESULTS: Eighty-four of the 207 patients (40.5%) developed AEs, with AEs involving the oral cavity and throat being the most common (56 patients; 27.1%). Sixteen patients (7.9%) had local mucosal swelling, but the swelling resolved in all the cases. Other allergen-induced symptoms such as nasal symptoms (29 events, 14.0%), eye symptoms (14 events, 6.8%) and ear symptoms (20 events, 9.7%) were also recognized. All the AEs were minor, and discontinuation of SLIT was not necessitated in any of the patients because of AEs. There were 52 AEs (25.0%) in the up-dose phase and 61 AEs (29.3%) in the maintenance phase. However, only 4 of the 161 patients (2.5%) developed AEs during the pollen season. Most AEs developing during the maintenance phase occurred in the first few weeks. In 60% of the cases, the AEs disappeared within 2 weeks, and in 6.0% (5 events), they persisted for longer than 2 months. There were no age-or sex-related differences in the prevalence of cedar pollen-specific IgE, or in the adherence to the treatment. CONCLUSION: AEs in SLIT were shown in many patients, however, the severity of AEs was mild and no events interfered SLIT.
The Ministry of Health, Labour and Welfare, while defining a significant reduction of the medical fee points for gastrostomy in the medical fee revision of fiscal year 2014, assigned additional fee points for evaluation...The Ministry of Health, Labour and Welfare, while defining a significant reduction of the medical fee points for gastrostomy in the medical fee revision of fiscal year 2014, assigned additional fee points for evaluation of the swallowing function by videofluoroscopy (VF) or videoendoscopy (VE) prior to gastrostomy. In addition, for facilities that carried out more than 50 gastrostomy operations, evaluation of the swallowing function was made mandatory in all cases and 35% of oral ingestion recovery rate to require the full amount calculation. Therefore, we evaluated the data on swallowing function evaluation in patients and gastrostomy at our hospital. During a 3-year period from February 2012, 114 patients who underwent gastrostomy at our hospital were enrolled. We evaluated the background disease, indications for gastrostomy, conduct/non-conduct of swallowing function tests prior to gastrostomy, videoendoscopic score (VE score), and the functional oral intake score before and after gastrostomy in the patients. The predominant background diseases were cerebrovascular disease (33%), Parkinson's syndrome (26%), and Alzheimer's disease (11%). The indications for gastrostomy were dysphagia (38%), request for gastrostomy from other hospitals or nursing care home (24%), and malnutrition due to anorexia (18%). The severity of the dysfunction was classified based on the VE score as mild (28%), moderate (47%), or severe (25%). Dysphagia did not reach the majority of reasons for gastrostomy and not few of background diseases were progressive neurological diseases such as Parkinson's disease. Therefore, it remains under debate whether it is necessary to perform swallowing functional evaluation by VE or VF in all cases prior to gastrostomy. In some cases in which gastrostomy was indicated, the VE scores were not so high. Therefore, a comprehensive evaluation based on the pathophysiology and social background is needed to judge the indication for gastrostomy. Leading support and participation in the calculation of additional fee points for the evaluation of swallowing function is an urgent issue for otolaryngologists.