Nihon Jibiinkoka Gakkai Kaiho
· 2017 Mar · PMID 30010309
Patients with vocal fold adhesions usually undergo surgery under general anesthesia, because of the possibility of postoperative adhesions according to the severity and cause. However, it has been reported that patients...Patients with vocal fold adhesions usually undergo surgery under general anesthesia, because of the possibility of postoperative adhesions according to the severity and cause. However, it has been reported that patients with minor bridging adhesion can be treated by only discission without any postoperative adhesion. Herein, we report the case of a patient with idiopathic bridging vocal fold adhesions who was treated by ambulatory surgery at the ENT clinic and showed a benign course. A male former professional singer who was in his 70s presented with a history of cough followed by the development of bridging central vocal fold adhesion. On the 10th day after the initial visit, we performed discission of the adhesion under local anesthesia using a surgical knife for the vocal fold. Although a delicate surgical technique is desirable for phonosurgery, we were able to perform surgery under local anesthesia in this case, because the adhesion was minor. We consider that endoscopic laryngeal surgery under local anesthesia is useful for the treatment of patients with bridging adhesions.
Tada H, Matsuyama T, Kudo T
… +1 more, Chikamatsu K
Nihon Jibiinkoka Gakkai Kaiho
· 2017 Mar · PMID 30010306
Angioedema is characterized by rapid and severe swelling of the subcutaneous and submucosal tissues. Angioedema involving the upper airway can lead to life-threatening airway obstruction, and needs prompt diagnosis and t...Angioedema is characterized by rapid and severe swelling of the subcutaneous and submucosal tissues. Angioedema involving the upper airway can lead to life-threatening airway obstruction, and needs prompt diagnosis and treatment. Herein, we report a case of acute angioedema which was suspected as having been caused by estrogen imbalance. A 32-year-old woman who was taking a fertility drug for infertility treatment, presented with sudden swelling of the face and neck region and breathing difficulty. Her symptoms continued to progress despite antibiotic and corticosteroid administration. We suspected hereditary angioedema (HAE), and administered a C1-inactivator, which led to immediate and dramatic resolution of the symptoms. Since the C4 and C1-inhibitor levels were normal, the possibility of HAE type III was considered. However, another possibility was that her complicated hormonal condition, including oral intake of a fertility drug, menstruation, and mental stress may have led to estrogen imbalance causing angioedema. Currently, a variety of hormone therapies is widely used ; therefore, caution is needed against the development of estrogen-dependent angioedema.
Hara M, Yoshihama K, Komori M
… +2 more, Fujii K, Morimoto N
Nihon Jibiinkoka Gakkai Kaiho
· 2017 Mar · PMID 30010303
The periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is an autoinflammatory disease, characterized, as its name suggests, by periodic fever, aphthous stomatitis, pharyngitis, and c...The periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is an autoinflammatory disease, characterized, as its name suggests, by periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis. This syndrome is the most common cause of recurrent fever in children, however the rate of recognition of this syndrome is still low. Tonsillectomy has been suggested as an effective treatment, even though the precise, pathophysiology underlying this syndrome remains unknown. In this study, we investigated the outcomes in patients who underwent tonsillectomy. In particular, we examined the surgical outcomes and clinical features of the patients who underwent tonsillectomy. A total of 19 patients with PFAPA syndrome underwent tonsillectomy at our hospital from July 2013 to May 2016. Before the surgery, while all the patients had received medications, none showed complete resolution of the syndromes. However, of the 19 patients, 15 showed complete resolution of the syndrome immediately after the surgery. Four patients had fever even after the surgery. Three patients showed partial remission, with the frequency and duration of the episodes decreasing after the surgery. However, in one patient, the fever persisted as before the surgery. There were no significant differences in the clinical characteristics, such as the age at onset, fever episodes, associated symptoms, or age at surgery among the three groups. However, we observed a trend towards a higher frequency of a family history in patients with persistent symptoms after surgery. Tonsillectomy was highly effective against PFAPA syndrome, however, some patients failed to respond to the procedure. Therefore, it is important to carefully evaluate the risks and benefits in each case. The indications for tonsillectomy have not yet been clearly established. It is essential to continue further investigations to establish effective therapeutic strategies for this syndrome.
Wakaoka T, Mizuta K, Shibata H
… +9 more, Hayashi H, Nishihori T, Kuze B, Aoki M, Ando K, Onishi M, Tanahashi S, Shirato H, Ito Y
Nihon Jibiinkoka Gakkai Kaiho
· 2017 Mar · PMID 30010300
Small cell neuroendocrine carcinoma of the head and neck is a rarely occurring poorly differentiated and high-grade malignant neoplasm characterized by highly active proliferation of neuroendocrine tumor cells. There are...Small cell neuroendocrine carcinoma of the head and neck is a rarely occurring poorly differentiated and high-grade malignant neoplasm characterized by highly active proliferation of neuroendocrine tumor cells. There are no established therapies for this disease. To clarify the clinical course and develop effective treatment(s) for the carcinoma, we reviewed the data of 8 patients of small cell neuroendocrine carcinoma of the head and neck treated by us between 2006 and 2014 at the Department of Otolaryngology, Gifu University School of Medicine and our affiliated hospitals. The patients consisted of 3 men and 5 women, ranging in age from 38 to 84 years old (mean : 60.9 years). The tumor arose from the nasal cavity or the paranasal sinuses in 3 cases, from the parotid grand in 2 cases, from the oropharynx in 2 cases, and from the hypopharynx in 1 case. The tumor that arose from the hypopharynx was a combined small-cell carcinoma with squamous cell carcinomas, and the one that arose from the oropharynx had already metastasized to the brain. Most of the patients were treated by chemotherapy and radiotherapy based on the treatment employed for small cell carcinoma of the lung. Only the patient in whom the tumor arose from a paranasal sinus was treated by surgery despite the definitive diagnosis of small cell carcinoma. We selected CPT-11 and a platinum agent for 4 patients, and VP-16 and a platinum agent for 3 patients as the first-line chemotherapy. Although two patients showed carcinoma-free survival, one died of recurrence of the regional lymph node metastases and five died of distant metastases despite the absence of locoregional recurrence. The 5-year survival rate was a dismal 25%, suggesting that we need to establish effective treatment(s) for the control of distant metastases in cases of the small cell neuroendocrine carcinoma of the head and neck.
Kataoka Y, Sugaya A, Maeda Y
… +4 more, Kariya S, Omichi R, Fukushima K, Nishizaki K
Nihon Jibiinkoka Gakkai Kaiho
· 2017 Feb · PMID 30035268
Since April 2012, genetic testing for congenital hearing loss is covered by the public health insurance in Japan. Recent (since August 2015) developments in next-generation sequencing technology have enabled the detectio...Since April 2012, genetic testing for congenital hearing loss is covered by the public health insurance in Japan. Recent (since August 2015) developments in next-generation sequencing technology have enabled the detection of 154 mutations in 19 genes. Genetic testing provides valuable information on hearing phenotype, prognosis, and prediction of associated symptoms. We report a hearing-impaired patient in whom multiple genetic mutations were detected. This patient carries two missense mutations in GJB2 (p.G45E, p.Y136X), as well as a mitochondrial mutation (7445A>G). Since the number of genes detectable by genetic testing has increased, the diagnosis of hearing loss can be made with greater accuracy. However, it is often difficult to clinically understand and interpret the genotype information, especially when multiple gene variants are detected in one patient or family. Genetic counseling plays an important part in the intervention for or follow-up of such patients. Genotypic and phenotypic information of other family members is necessary, so that both the patient and the family can understand and accept the results of genetic testing.
Akiyama K, Yonezaki M, Dobashi H
… +3 more, Kameda T, Hoshikawa H, Kadowaki N
Nihon Jibiinkoka Gakkai Kaiho
· 2017 Feb · PMID 30033930
Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis in patients with bronchial asthma and eosinophilic rhinosinusitis. Serum IgG4 levels are markedly elevated in patients with active EGPA, a dis...Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis in patients with bronchial asthma and eosinophilic rhinosinusitis. Serum IgG4 levels are markedly elevated in patients with active EGPA, a disease which has been closely associated with IgG4-related disease (IgG4RD). A 68-year-old male with a history of asthma and eosinophilic rhinosinusitis developed vasculitis and orbital symptoms. The results of a laboratory examination showed eosinophilia (4,067/μl; 39%), while image evaluations revealed hypertrophy of the rectus muscles, trigeminal nerve, lachrymal gland, and bilateral submandibular glands. Biopsy of the paranasal sinus showed the prominent infiltration of eosinophils and IgG4-positive plasma cells. The patient was diagnosed with EGPA concomitant with IgG4RD and treated with systemic steroids. Although concomitant cases of EGPA with IgG4RD are extremely rare, clinical manifestations associated with both diseases are sometimes mixed. Therefore, systemic scrutiny may be required for cases of EGPA with high serum IgG4 levels and pathognomonic symptoms or findings of IgG4RD
Yoshida T, Yamamoto M, Tanaka T
… +2 more, Ikemiyagi F, Suzuki M
Nihon Jibiinkoka Gakkai Kaiho
· 2017 Feb · PMID 30033714
The psychogenic vertigo has been diagnosed based on subjective dizzy symptom without abnormal findings of oculomotor tests and vestibular tests. We investigated the characteristics of the postural control system in patie...The psychogenic vertigo has been diagnosed based on subjective dizzy symptom without abnormal findings of oculomotor tests and vestibular tests. We investigated the characteristics of the postural control system in patients with psychogenic vertigo using stabilometry and Body Tracking Tests with a visual feedback test to assess the dynamic body balance. This study consisted of 14 patients with psychogenic vertigo and 92 aged-match healthy subjects. They were instructed to keep the center of pressure constantly in the target circle displayed on the screen in front of the subjects. The dynamic body balance was evaluated by the proportion of the center of pressure (COP) including in the target circle during the test. The psychogenic vertigo group showed a larger area and a smaller locus length per unit area in comparison with the healthy subject group (p<0.01). In spectral analysis with the maximum entropy method (MEM), the power of the medio-lateral and antero-posterior positional power spectrum under eyes open condition were significantly largest at around 0.125 Hz in the psychogenic vertigo group. No significant difference in the result of Body Tracking Tests with a visual feedback test was found between both groups. Our results suggest that the patients with psychogenic vertigo maintain body balance with extremely slowly and large movements for quiet stance during eyes open condition. The results of Body Tracking Tests with a visual feedback test may indicate that the spontaneous postural control itself in patients with psychogenic vertigo does not differ from that in healthy individuals. We believe that this test could be useful as one of the significant diagnostic tests for psychogenic vertigo.
Yuta A, Ogawa Y, Suzuki Y
… +4 more, Arikata M, Kozaki H, Shimizu T, Ohta N
Nihon Jibiinkoka Gakkai Kaiho
· 2017 Jan · PMID 30035467
Sublingual immunotherapy (SLIT) is thought to have enhanced efficacy in the second year of treatment. We studied treatment efficacy in both the first and the second years of treatment (2015 and 2016, respectively) in pat...Sublingual immunotherapy (SLIT) is thought to have enhanced efficacy in the second year of treatment. We studied treatment efficacy in both the first and the second years of treatment (2015 and 2016, respectively) in patients who began SLIT in 2014. Methods: We compared 132 patients who underwent SLIT (age, 41.8 ± 17.5 years; male-to-female ratio, 75: 57) and a control group of 56 patients who underwent primary pharmacotherapy (age, 44.9 ± 13.5 years; male-to-female ratio, 25: 31). The study was performed during the peak pollen seasons of 2015 and 2016. Pollen dispersal was similar in 2015 and 2016 (2,509 grains/cm2 and 3,505 grains/cm2, respectively). The clinical efficacy of SLIT was evaluated by assessing nasal and eye symptoms and total symptoms with symptom scores and combined symptom-medication scores, visual analog scale scores, and quality of life (QOL) scores according to the Japanese rhino-conjunctivitis QOL questionnaire (JRQLQ No. 1). QOL was also evaluated with JRQLQ No. 1. The first endpoint was enhanced efficacy of SLIT in the second year compared with that in the first year. Results: With respect to nasal and eye symptoms, the assessments in the primary pharmacotherapy group were unchanged in the second year; however, most of these assessments in the SLIT group demonstrated significantly enhanced efficacy of SLIT in the second year. In QOL of SLIT, only 2 of 17 showed significantly enhanced efficacy of SLIT in the second year. Conclusion: SLIT shows enhanced efficacy in the second year.