Language：Japanese   Publisher：The Society of Practical Otolaryngology  

DOI： 10.5631/jibirin.115.650

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1411202792

Language：Japanese   Publisher：(株)医学書院  

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1411202596

Publisher：(株)医学書院  

突発性難聴の治療に際して、高気圧酸素治療(HBOT)を施行しなかった症例(以下、ステロイド療法群)と、ステロイド療法とHBOTを併用した症例(以下、併用療法群)と比較し、HBOTのステロイド療法への上乗せ効果について検討した。ステロイド療法群は35例(男性16例、女性19例、平均54.2±2.9歳)、併用療法群は67例(男性35例、女性32例、平均53.4±1.8歳)であった。両群間の男女比、平均年齢、治療開始までの日数、めまいの有無、糖尿病の有無に有意差を認めなかった。併用療法群は有意に重症例が多かった。また治療前の聴力は、125Hz、250Hz、500Hzでは有意差を認めなかったが、1000Hz以上では併用療法群において難聴が有意に高度であった。以上から、すべてのGradeを含めた全体像での両群間の検討は行わないこととし、一定数の症例のあるGrade 3、4を比較検討した。両群間の治療効果をMann-Whitney's U検定を用いて検討すると、Grade 3では、統計学的に有意差を認めないが、周波数に関しては8000Hzのみ併用療法群が有意に聴力改善を認めた。Grade 4において、両群間の治療効果は統計学的に有意差を認めず、またいずれの周波数においても聴力改善に有意差は認めなかった。

DOI： 10.1016/j.anl.2020.06.008

PubMed

DOI： 10.1080/20002297.2020.1808425

PubMed

Publisher：日本口腔・咽頭科学会  

びまん性大細胞型B細胞リンパ腫を合併した耳下腺Warthin腫瘍の1例を経験したので若干の文献的考察を踏まえて報告する。症例は80歳代男性。受診の約2ヵ月前から右耳前部腫脹と疼痛を自覚し、次第に増大傾向を認めた。造影CT検査では、淡く均一に造影される腫瘤性病変を耳下腺に認めた。PET/CT検査では、最大SUV値28.9の異常集積を耳下腺に認めた。一度目の生検では、Warthin腫瘍と診断された。しかし生検部位と異なる耳下腺上方が急速に増大するため、後日再度生検術を施行した。免疫染色では異型細胞はCD20、CD25、CD79aに陽性であり、びまん性大細胞型B細胞リンパ腫(Diffuse large B-cell lymphoma:以下DLBCL)と診断された。以上よりワルチン腫瘍とDLBCLの合併と診断した。(著者抄録)

Language：English  

DOI： 10.1016/j.anl.2019.03.008

PubMed

Publisher：(NPO)日本頭頸部外科学会  

2007年1月から2017年9月までの間に当科を受診した急性副鼻腔炎あるいは嚢胞を原因とする鼻性眼窩内合併症20例の臨床的特徴について原因疾患別に比較検討を行った。急性副鼻腔炎例では、視力障害出現から48時間以上経過したものは視力予後が不良であった。嚢胞例の多くは術後性の後部篩骨洞嚢胞であった。視力障害出現から48時間経過しても視力は比較的保たれている症例が多かった。一方で、急速に視力障害が進行する症例があり、その視力予後は不良であった。嚢胞例の多くが診断までに時間を要しており、歯齦切開による経上顎洞法副鼻腔手術歴のある症例で視力障害を認めた場合には、後部篩骨洞嚢胞の存在を疑うことが肝要と思われる。(著者抄録)

Publisher：JAPAN SOCIETY FOR HEAD AND NECK SURGERY  

We treated 20 patients with acute sinusitis or paranasal cysts accompanied by orbital complications between January 2007 and September 2017. This retrospective study of these patients analyzed age, sex, location of sinus lesions, visual disturbance, and the relationship between the outcome and the interval between the onset of the visual disorder and the surgical procedure. Visual outcomes were poor for patients with sinusitis when the interval between the onset of the visual disturbance and surgery was＞48 hours. On the other hand, visual disturbances resulting from paranasal cysts were potentially reversible. However, visual outcomes were poor for patients with rapid deterioration of visual acuity. Many complications due to cysts required more time to diagnose. Therefore, cysts in the posterior ethmoid sinus should be suspected when patients with visual impairment have a history of transantral sinus surgery.

DOI： 10.5106/jjshns.29.267

Language：Japanese   Publisher：Japan Society of Stomato-pharyngology  

We report a case of diffuse large B-cell lymphoma arising from Warthin's tumor in the parotid gland. An 8X-year-old man presented with a mass in the right side of the parotid gland which was painful and gradually enlarged over two months. CT showed a uniform region in the parotid gland. A positron emission tomography/computed tomography （PET/CT） scan showed abnormal accumulation in the same area. The histological diagnosis was Warthin's tumor in the first biopsy. However, since the tumor was rapidly enlarging, a second biopsy was performed. Histological analysis showed variant cell, which stained positively for CD20, CD25, and CD79 and negatively for CD3, CD4, and CD8, and the tumor was diagnosed as malignant lymphoma, diffuse large B-cell type. Taking those findings together, we diagnosed the patient as malignant lymphoma with Warthin's tumor in the parotid gland.

DOI： 10.14821/stomatopharyngology.33.65

Publisher：(一社)日本耳鼻咽喉科学会  

再発性多発軟骨炎(relapsing polychondritis:以下RP)は、軟骨の慢性炎症を主徴とするまれな疾患であり病因は自己免疫応答と考えられている。本疾患は気道狭窄や心病変など、診断が遅れると致死的病変の合併もあり得るため早期診断が重要である。2011年4月〜2018年3月までに受診したRP9例の臨床像を検討した。症例は、男性4例、女性5例、初診時の年齢は33〜84歳で、症状の出現から診断までに約2ヵ月〜2年を要した。観察期間は、約3ヵ月〜7年である。治療前の臨床所見は、耳介軟骨炎6例、多発関節炎3例、鼻軟骨炎4例、眼の炎症2例、喉頭・気管軟骨炎6例、蝸牛あるいは前庭機能障害2例を認めた。併存する膠原病として、腸管ベーチェット病、関節リウマチ、原田病を1例ずつ認めた。診断に際して必ずしも生検は必要ないが、臨床症状のみで診断基準を満たさない場合には、病理組織検査が一助となる。しかし基礎疾患に対してステロイドを用いている症例では、病理検査結果や症状が修飾されている可能性があり注意が必要である。初回治療は、耳介病変が主である場合には、外来での少量ステロイド療法を施行した。しかし気道病変を伴った症例では、ほかの診療科を紹介しステロイド中・大量療法を施行した症例が多かった。予後は、8例は生存しているが、1例は他疾患で死亡された。(著者抄録)

Publisher：日本鼻科学会  

DOI： 10.7248/jjrhi.58.104

Publisher：The Oto-Rhino-Laryngological Society of Japan, Inc.  

<p>　Relapsing polychondritis is a rare and potentially fatal autoimmune disease of unknown etiology, characterized by inflammation and destruction of different cartilaginous structures, including the ear, nose, larynx, trachea, bronchi, peripheral joints, eyes, heart and skin, with a high risk of misdiagnosis.</p><p></p><p>　Data of nine patients with this condition were analyzed. The average age at diagnosis of the nine patients (four male and five female) was 56.4 years (33-84 years). The interval from onset to diagnosis varied from three months to two years. Auricular chondritis was detected in six patients, polyarthritis in three patients, nasal chondritis in four patients, inflammation of the eyes in two patients, laryngotracheal chondritis in six patients, and labyrinthine dysfunction in two patients.</p><p></p><p>　Underlying autoimmune diseases included Behçet's disease, polymyalgia rheumatica, and Vogt-Koyanagi-Harada disease. No biopsy findings are pathognomonic for the diagnosis of RP. Histopathological examination of an involved cartilage can be a valuable tool when accurate diagnosis proves difficult. However, steroid treatment, as in patients with autoimmune diseases can affect the results of histopathological examination and modify the clinical manifestations.</p><p></p><p>　Until date, therapy for RP is still empiric, due to the lack of standardized guidelines for the treatment, and depends on the basis of the disease activity and severity of organ involvement. Mild forms, such as auricular chondritis alone, are treated with NSAIDs and low-dose corticosteroids. Laryngotracheal complications require high-dose corticosteroids and immunosuppressants. As for convalescence, eight cases survived, and one died of other diseases.</p>

DOI： 10.3950/jibiinkoka.122.1322

Publisher：日本口腔・咽頭科学会  

我々はこれまでに扁桃周囲膿瘍を造影CTにおける膿瘍の形態からOval型とCap型に分類し、下極Cap型は病悩期間が短く、喉頭へ炎症が進展し急性喉頭蓋炎を発症しやすいことを報告してきた。今回は、下極型扁桃周囲膿瘍症例のOval型とCap型における年齢、性別、検出菌、膿瘍径の違いについての検討を行った。その結果、下極Cap型では、比較的女性の割合が高く、Streptococcus anginosus groupの検出頻度が高かった。下極Oval型と比較し、下極Cap型では病悩期間が短いものの、膿瘍径は大きい傾向にあった。(著者抄録)

DOI： 10.1002/lary.26971

PubMed

Publisher：日本耳鼻咽喉科感染症・エアロゾル学会  

扁桃周囲膿瘍症例のうち、ガレノキサシン(GRNX)を術前内服後に即時膿瘍扁摘を施行した19歳以上の患者10症例を対象に、臨床検査成績ならびにCT所見とGRNXの膿汁および患側扁桃組織内濃度を比較した。また、抗菌薬の組織移行性が不良となる要因について検討した。その結果、CRP値や白血球数が高値になるほどGRNXの組織移行性が低下することが判明した。膿瘍径が大きい症例や造影CTでring enhancementが認められず病悩期間が短い症例では、CRP値や白血球数が高値を示し、GRNXの組織移行性も低いことが示された。

Publisher：Japan Society for Infection and Aerosol in Otorhinolaryngology  

<p>Clinical findings of patients with peritonsillar abscesses were compared to the penetration of garenoxacin (GRNX) into the serum, abscesses, and palatine tonsil to determine the factors that reduce the efficacy of antibiotics toward this disease. Ten patients who underwent abscess tonsillectomies were enrolled in the study. After the oral administration of GRNX, general anesthesia was induced and samples of blood, pus from the abscess, and a part of the palatine tonsil were obtained prior to surgery for the measurement of GRNX concentration. Correlations between the concentrations of GRNX in the samples and the levels of C-reactive protein (CRP), white blood cell (WBC) count, size of the abscess and presence of ring enhancement estimated using computed tomography (CT), and the duration of the illness before surgery (in days) were examined. The data showed that the concentrations of GRNX in the abscess and serum were significantly decreased in patients with high levels of CRP (≥11 mg/dL). In patients with high WBC (≥19,000 cells/μL) counts, the concentrations were significantly decreased in the tonsil and serum. The concentrations of GRNX in the abscess were significantly lowered in patients with large abscesses (≥25 mm). The concentrations of GRNX in the abscess and tonsils were lowered when the abscess was without ring enhancement and when the illness persisted for longer than 7 days before surgery. These results indicate that severe inflammation reduces the penetration of antibiotics into the abscess and tonsils. In addition to the high levels of CRP and the high WBC count, a large abscess without ring enhancement and a short duration of illness might be indications for surgical drainage. Moreover, it is suggested that antibiotics with good tissue penetration should be used for the treatment of a peritonsillar abscess. </p>

DOI： 10.24805/jjsiao.6.1_15

Publisher：Japan Society of Stomato-pharyngology  

We previously reported that based on computed tomography （CT） findings, peritonsillar abscess （PTA） patients were classified into two categories by the abscess shape: the Oval type and the Cap type. When the CT classifications were compared with the clinical findings, patients with the inferior Cap type abscess had laryngeal edema and airway obstruction more frequently than the other categories of PTA. In the present study, we reviewed 240 patients diagnosed as having PTAs on the basis of the CT findings between April 2007 and March 2017. Age, gender, bacteria detected in pus and diameters of PTAs were investigated. On the axial view of enhanced CT images, the longest diameter of the PTAs was measured. Compared to the other categories, the ratio of female patients was relatively high in patients with the inferior Cap-type abscess. In addition, the <i>Streptococcus anginosus</i> group tended to be identified more frequently in patients with an inferior Cap-type abscess. The diameter of the PTAs was significantly greater in the inferior Cap-type PTA than in the inferior Oval-type PTA. On the other hand, the disease duration was shorter in the inferior Cap-type PTA compared to the inferior Oval-type PTA.

DOI： 10.14821/stomatopharyngology.31.187

Publisher：日本口腔・咽頭科学会  

Guillain-Barre症候群(以下GBS)の亜型で稀なもののひとつにacute oropharyngeal palsy(以下AOP)があり、今回我々は軟口蓋麻痺を初発症状としたAOPの1例を経験した。症例は16歳の男性で、両側軟口蓋の挙上不良、開鼻声を呈した。急性発症の末梢神経疾患が考えられ、GBSの亜型である可能性も疑い、抗ガングリオシド抗体を調べ、抗GQ1b-IgG抗体、抗GT1a-IgG抗体の上昇をみとめ、AOPと診断した。その後、経過観察のみで徐々に症状は改善し、約1ヵ月後に症状が消失した。耳鼻咽喉科医の口腔咽頭診察において、GBSの亜型疾患を念頭に置くことが重要と考えた。(著者抄録)

Publisher：日本口腔・咽頭科学会  

光学機器の進歩から早期の下咽頭癌が発見される機会は多くなり、生存率の向上のみならず機能温存に寄与している。ただ、すべての住民が医療技術の恩恵を受けているかは不明であり、鹿児島県における地域格差の有無に関して検討する。当院を受診した下咽頭癌を鹿児島市、鹿児島市以外の本土症例、離島症例に分けて病期分類や受診までの経緯を中心に検討した。離島からの症例は、鹿児島市内の症例と比較して統計学的有意に進行癌が多く、地域格差を認めた。紹介診療科に関しては早期癌ほど他科が多く、IV期のみが耳鼻咽喉科からの紹介が他科を上回っていた。(著者抄録)

DOI： 10.1093/intimm/dxx001

PubMed

Publisher：Japan Society of Stomato-pharyngology  

<p>　 We describe herein a case of acute oropharyngeal palsy (AOP), a rare subtype of Guillain-Barre syndrome (GBS). After the initial report of 3 AOP cases by O'Leary et al. in 1996, several other cases have been reported, but no disease concept, diagnostic criteria, or treatment have been established. Furthermore, there has been no report of AOP in the otolaryngology literature. A 16-year-old male presented with initial symptom of palatoplegia characterized by poor lifting of the bilateral soft palates, rhinolalia aperta, and slight loss of pharyngeal reflex. Acute development of peripheral nerve disease and a GBS subtype were suspected. Diagnosis of AOP is based on the presence of anti-ganglioside antibodies and elevation of anti-GQ1b-IgG and anti-GT1a-IgG antibody levels. The anti-GQ1b-IgG antibody level was (2+), the anti-Ga1NAc-GD1a-IgM antibody level was (2+), the anti-GT1a-IgM antibody level was (1+), and the IgG antibody level was (2+). Other antibodies were negative. Based on the clinical symptoms, course, and antibody test results, the patient was diagnosed as having AOP. The symptoms gradually improved over the time course with observation alone and disappeared after about one month. The findings of this case suggests that subtypes of GBS should be considered in an oropharyngeal examination. Otolaryngologists who routinely perform oropharyngeal examinations should take the subtype diseases of GBS into consideration as a potential cause of acute development of rhinolalia aperta and nasopharyngeal reflux.</p>

DOI： 10.14821/stomatopharyngology.30.171

Publisher：Japan Society of Stomato-pharyngology  

<p>　<i>Objective</i>: In recent years, the opportunities to detect hypopharyngeal cancer in the early stage have increased thanks to advances in optical instruments. In this report, we discuss regional differences and the process of recent hospital visits in patients with hypopharyngeal cancer who visited our hospital.<br>　<i>Methods</i>: The subjects were patients with hypopharyngeal cancer who were referred to the department of Otolaryngology, Kagoshima University Medical and Dental Hospital during the period from January 2009 to December 2015.<br>　<i>Results</i>: Among 45 hypopharyngeal cancer patients from Kagoshima City, 4 (8.8%), 3 (6.6%), 13 (28.8%), 5 (11.1%), and 20 patients (44.4%) were diagnosed as having phase 0, I, II, III and IV, respectively. Among 75 patients from the mainland, other than Kagoshima, 6 (8.0%), 5 (6.6%), 12 (16.0%), 12 (16.0%), and 40 patients (53.3%) were diagnosed as having phase 0, I, II, III and IV, respectively. Among 23 patients from isolated islands, 0 (0%), 3 (13.0%), 2 (8.7%), 3 (13.0%) and 15 patients (65.2%) were diagnosed as having phase 0, I, II, III and IV, respectively. In the comparison between the groups, a statistically significant difference (<i>p</i>=0.04) was confirmed between the patients from Kagoshima City vs. those from the isolated islands.<br>　In the phase IV group alone, the number of patients who were referred by a department of otolaryngology was higher, while many patients with phase 0 to III were referred by other departments.<br>　<i>Conclusion</i>: In a statistical comparison, the number of patients with advanced cancer from the isolated islands was significantly higher than that of patients from Kagoshima City, suggesting a regional difference. Regarding the department that referred patients to our hospital, in the phase IV group alone, the number of patients referred by the department of otolaryngology was higher, while many patients in earlier stages were referred from other departments.</p>

DOI： 10.14821/stomatopharyngology.30.85

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