Acta oto-laryngologica. Supplementum最新文献

Conclusions: The results of a series of studies including the present study suggest that acute dysfunction of the utricular afferents accompanied by acute dysfunction of the saccular afferents might require more time for the compensation of the otolith-ocular system than acute utricular dysfunction that was not accompanied by acute saccular dysfunction. Perhaps the inputs from the saccule also have some contribution to the subjective visual horizontal (SVH).

Objective: To clarify if acute dysfunction of the saccular afferents affects the SVH.

Patients and methods: Twenty-six patients with vestibular neurolabyrinthitis (20 men and 6 women, 23-67 years of age) were enrolled in this study. They had undergone measurement of SVH at the early stage (within 1 month after the attack) and 3 months after the attack. For the measurement of SVH, we used a device that has a red bar of light-emitting diodes with a head fixing frame. They also underwent vestibular evoked myogenic potentials (VEMPs) testing. For the recording of VEMPs, 95 dBnHL clicks were presented.

Results: Patients with vestibular neurolabyrinthitis showed deviation of SVH toward the affected side-down at the early stage after the attack, irrespective of VEMP results. However, 3 months after the attack SVH was significantly more deviated toward the affected side-down in patients who showed absent VEMPs than those with VEMPs present (p<0.01 Mann-Whitney U test).

Conclusions: Data about the recovery course of facial function after intratemporal facial nerve reconstruction using interposition nerve graft would provide useful information for clinicians to understand the regenerative process of the facial nerve after this type of surgery. It would also enable them to obtain informed consent from the patients by preoperatively explaining the predicted outcome of the postoperative facial paralysis.

Objective: The purpose of this study was to describe the recovery course of facial movement and electrophysiological findings after intratemporal facial nerve reconstruction using interposition graft.

Patients and methods: Five patients who underwent reconstruction of the facial nerve using interposition nerve graft immediately after facial nerve excision during surgery for temporal bone lesions were included in this study. Each patient was evaluated for facial movement (Yanagihara score), blink reflex (BR), and electroneurography (ENoG) preoperatively and postoperatively.

Results: Improvement in facial movement began 8-10 months postoperatively. The score then gradually increased, and reached a plateau level by 2 years following surgery. The final score in four of the five patients ranged from 20 to 24 points, while the facial score of one patient only reached 12 points even at 3 years after surgery. All patients demonstrated moderate to severe synkinesis. The reappearance of R1 in BR occurred 7-10 months postoperatively, almost simultaneously with the beginning of recovery of facial movement. The latency of R1 on the operated side became shortened with increasing postoperative time, although it remained considerably longer than that on the unoperated side, even after 2 postoperative years. The onset of recovery of ENoG value (10-12 months postoperatively) was always delayed compared with the actual facial movement recovery and never returned to the level in the unoperated side.

Conclusion: The present study demonstrated the age-related decrease in the axonal diameter of the olfactory nerve. This finding may represent the maturational change of the olfactory receptor neurons.

Objectives: The aim of this study was to investigate age-related changes in the axonal diameter of the olfactory nerve in the lamina propria.

Materials and methods: Female ICR mice, postnatal age 10 days, 3 months, 7 months, and 16 months, were studied. The electron micrographs of septal olfactory mucosa were used to measure the axonal diameters of olfactory nerves.

Results: The distribution of the diameter shifted toward the thinner side between 10-day-old and 3-month-old mice. The axonal diameter showed significant decreases (p < 0.001) from the age of 10 days to that of 3 months.

Conclusions: The progression of olfactory neuroblastoma showed a biphasic pattern. As well as Hyams' histopathological grading and neck metastasis at presentation, early phase recurrence should be regarded as an important prognosticator. A high local failure rate suggests that craniofacial resection followed by postoperative radiotherapy should still be the standard treatment for olfactory neuroblastoma.

Objective: The aim of this study was to evaluate factors associated with survival and local control of olfactory neuroblastoma in the long run and to estimate treatment strategies.

Patients and methods: Twelve patients (seven men and five women) who had undergone initial curative treatment for olfactory neuroblastoma were retrospectively analyzed.

Results: Cause-specific 10-year survival was 64.8%, while disease-free 10-year survival remained 28.6%. Local failure was found in half of the patients. All of the three patients who did not receive radiotherapy developed local failure. A biphasic pattern of recurrence was observed. The early phase recurrence group showed a significantly poorer survival than the late phase recurrence group. Hyams' histopathological grading and neck metastasis at presentation were also correlated with survival.

Conclusions: Labeling experiments using NeuroVue Red dye allowed us to demonstrate individual afferent fiber tracks in the cochlea from the synaptic region of the inner hair cell in the organ of Corti (OC) to the spiral ganglion in Rosenthal's canal. Further optimization is necessary to obtain 3-dimensional (3D) neural distribution in the apical region for frequency mapping.

Objectives: We intend to develop a method by which the radial fibers of the spiral ganglion (SG) can be individually visualized and tracked in 3D from the base to the apex of the cochlea. The combined trajectories of fibers from each cochlea could then be calculated for modeling of the 3D relationship of OC and SG in cochlear implant studies to assist in the optimization of cochlear implants for music and speech perception in noise.

Materials and methods: We tested three different methods to visualize cochlear nerve fibers from OC to SG. Adult rat and mouse ears were stained with DiI dye, modified Golgi-Cox method or NeuroVue dye, sectioned or whole-mounted, and viewed with confocal or standard light microscope.

Results: In DiI staining, spacial resolution and the number of neurons to be stained are too low to utilize this method to create a characteristic frequency map of the cochlea. The Golgi method mainly stained efferent nerve fibers, resulting in less information on cochlear nerve distribution. NeuroVue Red dye allowed clear tracking of individual fibers when combined with DAPI counterstaining.

Conclusion: This superselective intra-arterial intervention technique enabled us to administer a higher dose of cisplatinum to the local lesion with a lower incidence of adverse issues by use of neutralizer, compared with the conventional methods.

Objective: A wide variety of modalities, including surgery, radiotherapy, and chemotherapy, alone or in combination, have been reported for the treatment of maxillary sinus cancer. However, there is still much controversy with regard to the optimum treatment to obtain better local control and acceptable preservation of shape and function. Since 2001, we have performed superselective intra-arterial infusion chemotherapy in combination with radiotherapy and surgery aiming at a higher local control rate.

Patients and methods: This was a review of prospective collected data. The therapeutic design consisted of weekly intra-arterial infusion of high dose CDDP with concomitant radiotherapy and planned surgery performed during chemo-radiation therapy. From June 2001 to January 2004, 14 patients with squamous cell carcinoma of maxillary sinus underwent this treatment procedure at the University of Tokyo Hospital.

Results: The local response rate with this combined therapy was 85.7%. Overall survival rates at 1 and 2 years were 78.6% and 56.2%, respectively, with median follow-up of 25.5 months.

Hearing loss occurs rarely in Ehlers-Danlos syndrome (EDS). We report a case of a 24-year-old woman with EDS who had conductive deafness due to otosclerosis and scar tissues around the malleus and incus. The scar was considered to develop by inflammatory response specific to EDS that had been induced by otitis media with effusion. Following stapes mobilization and removal of the scar tissues, her hearing was improved for several months but showed deterioration thereafter, probably due to recurrence of ossicular fixation. The tendency toward scar formation, infection, and inflammatory response, especially to foreign bodies, in EDS needs to be kept in mind to determine treatment of choice in patients with EDS and conductive hearing loss.

Conclusion: Lomerizine, a calcium channel blocker, may be effective as a treatment for migraine-associated vertigo (MAV). Objective. To determine the clinical characteristics of patients with MAV in Japan and the effectiveness of lomerizine.

Patients and methods: This was a retrospective chart review carried out in a university hospital of 33 patients who fulfilled the diagnostic criteria for MAV. All patients were initially treated with dietary manipulation. If this therapy was unsuccessful, oral medications, mainly lomerizine, were administered. Medical records were reviewed to find clinical characteristics of patients with MAV and to evaluate the effects of the therapy on vertigo/dizziness symptoms.

Results: A marked female predominance was found (23 women, 10 men). The frequency and the duration of vertigo varied across patients. About 60% of the patients had cochlear symptoms during an attack, among which bilateral aural fullness was most frequent. Oto-neurological examination showed abnormalities in 33% of the patients. Overall, 27 of the 33 patients (82%) responded to our therapy. Among the 22 patients who were prescribed lomerizine, 19 patients (87%) showed resolution or significant improvement of the symptoms.

Conclusion: Tumors developing into the muscle layer and tumor thickness > or =5 mm are the most important risk factors associated with nodal metastasis.

Objective: It is necessary to identify the risk factors associated with cervical metastasis in patients with oral floor cancer to reveal the role of elective neck dissection for oral floor cancer.

Patients and methods: Forty-eight patients with oral floor cancer were retrospectively analyzed for a correlation between clinicopathologic factors and cervical lymph node metastasis using Fisher's exact test and a logistic regression test.

Results: Univariate analysis showed significantly positive correlations for growth type, mitosis, perineural invasion, vascular invasion, lymphatic invasion, depth, thickness, and infiltration growth ratio. Multivariate analysis had a significantly positive correlation with nest formation and depth in all patients, and with thickness in patients with T1 or T2. In patients with bilateral cervical lymph node metastasis, lymph node metastasis was significantly positively correlated with perineural invasion.

Conclusions: Reduction of distant metastases is essential for better survival. Effective adjuvant chemotherapy should be developed for patients with advanced primary disease (T>2) as well as for patients with advanced nodal status (N>0 or PLN>2).

Objectives: The aim of this study was to identify prognostic factors for hypopharyngeal cancer.

Patients and methods: In all, 142 previously untreated patients were analyzed retrospectively; 75% of the cases were stage III or IV. Surgical resection was administered as primary treatment to 116 of the patients (82%), while 26 patients (18%) underwent primary radiotherapy.

Results: The cause-specific 5-year actuarial survival was 46.3%. Distant metastases were the most frequent (23%) cause of failure, followed by local recurrence (15%), and regional recurrence (13%). Cox's regression analysis showed that the significant factors affecting cause-specific survival were N classification, T classification, number of pathological lymph node metastases (PLN), lymphatic invasion, and positive surgical margin. Similarly, T classification and PLN affected distant metastases.