Acta oto-laryngologica. Supplementum最新文献

Conclusion: In regard to the treatment of carcinoid tumor of the larynx, irradiation is not effective and tumor excision with a minimum surgical margin is associated with a high risk of local recurrence. Lymph node metastases to the neck are associated with worsening of the prognosis. To improve the survival rate, primary resection with a sufficient surgical margin (e.g. partial laryngectomy) and (elective) neck dissection is recommended, even for patients with early stage carcinoid tumors of the larynx.

Objective: The objective of this study was to clarify the prognostic factors, modalities of treatment for the primary lesions, and importance of neck dissection in the treatment of carcinoid tumors of the larynx.

Patients and methods: The data of 33 cases of carcinoid of the larynx reported from Japan (including 2 of our cases) were analyzed.

Results: The distributions of the T and N classifications of the lesions were as follows T1, 50.0%; T2, 32.2%; T3, 14.3%; T4, 3.6%; N0, 57.1%; N1, 17.9%; N2, 25.0%; and N3, 0%. Fifteen patients underwent radiation therapy, of whom five underwent curative radiotherapy. While complete remission (CR) was maintained in one of these patients (T1N0), the remaining four patients developed recurrence. Five patients underwent preoperative radiation therapy. The response to the treatment was rated as no change in four patients and as progressive disease in the remaining one patient. Among the patients with N0 disease, seven patients (43.8%) developed lymph node metastases in the neck postoperatively. Distant metastases were the most frequent cause of death in the patients. The 3-year, 5-year, and 10-year survival rates of the patients were 58.5%, 36.5%, and 12.2%, respectively. Significant differences were recognized in the survival rates between patients with and without neck lymph node involvement at the first treatment (p=0.008), and between patients with and without postoperative lymph node recurrence in the neck (p=0.037).

Conclusion: The early diagnosis of deafness and the early fitting of hearing aids in multiply handicapped children are recommended for language development in these children even when their neurological or mental status is poor.

Subjects and methods: The subjects consisted of 5 hearing-impaired infants with no other problems and 28 hearing-impaired children with multiple handicaps. Behavioral audiometry and auditory brainstem responses were used for evaluating hearing impairment. The 5 hearing-impaired infants with no other problems underwent hearing aid fitting at approximately 1 year of age and the 28 hearing-impaired children with multiple handicaps underwent hearing aid fitting at various times from 1 to 5 years of age. The effects of their hearing aids were compared on the basis of auditory behavioral changes. The developmental scale of auditory behaviors in infancy that we proposed was introduced to evaluate the development of auditory behaviors.

Results: The auditory behaviors of the hearing-impaired children with no other problems showed constant changes with age after hearing aid fitting. However, among the 28 hearing-impaired children with multiple handicaps, 17 showed improvement in auditory behaviors, 5 showed no improvement in auditory behaviors because of the associated severe motor and mental retardation, and epilepsy, and 6 were unable to adapt to wearing hearing aids.

Conclusions: The precise risk factors for neurological complications after acoustic neurinoma radiosurgery were identified on long-term follow-up. Type 2 neurofibromatosis was found to be a risk factor for hearing loss and peripheral tumor dose was a risk factor for seventh and fifth cranial nerve injuries. These risk factors corresponded to those reported at other institutions. At the present time, controversy exists regarding history of prior surgical resection and tumor size as risk factors for cranial nerve complications.

Objectives: To identify more precisely the risk factors for neurological complications after stereotactic radiosurgery (SRS) based on long-term follow-up.

Patients and methods: Between June 1990 and September 1998, 138 patients with acoustic neurinomas had SRS at Tokyo University Hospital. Of these, the 125 patients who were followed up for at least 6 months were entered into the present study. The patients' ages ranged from 13 to 77 years (median 53 years). The average tumor diameter ranged from 6.7 to 25.4 mm (mean 13.9 mm). The maximum tumor doses ranged from 20 to 40 Gy (mean 29.8 Gy), and the peripheral doses ranged from 12 to 25 Gy (mean 15.4 Gy). One to 12 isocenters were used (median 4). The follow-up period ranged from 6 to 191 months (median 60 months). The potential risk factors for neurological complications were analyzed using two univariate actuarial analyses. The neurological complications studied included hearing loss, facial palsy, and trigeminal nerve dysfunction. The variables analyzed were age, gender, prior operation, neurofibromatosis type 2 (NF2), tumor diameter, maximum tumor dose, peripheral tumor irradiation dose, and the number of isocenters. Variables with significant p values (<0.05) on both actuarial analyses were considered risk factors.

Results: NF2 was significantly correlated with both total hearing loss and pure tone threshold (PTA) elevation; a history of prior surgical resection, tumor size, and the peripheral tumor dose were significantly correlated with facial palsy; and the peripheral tumor dose was significantly correlated with trigeminal neuropathy.

The vertebrate inner ear is derived from the otic placode and undergoes a complicated series of morphogenetic processes to differentiate into an elaborate structure harboring mechanosensory epithelia featuring hair cells, the mechanoreceptors of hearing and balance. Recently, the principal mechanisms producing hair cells and the key molecules involved in their fate determination and differentiation have been gradually unveiled. The in-depth understanding of hair cell development is consequently providing clues to strategies for mammalian hair cell regeneration. Among them, the identification and characterization of progenitor cells for the hair cell lineage, which is just emerging, is of particular interest. Herein, we review the molecular mechanisms of inner ear development with particular focus on perspectives for hair cell regeneration.

Conclusion: Among mass lesions inside the temporal bone, benign tumors and cholesteatomas can be differentiated by contrast enhancement in T1-weighted images (T1WI) and by diffusion-weighted images (DWI). Moreover, DWI will also facilitate discrimination between cholesteatomas accompanied by granulation and other non-neoplastic lesions such as mucoceles and cholesterol granulomas.

Objectives: To review the imaging characteristics of mass lesions inside the temporal bone and to investigate pertinent imaging modalities for differential diagnosis, which is crucial for appropriate treatment planning.

Patients and methods: This was a retrospective case series study of six patients seen between 2002 and 2005 with mass lesions deep inside the temporal bone.

Results: One patient had facial schwannoma, two had glomus jugulare tumor, and three had cholesteatoma. Plain high resolution CT gave few clues to the nature of the mass lesions. MRI study provided us with better clues: contrast enhancement on T1WI was observed only in benign tumors and only cholesteatomas showed high intensity on DWI. With the assistance of neurosurgeons, surgery was successfully performed in all cases.

Conclusion: This study illustrates common sites of infection seen in peritonsillar abscesses with involvement of the pharyngeal space and retropharyngeal space. Abscesses behind and/or inferior to the tonsil were encountered more frequently than expected. In these cases, the drainage had to be placed in the inferior pole of the tonsil and these types were frequently seen in older patients.

Objectives: The aim of this study was to assess to what extent abscesses spread in patients with peritonsillar abscess and to determine to what extent pus can be drained intraorally.

Patients and methods: The clinical charts of 45 patients with peritonsillar abscess involvement of the parapharyngeal space and/or retropharyngeal space were retrospectively reviewed.

Results: In 45 cases, 21 patients were diagnosed with the superior type, and we could drain the pus intraorally in 90% of the patients. On the other hand, 24 cases were diagnosed with the inferior type and they were drained intraorally in 58% of the cases.

Conclusions: The data suggest that sound lateralization sensitivity during interaural time difference (ITD) discrimination is altered by eccentric gaze and that sound lateralization shifts toward the direction of the gaze.

Objective: Using dichotic sounds, the effect of eye position on the orientation of sound lateralization was investigated in humans.

Subjects and methods: The subjects were studied by testing ITD discrimination under different conditions of visual fixation.

Results: The amplitudes obtained during the ITD discrimination tests during eccentric fixation were significantly greater than those obtained while gazing straight ahead (p<0.05). The median line of amplitude obtained during the ITD discrimination test shifted toward the direction of the gaze.

Conclusions: The horizontal portion of the petrous carotid artery (HPCA) of mandibulofacial dysostosis (MFD) patients had anterior-inferior displacement or was aplasia at birth. Our findings indicate that most MFD patients have aplasia of the internal carotid artery. This information may be very important for safe reconstruction surgery in atresia.

Objective: MFD rarely has malformations of the cardiovascular system such as those seen in Goldenhar syndrome. This study aimed to compare MFD patients and normal subjects with respect to the length and diameter of the HPCA.

Subjects and methods: We radiographically studied 22 MFD patients (44 sides) using high-resolution computed tomography (HRCT), measuring the length and diameter of the HPCA and the angle between the right and left HPCA using computer software. Findings were compared with those in 86 ears with normal auricles (control group) using the nonparametric test.

Results: The HPCA in MFD patients averaged 23.2 mm in length and 4.8 mm in diameter. The angle between the right and left HPCA averaged 100.2 degrees. In MFD patients, on average, HPCA were 2.0 mm shorter (p=0.001) and 0.4 mm narrower (p=0.016) than in control subjects. Mean angle between right and left HPCA was 5.4 degrees more acute in MFD patients than in control subjects (p=0.026). Moreover, the genu of the vertical and horizontal petrous ICA in the MFD group was on average 3.2 mm more inferior than in controls (p<0.001).

Conclusion: The local control rate following surgery was very high in patients with post-cricoid carcinoma; however, many of the patients undergoing surgery later developed distant metastasis. Therefore, establishment of chemotherapeutic regimens for preventing distant metastasis is desirable.

Objectives: To define the clinical course of the cancer, the problems that might be associated with its treatment, and the future course of treatment of this cancer at our hospital.

Patients and methods: This study included 21 patients with post-cricoid carcinoma who had undergone primary treatment at our hospital between 1989 and 2004. The present study was designed to retrospectively investigate the therapeutic outcome of post-cricoid carcinoma at our hospital.

Results: The 5-year cause-specific survival rate was 52%. All the patients who eventually died did so within 3 years of the treatment. Seven patients had distant metastases, representing a higher frequency as compared with that of patients with recurrence of the primary focus and cervical lymph node metastasis. All of these patients who had been treated by surgery died of the cancer.