Acta oto-laryngologica. Supplementum最新文献

Conclusions: For T2 tumors, surgery was indicated if functional preservation was possible. For T3/T4 tumors, the rate of primary disease control was not high and surgery frequently involved total laryngectomy. Points that surgeons must heed when performing such surgery were delineated.

Objectives: Because tumors originating from the base of the tongue are rare, few large-scale studies of such tumors have been performed. We reviewed treatments and outcomes at our department to establish effective future therapeutic plans.

Patients and methods: From 1971 to 2000, 84 patients with previously untreated and resectable squamous cell carcinoma of the base of the tongue were treated at the Head and Neck Department of the Cancer Institute Hospital, Tokyo. Treatment selection and results were investigated.

Results: The main treatment options were radiotherapy for primary lesions < or = T2 and surgery for primary lesions > or = T3. Overall disease-specific 5-year cumulative survival rate was 59.8%, but there was no significant difference in survival rate at each stage between the two treatments. Among patients who died of the primary disease, the area that was most difficult to control was the superior margin of the lateral wall of the oropharynx (n=7). The incidence of contralateral or retropharyngeal lymph node metastasis was low if tumors neither crossed the midline nor infiltrated the lateral wall. While total laryngectomy was performed on 48 patients, the larynx was operatively preserved in 5 T3 patients and one T4 patient.

Conclusions: Endoscopic intranasal dacryocystorhinostomy (DCR) has the following advantages over external surgery: pain and hemorrhage are minimal; postoperative facial swelling and scarring are absent; and symptoms resolve rapidly after surgery. Furthermore, as no significant differences in postoperative results were apparent between external and endoscopic intranasal DCR, and because no facial skin incision is required, the clinical usefulness of endoscopic intranasal DCR is high.

Objectives: In the treatment of nasolacrimal duct obstruction or chronic dacryocystitis in which epiphora or ocular discharge are chief complaints, endoscopic intranasal DCR is a safe, easy, minimally invasive, and reliable approach. In the present study, we describe the surgical procedures, techniques, and results of endoscopic intranasal DCR, and investigate its clinical usefulness.

Subjects and methods: The subjects were 21 patients with nasolacrimal duct obstruction who underwent a total of 24 endoscopic intranasal DCR procedures. Etiologies of the obstruction were, respectively, cryptogenic (62.5%), secondary to partial maxillectomy (16.7%), complication of sinus surgery (12.5%), and due to underlying disease--Wegener's granulomatosis (4.2%) or nasal T-cell lymphoma (4.2%). To assess the clinical usefulness of this procedure, postoperative courses were assessed by reviewing medical records and conducting telephone interviews. In addition, to assess the therapeutic effects, postoperative results were statistically compared to those of external DCR.

Results: Closure of the surgical opening was seen in two cases (8.3%). In both cases, after the closed region was opened using an endoscopic procedure, symptoms resolved. Finally, lacrimal passage obstruction was not observed by lacrimal irrigation in any patient. None of the patients in the present study experienced major complications during or after surgery, and since their symptoms improved, the degree of satisfaction was high. When compared to external DCR, endoscopic intranasal DCR showed no statistically significant difference in postoperative results, thus confirming that similar therapeutic effects could be obtained for the two procedures.

Conclusions: Steroid treatment was effective in improving hearing in most episodes in our and previously reported patients with acute hearing loss associated with aortitis syndrome. This suggests that inflammatory changes due to autoimmune responses may play an important role in the manifestation of hearing loss in aortitis syndrome.

Objectives: To clarify clinical features in patients with aortitis syndrome who exhibited hearing loss.

Case reports: We describe two patients, 39-year-old and 53-year old women, who developed several episodes of acute sensorineural hearing loss associated with aortitis syndrome.

Results: In both patients, hearing loss involved the cochlea and hearing recovered following corticosteroid treatment. A literature review revealed that hearing loss was commonly manifested in middle-aged females and involved bilateral ears. Corticosteroid treatment was effective in improving hearing in most episodes in the previously reported cases as in our patients.

Conclusion: When selecting the appropriate surgical approach the pathological type of tumor, the physiological status as well as the functional aspects should be considered. Understanding the strengths and weaknesses of each surgical technique and knowledge of the particular tumor biology facilitates selection of the most appropriate surgical approach and a successful outcome.

Objectives: The purpose of this study was to review cases that underwent skull base surgery for a variety of tumors that involved the temporal bone. We reviewed a single center's 25-year experience for epidemiologic characteristics, symptoms, treatment type and outcomes.

Patients and methods: The medical records and radiological images of 91 patients, who underwent skull base surgery, were retrospectively reviewed.

Results: Among the 91 patients, 61 cases had benign disease and 30 had malignancies. A facial nerve schwannoma was the most common benign intratemporal tumor and a squamous cell carcinoma was the most common malignant tumor. With the facial nerve schwannoma, facial nerve paralysis and hearing loss were the most common presenting complaints; otalgia was the most common presenting symptom for temporal bone cancer. For patients with a glomus tumor, there was a characteristic pulsating tinnitus. A majority of the facial nerve schwannomas were resectable through the transmastoid approach. The infratemporal fossa approach type A was usually required for lower cranial nerve schwannomas and glomus jugulare tumors. However, the fallopian bridge technique with hypotympanectomy was another surgical option. Partial temporal bone resection and subtotal temporal bone resections were performed in cases with temporal bone cancer. The disease free 5-year survival of the temporal bone cancers was 42% and for the squamous cell carcinomas, it was 44%.

Conclusion: Benefits of the use of anteriorly and inferiorly based periosteal flaps (AIPFs) in congenital aural atresia (CAA) patients was found to be effective at reducing canal stenosis (CS) occurrence by long term F/U. However, in terms of minimizing CS, in addition to recruitment of AIPFs, considerations of patient factors, such as degree of microtia and age are mandatory.

Objectives: AIPF during canaloplasty were evaluated with a specific focus on whether this technique can offset the negative effects of several risk factors for postoperative CS after CAA surgery.

Subjects and methods: The authors undertook a retrospective review of the medical records of 164 congenital aural atresia patients (190 ears) who had undergone surgery at Seoul National University Hospital. Median follow up period was 54 months. The anterior approach surgical method with and without the use of AIPFs were utilized in 111 and 79 ears respectively. Comparison of the influences of several factors on CS occurrence was undertaken by statistical analyses to evaluate whether this AIPFs technique can counterbalance the negative effect of patient factors in postoperative CS.

Results: Those with a younger age (<12 yrs), moderate to severe microtia (grade II, III), or those in whom AIPF was not used in surgery (non AIPF group) were found to show statistically significant higher frequency of CS(+). Nevertheless, the positive effect of AIPF was not able to completely counterbalance the effects of negative patient factors on CS development. A protocol compatible with the results of this study that minimizes CS is presented in the discussion.

Conclusion: There was no beneficial effect of an additional cycle of oral steroid therapy in partially recovered patients with sudden sensorineural hearing loss after initial oral steroid therapy.

Objectives: Partial recovery of hearing after one cycle of steroids might be the result of a relatively short duration of medication. We evaluated the efficacy of an additional cycle of steroids in those patients.

Subjects and methods: With strict inclusion criteria, we selected the patients with hearing gain more than 10 dB, but still worse than 30 dB with hearing level, at the end of one cycle of steroid therapy. They were divided into a control group with no further treatment and a study group treated with an additional cycle of steroids. We compared their hearing outcomes, recovery rates and the mean duration of hearing improvement.

Results: We could not find any significant difference in either hearing outcomes, recovery rates or the mean duration of hearing improvement between the one-cycled group and the two-cycled group.

Conclusion: Pre-RT ND in patients with HNSCC undergoing organ preservation treatment is safe, advantageous, poses no additional morbidity owing to the elective neck dissection, and may possibly improve survival outcomes.

Objective: Establish the role of pre-radiation neck dissection (pre-RT ND) in patients with head & neck squamous cell carcinoma (HNSCC) undergoing organ preservation treatment.

Materials and methods: Fourteen patients with histologically confirmed HNSCC in stages III approximately IV with proven regional metastasis were enrolled in the organ preservation approach incorporating pre-RT ND at a tertiary referral center between May 1998 and August 2004. Site matched patients treated with organ preservation intent in the conventional fashion were used as controls. Data were collected for their diagnosis, management, treatment outcome, and follow up.

Results: Disease free survival was significantly better for the pre-RT ND group. There was no significant difference in overall survival, pattern of recurrence, and primary organ preservation rate between the two groups. No significant morbidity owing to neck dissection was noted in patients who underwent neck dissection. Although the delivery of radiation to the primary site was delayed for patients in the pre-RT ND group, it did not influence the major outcomes.

Conclusion: Both single and multiple injections of ITGM were effective in vertigo control and functional improvement. However, the risk of sensorineural hearing loss was much lower for a single injection than for multiple injections.

Objectives: While intratympanic gentamicin injection (ITGM) has been established as treatment option for intractable Meniere's disease, several injection protocols have been introduced. The risk of sensorineural hearing loss (SNHL) has been reported to be variable for each protocol. Among the protocols, the single injection protocol is an easy to administer, well-tolerated and cost effective technique, as compared with others. We compared the clinical efficacy of ITGM with regard to the vertigo control rate and the incidence of SNHL between two different protocols: the use of single and multiple injections.

Materials and methods: A retrospective review was conducted for 30 subjects who were treated with ITGM with intractable unilateral Meniere's disease from May 1997 through February 2005. The patients were divided into two groups according to the protocol utilized: the multiple injection group (n =10) and the single injection group (n =20). Treatment efficacy was evaluated by using the AAO-HNS Committee on Hearing and Equilibrium guidelines (1995).

Results: Effective vertigo control (Class A and B) were accomplished in 90% of patients in the multiple injection group and in 90% of patients in the single injection group. Functional status was also markedly improved in both groups. However, a significant hearing loss occurred more frequently in the multiple injection group (71%) than in the single injection group (5%). The rate of caloric loss was not different for the two groups (88% for the multiple injection group vs. 85% for the single injection group).

Conclusion: The changes of nasal resistance and cross-sectional area (CSA) with aging could suggest that it might be attributed to the change (atrophy) of the non-erectile structural tissues including bone and soft tissues rather than the erectile tissues. Subjects older than 60 years of age had significantly slower ciliary beat frequency (CBF), which could suggest nasal function might begin to decrease at around 60 years of age.

Objectives: Nasal physiology can be changed with aging, however, there has been little data that prove senile change of the nasal cavity. This study was conducted to evaluate the effect of aging on nasal resistance and ciliary movement of the nasal cavity.

Methods: One hundred and fifty three healthy subjects were included in this study. Acoustic rhinometry and rhinomanometry before and after nasal decongestion, and CBF were measured.

Results: The CSA at the attachment of the inferior turbinate was increased with age in both before and after decongestion. However, the difference of CSA between pre- and post-decongestion did not change significantly with age. At the nasal valve area, the CSA showed almost same values between age groups and the difference between pre-and post-decongestion was very small. The nasal resistance was markedly decreased from 2nd to 3rd decade and did not change significantly after 3rd decade. Subjects older than 60 years of age had significantly slower CBFs compared to those younger than 60 years (10.18+/-0.98 vs. 12.43+/-1.46) (P<.001).

Conclusion: While the complication rate for silicone sheets was similar to that reported for silicone rubber, there are several advantages to the use of silicone sheets for correcting minor dorsal irregularities. Therefore, silicone sheets can be used as a versatile graft material for dorsal augmentation in rhinoplasty.

Objectives: Silicone implants mostly in the form of prefabricated silicone rubber remain the most commonly used materials for nasal augmentation in Asians. The present study analyzed the use of silicone sheets rather than silicone rubber for nasal dorsal augmentation rhinoplasty.

Materials and methods: Data from 27 patients who underwent dorsal augmentation with silicone sheets between April 2003 and July 2005 were retrospectively reviewed.

Results: All patients received silicone sheets to augment the nasal dorsum and/or radix. Twenty-four patients had satisfactory outcomes. One patient (3.7%) complained the implant was too visible, one experienced infection, and one experienced endonasal extrusion of the implant. All three cases were readily managed by implant removal and administration of antibiotics.