Retrospective Observational Study on Telemedicine in Sublingual Immunotherapy for Patients with Japanese Cedar Pollinosis and House Dust Mite Allergic Rhinitis.

Introduction: In Japan, telemedicine has gradually expanded due to deregulation in response to the COVID-19 pandemic. However, its current status remains unclear, as it is primarily provided by general practitioners. This study aims to examine the use of telemedicine in sublingual immunotherapy (SLIT) for patients with Japanese cedar pollen allergy and/or house dust mite allergic rhinitis. Methods: We conducted a retrospective analysis of medical record data from seven otorhinolaryngology clinics and performed an exploratory evaluation between a group that combined telemedicine and in-person visits during the initial 6 months of SLIT and another group with only in-person visits. Results: Following propensity score matching, 51 and 82 patients were eligible for the telemedicine and in-person groups, respectively, with 33 cases in both groups. Both groups had similar characteristics after matching. No significant difference was found in the withdrawal rate at 6 months from the start of SLIT (6.1% and 9.1% in each group; p = 1.00), side effects, or treatment efficacy between the two groups. The average copayment for patients tended to be significantly higher in the telemedicine group after one, three, and 6 months following SLIT initiation. Discussion: The situation of patients who receive an appropriate combination of telemedicine and in-person visits is not significantly different from patients who receive in-person visits alone. This study may help indicate the actual status of telemedicine in Japan. Further investigation at more facilities is necessary in the future to dispel concerns in the practice setting.

Vestibular dysfunction and compensation after removal of acoustic neuroma.

OBJECTIVE: To evaluate vestibular function after unilateral acoustic neuroma surgery via a retrosigmoid approach. METHODS: Thirty-eight patients were tested using caloric irrigation, static posturography, and the Dizziness Handicap Inventory (DHI) before, and one week to nine months after surgery. RESULTS: Twenty-six patients were categorized as a response group and 12 as a no-response group on the basis of preoperative caloric irrigation findings. The posturographic parameters and DHI scores at one week after surgery showed significant deterioration in the response group, but not in the no-response group. However, they recovered to the preoperative baseline at 3 months after surgery. The posturographic parameters and DHI scores for older patients tended to be worse than those for younger patients at 6 and 9 months after surgery. CONCLUSION: Patients in whom caloric responses are retained preoperatively show a temporary disturbance of balance after removal of acoustic neuroma. Disequilibrium after surgery ameliorates to the preoperative baseline within three months due to vestibular compensation, regardless of preoperative vestibular function. It is possible that poorer vestibular compensation may facilitate incomplete recovery in older patients after surgery.

Bone marrow stem cell transplantation to olfactory epithelium.

OBJECTIVES: We sought to develop a new therapeutic strategy for degeneration of olfactory receptor neurons (ORNs). METHODS: We transplanted into Balb/C mice, locally by transnasal injection and systemically via the tail vain, BrdU-labeled bone marrow stem cells, also known as NRGs, which have the ability to differentiate into neural cells. Bone marrow stem cells engrafted into the olfactory epithelium were examined immunohistochemically. RESULTS: Compared with previous studies, in which bone marrow was transplanted rather than bone marrow stem cells, migration of transplanted bone marrow stem cells into the olfactory epithelium was observed earlier, and engraftment rates were significantly higher. However, migrated bone marrow stem cells were positive for GAP43 but not for olfactory marker protein. CONCLUSIONS: These results suggest that engrafted cells had differentiated into premature, but not mature, ORNs. Further experiments using autologous bone marrow stem cells in combination with various growth factors and/or neurotrophic factors should aid the development of new therapeutic methods for degenerated ORNs.

Effect of intranasal administration of basic fibroblast growth factor on olfactory epithelium.

To further study the effects of basic fibroblast growth factor (bFGF) on the olfactory epithelium, bFGF was intranasally administered twice a day for 6 weeks to 2.5-month-old and 7-month-old mice. The effects were immunohistochemically examined by using antibodies against proliferating cell nuclear antigen, olfactory marker protein, and GAP43. The number of cells positive for proliferating cell nuclear antigen in the supporting cell layer increased dramatically, and that of GAP43-positive cells, or globose basal cells, increased significantly, especially in aging mice. However, no significant changes were observed in the number of olfactory marker protein-positive cells or mature olfactory receptor neurons. These results suggest that topical application of bFGF promotes proliferation of globose basal cells and supporting cells.

Risk factors for recurrence of benign paroxysmal positional vertigo.

OBJECTIVE: To assess the results of treatment for a first episode of benign paroxysmal positional vertigo (BPPV) and risk factors for recurrence. STUDY DESIGN: Retrospective chart review of 148 BPPV patients at a tertiary care referral centre. MATERIALS AND METHODS: The canalith repositioning procedure (CRP) was performed until vertigo and nystagmus were resolved. Using multivariate logistic regression, we estimated the relationship between the rate of BPPV recurrence within 1 year and various risk factors for BPPV. RESULTS: Among the 145 patients after successful manoeuvre or spontaneous resolution, BPPV recurred in 31 patients (21%) within 1 year. Patients with recurrent BPPV in the posterior semicircular canal required more CRP sessions and a longer period. The rate of BPPV recurrence in patients with endolymphatic hydrops (75%) was significantly higher than in those without (odds ratio 17; 95% confidence interval 2.9-101). Both the first episode of BPPV and recurrent BPPV affected the same ear associated with endolymphatic hydrops in all patients with this complication. CONCLUSIONS: Our data suggest that endolymphatic hydrops is a risk factor for recurrence of BPPV and that prevention of recurrent BPPV is important for control of endolymphatic hydrops.

Retropharyngeal node metastasis from papillary thyroid carcinoma.

BACKGROUND: Papillary thyroid carcinomas commonly metastasize to paratracheal and jugular lymph nodes. Metastasis to the retropharyngeal node is rare for this tumor. METHODS: Five patients underwent surgical treatment for metastasis of thyroid papillary carcinoma to the retropharyngeal lymph nodes that presented as a parapharyngeal or retropharyngeal mass. All patients had a history of total or subtotal thyroidectomy as their initial treatment. Among them, 3 patients had undergone ipsilateral modified radical neck dissection at their initial treatment. The other 2 patients had a history of bilateral or ipsilateral modified neck dissection for their subsequent cervical lymph node metastases. RESULTS: Metastatic retropharyngeal nodes were successfully resected via transcervical approach in all patients. Although aspiration and difficulty in swallowing were observed in 2 patients after surgical treatment for metastatic retropharyngeal nodes, these complications spontaneously resolved within a few months. CONCLUSIONS: This study suggests that neck dissection and/or metastatic cervical lymph nodes might alter the direction of lymphatic drainage to the retrograde fashion, resulting in the unusual metastasis to the retropharyngeal lymph nodes. Although the cases described here are rare, metastasis to the retropharyngeal node should be considered at the follow-up for thyroid papillary carcinoma. Because these metastases will be missed by routine ultrasonography of the neck, periodic CT scan or MRI is recommended for follow-up, especially for patients with a history of neck dissection.

A rare spontaneous temporal meningoencephalocele with dehiscence into the pterygoid fossa.

We present an extremely rare case of basal meningoencephalocele that protruded into the left pterygoid fossa from the middle cranial fossa. After a 30-year-old woman experienced a generalized tonic-clonic seizure, computed tomography (CT) scanning showed a large bone defect of the left middle cranial base. A mass lesion with low signal intensity on T1- and high signal intensity on T2-weighted magnetic resonance imaging (MRI) was visualized in the left pterygoid fossa. A biopsy was performed through the transantral approach. Because cerebrospinal fluid (CSF) was observed to flow from the mass lesion, it was diagnosed as a meningoencephalocele. CT showed bone defects in the skull base and a well-circumscribed expansile mass lesion. MRI demonstrated that the brain parenchyma extended into a CSF-filled meningocele. These findings demonstrate that CT and MRI provide adequate information for the diagnosis of meningoencephaloceles.