The morphometrical evaluation after uvulopalatopharyngoplasty.

OBJECTIVES: The aim of this study was to evaluate the efficacy of uvulopalatopharyngoplasty (UPPP) and the corresponding postoperative morphometrical changes. METHODS: Patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Pre- and postoperative tests, including CTs, pharyngeal volume (PV), cross-sectional area (CSA), and six-category morphometrical studies, were performed. RESULTS: Of 11 patients included, 10 showed improvement of symptoms. BMI correlated with the respiratory event index (REI). In terms of PV, there was a significantly wider postoperative area. The rate of change between preoperative REI and postoperative REI (ΔREI) correlated with the amount of change of PV between preoperative PV and postoperative PV (ΔPV). CSA increased postoperatively and correlated with REI. Uvula space (UV) and distance between the hyoid bone and the base of the tongue (HB) increased postoperatively, and posterior airway space (PAS) and epiglottic space (Epi) decreased postoperatively. UV and PAS were significant (p = 0.046, 0.014). UV was related to REI. CONCLUSION: Widening the PV, increasing CSA, and the posterior movement of the tongue base after UPPP surgery were found. The improvement of REI did not depend only on volume. These results suggest that it was important not only to widen the PV but also to improve the shape of the pharynx.

New Modified Transoral Approach to Remove a Hilar Stone of the Submandibular Gland: A Case Report.

Nerve damage and intraoperative bleeding for the removal of the hilar stones are possible. We used the new modified lateral oral floor approach with a 2-3 cm longitudinal mucosal incision outside of the Wharton's. There were no complications and our technique seemed to be effective.

Postoperative functional evaluation of obstructive sleep apnea syndrome by computational fluid dynamics.

The aim of this study is to evaluate the efficacy of uvulopalatopharyngoplasty and the corresponding postoperative airflow. Eleven patients diagnosed with obstructive sleep apnea syndrome who complained of snoring and apnea were enrolled in this study. Computational fluid dynamics (CFD) was implemented. CFD could be accomplished in nine cases. Airflow analysis was not possible in cases with a high respiratory event index (REI) score. Before surgery, stenosis was identified in the oropharynx and epiglottic area. And the airflow velocity and pressure were found to have significantly decreased in the oropharynx postoperatively, while in the epiglottic area, those data had increased postoperatively in some cases. The velocity and pressure of the oropharynx are related to REI score. From the CFD analysis, airflow analysis is important for evaluating the apnea state. It is suggested that the postoperative function can now be predicted preoperatively.

Congenital External Auditory Canal Cholesteatoma Resected by a Transcanal Endoscopic Approach.

OBJECTIVE: To describe the first case of congenital external auditory canal cholesteatoma resected via a transcanal endoscopic approach and describe the possible pathologenesis of cholesteatoma. PATIENT: A 2-year-old female patient presented with a cholesteatoma that extended from the floor of the external auditory bony canal to the inferior quadrant of her right tympanic membrane. INTERVENTION: Otological examinations and computed tomography were performed. The cholesteatoma was resected using a transcanal endoscopic approach. RESULTS: Pathologic examination confirmed the diagnosis of external auditory canal cholesteatoma. The patient's postoperative hearing was observed to be normal. Cholesteatoma did not recur during the 2-year follow-up period. Computed tomography scan revealed an isodense mass, partly surrounded by bony tissue, on the floor of the external auditory canal, outside of the inferior quadrant of an intact tympanic membrane. A minor malformation of the bony tissue, covering the inferiolateral surface of the cholesteatoma, was observed. The proposed mechanisms of pathogenesis are: 1) the embryonic developmental deficits of the meatal plug, during its differentiation into squamous epithelium, cause the arrest of ectodermal tissues, 2) a remnant of the squamous epithelium becomes trapped in the niche of the foramen tympanicum. CONCLUSION: A rare case of congenital external auditory canal cholesteatoma, located on the inferior external auditory canal, was diagnosed and resected using a transcanal endoscopic approach. It was possibly caused by a minor anomaly of the first branchial cleft or by a remnant of the squamous epithelium trapped in the foramen tympanicum.

Successful treatment of non-HIV progressive multifocal leukoencephalopathy: case report and literature review.

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a subacute onset demyelinating disease caused by JC virus and characterized by multifocal involvement of the subcortical white matter and cerebellar hemispheres or peduncles on magnetic resonance imaging (MRI). However, non-HIV PML patients with brain lesions limited to the cerebellum and brainstem have not been well characterized. METHODS: We report a 68-year-old man with systemic lupus erythematosus under treatment with immunosuppressants who developed non-HIV PML with brain lesions limited to the cerebellum and brainstem and successfully treated with a combination of mefloquine and mirtazapine. We performed a literature review to characterize patients with non-HIV PML with brain lesions limited to the cerebellum and brainstem. RESULTS: Eight cases with non-HIV brainstem/cerebellar form PML were identified including our case. All cases had compromised status related underlying diseases. Four (50%) had a good prognosis. Five cases were treated, including 3 with favourable outcomes. Between the good prognosis group (n = 4) and the poor prognosis group (n = 4), treatment status for PML and the interval between the initial manifestation and diagnosis did not differ. Among those who performed contrast-enhanced brain imaging, lesion enhancement was related to good prognosis (good prognosis group vs. poor prognosis group; 100% vs. 0%). CONCLUSION: PML should be considered in the differential diagnosis of brain lesions limited to the cerebellum and brainstem in immunocompromised patients. The presence of immune response against JC virus and inflammatory reactions may indicate good prognosis in non-HIV brainstem/cerebellar form PML.

Sinonasal Inverted Papilloma: Efficacy of Demucosation to Reduce Recurrence After Surgical Managements.

To compare the outcomes of various surgical approaches to resect sinonasal inverted papilloma and to discuss their advantages and disadvantages. A retrospective chart review of 61 consecutive patients with sinonasal inverted papilloma was performed. Surgical treatment included non-demucosation endoscopic sinus surgery (ESS), demucosation ESS, endonasal medial maxillectomy (EMM), Draf type 3, Caldwell-Luc surgery, Denker, Killian, and lateral rhinotomy. Recurrence rates were compared between endonasal and external approaches and between demucosation and non-demucosation. After the first curative surgery, the non-demucosation ESS, endonasal demucosation (demucosation ESS, EMM, and Draf type 3), and external surgery showed recurrence rates of 61.5%, (8/13), 0.0% (0/21), and 7.4% (2/27), respectively. A significantly lower recurrence rate was observed in the endonasal demucosation (p < 0.001) and in the demucosation ESS group (p < 0.001) in comparison with the non-demucosation ESS. However, as for recurrence rate, no statistically significant difference was observed between endonasal surgery and external surgery (p = 0.162). Demucosation is a better strategy for the treatment of inverted papilloma than is non-demucosation. Demucosation is the key procedure for preventing recurrence.

A case of neck xanthogranulomatous inflammation-suspected malignant tumor.

Xanthogranulomatous inflammation (XGI) is an uncommon chronic inflammatory disease. A 59-year-old male presented with a neck mass which had been diagnosed as an undifferentiated carcinoma. From CD68 staining, XGI was confirmed. It is important to consider the possibility of XGI for a neck mass mimicking a malignant tumor.

A Small Glomus Tympanicum Tumor Resected by Minimally Invasive Transcanal Endoscopic Approach.

We present a case of the transcanal endoscopic resection of a glomus tympanicum tumor. A 51-year-old woman presented with pulsatile tinnitus of the right ear persisting for 6 months. A reddish mass was observed through her tympanic membrane. A computed tomography scan revealed a small mass in the mesotympanum. She was diagnosed with a right-sided glomus tympanicum tumor. The glomus tympanicum tumor was classified as type 1 using the Glasscock-Jackson classification, class A using the Fisch classification, and class A1 using the modified Fisch and Mattox classification. The tumor was transcanally and completely resected by endoscopy without any complication. Before and after the surgery, pure-tone audiometry showed a normal hearing level. Preoperative right-sided pulsatile tinnitus resolved after the surgery. Transcanal endoscopic ear surgery is a favorable surgical method for small localized glomus tympanicum tumors.

Apocrine Adenoma of the External Auditory Canal with Pseudoepitheliomatous Hyperplasia.

The tumors derived of the ceruminous gland in the external auditory canal are rare. Here, we report a case of a ceruminous adenoma (apocrine adenoma) with refractory chronic inflammation in the external auditory canal. A 46-year-old man presented with otorrhea, itching, and a foreign body sensation in his right ear. A soft reddish protruding lesion was revealed at the posterosuperior portion of the entry to the right external auditory canal by otoscopy. The skin lesion was endaurally resected; histopathology showed luminal structures in the middle to deep layer of the epidermis and inflammatory granulation below pseudoepitheliomatous hyperplasia. The walls of the luminal structures consisted of inner luminal secretory cells featuring apical decapitation secretion and outer myoepithelial cells. The patient was diagnosed with an apocrine adenoma. Three years after surgery, there has been no evidence of recurrence. Complete resection, including the deep layer of the epidermis, is necessary.

Endoscopic Type 1 Tympanoplasty in Chronic Otitis Media: Comparative Study with a Postauricular Microscopic Approach.

OBJECTIVE: To compare surgical outcomes after tympanoplasty without ossiculoplasty for chronic otitis media between transcanal endoscopic ear surgery (TEES) and postauricular microscopic ear surgery (PAMES). STUDY DESIGN: Case-control study. SETTING: Tertiary care university hospital. SUBJECTS AND METHODS: Consecutive patients (N = 122) who had undergone tympanoplasty without ossiculoplasty for chronic otitis media were enrolled in this retrospective study and divided into 2 groups: TEES (n = 47) and PAMES (n = 75). Middle ear condition was graded with the middle ear risk index. Hearing, repair of tympanic membrane perforation, and surgical time were assessed. RESULTS: The surgical success rate for hearing (air-bone gap ≤20 dB) was 95.7% in the TEES group and 84.0% in the PAMES group. Lower middle ear risk resulted in similar mean (95% CI) closure of air-bone gaps (TEES: 9.6, 6.5-12.6; PAMES: 8.0, 6.4-9.7; P = .333), whereas higher middle ear risk demonstrated significantly larger closure of air-bone gaps for the TEES group (10.1, 3.3-16.9) than the PAMES group (-0.2, -4.5 to 4.2; P = .009). The surgical success rate for repair of tympanic membrane perforation and surgical time were equivalent between TEES and PAMES. CONCLUSION: Under favorable conditions of the middle ear, TEES and PAMES resulted in similar hearing improvement by tympanoplasty without ossiculoplasty. However, under adverse conditions of the middle ear, TEES was a more beneficial approach for hearing improvement than PAMES.

Effects of nasal septum perforation repair on nasal airflow: An analysis using computational fluid dynamics on preoperative and postoperative three-dimensional models.

OBJECTIVE: The purpose of this research is to examine the changes in nasal airflow dynamics before and after the nasal perforation repair. METHODS: Three dimensional (3D) models of the nasal cavity before and after septal perforation repair was reconstructed using preoperative and postoperative computed tomography (CT) images of a patient. The numerical simulation was carried out using ANSYS CFX V15.0. Pre- and post-operative models were compared by their velocity, pressure (P), pressure gradient (PG), wall shear (WS), shear strain rate (SSR) and turbulence kinetic energy (TKE) in three plains. RESULTS: In the post-operative state, the cross flows disappeared. In preoperative state, there were areas showing high PG, WS, SSR at the posterior border of the perforation, which exactly correspond to the area showing erosive mucosa on endoscopic inspection of the patient. In postoperative state, such high PG, WS and SSR areas disappeared. High TKEs also disappeared after surgery. CONCLUSION: The effects of septal perforation repair on airflow dynamics were evaluated using computer fluid dynamics (CFD). High WS, PG and SSR observed at the edge of the septal perforation may be related to the clinical symptom such as nasal bleeding and pain. TKE was considered to cause nasal symptom.

Nasal, oral, and pharyngolaryngeal manifestations of pemphigus vulgaris: Endoscopic ororhinolaryngologic examination.

Pemphigus vulgaris is an autoimmune blistering disorder that involves the skin and mucous membranes. Few reports have described nasal and oropharyngolaryngeal lesions in pemphigus vulgaris using an endoscopic ororhinolaryngologic examination. We retrospectively reviewed the clinical records of 11 patients with pemphigus vulgaris between 2001 and 2013 with respect to their symptoms, lesion sites, lesion features, and treatments received. All patients had undergone an endoscopic ororhinolaryngologic examination. Their mucosa-related symptoms were sore throat, oral pain, odynophagia, gingival bleeding, hoarseness, and epistaxis. The most frequent sites were the oral cavity (gingiva and buccal mucosa), larynx (epiglottis and vocal fold), oropharynx (soft palate), and nasal cavity (nasal septum). Lesions were typically characterized by erosion, erosion with a whitish exudate, and erythematous patches. Thus, our study findings reveal that pemphigus vulgaris involves both the nasal and oropharyngolaryngeal regions. Patients with pemphigus vulgaris should undergo an endoscopic ororhinolaryngologic examination to determine the range of their lesions.

Bilateral objective tinnitus in an infant with tuberous sclerosis.

This is the first report of objective tinnitus presenting as audible spontaneous otoacoustic emission in a patient with tuberous sclerosis. The tinnitus was loud, continuous, and high pitched: 7757.8 and 6257.8 Hz. The auditory system may be dysfunctional in patients with tuberous sclerosis. Possible causes of tinnitus in these patients are abnormal myelination and dysfunctional axons and neurons associated with tuberous sclerosis. A disturbance of the outer hair cells or the MOC efferent fibers innervating the outer hair cells is considered to be the source of the loud spontaneous otoacoustic emission.

Changes in Listing plane thickness caused by vestibular schwannoma: a parameter for evaluating the accuracy of the gravity-oriented internal model.

OBJECTIVE: Three-dimensional analysis of video-oculograms can be used to calculate Listing plane for patients and experimental subjects. Listing plane reflects the head's orientation with respect to gravity, which suggests that the plane is derived from otolithic vestibular input, itself, or from a gravity-oriented internal model constructed through integration of visual, vestibular, and proprioceptive sensory inputs. The goal of this study was to determine whether the Listing plane can serve as a parameter for evaluating static (peripheral or central) vestibular function. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Healthy subjects and patients with unilateral vestibular schwannoma without any previous treatment. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Video-oculograms were recorded from healthy subjects (aged 36.8 ± 6.3 yr) and from patients (aged 60.3 ± 7.5 yr) during voluntary gaze with the head in an upright or each-side-down orientation, and the thicknesses of the calculated Listing planes were then compared. RESULTS: Results revealed thickening of the Listing plane in patients only when the head was in an impaired-side-down orientation (1.250 ± 0.795 and 1.074 ± 0.759 degrees in the right- and left-side-down head orientations in healthy subjects versus 2.222 ± 1.237 degrees in the impaired-side-down orientation in patients), and this thickening correlated with caloric weakness. By contrast, neither the sensation of postural instability nor postural disturbance in force platform recordings contributed to the thickness of Listing plane. CONCLUSION: The thickness of the Listing plane could be a novel parameter for quantitatively evaluating static vestibular (otolithic) function, although central compensation might exist.

Inflammatory pseudotumour of the paranasal sinuses--a case report.

Inflammatory pseudotumour represents benign non-specific granulation, and is uncommon in the head-and-neck region, particularly in the paranasal sinuses. We present herein the case of a 63-year-old woman with inflammatory pseudotumour of the paranasal sinuses. Physical examination and computed tomography revealed a mass in the bilateral nasal cavity and paranasal sinuses with extension to bilateral orbits. Multiple intranasal biopsies revealed marked lymphoplasmatic infiltration and myofibroblastic proliferation with hyalinisation. Systemic steroid therapy was selected and was very effective. The lesion has shown no evidence of enlargement for more than 1 year. The difficulties in establishing the clinico-pathological diagnosis and treatment are discussed.

An anatomic study of the horizontal petrous internal carotid artery: sex and age differences.

OBJECTIVE: This study aimed to determine the length and diameter of the horizontal portion of the petrous carotid artery (HPCA) and to evaluate sex and age differences in these variables. METHODS: We examined standard axial sinus computed tomographic images in 345 patients (690 sides), measuring length and diameter of the HPCA and the angle between right and left HPCA using computer software. RESULTS: The HPCA averaged 26.7 mm in length and 5.7 mm in diameter. The angle between the right and left HPCA averaged 101.5 degrees . HPCA length averaged 27.1mm in men and 25.8mm in women; HPCA diameter averaged 5.9 mm in men and 5.3 mm in women. The HPCA of men was approximately 0.8 mm wider and the angle between right and left HPCA was on average 8.7 degrees more obtuse in the 60+ years group than in the

Evaluation of super-high-dose steroid therapy for sudden sensorineural hearing loss.

OBJECTIVE: To determine the efficacy of a high-dose steroid regimen for patients with sudden sensorineural hearing loss (SSNHL) and to evaluate the relationship between outcome and initial steroid dose. STUDY DESIGN AND SETTING: We conducted a retrospective study of 112 patients presenting to Saitama Medical Center. Patients received tapering courses of hydrocortisone (HC) with an initial dose of either 1200 mg or 600 mg. RESULTS: More than 87% of patients had recovery of hearing. When hearing stabilized, there were no significant differences between the 1200 mg and 600 mg groups in terms of hearing outcome (P>0.05). However, at completion of treatment, the 1200 mg group exhibited significantly superior complete recovery rate and improvement rate (P<0.05). CONCLUSION: Application of our treatment protocol of a tapered course of 1200 mg HC significantly and rapidly improves recovery outcomes in patients of SSNHL. EBM RATING: C-4.