An essential dose of cisplatin for super-selective intra-arterial infusion concomitant with radiotherapy in patient with maxillary squamous cell carcinoma.

The present study investigated the efficacy and safety of using a lower dose of cisplatin (CDDP) in super-selective intra-arterial concurrent chemoradiotherapy (SSIACRT) to treat maxillary squamous cell carcinoma. 10 patients with maxillary squamous cell carcinoma (T3 n = 6, T4a n = 4) without regional or distant metastasis were treated by SSIACRT. The CDDP dose per course was 100 mg/body, i.e. 50-80 mg/m(2). 6-9 weeks after SSIACRT, partial maxillectomy was performed on all patients. Clinical and histological responses, survival rates, and adverse events were investigated. 10 (100%) of 10 patients achieved both clinical and pathological complete or partial remission. The 3-year overall and disease-free survival rates were 100 and 90%, respectively. Grade 3 toxicity was experienced by two patients. In conclusion, the SSIACRT regimen with a lower dose of CDDP (100 mg/body) had an equivalent therapeutic outcome and lower toxic outcome compared to a higher dose of CDDP. This regimen could be an effective and safe therapeutic modality for maxillary squamous cell carcinoma except T4b and N1/2 disease.

Flap suturing endonasal dacryocystorhinostomy assisted by ultrasonic bone aspirator.

BACKGROUND: In the external dacryocystorhinostomy (DCR), a sutured anastomosis technique performed between the nasal mucosal and lacrimal sac flaps reported by Dupuy-Dutemps and Bourguet was the gold standard and was believed to lead to the success of the surgery. However, because of the small working space, a flap suturing technique has not been completely established in endonasal DCR (END-DCR). OBJECTIVES: The effect of the modified flap suture anastomosis technique using a Sonopet ultrasonic bone aspirator was retrospectively compared to that using a diamond burr in patients with nasolacrimal duct obstruction. MATERIALS AND METHODS: One hundred ten patients underwent the modified flap suturing technique using the Sonopet, and 30 patients were operated on using a diamond burr. RESULTS: Successful patency of the lacrimal ostium (LO) was obtained in all patients in both groups. The rates of successful suturing during the operation and of a large diameter of the LO 3 months after the operation were significantly higher in patients in whom the Sonopet rather than the burr was used. CONCLUSIONS AND SIGNIFICANCE: The Sonopet might offer similar surgical outcome to the traditional microdrill DCR and is a safer means of bone removal in END-DCR in the small working space.

[Effect of S-1 in a patient with metastatic eyelid sebaceous carcinoma].

We report a 68-year-old female with a history of repeated right cervical lymph node metastasis secondary to eyelid sebaceous carcinoma. She had undergone right neck dissection due to lymph node metastasis at the department of surgery in an other local hospital. After the orbital exenteration, she underwent multiple operations, including 2 right partial parotidectomy and then total parotidectomy, 4 right cervical lymph node excisions and 1 left upper neck dissection due to lymph node metastasis. Adjuvant chemotherapy with S-1(at a dose of 80 mg per day)alone was applied as tumor dormancy therapy on an outpatient basis. Any adverse events during S-1 medication were observed. New metastatic lesions were not found until 29 months after the beginning of chemotherapy with S-1 alone. Although the effectiveness of S-1 for eyelid sebaceous carcinoma has not been demonstrated, S-1 might be useful in patients with recurrent eyelid sebaceous carcinoma based on our patient's recurrence-free survival.

Effects of transtympanic intermittent pressure therapy using a new tympanic membrane massage device for intractable Meniere's disease and delayed endolymphatic hydrops: a prospective study.

BACKGROUND: The retrospective study showed that the effect of the middle ear pressure treatment by the tramstympanic membrane massage (TMM) device was similar to that of the Meniett device. OBJECTIVES: The new TMM device named EFET device was prospectively evaluated in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) and we compared the effects to the Meniett device. MATERIALS AND METHODS: 23 ears of 19 patients were treated with an EFET device, and 17 ears of 15 patients were treated with the Meniett device. All patients suffering from intractable MD and DEH were treated for 4 months. The insertion of a transtympanic ventilation tube was necessary for the Meniett device, but not the EFET device. RESULTS: In patients treated by the EFET and Meniett devices, the frequency of vertigo significantly improved after treatment. The distribution of vertigo outcomes at 4 months after treatment did not differ between patients treated with the both devices. CONCLUSIONS AND SIGNIFICANCE: Middle ear pressure treatment by the EFET device is effective and provides minimally invasive options for intractable MD and DEH like the Meniett device.

Long-term effect of transtympanic intermittent pressure therapy using a tympanic membrane massage device for intractable meniere's disease and delayed endolymphatic hydrops.

BACKGROUND: A 12-month follow-up study showed that middle ear pressure treatment with a transtympanic membrane massage (TMM) device had a similar effect to a Meniett device. OBJECTIVES: The effects of pressure treatment with a TMM device were retrospectively compared to the effects of treatment with a Meniett device in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) who were followed for a minimum of 24 months. MATERIALS AND METHODS: Twenty-seven patients were treated with the TMM device and 14 patients were treated with a Meniett device. The insertion of a transtympanic ventilation tube was necessary for the Meniett device but not for the TMM device. RESULTS: In patients treated with the TMM and Meniett devices, the frequency of vertigo significantly improved at 19-24 months after treatment. The distribution of vertigo at 19-24 months after treatment did not differ between the patients treated with the two types of devices. Pressure treatment for 8 months or more was suitable to achieve remission. CONCLUSIONS AND SIGNIFICANCE: Middle ear pressure treatment for 8 months or more with a TMM or Meniett device was equally effective and provided minimally invasive treatment options for intractable MD and DEH.

Lacrimal Drainage System Obstruction Following Inferior Turbinate Surgery.

Objective: To provide information on the clinical characteristics and management of an uncommon acquired nasolacrimal drainage system obstruction (NLDSO). Methods: A patient was treated with microdebrider-assisted endoscopic marsupialization for a cystic lesion located in the synechiae between the inferior turbinate and the lateral wall of the inferior meatus. Results: A 21-year-old woman suffered from epiphora and purulent discharge 1 week after inferior turbinate surgery. Endoscopy reveled synechiae between the inferior turbinate and the lateral wall of the inferior meatus. Computed tomography-dacrocystography (CT-DCG) showed enlargement of the nasolacrimal duct and cystic accumulation of contrast medium from the lacrimal orifice posteriorly. The patient was treated with nasal endoscopic marsupialization of the cyst and then powered inferior turbinoplasty. Six months after the operation, both endoscopy and CT scan showed a widely patent left inferior meatus and nasolacrimal orifice. Conclusions: We report the first case of post-operative NLDSO following inferior turbinate surgery. Nasal endoscopy and CT-DCG are useful to diagnose the location of a NLDSO. Otorhinolaryngologists should be aware that surgery may lead to the formation of a NLDSO and that endoscopic marsupialization is a curative treatment for these distal-end NLDSO. NLDSOs are caused by synechiae, which are a complication of inferior turbinate surgery.

Cerebral Hemodynamic Responses to the Sensory Conflict Between Visual and Rotary Vestibular Stimuli: An Analysis With a Multichannel Near-Infrared Spectroscopy (NIRS) System.

Sensory conflict among visual, vestibular, and somatosensory information induces vertiginous sensation and postural instability. To elucidate the cognitive mechanisms of the integration between the visual and vestibular cues in humans, we analyzed the cortical hemodynamic responses during sensory conflict between visual and horizontal rotatory vestibular stimulation using a multichannel near-infrared spectroscopy (NIRS) system. The subjects sat on a rotatory chair that was accelerated at 3°/s2 for 20 s to the right or left, kept rotating at 60°/s for 80 s, and then decelerated at 3°/s2 for 20 s. The subjects were instructed to watch white stripes projected on a screen surrounding the chair during the acceleration and deceleration periods. The white stripes moved in two ways; in the "congruent" condition, the stripes moved in the opposite direction of chair rotation at 3°/s2 (i.e., natural visual stimulation), whereas in the "incongruent" condition, the stripes moved in the same direction of chair rotation at 3°/s2 (i.e., conflicted visual stimulation). The cortical hemodynamic activity was recorded from the bilateral temporoparietal regions. Statistical analyses using NIRS-SPM software indicated that hemodynamic activity increased in the bilateral temporoparietal junctions (TPJs) and human MT+ complex, including the medial temporal (MT) area and medial superior temporal (MST) area in the incongruent condition. Furthermore, the subjective strength of the vertiginous sensation was negatively correlated with hemodynamic activity in the dorsal part of the supramarginal gyrus (SMG) in and around the intraparietal sulcus (IPS). These results suggest that sensory conflict between the visual and vestibular stimuli promotes cortical cognitive processes in the cortical network consisting of the TPJ, the medial temporal gyrus (MTG), and IPS, which might contribute to self-motion perception to maintain a sense of balance or equilibrioception during sensory conflict.

Case Report: Response to Intra-arterial Cisplatin and Concurrent Radiotherapy Followed by Salvage Surgery in a Patient With Advanced Primary Sinonasal Low-Grade Non-intestinal Adenocarcinoma.

Background: The clinical usefulness of concurrent chemoradiotherapy before surgery in the treatment of primary, locally advanced sinonasal low-grade, non-intestinal type adenocarcinoma (LG non-ITAC) is unclear. Methods: We present the first case report of the efficacy of super-selective intra-arterial cisplatin (CDDP) infusion concurrent with conventional fractionated radiotherapy (RT) for LG non-ITAC in a Japanese patient. Results: A white, rugged-marginal mass that was histopathologically diagnosed as LG non-ITAC occupied the right nasal cavity. Based on the imaging findings, including computed tomography, magnetic resonance imaging, and positron emission tomography, the tumor was diagnosed as T4aN0M0, stage IVa. After treatment, the nasal tumor disappeared leaving only a small bulge in the medial wall of the middle turbinate. The patient also underwent right transnasal ethmoidectomy performed as salvage surgery. A histopathological examination revealed that the lesion was replaced by granulation tissue with lymphocytic infiltration and hemosiderin-laden macrophages, and no viable tumor cells remained. In the seven years after treatment, the patient has not experienced any local recurrence or regional or distant metastasis. Conclusions: Super-selective intra-arterial CDDP infusion concurrent with conventional fractionated RT followed by salvage surgery might be useful for the management of sinonasal LG non-ITAC.

Prognosis of low-tone sudden deafness - does it inevitably progress to Meniere's disease?

CONCLUSION: We conclude that not all low-tone sudden deafness (SD) patients suffered from endolymphatic hydrops even if they had vertigo attack at the onset and that electrocochleography (ECochG) was a useful prognostic tool. OBJECTIVES: To investigate whether low-tone SD was a precursor of Meniere's disease and whether patients with low-tone SD suffered from endolymphatic hydrops. PATIENTS AND METHODS: This was a retrospective case review in the university hospital. A total of 184 patients with low-tone SD were divided into two groups with single and recurrent episodes. The progress, follow-up audiograms, and ECochG results of the patients were reviewed and compared with those of patients with high-tone SD and Meniere's disease. RESULTS: In all, 83 of 177 patients with low-tone SD unaccompanied by vertigo had recurrent hearing loss; 15 of the 83 developed vertiginous attacks. The remaining 94 patients had a single episode. Three of the seven patients with low-tone SD accompanied by vertigo had recurrent hearing loss; two of the three were subsequently confirmed to have Meniere's disease. The other four had a single episode. No difference in rate of progress from SD to Meniere's disease was observed among the low-tone and the high-tone SD groups. The average -SP/AP of each group with a single episode is smaller than that of other groups with recurrent episodes and Meniere's disease.

Mumps virus may damage the vestibular nerve as well as the inner ear.

We report a case of mumps deafness with acute vestibular symptoms secondary to both retrolabyrinthine and inner ear dysfunction. To our knowledge, no such case has been reported elsewhere. The patient was a 6-year-old girl in whom mumps deafness was initially diagnosed. Two days after onset of the hearing impairment, severe vertigo developed. Neurotologic examinations revealed spontaneous right-beating nystagmus, left canal paresis, absence of vestibular-evoked myogenic potentials in the left ear, and absence of responses to a left galvanic body sway test (GBST). The vertigo resolved 7 days after onset. However, the left hearing impairment progressed to complete deafness. Six months later, left canal paresis was still present, but bilateral GBST responses were normal, suggesting that retrolabyrinthine vestibular function had been restored. Mumps virus may affect retrolabyrinthine function as well as the inner ear.

Lymphoepithelial carcinoma of the maxillary sinus: A case report and review of the literature.

RATIONALE: Most cases of lymphoepithelial carcinoma (LEC) occur in the nasopharynx, and LEC in the sinonasal tract is extremely rare; thus, the clinical characteristics of sinonasal LEC are not well known. PATIENT CONCERNS: A 63-year-old Japanese man presented with a three-week history of left cheek pain, nasal obstruction and cheek swelling. DIAGNOSES: Enhanced CT and MRI revealed a tumor of the left maxillary sinus that invaded the left orbit and hard palate, with multiple swollen left cervical lymph nodes. Open biopsy was performed, and the specimen was diagnosed as LEC. INTERVENTIONS: Alternating chemoradiotherapy (ALCRT) followed by salvage surgery was performed. OUTCOMES: Our patient has been disease free for 5 years. LESSONS: A literature review of the epidemiology, etiology, clinical course and management of sinonasal LEC is highlighted. We believe ALCRT followed by salvage surgery to be a highly optimal treatment for sinonasal LEC from the viewpoint of a balance between quality of life and a high curative effect.

Effects of vestibular nerve section on sound-evoked myogenic potentials in the sternocleidomastoid muscle of monkeys.

OBJECTIVE: The aim of this study was to elucidate the neural pathway for sound-evoked myogenic potentials (SEMPs) in monkeys with characteristics similar to those of vestibular evoked myogenic potentials in humans. METHODS: Six macaque monkeys were examined. The effects of total and selective vestibular nerve section on the SEMPs were evaluated in three monkeys. RESULTS: After total vestibular nerve section, the SEMPs and caloric nystagmus were eliminated, and the auditory brainstem response remained. After selective superior vestibular nerve section, the SEMPs remained, but caloric nystagmus was eliminated. CONCLUSIONS: The inferior vestibular nerve comprises a neural pathway for SEMPs in monkeys. SIGNIFICANCE: SEMP in monkeys may provide a model of human VEMPs.

Effects of selective cochlear toxicity and vestibular deafferentation on vestibular evoked myogenic potentials in guinea pigs.

CONCLUSION: The findings suggest that sound-evoked myogenic potentials on the guinea pig sternocleidomastoid muscle (SM) originate from the vestibular end organ and not from the cochlea of the inner ear. OBJECTIVE: Studies in animals of the sound evoked vestibular myogenic potentials on the SM should aid in elucidating the pathway of the vestibular-evoked myogenic potential (VEMP). However, details of the pathway of the VEMP remain to be elucidated. This study aimed to clarify aspects of this pathway. MATERIALS AND METHODS: In the present study, short latency biphasic myogenic potentials on the SM in guinea pigs were induced by an intense brief sound. RESULTS: The thresholds of the potentials were 67 dB SPL above those of the auditory brainstem response (ABR). The potentials were eliminated by a vestibular deafferentation, but were observed after selective cochlea toxicity using an amikacin injection.

Positron emission tomography for predicting malignancy of sinonasal inverted papilloma.

BACKGROUND: Sinonasal inverted papilloma (IP) is an uncommon nasal tumor. It is known for being locally invasive and recurrent, with a high probability of malignant transformation. Accurate initial staging and close surveillance are critical in the management of the disease. METHODS AND RESULTS: Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) was performed in 5 patients with IP. High FDG uptake (maximum standardized uptake (SUVmax) value >3.0) was observed in all patients, and 2 patients with IP associated with squamous cell carcinoma (SCC) exhibited higher SUVmax values. CONCLUSION: The SUVmax value of a sinonasal tumor can warn the surgeon of the probability of an associated malignancy, even when preoperative biopsy demonstrates a purely benign papilloma.

Sound-evoked myogenic potentials on the sternocleidomastoid muscle in monkeys.

CONCLUSION: We recorded sound-evoked myogenic potentials of the sternocleidomastoid (SCM) muscle using awake monkeys. The characteristics of these potentials are similar to those of vestibular evoked myogenic potentials (VEMPs) in humans, suggesting that the sound-evoked myogenic potentials of the SCM muscle in monkeys may be utilized as an animal model of VEMPs. OBJECTIVE: The pathway of the VEMPs remains uncertain as no animal model has yet been used to record sound-evoked myogenic potentials in the SCM muscle. Therefore, the present study aimed to establish an animal model of VEMPs using macaque monkeys. MATERIALS AND METHODS: Four macaque monkeys were used. A pair of electrodes was attached on the SCM muscle ipsilateral side to the intense sound stimulation. RESULTS: The sound-evoked myogenic potentials of the SCM muscle exhibited a biphasic waveform. When a click at 125 dBSPL was applied, the peak latency of the first positive wave was 12.5 ms and was not delayed when the stimulating sound intensity was reduced. The thresholds of the myogenic potentials were 103 dBSPL, which were 43 dB higher than those of the auditory brainstem response (ABR). When a short tone burst was applied, the reactive optimal frequency of the myogenic potentials was relatively low (500-1000 Hz).

A tangible head model showing semicircular canals for demonstrating the physical treatment for BPPV.

CONCLUSIONS: It was shown that practicing with a tangible head model with semicircular canals is a useful educational tool for learning the physical treatment for BPPV. OBJECTIVES: To assess the efficacy of using a tangible head model with semicircular canals to teach the physical treatment for BPPV. METHODS: This study compared the number of canalith particles in the posterior semicircular canal that 20 participants could move from the ampulla to the utricle, before and after practicing with the tangible model. RESULTS: Before practicing with the model, they could move 2.5 (mean value) of 10 canalith particles. However, after practicing, they could move 6.6 (mean value) of 10 canalith particles. There was a statistical difference (p < 0.01) between the two trials.

Endonasal flap suture-dacryocystorhinostomy (eFS-DCR): a new surgical technique for nasolacrimal duct obstruction (NLDO).

CONCLUSION: Endonasal flap suture-dacryocystorhinostomy (eFS- DCR) is a new and valuable technique for the treatment of nasolacrimal duct obstruction (NLDO). This technique could improve the success rate of endonasal DCR in comparison to external DCR. OBJECTIVE: The standard procedure for NLDO is DCR. DCR can be performed via either an external or endonasal approach. External DCR is now regarded as the gold standard in the treatment of NLDO because of its higher success rate. However, we report a new endonasal surgical technique, eFS-DCR, and assess its efficacy by comparison with the standard endonasal DCR. METHODS: We prospectively investigated a series of 62 consecutive patients with NLDO undergoing endonasal DCR. There were two surgical intervention groups: group 1 (24 patients, 28 sites) undergoing endonasal DCR without eFS; and group 2 (38 patients, 47 sites) undergoing eFS-DCR. Study end points were success rate, the ostium diameter (OD) of the lacrimal sac after DCR, and the duration of stent placement. We compared the two groups on these three points. RESULTS: The success rate was 78.6% (22 of 28 sites) for group 1 (DCR without eFS) and 97.9% (46 of 47 sites) for group 2 (eFS-DCR). The ostium size in patients in group 2 was larger than that in group 1. The median time for the duration of stent placement was 42.5 days for group 1 and 31.5 days for group 2. There was a statistical difference (p < 0.01) in all these parameters between the two groups.

Cochlear implantation in a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes syndrome.

OBJECTIVE: The aim of this study was to investigate the usefulness of a Nucleus C124M cochlear implant in a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome. MATERIAL AND METHODS: A 29-year-old woman with MELAS syndrome presented with sensorineural hearing loss and diabetes mellitus and underwent multichannel cochlear implantation. The follow-up period was 10 months. The case history, assessment of mitochondrial disease, indications for the cochlear implant and the benefits of cochlear implantation were evaluated. RESULTS: Nine months after the surgery the patient could use the telephone and was quite satisfied with the improvement in communication due to the cochlear implant. CONCLUSION: Cochlear implantation can be recommended for patients with MELAS syndrome if they have residual retrocochlear function. Single photon emission computerized tomography was found to be very useful for evaluating retrocochlear function.

Response to intra-arterial cisplatin and concurrent radiotherapy in a patient with primary mucosal malignant melanoma of the nasal cavity.

BACKGROUND: The prognosis for patients with mucosal malignant melanoma (MMM) of the nasal cavity is very poor because of the radioresistance of melanoma cells. METHODS: We present the first case report of the efficacy of superselective intra-arterial cisplatin (CDDP) infusion concurrent with hypofractionated radiotherapy (RT) for MMM of the nasal cavity. RESULTS: A pink, polypoid mass, histopathologically diagnosed as an amelanostic melanoma, occupied the right nasal cavity. After the treatment, a nasal tumor disappeared, leaving only a small bulge in the medial wall of the middle turbinate. Histopathologic examination revealed scattered degenerated melanoma cells, remaining only in the small restricted area in the medial surface of the excised middle turbinate. Twelve months after the treatment, the patient has not experienced any local recurrence or regional and distant metastasis. CONCLUSIONS: The superselective intra-arterial CDDP infusion concurrent with hypofractionated RT might be useful for the management of nasal MMM.

Application of hyperdry amniotic membrane patches without fibrin glue over the bony surface of mastoid cavities in canal wall down tympanoplasty.

CONCLUSION: Fibrin glue might be an inessential bioadhesive for attachment of hyperdry amniotic membrane (AM) patches in canal wall down (CWD) tympanoplasty. OBJECTIVE: To clarify the pliability and adherence capability of human hyperdry AM, the feasibility of fixing hyperdry AM without fibrin glue to the bony surface of the mastoid cavity was evaluated in CWD tympanoplasty. METHODS: This was a retrospective chart review. In seven ears of seven patients, the AM was simply attached over the bony surface of the mastoid cavity without fibrin glue (AMG(-) group). In 22 ears of 20 other patients, hyperdry AM (11 ears of 11 patients, AMG(+) group) or temporal fascia (11 ears of 9 patients, TFG(+) group) was attached over the bony surface of the mastoid cavity with fibrin glue. Times for graft epithelization were compared among the three groups. RESULTS: Complete epithelization of the mastoid cavity took place in all patients in all three groups. The mean time to complete epithelization of the graft in the AMG(-) and AMG(+) groups was significantly faster than that in the TFG(+) group (p < 0.05) and was not significantly different between the two AM groups (p > 0.05).