Long-term changes in serum squamous cell carcinoma antigen levels after surgery in patients with sinonasal inverted papilloma

鼻副鼻腔内反性乳頭腫の術後再発に対する血中 SCC 抗原の長期経過の検討

Nippon Jibiinkoka Tokeibugeka Gakkai Kaiho

日本耳鼻咽喉科頭頸部外科学会会報


A Case of Eosinophilic Granulomatosis with Polyangiitis That Developed After the Initial Administration of Dupilumab

デュピルマブ初回投与後に発症した好酸球性多発血管炎性肉芽腫症例


当科で難聴の遺伝学的検査を施行した症例の検討

当科で難聴の遺伝学的検査を施行した症例の検討


軟骨伝導補聴器が有効であったカルタゲナー症候群例

軟骨伝導補聴器が有効であったカルタゲナー症候群例


The effects of continuous administration of diazepam on the recovery of lesion-induced nystagmus in unilaterally labyrinthectomised rats.

These findings suggested that continuous administration of diazepam accelerates the initial process of VC; however, it does not suppress the nystagmus-driving mechanisms in rats.


顔面神経麻痺のリハビリテーション

顔面神経麻痺のリハビリテーション


A Case of Downbeat Nystagmus Induced by Carbamazepine Intoxication

カルバマゼピン中毒により下眼瞼向き眼振を認めた薬剤性めまい症例


Risk factors of first bite syndrome after surgical resection of parapharyngeal space tumors.

The present findings suggest that concomitant surgical settings of 1) sympathetic denervation of the parotid gland with ligation of the external carotid artery or injury of the sympathetic nerve plexus around the external carotid artery during its mobilization, and 2) residual parotid gland tissue are risk factors for the development of first bite syndrome after surgical resection of parapharyngeal space tumors. J. Med. Invest. 70 : 150-153, February, 2023.

The Journal of Medical Investigation : JMI


Effect of Surgical Training Using a Virtual Reality Sinus Simulator in Medical Education

バーチャルリアリティーを用いた内視鏡下鼻副鼻腔手術シミュレーターによる医学教育実習の効果


Clinical Outcomes of Treatment for Tongue Cancer at Tokushima University Hospital

当科における舌癌の治療成績 (武田憲昭教授退任記念総説集)


Hearing Outcomes After Tympanoplasty for Cholesteatoma at Tokushima University Hospital

当科における真珠腫性中耳炎の手術成績 (武田憲昭教授退任記念総説集)


New method to evaluate sequelae of static facial asymmetry in patients with facial palsy using three-dimensional scanning analysis.

The present findings suggest that affected-unaffected side differences in the depth of the nasolabial fold of the measured using three-dimensional scanning analysis can be used as an index of sequelae of static facial asymmetry. It is also suggested that the index can evaluate whether interventions are effective for the treatment of sequelae.


Long-term changes in serum squamous cell carcinoma antigen levels after surgery in patients with sinonasal inverted papilloma.

These findings suggest that SCCA can be a tumor marker of IP. It is also suggested that postoperative elevation of SCCA levels is a clinical marker for monitoring the recurrence of IP during the follow-up period. A SCCA cut-off value of 1.85 ng/ml postoperatively may predict the subsequent recurrence of IP with high sensitivity and specificity.


Development of receptive vocabulary and verbal intelligence in Japanese children with unilateral hearing loss.

These findings suggest that the development of receptive vocabulary and verbal intelligence was delayed in preschool-age children with UHL and that most of them caught up to exhibit normal language ability after school admission.


Aural stimulation with capsaicin prevented pneumonia in dementia patients

カプサイシン軟膏による外耳道刺激は高齢認知症患者の肺炎を予防する

Nippon Jibiinkoka Tokeibugeka Gakkai Kaiho

日本耳鼻咽喉科頭頸部外科学会会報


Dietary Supplementation with Monosodium Glutamate Suppresses Chemotherapy-Induced Downregulation of the T1R3 Taste Receptor Subunit in Head and Neck Cancer Patients.

(Background) We investigated the effect of dietary supplementation with monosodium glutamate (MSG) on chemotherapy-induced downregulation of the T1R3 taste receptor subunit expression in the tongue of patients with advanced head and neck cancer. (Methods) Patients undergoing two rounds of chemoradiotherapy were randomly allocated to a control or intervention group (dietary supplementation with MSG at 2.7 g/day during the second round of chemotherapy). The relative expression of T1R3, a subunit of both umami and sweet taste receptors, in the tongue was assessed by quantitative polymerase chain reaction analysis. Dysgeusia was assessed with a visual analog scale and daily energy intake was evaluated. (Results) T1R3 expression levels in the tongue, taste sensitivity, and daily energy intake were significantly reduced after the first round of chemotherapy compared with before treatment. Furthermore, these parameters significantly decreased after the second round of chemotherapy, but the extent of decrease was significantly attenuated in the MSG group compared with the control group. (Conclusions) MSG supplementation suppresses chemotherapy-induced dysgeusia, possibly due to the inhibition of the T1R3-containing taste receptor downregulation in the tongue, thereby increasing energy intake in patients with advanced head and neck cancer.


Effects of vocal nodules on acoustic characteristics of voice in children : an acoustic analysis of voice.

Objective : In the present study, an attempt was made to evaluate the acoustic characteristics of voice in pediatric patients with vocal nodules using acoustic analysis of voice. Methods : Thirty-five pediatric patients with vocal nodules and 32 control children without dysphonia were enrolled in this study. Their voice samples were analyzed using the Multi-Dimensional Voice Program. Acoustic parameters of voice, such as pitch period perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and noise-to-harmonic ratio (NHR), were measured. Results : In phonation at a loudness of over 80 dBA, the PPQ, APQ, and NHR values of the voice significantly increased in children with vocal nodules than in the control children without dysphonia. The sensitivities and specificities of PPQ, APQ, and NHR for prediction of vocal nodules in children were 62.86% and 84.38%, 74.29% and 75.00%, and 31.43% and 93.75%, respectively. Discussion : The present findings suggest that vocal nodules affect vocal fold vibration, resulting in impaired control of pitch and loudness leading to increased noise components. NHR could be used to evaluate the efficacy of treatment, such as voice rehabilitation, in pediatric patients with vocal nodules because of its high specificity for prediction of vocal nodules in children. J. Med. Invest. 68 : 276-279, August, 2021.


Vestibular and cochlear nerve enhancement on MRI and its correlation with vestibulocochlear functional deficits in patients with Ramsay Hunt syndrome.

In patients with RHS, the origin of vertigo may be superior vestibular neuritis, which is affected by reactive varicella-zoster virus from the geniculate ganglion of the facial nerve through the faciovestibular anastomosis. The results also suggested that in some RHS patients, inferior vestibular neuritis contributes to the development of vertigo and that the origin of refractory sensorineural hearing loss is cochlear neuritis.

Among RHS patients, 79%, 53%, 17% and 26% showed CP in the caloric test, abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, respectively. SIinc rates of the SVN were significantly increased in RHS patients with CP in the caloric test, and with abnormal responses to oVEMP and cVEMP. SIinc rates of the SVN tended to increase in RHS patients with refractory sensorineural hearing loss (p = 0.052). SIinc rates of the IVN were significantly increased in RHS patients with abnormal responses to oVEMP and cVEMP, and refractory sensorineural hearing loss, but not in those with CP in the caloric test. SIinc rates of the CN were significantly increased in RHS patients with CP in the caloric test, abnormal response to oVEMP and refractory sensorineural hearing loss, but not in those with abnormal response to cVEMP.


Effects of Betahistine on the Development of Vestibular Compensation after Unilateral Labyrinthectomy in Rats.

These findings suggest that betahistine facilitated the late, but not the initial, process of VC in UL rats.


Differential cytokine profiles in pediatric patients with PFAPA syndrome and recurrent tonsillitis.

Objective : An attempt was made to identify characteristic cytokine profiles to distinguish periodic fever with aphthous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPAS) from recurrent tonsillitis, of which clinical manifestations are similar to those of PFAPAS in children. Methods : Serum concentrations of IL-6, IL-4 and IFN-γ were measured during febrile episodes in pediatric patients. Results : The levels of IL-6 during febrile episodes were markedly increased above the upper limit of normal ranges in patients with both PFAPAS and recurrent tonsillitis, but there were no significant differences between groups. The levels of IL-4 during febrile episodes in PFAPAS patients were significantly lower than those in recurrent tonsillitis patients. The levels of IFN-γ during febrile episodes in PFAPAS patients were significantly higher than those in recurrent tonsillitis patients. Conclusion : In pediatric patients with PFAPAS, despite an increase of IL-6, IL-4 was suppressed with a marked increase of IFN-γ during febrile episodes. On the contrary, in febrile pediatric patients with recurrent tonsillitis, both IL-6 and IL-4, but not IFN-γ were increased. The characteristic cytokine profiles of IL-6, IL-4 and IFN-γ can be used for differential diagnosis of PFAPAS from recurrent tonsillitis in children in clinical ear, nose and throat (ENT) settings. J. Med. Invest. 68 : 38-41, February, 2021.

The Journal of Medical Investigation : JMI


A Case of Extramedullary Relapse of APL on the Tympanic Membrane

鼓膜に髄外再発した急性前骨髄球性白血病例

Temporal bone lesions are rarely seen in patients with acute promyelocytic leukemia (APL) during the remission phase. We report a case of APL who showed extramedullary relapse on the tympanic membrane while in the complete remission phase. A 48-year-old male patient with APL in complete remission after the initial therapy presented with left ear fullness. Endoscopic examination revealed a mass on the left tympanic membrane, and temporal bone CT showed a mass localized on the left tympanic membrane. He was diagnosed as having extramedullary relapse of APL based on the histopathological findings of the lesion on the tympanic membrane. There were no APL cells in the blood or bone marrow. However, PCR analysis revealed the presence of PML-RARα in the bone marrow. Based on these findings, we diagnosed the patient as having molecular recurrence of APL, and administered chemotherapy. During the treatment, the ear lesion decreased steadily in size, and finally disappeared. Absence of PML-RARα in the bone marrow specimen after the treatment indicated that the patient had entered the second remission phase. Subsequently, hematopoietic stem-cell transplantation was performed, and the patient remains in remission. In a patient with a history of leukemia presenting with temporal bone lesions, extramedullary relapse should be considered in the differential diagnosis even if the patient is in the remission phase.


Effects of corticosteroid on mRNA levels of histamine H1 receptor in nasal mucosa of healthy participants and HeLa cells.

The purpose of this study is to examine the effect of intranasal corticosteroid (INCS) administration on histamine H1 receptor (H1R) gene expression in the nasal mucosa of healthy participants and the effects of dexamethasone on basal and histamine-induced H1R mRNA expression, and histamine-induced phosphorylation of extracellular signal-regulated kinase (ERK) in HeLa cells. Sixteen healthy participants were given INCS once daily for a week. After pretreatment of dexamethasone, HeLa cells were treated with histamine. Levels of H1R mRNA and phosphorylation of ERK were measured using real time PCR and immunoblot analysis, respectively. Levels of H1R mRNA in the nasal mucosa of healthy participants receiving INCS was significantly decreased. Dexamethasone suppressed basal levels of H1R mRNA, and histamine-induced up-regulation of H1R mRNA and ERK phosphorylation in HeLa cells. These data suggested that corticosteroid inhibited both basal transcription and histamine-induced transcriptional activation of H1R through its suppression of ERK phosphorylation in the signaling pathway involved in H1R gene transcription. It is further suggested that pre-seasonal prophylactic administration of INCS suppresses both basal and pollen-induced upregulation of H1R gene expression in the nasal mucosa of patients with pollinosis, leading to prevention of the exacerbation of nasal symptoms during peak pollen season. J. Med. Invest. 67 : 311-314, August, 2020.


A Case of Rosai-Dorfman Disease with Multiple Extranodal Lesion

多発する節外病変を認めたRosai-Dorfman病例

Rosai-Dorfman disease is a rare histiocytic disorder characterized by accumulation of histiocytes in the affected tissue. Herein we report on a case of Rosai-Dorfman disease with multiple lymphadenopathy and multiple extranodal lesions. A 22-year-old woman was referred to our hospital with bilateral submandibular swelling and a localized swelling in the root of the nose. Endoscopic examination revealed mass lesions in both nasal cavities and the subglottic area. A full-body CT revealed multiple nasal masses, cervical lymphadenopathy, and an intrathymic mass. We diagnosed her as having Rosai-Dorfman disease based on the histopathological findings of accumulation of histiocytes and emperipolesis in the nasal lesion and cervical lymph node specimens. Histopathological examination is required for the diagnosis of Rosai-Dorfman disease. After steroid treatment for 3 months, reduction in the size of the lymph nodes in the neck, nasal cavity lesions, and intrathymic mass was noted. However, the size of the subglottic mass remained almost unchanged. In this case, steroid treatment was mostly effective on the lesions. In case of airway obstruction due to increase in the size of the subglottic mass, surgical resection should be indicated.


顔面神経麻痺程度の客観的評価 ―ハイスピードカメラを用いた自発性瞬目速度の測定―


Daily auricular stimulation with capsaicin ointment improved cough reflex sensitivity in elderly patients with dysphagia: a pilot study.

Daily auricular stimulation with capsaicin ointment would be a safe and effective intervention to prevent pneumonia in elderly with a risk of aspiration.


Electroneurography cannot predict when facial synkinesis develops in patients with facial palsy.

The objective of this study is to clarify when facial palsy patients with lower value of Electroneurography (ENoG) should begin the rehabilitation to prevent the development of facial synkinesis. For this purpose, we examined the relationship between the value of ENoG measured 10-14 days after facial palsy onset and the onset day of the development of oral-ocular synkinesis. Sixteen patients with facial palsy including 11 with Bell's palsy and 5 with Ramsay Hunt syndrome (7 men and 9 women ; 15-73 years old ; mean age, 41.6 years) were enrolled in this study. There was no correlation between ENoG value and the onset day of the development of oral-ocular synkinesis (ρ = .09, p = .73). Oral-ocular synkinesis began to develop in 4.0 ± 0.7 months (mean ± SD ; range : 3.1-5.0 months) after facial palsy onset regardless of ENoG value. In conclusion, ENoG value cannot predict when facial synkinesis develops in patients with facial palsy. We recommend that facial palsy patients with a high risk for the development of synkinesis begin the biofeedback rehabilitation with mirror to prevent the development of facial synkinesis 3 months after facial palsy onset. J. Med. Invest. 67 : 87-89, February, 2020.


Aural stimulation with capsaicin prevented pneumonia in dementia patients.

These findings suggest that daily long-term aural stimulation with capsaicin ointment enhanced the cough reflex via Arnold's ear-cough reflex as a glottis protective measure, resulting in the reduction of incidence of pneumonia in elderly dementia patients at high risk of aspiration. The daily aural stimulation with capsaicin ointment may be a safe and promising intervention to prevent aspiration pneumonia in elderly people, especially those who cannot undergo swallowing exercise.


A Case of Kimura Disease with a Bulky Preauricular Mass

耳前部に巨大な腫瘤を形成した木村病例

Kimura disease, or eosinophilic granuloma of the soft tissue, is a chronic inflammatory granuloma arising from the subcutaneous soft tissues or lymph nodes of the head and neck. We report the case of a 51-year-old male patient with Kimura disease who presented with a bulky left preauricular mass. The peripheral blood eosinophil count and serum levels of IgE and antibodies against candida antigens were elevated. Contrast-enhanced MRI revealed involvement of the parotid gland, and the patient was treated by resection of the bulky mass and of the superficial lobe of the parotid gland. Histopathological examination of the resected specimen showed proliferation of the lymphoid follicles with marked eosinophilic infiltration in the lesion, and we made the diagnosis of Kimura disease. After the surgery, the peripheral blood eosinophil count as well as the serum levels of IgE and antibodies against candida antigens decreased, with no evidence of relapse for at least three years after the surgery. Our findings suggest that type I allergy to Candida albicans plays an important role in the development of Kimura disease.


Effect of Surgical Training Using a Virtual Reality Temporal Bone Simulator in Medical Education

医学教育におけるバーチャルリアリティーを用いた側頭骨手術シミュレーション実習の効果

 To estimate the effects of a virtual reality temporal bone simulator in medical education.

 Two hundred and thirty-five medical students undergoing bedside learning were recruited in this study for two years. The same instructor provided the training during the first year, while several instructors provided the training, based on a guidance manual, during the second year. We examined the students' knowledge of anatomy of the temporal bone and administered a questionnaire to determine their comprehension of surgical procedures involving the temporal bone after the training as compared to the level of understanding before the training.

 The percentage of correct answers in the examination of anatomical knowledge about the temporal bone after the simulation in the first and second year improved from 51.8% to 83.9% and 49.4% to 80.0%, respectively. The percentages of medical students who responded with "well understood" or "I think I understood" to questions in the questionnaire on comprehension of surgical procedures involving the temporal bone in the first and second year were 84.3% and 76.4% for mastoidectomy, 74.8% and 66.4% for tympanotomy and 67.8% and 52.3% for cochleostomy, respectively. The anatomical and surgical comprehension levels, except for the case of cochleostomy, did not differ between students who received instructions from several instructors and those who received from the same instructor in this study. The training using a virtual reality temporal bone simulator was useful to improve the students' anatomical knowledge about the temporal bone and their comprehension of surgical procedures involving the temporal bone, and to unify the training content, regardless of the instructor because of standardization and customization of the surgical procedure. Thus, the training using a virtual reality temporal bone simulator is one of the most effective tools of medical education for both medical students and instructors.


Quantitative assessment of vestibular otopathology in granulomatosis with polyangitis: A temporal bone study.


Electroneurography in the acute stage of facial palsy as a predictive factor for the development of facial synkinesis sequela.

The value of ENoG 10-14days after the onset of facial palsy is a predictive factor for the development of facial synkinesis 12 months later. Since facial palsy patients with a ENoG value inferior to 46.5% have a high risk of developing synkinesis, they should receive the facial biofeedback rehabilitation with a mirror as a preventive therapy.


Structural Analysis of Tensor Tympani Muscle, Tympanic Diaphragm, Epitympanum, and Protympanum in Menière's Disease: a Human Temporal Bone Study.

The position, configuration, and size of the tensor tympani muscle and tendon do not seem to play a role in the pathogenesis of Menière's disease. Because the tympanic isthmus and protympanum in Menière's disease are not smaller than controls and that none of the temporal bones had otitis media or cholesteatoma, it is unlikely that there was dysventilation in the middle ear.


Ramsay Hunt Syndrome during Anti-Retroviral Therapy in an HIV-Seropositive Patient

治療中にハント症候群を発症したHIV感染症例

We report the case of an HIV-seropositive patient with Ramsay Hunt syndrome. A 55-year-old bisexual man diagnosed as being HIV-seropositive was started on anti-retroviral therapy (ART), because his CD4+T cell count had decreased to under 200/μL over a period of 2 months. A week after the start of ART, he was diagnosed as having Ramsay Hunt syndrome, based on the presence of herpes zoster oticus and a positive serological test for VZV antibody. We speculate that the facial palsy was associated with the immune reconstitution inflammatory syndrome (IRIS), as follows. The decrease of the CD4+T cell count induced reactivation of VZV in the geniculate ganglion, but facial palsy did not develop. With the reconstitution of the immune system associated with increase of the CD4+T cell count by the ART, the reactivated VZV in the geniculate ganglion elicited an inflammatory response; the associated release of cytokines caused injury to the facial nerve.


ミラーバイオフィードバック

ミラーバイオフィードバック


The temperature of aural air stimulation equivalent to aural stimulation with water at 20<SUP>°</SUP>C in the caloric test.

少量注水法に対応するエアーカロリック検査の刺激条件の検討

In the present study, we examined the temperature of aural air stimulation that was equivalent to aural stimulation with water at 20°C in the caloric test. In 10 ears of 5 healthy volunteers, the maximum slow phase eye velocities (MSPEVs) of nystagmus induced by aural stimulation with air at 22°C, 46°C and 16°C were the same as those with water at 30°C, 44°C and 20°C, respectively. These findings suggest that caloric stimulation with air at 16°C is equivalent to that with water at 20°C that is commonly used in the caloric test in Japan. The MSPEVs of nystagmus induced by aural stimulation with air at 16°C were over 20°/sec in all ears except one, in which the MSPEV was 19.7°/sec. The criteria of canal paresis where the MSPEV of caloric nystagmus induced by aural stimulation with water at 20°C is less than 20°/sec can be used in the caloric test with aural air stimulation at 16°C.


発症した病的共同運動に対するボツリヌス毒素・ミラーバイオフィードバック併用療法の治療開始時期による効果の検討


小児集団リハビリテーションにおける病的共同運動治療の長期経過観察症例の検討

小児集団リハビリテーションにおける病的共同運動治療の長期経過観察症例の検討


A Case of Descending Necrotizing Mediastinitis Treated with Continuous Saline Irrigation with a Pleated Drain

外科的ドレナージとプリーツドレーンによる持続洗浄が有効であった降下性壊死性縦隔炎例

Descending necrotizing mediastinitis (DNM) requires an early and aggressive surgical approach. We report herein on a case of DNM in which continuous saline irrigation with a pleated drain was found to be useful. A 71-year-old man presented with a sore throat and a peritonsillar abscess, CT imaging showed that an abscess with gas had spread widely over the mediastinum. The pus culture showed Streptococcus milleri group, and anaerobic bacteria were not identified in this case, The CT imaging findings on the other hand revealed suspected anaerobic infection and so the conditions in this case had caused serious mixed infection. We performed aggressive therapies such as cervicomediastinal and transthoracic drainage combined with broad-spectrum antimicrobial therapy, but the abscess was not cleared. We therefore added transcervical continuous saline irrigation with a pleated drain. The patient responded well to this treatment and was discharged on the 62nd postoperative day. We found that continuous saline irrigation with a pleated drain was useful in this case.


Vestibular and cochlear neuritis in patients with Ramsay Hunt syndrome: a Gd-enhanced MRI study

It is suggested that vertigo in patients with Ramsay Hunt syndrome is mostly induced by superior vestibular neuritis consecutive to the reactivation of varicella-zoster virus (VZV) infection from the geniculate ganglion through the faciovestibular anastomosis. Refractory hearing loss in patients with Ramsay Hunt syndrome may be due to cochlear neuritis following the spread of VZV. An attempt was made to selectively identify vestibulocochlear nerves in the internal auditory canal (IAC) on gadolinium (Gd)-enhanced MRI in patients with Ramsay Hunt syndrome. Fourteen patients with Ramsay Hunt syndrome presenting with facial palsy, herpes zoster oticus, vertigo, and/or sensorineural hearing loss were scanned on 1.5 T MRI enhanced with Gd. Perpendicular section images of the IAC were reconstructed to identify the facial, superior, and inferior vestibular nerves and the cochlear nerves separately. All except one of the patients with Ramsay Hunt syndrome with vertigo showed both canal paresis on the caloric test and Gd enhancement of the superior vestibular nerve in the IAC on MRI. Among 10 patients with hearing loss, 3 patients with severe to moderate sensorineural hearing loss showed Gd enhancement of the cochlear nerve in the IAC on MRI.


ボツリヌス投与量を減らしたボツリヌス毒素・ミラーバイオフィードバック併用療法

ボツリヌス投与量を減らしたボツリヌス毒素・ミラーバイオフィードバック併用療法


顔面神経麻痺の予後診断とリハビリテーションについて

顔面神経麻痺の予後診断とリハビリテーションについて


小児顔面神経麻痺後遺症患者における集団リハビリテーション

小児顔面神経麻痺後遺症患者における集団リハビリテーション


発症した病的共同運動に対するボツリヌス毒素・ミラーフィードバック併用療法の長期成績


Hunt症候群における内耳道造影MRIについて

Hunt症候群における内耳道造影MRIについて


顔面神経麻痺患者に対する集団リハビリテーション

顔面神経麻痺患者に対する集団リハビリテーション


上前庭神経障害によるめまいと考えられた不完全Hunt症候群症例

上前庭神経障害によるめまいと考えられた不完全Hunt症候群症例


Hunt症候群における聴力障害の検討

Hunt症候群における聴力障害の検討


完全脱神経を来たしたHumt症候群に対するリハビリテーション

完全脱神経を来たしたHumt症候群に対するリハビリテーション