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


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.


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)


Clinical Outcomes of Treatment for Hypopharyngeal Cancer at Tokushima University Hospital

当科における下咽頭癌の治療成績 (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.

The Journal of Medical Investigation : JMI


A Case of von Willebrand's Disease Diagnosed by Refractory Tonsillar Hemorrhage with a Family History

難治性扁桃出血を契機に診断された家族歴を有するvon Willebrand病例

The disease termed von Willebrand's disease (vWD) is an autosomal-dominant hereditary bleeding disorder caused by dysfunction or deficiency of the clotting factor called von Willebrand factor (vWF); vWF is produced by the vascular endothelial cells and bone marrow megakaryocytes, and plays a major role in platelet adhesion and aggregation in the processes of primary hemostasis.

We reported the case of 3-year-old girl with vWD, who presented us with refractory tonsillar hemorrhage. Because of the family history of refractory bleeding, the concentration and activity of vWF in the blood were measured. Accordingly, the child was diagnosed as having vWD as she met the following diagnostic criteria: 1) abnormal bleeding episode; 2) vWF antigen titer or vWF activity less than 30% or equivalent to the mean -2SD. After additional laboratory examination, we diagnosed her as having type2A vWD. Moreover, her mother, grandmother and 2 second cousins were also diagnosed having type2A vWD. Following the diagnosis, the refractory pharyngeal bleeding was controlled by intravenous factor VIII/vWF supplementation.

Because refractory epistaxis and oral mucosal bleeding are common symptoms in patients with vWD, it is important for otolaryngologists to promptly diagnose this disease by type and advise patients on the appropriate course of treatment.


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.


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.

The Journal of Medical Investigation : JMI


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.


Effects of FM system fitted into the normal hearing ear orcartilage conduction hearing aid fitted into the affected ear on speech-in-noise recognition in Japanese children with unilateral congenital aural atresia.

The effects of FM system fitted into the normal hearing ear (NHE) or a cartilage conduction hearing aid (CCHA) fitted into the affected ear (AE) on the speech recognition ability in noise were examined in children with unilateral congenital aural atresia (UCAA). In children with bilateral normal hearing (BNH), speech recognition score (SRS) was significantly decreased in the noisy environment of -5 dB signal-to-noise ratio (SNR), compared with those in quiet. In children with UCAA, SRS was significantly decreased in noisy environments of 0 and -5 dB SNR, compared with those in quiet. In noisy environments of 0 and -5 dB SNR, SRS in children with UCAA was significantly decreased, compared those in children with BNH. In the noisy environment of -5 dB SNR, SRS in UCAA children aided by FM system fitted into NHE was significantly better than those in unaided children in the same group. In the noisy environment of 0 dB SNR, SRS in UCAA children aided by CCHA into AE tended to be higher than those in unaided children in the same group. FM system and CCHA can be recommended as an audiological management for the improvement of speech recognition in children with UCHL in classrooms. J. Med. Invest. 67 : 134-138, 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.


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.


Effects of FM system fitted into normal hearing ear on speech-in-noise recognition in Japanese school-aged children with unilateral severe-to-profound hearing loss

We examined speech recognition ability of elementary school-aged Japanese children with unilateral hearing loss under noisy environments and then examined the effects of the FM system fitted into their normal hearing ear on their speech recognition ability. Twelve children with severe-to-profound sensorineural hearing loss and ten age-matched children with bilateral normal hearing received speech recognition test in quiet and noisy environments. Other nine children with severe-to-profound sensorineural hearing loss received speech recognition test with or without the FM receiver fitted to the normal hearing ear in quiet and noisy environments. Signal-to-noise ratio (SNR) in Japanese elementary school classrooms was estimated to be -6.9 dB at a preferential seat. In noisy environment of -5 dB SNR similar to working classrooms, the correct rates of speech recognition test in children with unilateral hearing loss were significantly lower, compared with those in children with bilateral normal hearing. In the noisy environment, the correct rates in children aided by the FM system with unilateral hearing loss were significantly better, compared with unaided ones. The results suggested that the FM system is recommended as an audiological management for improvement of speech recognition of children with unilateral hearing loss in noisy classrooms. J. Med. Invest. 65:216-220, August, 2018.

The Journal of Medical Investigation : JMI


Aural stimulation with capsaicin ointment improved swallowing function in elderly patients with dysphagia: a randomized, placebo-controlled, double-blind, comparative study.

The aim of this study was to assess whether aural stimulation with ointment containing capsaicin improves swallowing function in elderly patients with dysphagia. A randomized, placebo-controlled, double-blind, comparative study. Secondary hospital. Twenty elderly dysphagic patients with a history of cerebrovascular disorder or Parkinson's disease were randomly divided into two groups: 10 receiving aural stimulation with 0.025% capsaicin ointment and 10 stimulated with placebo. The ointments were applied to the external auditory canal with a cotton swab. Then, swallowing of a bolus of blue-dyed water was recorded using transnasal videoendoscopy, and the swallowing function was evaluated according to both endoscopic swallowing scoring and Sensory-Motor-Reflex-Clearance (SMRC) scale. The sum of endoscopic swallowing scores was significantly decreased 30 and 60 min after a single administration in patients treated with capsaicin, but not with placebo. Reflex score, but not Sensory, Motion and Clearance scores, of the SMRC scale was significantly increased 5, 30 and 60 min after single administration in patients treated with capsaicin, but not with placebo. No patient showed signs of adverse effects. As capsaicin is an agonist of the transient receptor potential vanilloid 1 (TRPV1), these findings suggest that improvement of the swallowing function, especially glottal closure and cough reflexes, in elderly dysphagic patients was due to TRPV1-mediated aural stimulation of vagal Arnold's nerve with capsaicin, but not with a nonspecific mechanical stimulation with a cotton swab.


Efficacy of proton pump inhibitor in combination with rikkunshito in patients complaining of globus pharyngeus

Globus pharyngeus (GP) is a common symptom of laryngopharyngeal reflux disease (LPRD), and proton pump inhibitor (PPI) and rikkunshito, a traditional Japanese medicine having prokinetic effect improve LPRD symptoms. In the present study, we examined the efficacy of high-dose PPI in combination with rikkunshito in patients complaining of GP. 106 patients complaining of GP without any organic endoscopic findings were enrolled. Patients were first administrated with high-dose PPI alone for 4 to 8 weeks and the symptom was improved in 65 patients. Among 41 patients with PPI-refractory GP, 22 patients were administrated with high-dose PPI in combination with rikkunshito, and the symptom was improved in 14 of 22 patients 4 weeks later. The average value of a modified reflux symptom index of the responders was similar to that of non-responders. Only a few patients had positive values in reflux finding scores in both groups. The present findings suggest the existence of a high prevalence of LPRD in patients complaining of GP. The data also suggest that gastroesophageal dysmotility is involved in GP, in addition to excessive acid reflux. The pre-therapeutic laryngopharyngeal symptoms and endoscopic findings could not predict the efficacy of the treatment for GP. J. Med. Invest. 63: 227-229, August, 2016.


[Aural Stimulation with Capsaicin Ointment Improved the Swallowing Function in Patients with Dysphagia: Evaluation by the SMRC Scale].

外耳道へのカプサイシン軟膏刺激による嚥下障害患者の嚥下機能の改善 SMRCスケールを用いた評価

Cough and swallowing reflexes are important airway-protective mechanisms against aspiration. Angiotensin-converting enzyme (ACE) inhibitors, one of the side effects of which is cough, have been reported to reduce the incidence of aspiration pneumonia in hypertensive patients with stroke. ACE inhibitors have also been reported to improve the swallowing function in post-stroke patients. On the other hand, stimulation of the Arnold nerve, the auricular branch of the vagus, triggers the cough reflex (Arnold's ear-cough reflex). Capsaicin, an agonist of Transient Receptor Potential Vanilloid 1 (TRPV1), has been shown to activate the peripheral sensory C-fibers. Stimulation of the sensory branches of the vagus in the laryngotracheal mucosa with capsaicin induces the cough reflex and has been reported to improve the swallowing function in patients with dysphagia. In our previous study, we showed that aural stimulation of the Arnold nerve with 0.025% capsaicin ointment improved the swallowing function, as evaluated by the endoscopic swallowing score, in 26 patients with dysphagia. In the present study, the video images of swallowing recorded in the previous study were re-evaluated using the SMRC scale by an independent otolaryngologist who was blinded to the information about the patients and the endoscopic swallowing score. The SMRC scale is used to evaluate four aspects of the swallowing function: 1) Sensory: the initiation of the swallowing reflex as assessed by the white-out timing; 2) Motion: the ability to hold blue-dyed water in the oral cavity and induce laryngeal elevation; 3) Reflex: glottal closure and the cough reflex induced by touching the epiglottis or arytenoid with the endoscope; 4) Clearance: pharyngeal clearance of the blue-dyed water after swallowing. Accordingly, we demonstrated that a single application of capsaicin ointment to the external auditory canal of patients with dysphagia significantly improved the R, but not the S, M or C scores, and this effect lasted for 60 min. After repeated aural stimulation with the ointment for 7 days, the R score improved significantly in patients with severe dysphagia. The present findings suggest that stimulation of the Arnold's branch of the vagus in the external auditory canal with capsaicin improves the glottal closure and cough reflex in patients with dysphagia. Thus, aural stimulation with capsaicin represents a novel treatment for dysphagia. It is also suggested that repeated alternative aural stimulation with capsaicin for a week, rather than a single application, is needed to improve the swallowing function in patients with severe dysphagia. By the same mechanism as that underlying the effect of ACE inhibitors, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in patients with dysphagia.

ACE (angiotensin converting enzyme) 阻害薬は, 副作用である咳反射の亢進により誤嚥を防止して嚥下性肺炎の罹患率を減少させ, 嚥下障害患者の嚥下機能を改善させる. 一方, 外耳道の刺激は迷走神経反射を介して咳を誘発する. また, カプサイシンは TRPV1 (transient receptor potential vanilloid 1) を活性化して知覚神経を刺激する. われわれは以前の研究で, 嚥下障害患者の外耳道へのカプサイシン軟膏刺激が, 嚥下内視鏡検査のスコア評価法により評価した嚥下機能を改善させることを報告した. 本研究では, 以前の研究の嚥下内視鏡検査ビデオ動画を, 患者情報およびスコア評価法の結果を知らない耳鼻咽喉科専門医が独立して SMRC スケールにより評価した. SMRC スケールは嚥下内視鏡検査の評価法であり, 嚥下の4つの機能である咽頭知覚 (Sensory), 嚥下運動 (Motion), 声門閉鎖反射・咳反射 (Reflex), 咽頭クリアランス (Clearance) を別々に評価する. その結果, 外耳道への0.025%カプサイシン軟膏塗布により, 26名の嚥下障害患者の嚥下機能のうち声門閉鎖反射・咳反射が有意に改善し, この効果は塗布後60分後まで持続した. 嚥下機能がより低下している患者の声門閉鎖反射・咳反射は, 外耳道へのカプサイシン軟膏の単回塗布では変化しなかったが, 1週間連日塗布により有意に改善した. この結果から, カプサイシン軟膏による外耳道刺激は, 新しい嚥下障害の治療法として用いられる可能性があり, ACE 阻害薬のように嚥下性肺炎を予防できる可能性も考えられた.


Effects of aural stimulation with capsaicin ointment on swallowing function in elderly patients with non-obstructive dysphagia.

In the present study, an attempt was made to examine the effects of aural stimulation with ointment containing capsaicin on swallowing function in order to develop a novel and safe treatment for non-obstructive dysphagia in elderly patients. A prospective pilot, non-blinded, non-controlled study with case series evaluating a new treatment. Secondary hospitals. The present study included 26 elderly patients with non-obstructive dysphagia. Ointment containing 0.025% capsaicin (0.5 g) was applied to the external auditory canal with a cotton swab under otoscope only once or once a day for 7 days before swallowing of a bolus of colored water (3 mL), which was recorded by transnasal videoendoscopy and evaluated according to the endoscopic swallowing score. After a single application of 0.025% capsaicin ointment to the right external auditory canal, the endoscopic swallowing score was significantly decreased, and this effect lasted for 60 minutes. After repeated applications of the ointment to each external auditory canal alternatively once a day for 7 days, the endoscopic swallowing score decreased significantly in patients with more severe non-obstructive dysphagia. Of the eight tube-fed patients of this group, three began direct swallowing exercises using jelly, which subsequently restored their oral food intake. These findings suggest that stimulation of the external auditory canal with ointment containing capsaicin improves swallowing function in elderly patients with non-obstructive dysphagia. By the same mechanism used by angiotensin-converting enzyme inhibitors to induce cough reflex, which has been shown to prevent aspiration pneumonia, aural stimulation with capsaicin may reduce the incidence of aspiration pneumonia in dysphagia patients via Arnold's ear-cough reflex stimulation.