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Conclusions:The comorbidity of sleep disturbance with chronic dizziness in women was related to the intensity of distress and interference with their lives due to dizziness, although it was not related to objective variables of dizziness. In addition, the presence of sleep disturbance was associated with severe anxiety and depression, and low health-related quality-of-life (QoL). Objectives:This study investigated the effect of sleep disturbance in patients with chronic dizziness on symptoms of dizziness, handicaps due to dizziness, health-related QoL, and emotional distress. Method:The participants of this study were 252 in-patients with chronic dizziness. Participants completed questionnaires containing the Dizziness Handicap Inventory (DHI, three sub-scales: Physical [DHI-P], Emotional [DHI-E], and Functional [DHI-F] scores), Pittsburgh sleep quality index (PSQI-J), Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study 8-items Short Form Health Survey (SF-8, health-related QoL). The participants then underwent gravity center fluctuation measurement as an objective indicator of the severity of dizziness. Results:The prevalence of sleep disturbance (PSQI-J global score ≧6) was 65.1% in these participants. Two-way ANOVA of the DHI scores showed significant interaction between sleep disturbance and sex in DHI total, DHI-E score, and DHI-F score, indicating that these scores were higher in women with sleep disturbance. Regarding DHI-P score, only the main effect of sex was significant (women > men). Sleep disturbance had no significant effect on objective indicators of severity of dizziness. Patients with sleep disturbance had significantly higher HADS scored and a lower SF-8 scored than patients without sleep disturbance. [ABSTRACT FROM PUBLISHER]

Conclusion:All definite Meniere’s disease (MD) had endolymphatic hydrops (EH) at least in the cochlea or the vestibule. Symptoms of MD may appear after formation of EH. It is assumed that the probability of immediate progression to bilateral MD from unilateral MD is very low in patients without EH on the non-affected side. Objective:To evaluate the EH on both sides in patients with unilateral and bilateral MD, and to investigate factors with progression to bilateral MD including the degree of EH, hearing level, and the duration of MD. Patients and methods:The study included 29 patients with unilateral definite MD and 12 patients with bilateral definite MD. The endolymphatic space size was visualized by using 3-Tesla magnetic resonance imaging. Results:All patients with unilateral and bilateral MD had significant or mild EH at least in the cochlea or the vestibule on the affected side. On the non-affected side, EH was not observed at all in eight patients, but asymptomatic EH was observed in the cochlea in 14 patients and in the vestibule in 16 patients. There was no relationship between the EH on the non-affected side and the duration of MD. [ABSTRACT FROM PUBLISHER]

Conclusion:Red cell distribution width (RDW) can predict outcome in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Further studies are required to clarify the potential pathophysiological explanations for these findings. Objectives:RDW is one of the parameters reported in a complete blood count, and is elevated in direct proportion to variation in red cell size (anisocytosis). High RDW values are strongly associated with poor clinical outcomes in various diseases, including inflammatory and thrombotic diseases. To identify a prognostic biomarker that better predicts outcomes after ISSNHL, the association between RDW values at hospitalization and prognosis in patients with ISSNHL was assessed. Method:This study measured RDW and performed hearing assessments in 89 consecutive patients with ISSNHL. Patients were then divided into two groups (‘recovered’ and ‘unrecovered’), according to their response to the treatment, and further analysis undertaken. Results:Mean RDW was significantly higher in the unrecovered group (13.2% ± 1.0% compared with 12.7% ± 0.7% in the recovered group,p = 0.031). After adjusting for potentially confounding factors in a binary logistic regression model, only RDW was associated with recovery from ISSNHL (odds ratio = 2.33, 95% confidence interval = 1.20–4.51,p = 0.012). [ABSTRACT FROM PUBLISHER]

ConclusionThe results suggest that SOD1 rs4998557 could be associated with susceptibility to SSNHL in the Japanese population.ObjectivesTo assess the gene association with sudden sensorineural hearing loss (SSNHL).MethodsA two-stage case control study was conducted to explore the relationship of the candidate genes to SSNHL. The 192 gene samples from SSNHL patients registered in the intractable inner ear disease gene bank were enrolled. As the candidate genes, 39 SNPs from 31 genes were selected for the first stage study. The second stage study examined whether the SOD1 gene polymorphisms, defined by significant differences between cases and controls in the first stage study, are associated with SSNHL.ResultsSignificant differences were observed in four SNPs from three genes, Glutathione-S-transferase pai 1 (GSTP1), proteine kinase C heta (PRKCH), and superoxide dismutase 1 (SOD1), in terms of allele frequency between SSNHL patients and HapMap controls. In the SOD1 gene, a significant difference was observed in the dominant model study of the SNP rs4998557 in the second stage study. Furthermore, as a result of dividing SSNHL patients based on the clinical data, the difference was more apparent in the case of the over 60 dB group and the tinnitus–positive group. [ABSTRACT FROM PUBLISHER]

Conclusion: The prevalence of low-tone hearing loss (LTHL) is significantly high in spinocerebellar degeneration (SCD) with cerebellar predominance, including multiple-system atrophy C (MSA-C) and cortical cerebellar atrophy (CCA).Objective: This study aimed to test the hypothesis that SCD with cerebellar predominance, MSA-C and CCA may cause auditory symptoms.Methods: The shape and threshold of pure-tone audiograms were evaluated for MSA-C (n = 47; mean (± SD) age, 61.6 ± 8.9 years), CCA (n = 16; 62.8 ± 9.5 years), and age-matched controls (n = 169; 62.5 ± 10.7 years). To differentiate specific hearing loss for MSA-C and CCA from presbycusis, the shape of audiograms was examined based on previously established audiological criteria.Results: When audiogram shape was defined according to audiological criteria, the odds ratio for LTHL in SCD compared to controls was 2.492 (95% confidence interval (CI) = 1.208–5.139;p < 0.05, Pearson’s Chi-square test) in MSA-C and 2.194 (95% CI = 0.709–6.795) in CCA. When the selection of audiogram shape according to these criteria was verified by three certified audiologists, odds ratios for LTHL in MSA-C and CCA were 3.243 (95% CI = 1.320–7.969) and 3.692 (95% CI = 1.052–12.957), respectively, significantly higher than in controls. [ABSTRACT FROM PUBLISHER]

Conclusions: Tracheoesophageal diversion (TED) and laryngotracheal separation (LTS) can prevent aspiration pneumonia and improve the morbidity of patients with severe motor and intellectual disability (SMID). By improving hospitalization rates and care needs, the quality-of-life can be improved for the patients and their parents. Objectives: This study evaluated the clinical outcomes of TED and LTS in patients with intractable aspiration and SMID. Methods: This study retrospectively reviewed patients with SMID and intractable aspiration pneumonia who underwent TED or LTS at the institution between January 2008 and January 2015. It assessed the frequency of sputum suctioning, the number of pre-operative and post-operative hospitalizations, the operative time, and complications. Results: Forty patients were identified during the study period. After surgery, there were significant reductions in the frequency of secretion suctioning (from 165.0 times/day to 33.0 times/day) and the number of hospitalizations because of aspiration pneumonia (from 5.4 times/year to 0.2 times/year). A tracheocutaneous fistula occurred in one (2.5%) patient, and two (5.4%) patients developed tracheoinnominate artery fistulas. In the latter group, the innominate arteries were successfully ligated and endovascular embolization was performed. [ABSTRACT FROM AUTHOR]

Conclusion: The infiltrative growth pattern may predict tumor depth and lymph node metastasis. INF-a seems to fall into a low-risk category, and no additional treatment may be required immediately. Objectives: Tumor depth is a predictor of lymph node metastasis in early pharyngeal cancers. An infiltrative growth pattern is also a prognostic factor in other cancers. This study aimed to elucidate the predictive role of infiltrative growth pattern in early pharyngeal cancers. Methods: Thirty-eight lesions from 37 patients who had undergone trans-oral resection of pharyngeal cancers were included. According to the Japanese Classification of Esophageal Cancer, infiltrative growth pattern was classified into three groups; INF-a, INF-b, and INF-c. The correlation between infiltrative growth pattern and tumor depth, cervical lymph node metastasis was analyzed. Results: Of the 38 lesions, 25 were INF-a, nine were INF-b, and four were INF-c lesions. Lymph node metastasis was observed in three INF-b and one INF-c lesions. In contrast, no INF-a had lymph node metastasis. All INF-a lesions showed shallow invasion of the sub-epithelium; INF-b and INF-c lesions had significantly greater depth than INF-a. [ABSTRACT FROM AUTHOR]

Conclusions: The head and neck cancer patients with more co-morbidities and those dependent on tube feeding are at a high risk of severe infections during chemotherapy. Therefore, prophylaxis with colony-stimulating factors and/or antibiotics should be considered for those patients. Objectives: To investigate the risk factors for severe infection during chemotherapy in head and neck cancer patients. Methods: A retrospective study was conducted of 129 patients with head and neck cancer who received taxane-based and platinum-based chemotherapy between 2008–2013. Logistic regression models were used to evaluate risk factors. Results: Febrile neutropenia occurred in 50 patients out of the 129 (39%), severe infections occurred in 24 patients (19%), and bacteremia in two patients (2%). In univariate analysis, low serum albumin levels and tube feeding were significantly associated with severe infections (p = 0.015 and < 0.001, respectively). In multivariate analysis, the odds ratios for a higher modified Charlson co-morbidity index and tube feeding were 2.80 and 9.74, respectively. These two were independent predictive factors for severe infections (p = 0.020 and 0.001, respectively). [ABSTRACT FROM AUTHOR]

Conclusions: Serum squamous cell carcinoma antigen (SCC-Ag) level was an independent prognostic factor for survival in patients with head and neck squamous cell carcinoma (HNSCC), and the prognostic value depended on the carcinoma site. Objectives: To assess the value of SCC-Ag as a prognostic indicator in patients with HNSCC and to determine the effect of primary tumor site on prognosis. Methods: We reviewed 493 patients with HNSCC between 2004 and 2012. The chi-squared test was used to assess associations between SCC-Ag levels and TNM classification. A Cox proportional hazard model was used to assess the hazard ratio of SCC-Ag at different sites for death, and it was analyzed as a continuous variable. Results: The median serum level of SCC-Ag was 1.1 ng/ml (range 0-20). SCC-Ag was significantly higher in patients with advanced T and N classification tumors. Primary sites in the oral cavity, in the hypopharynx, advanced T and N classification, distant metastasis, and SCC-Ag were negatively associated with survival in univariate analysis. Multivariate analysis revealed that SCC-Ag was a significant risk factor for overall survival in cancers of the oral cavity, hypopharynx, and larynx, but not in oropharyngeal cancer. [ABSTRACT FROM AUTHOR]

Conclusion: The present results demonstrate that a small implant size, undercorrection of the vocal fold, antero-posterior implant malposition, and the use of expanded polytetrafluoroethylene (ePTFE) are the primary factors that cause a poor outcome of medialization thyroplasty (MT). Objectives: To assess the postoperative laryngeal condition using computed tomography (CT) in patients with unilateral vocal fold paralysis who underwent MT alone, and to identify the primary causal factors in terms of the surgical procedures that affect the outcomes of MT. Methods: Twenty-two patients who underwent MT alone were divided into two groups based on either the maximal phonation time or the perceived vocal breathiness. Two laryngologists assessed the postoperative laryngeal CT images during sustained vowel phonation and judged whether there were abnormalities of the arytenoid cartilage position, window position, implant size, and implant position, as well as the degree of correction of the vocal fold. As implant material, a silicone block, ePTFE, and hydroxyapatite had been inserted in 2, 9, and 11 patients, respectively. Comparisons of the prevalence of abnormalities in the abovementioned factors between the different outcomes and between the types of material used for the implant were performed. Results: Twelve patients with a poor outcome and 10 with a good outcome showed 36 and 18 abnormal findings identified by either of the two laryngologists, respectively. In the poor outcome group, a smaller implant size and undercorrection of the vocal fold showed both high kappa values and a significantly higher prevalence than those in the good outcome group ( p < 0.001 and p < 0.05), respectively. The comparison between material types demonstrated that the sheet-like material (ePTFE) group exhibited a significantly higher prevalence of undercorrection than the block-like material group ( p < 0.05). [ABSTRACT FROM AUTHOR]

Conclusion: An epidemiological survey of hospitals and private clinics in Japan regarding idiopathic sudden sensorineural hearing loss (SSNHL) revealed that the incidence of SSNHL was 60.9 per 100 000 population. There were more females than males in the younger generation. Objective: The incidence of SSNHL varies largely by country. Because the Japanese criteria for diagnosing SSNHL have changed in accordance with those widely used in other parts of the world, a clinicoepidemiological study was undertaken using the new criteria. Methods: Ehime, Aichi, and Iwate Prefectures were selected from the western, central, and northeastern regions of Japan, respectively. The subjects for this study were patients who suffered SSNHL between April 1, 2012 and March 31, 2013. Questionnaires were mailed to all hospitals and private clinics in which ENT doctors were working. Initial and final audiograms were requested for 10% of the patients. Results: In all, 78 of 90 hospitals (87%) and 303 of 407 private clinics (74%) responded. It was reported that 1663 patients visited hospitals and 3090 patients visited only private clinics. It was estimated that 6205 SSNHL patients visited hospitals or private clinics in 1 year from a population of 10 145 000. Also, 23% of patients suffered acute low-tone SNHL (female to male ratio; 3:1 in definite cases). [ABSTRACT FROM AUTHOR]

Conclusion: Three-dimensional cone beam computed tomography (3DCT) images revealed characteristic malformations of the membranous labyrinth of the inner ear in Meniere's disease (MD). The morphology of the membranous region between the vestibular cecum of the cochlea and the saccule of ears with MD was compared to that of healthy ears. The present study supports the hypothesis proposed earlier that reuniting duct blockade is a result of the dislodgement of saccular otoconia. Objective: To visualize the membranous labyrinth using 3DCT and to investigate the pathology of MD. Methods: A preparatory study was conducted to determine the optimal 3DCT window settings for the detection of water, muscle, calcium carbonate (CaCO3), and bone. Based on this preparatory study, the ears of 13 healthy volunteers and 25 MD patients definitely diagnosed according to the criteria issued by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were visualized. Results: The differences in the membranous labyrinth between MD ears and healthy ears could be visualized using 3DCT. The images were classified into three types based on their morphological pattern. The ears of patients with MD were different from normal ears in terms of this classification. [ABSTRACT FROM AUTHOR]

Conclusions: Comorbidities as well as T classification were the primary determinants for the nutritional status of patients with head and neck cancer. Objectives: We aimed to elucidate the underlying conditions of malnutrition in patients with head and neck cancer. Methods: We retrospectively reviewed 726 patients diagnosed with head and neck cancer between 2004 and 2013. Associations between malnutrition and clinical parameters were assessed using univariate and multivariate analyses. Results: Median body mass index was 21.5 (range 11.6-38.0). According to World Health Organization criteria, the nutritional status of these patients was classified into four groups: underweight (18%), normal (63%), overweight (17%), and obese (1%). Comorbidities were detected in 40% of patients. Multivariate analysis revealed the following factors to be independent factors associated with malnutrition: advanced T stage, metachronous cancer, collagen disease, gastrointestinal disease, and pulmonary disease. [ABSTRACT FROM AUTHOR]

Conclusion: In tongue squamous cell carcinoma (SCC), high levels of regulatory T-cell (Treg) infiltration in tumor nests are observed in the cases with poor prognosis. Objectives: The role of Tregs in head and neck cancers remains unclear. The aim of this study was to observe the distribution of Tregs in different stages of tongue SCC and estimate the effects on prognosis. Methods: Thirty-four cases with tongue SCC were examined immunohistochemically for CD4, CD8, and Forkhead box P3 (Foxp3). Immunoreactive cells were counted in cancer stroma and nest regions, and relationships between cell numbers and disease-free survival rates were analyzed. Results: In the 34 cases, univariate analysis for disease-free survival indicated high-level infiltration of Tregs (CD4+Foxp3+) into both cancer nests and stroma and presence of helper T (CD4+Foxp3-) cells in cancer stroma as potential predictors of significantly worse prognosis. In early-stage cases (stage I/II), high-level infiltration of Tregs in cancer nests correlated significantly with poor disease-free survival rate. Multivariate analysis for disease-free survival found no independent variables. [ABSTRACT FROM AUTHOR]

Conclusion: The outcome of this treatment was good, indicating that it is safe and effective. A favorable outcome was obtained, especially in patients with T3, N0-1, and N2a-b cancer, while outcome remained unfavorable in patients with T4a and N2c cancer. Consideration should be given to the need for intensity-modulated radiation therapy (IMRT) and maintenance therapy. Objective: To improve the survival and functional organ preservation rates in patients with lateral oropharyngeal squamous cell carcinoma. Methods: The primary site was treated conservatively by neoadjuvant chemotherapy and/or concurrent chemoradiation therapy. Chemotherapy was administered by superselective intra-arterial infusion and cervical lymph node metastasis was treated by radical neck dissection. Results: Among 71 patients, the 5- and 10-year overall survival rates were 85.1% and 63.5%, respectively; and the 5- and 10-year functional organ preservation rates were 61.0% and 51.6%, respectively. The outcomes were especially good in patients with T3 N0-1, and N2a-b cancer. All patients with N2c cancer had poor outcomes. [ABSTRACT FROM AUTHOR]

Conclusion: The findings suggest that in patients with posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (P-BPPV), head trauma and prolonged bedrest, but not inner ear disease, are risk factors for poor outcome of a single Epley maneuver and persistent residual positional vertigo. Objectives: We first examined the efficacy of a single Epley maneuver and then assessed the time course in remission of residual positional vertigo in patients with idiopathic P-BPPV and secondary P-BPPV. Methods: A total of 157 patients with idiopathic P-BPPV and 40 patients with secondary P-BPPV (secondary to head trauma in 8 patients, to prolonged bedrest in 14 patients, and to inner ear disease in 18 patients) were treated with a single Epley maneuver. Results: The negative rates of the Dix-Hallpike test on day 7 after a single Epley maneuver in both patients with P-BPPV secondary to head trauma (25%) and those with prolonged bedrest (36%) were significantly lower than that (73%) in patients with idiopathic P-BPPV. Additionally, the remission of residual positional vertigo in the former groups of patients was significantly delayed in comparison with that of the latter group. However, there were no significant differences in the efficacy of a single Epley maneuver and persistent residual positional vertigo between idiopathic P-BPPV and P-BPPV secondary to inner ear disease. [ABSTRACT FROM AUTHOR]

Conclusion: It was proved that cyclin D1-positive status in surgical margins was an independent prognostic indicator of local recurrence. The expression of cyclin D1 in tumor-free surgical margins may better predict local recurrence in patients with head and neck squamous cell carcinoma (HNSCC) after surgical treatment with curative intent. Objective: This retrospective study aimed to determine the prognostic indicators for local recurrence in HNSCC. Methods: A total of 116 HNSCC patients who underwent surgical treatment with curative intent and had histopathologically tumor-free margins were eligible for this study. The expression of p53 and cyclin D1 was assessed by immunohistochemical staining in surgical margins as well as in tumor specimens. Results: In all, 63 patients (54.3%) had p53-positive tumor specimens and 34 patients (29.3%) had p53-positive margins. Seventy-six patients (65.6%) had cyclin D1-positive tumor specimens and 54 patients (46.6%) had cyclin D1-positive margins. A significant difference in local control rates was observed between patients with cyclin D1-positive and -negative margins (77.2% vs 91.5%, log rank test, p = 0.0139). Multivariate Cox proportional hazards testing indicated that the hazard ratio of cyclin D1-positive margins for local recurrence was 4.58 (95% confidence interval 1.14-21.69, p = 0.0304). [ABSTRACT FROM AUTHOR]

Conclusions: Physicians should consider additional treatment strategies for Meniere's disease patients with a long history of disease and hearing loss in the secondary affected ear and also provide psychological support regarding future progressive bilateral hearing loss. Objectives: To treat intractable Meniere's disease patients effectively, we need to understand the psychological condition of each patient. We examined the state of neurosis and depression in patients and correlated this with demographic and background information. Methods: Between 1998 and 2009, we enrolled 207 patients with intractable Meniere's disease in this prospective study. We used the Cornell Medical Index and the Self-rating Depression Scale to evaluate their psychological condition. We also obtained demographic and background information relating to sex, age, duration of disease, vertigo frequency, hearing level in bilateral sides, and plasma vasopressin level. Results: Neurosis and depression was diagnosed in 40.1% and 60.4%, respectively, of patients with intractable Meniere's disease. Our results showed that surgical treatment significantly improved vertigo and hearing ability in patients with no psychological symptoms compared with those exhibiting psychological symptoms. Patients with a longer duration and worse hearing level in the secondary affected ear had a significantly higher incidence of mental illness than those with a shorter duration and better level of hearing. [ABSTRACT FROM AUTHOR]

Conclusion: Superselective intra-arterial chemotherapy, which enables local control and laryngeal preservation, is a safe and useful therapy for preservation of nutrition, speech, and swallowing functions. Objective: To improve the laryngeal preservation rate in patients with hypopharyngeal piriform sinus squamous cell carcinoma by superselective intra-arterial chemotherapy. Methods: Fifty-seven patients received anterograde intra-arterial administration of docetaxel and cisplatin, and two courses of intravenous continuous infusion of 5-fluorouracil as a neoadjuvant chemotherapy over 120 h starting on day 2. Concurrent chemoradiotherapy was administered from the third course to control the primary cancer. Remaining neck lymph node metastases were treated in principle by neck dissection. Results: The 5- and 10-year survival rates were 68.5% and 58.9%, respectively. The 5-year rates by the T classification were 96.0% (10-year rate, 88.6%) in T3, 48.1% in T4a, and 16.7% in T4b. The 5- and 10-year laryngeal preservation rates were 65.2% and 62.4%, respectively. The 5-year rates by the T classification were 92.4% (10-year rate, 87.6%) in T3, 36.2% in T4a, and 16.7% in T4b. No irreversible side effects, complications, or sequelae were reported. Superselective intra-arterial chemotherapy showed superior laryngeal preservation as well as high survival rates, particularly in T3, and was considered a useful therapy. [ABSTRACT FROM AUTHOR]

Conclusion: Superselective intra-arterial chemotherapy, which can provide local control and laryngeal preservation, is safe and useful for preserving pharyngeal and laryngeal functions. Objective: To evaluate superselective intra-arterial chemotherapy in terms of the contribution to survival and laryngeal preservation in squamous cell carcinoma (SCC) of the anterior oropharyngeal wall. Methods: A total of 51 patients with SCC of the anterior oropharyngeal wall received intra-arterial administration of docetaxel at 60 mg/m2 and cisplatin at 60 mg/m2 anterogradely, followed by intravenous continuous infusion of 5-fluorouracil at 750 mg/m2/day over 120 h starting on day 2. Neck lymph node metastases were treated by neck dissection. Results: The 5- and 10-year survival rates of the 51 patients were 72.8% and 66.4%, respectively. The 5-year survival rates of patients with T2, T3, T4a, and T4b cancer were 100%, 88.7%, 41.9%, and 33.3%, respectively. The 5- and 10-year laryngeal preservation rates of the 51 patients were 63.4% and 30.0%, respectively. The 5-year laryngeal preservation rates of patients with T2, T3, T4a, and T4b cancer were 100%, 75.2%, 23.6%, and 33.3%, respectively. No irreversible side effects, complications, or sequelae were reported. [ABSTRACT FROM AUTHOR]

Conclusions: This study showed that patients with acoustic tumor (AT) with hearing loss in the contralateral side had severe mood disturbances. It is important for physicians to provide patients who have better hearing in the tumor side with adequate information regarding the possibility of profound bilateral hearing loss and how to communicate with others in such situations. Objectives: We examined the pretreatment status as regards neurosis and/or depression of patients with an AT using the Cornell Medical Index (CMI) and Self-rating Depression Scale (SDS) and clarified the relationship with the patients' background. Methods: We enrolled 30 patients with unilateral AT between 1997 and 2010. At the time of diagnosis, we examined each patient's psychological condition, sex, age, laterality, tumor size, hearing level on bilateral side, facial paresis, headache, and canal paresis. Results: In all, 20.0% of AT patients were diagnosed with neurosis using the CMI and 26.7% had depression according to the SDS. χ2 analysis showed that patients with AT with hearing deterioration on the contralateral side had mental illness significantly more often than those with normal hearing on the contralateral side. Multivariable regression analysis revealed that the pretreatment status of hearing level on the contralateral side significantly affected the patients' psychological condition. [ABSTRACT FROM AUTHOR]

Conclusion: Concurrent chemoradiation therapy with docetaxel (DOC) at a dose of 10 mg/m2 twice a week contributed to laryngeal preservation. Objective: To determine laryngeal preservation following concurrent chemoradiation therapy with DOC. Methods: A total of 141 patients with untreated T2N0M0 squamous cell carcinoma of the glottic larynx were included in the study. The treatments were either radiation therapy alone or DOC intravenously administered at a dose of 10 mg/m2 once or twice a week during radiotherapy with 4 MV linac X-ray (total of 66 Gy for 33 days). Results: The response and CR rates were 100% and 90.5% in the once-weekly combination group, and 100% and 97.6% in the twice-weekly combination group, respectively. The 5-year survival rates were 76.8% in the once-weekly combination group and 96.8% in the twice-weekly combination group. The 5-year laryngeal preservation rates were 83.8% in the once-weekly combination group and 97.6% in the twice-weekly combination group. The most common side effects were mucositis, dermatitis, and alopecia. The patients who received DOC twice a week showed more severe cancer tissue degeneration, and pathological examination of serial sections indicated that the safety margin for partial laryngectomy was considered to be 3 mm from the gross tumor with good glottal closure. [ABSTRACT FROM AUTHOR]

Conclusions: Inferior vestibular neuritis (IVN) is a relatively minor subtype of vestibular neuritis (VN) and its clinical characteristics are unique. Objectives: To clarify clinical characteristics of IVN in comparison with conventional VN. Methods: This was a retrospective case series review. Caloric responses and cervical vestibular evoked myogenic potential (cVEMP) responses were measured in 71 patients with VN. The patients were classified into three groups: (1) IVN group, who showed only asymmetrical cVEMP responses; (2) superior VN (SVN) group, who showed only asymmetrical caloric responses; (3) total VN (TVN) group, who showed asymmetrical responses in both tests. The clinical records of time course of subjective symptoms (duration of attack, duration of hospitalization, and time to remission) were reviewed and other profiles (age, sex, affected side, acute symptoms, and sequelae) were evaluated. Results: Of the 71 patients with VN, 13 (18%) were classified as having IVN. The mean age and time to remission of patients with IVN (44.2 ± 4.8 years, 0.9 ± 0.5 months) were significantly lower and shorter, respectively, than those of patients with TVN (57.3 ± 2.5 years, 4.9 ± 4.7 months). There were no significant differences in other symptoms and profiles among the three groups. No patients with IVN showed benign paroxysmal positional vertigo as a sequela. [ABSTRACT FROM AUTHOR]

Conclusion: Haplogroup D4b, especially subhaplogroup D4b2, may be one of the modifiers associated with the phenotypic expression of hereditary hearing loss (HL). Objectives: The present study investigated the association between suspected hereditary HL and 12 major mtDNA haplogroups in a Japanese population. Besides the mutations of mitochondrial DNA, many modifiers including environmental factors and genetic polymorphisms are involved in HL. Methods: The subjects comprised 373 unrelated Japanese patients with suspected hereditary HL and 480 controls. Twenty of the 373 patients were excluded from the study because the m.1555A>G or the m.3243A>G mutation had been detected in them. The mitochondrial haplotypes were classified into 12 major Japanese haplogroups (i.e. F, B, A, N9a, N9b, M7a, M7b, G1, G2, D4a, D4b, and D5). The frequency of each haplogroup in patients with HL was compared with that of the controls using the chi-squared test. Results: The frequency of the HL patients carrying the mitochondrial haplogroup D4b was significantly higher than that of the controls (37/353 [10.5%] vs 31/480 [6.5%]; OR 1.70 [95% CI 1.03-2.79, p = 0.036]) and evidence for enhancement was found in subhaplogroup D4b2 (32/353 [9.1%] vs 24/480 [5%], OR 1.89 [95% CI 1.09-3.28, p = 0.021]). [ABSTRACT FROM AUTHOR]

Conclusion: Persistent obstructive sleep apnoea syndrome (OSAS) occurs in approximately 20% of normal-weight children after adenotonsillectomy (T&A) and, in nearly 70% of them, it is caused by adenoid regrowth. Patients with severe or moderate OSAS showed a high incidence of persistent disease even after T&A. Allergic disease, severity and large adenoid size are associated with adenoid regrowth and persistent disease. Objectives: To investigate factors contributing to persistent OSAS and adenoid regrowth after T&A in normal-weight children. Methods: This was a prospective, observational study at a single institute and involved 49 normal-weight children with severe or moderate OSAS (apnoea-hypopnoea index, AHI, ≥ 5) who underwent T&A. Background information, nasal endoscopic data and pre- and postoperative polysomnographic data were collected. A third polysomnography (PSG) was performed 1.5 year postoperatively in children who subsequently developed symptoms of sleep disturbance. Results: Thirteen children (27%, 13/49) were symptomatic 1.5 years after T&A. Allergic rhinitis (38.5% vs 11.1%, p = 0.03) and allergic disease (69.2% vs 30.6%, p = 0.02) were seen more frequently in these children. A third PSG confirmed persistent disease (AHI ≥ 5) in nine children (18.4%, 9/49). Six children (12.2%, 6/49) were diagnosed as having adenoid regrowth and three (6.1%, 3/49) underwent revision adenoidectomy. [ABSTRACT FROM AUTHOR]

Conclusion: Patients who received concurrent chemoradiation therapy with carboplatin were followed up on a long-term basis. In 25 patients treated with carboplatin at an AUC of 2.0 mg/ml, the complete response (CR), 10-year survival, and 10-year larynx preservation rates were 96.0%, 91.1%, and 75.2%, respectively, and the safety margin for partial laryngectomy was 4 mm from the gross tumor. Objectives: To perform long-term follow-up of the therapeutic outcomes of concurrent chemoradiation therapy and salvage surgery to determine the additive and synergistic effects of anticancer drugs combined with chemoradiotherapy. Methods: Fifty male patients (aged 33-76 years) with untreated T2N0M0 squamous cell carcinoma of the glottic larynx were included. Carboplatin was intravenously administered once a week for 4 weeks. Radiotherapy was delivered by an external beam of 4 MV linac X-ray (total = 66 Gy). Results: The AUC 1.5 combination group showed overall response, CR, 5-year survival, 10-year survival, 5-year larynx preservation, and 10-year larynx preservation rates of 100.0%, 68.0%, 83.4%, 77.0%, 75.2%, and 75.2%, respectively. The AUC 2.0 combination group showed corresponding rates of 100%, 96.0%, 95.7%, 91.1%, 82.9%, and 72.7%, respectively. The most common side effects of grade 3 or more were leukopenia, neutropenia, and mucositis (stomatitis), and all were reversible. Thirteen patients (52.0%) in the AUC 1.5 combination group and nine patients (36.0%) in the AUC 2.0 combination group required salvage surgery. Histologically, concurrent chemoradiation therapy with carboplatin caused more severe cancer tissue degeneration. Pathological examinations indicated that the safety margin for partial laryngectomy was 4 mm from the gross tumor. [ABSTRACT FROM AUTHOR]

Conclusions: We successfully reduced the incidence of pharyngocutaneous fistulas (PCFs) in high-risk patients undergoing surgery by using pectoralis major myocutaneous flaps (PMMCFs) and deltopectoral flaps (DPFs) to cover suture lines. Objectives: We used coverage of suture lines with PMMCFs and DPFs in patients with high risk of PCFs undergoing total laryngectomy (TL) or total pharyngolaryngectomy (TPL) to determine whether coverage of suture lines during salvage surgery can reduce the incidence of PCFs. Methods: This retrospective study was based on a review of 52 patients who underwent salvage TL or TPL between 2001 and 2011; we have been using PMMCFs or DPFs during salvage surgery since 2008. Details of postoperative complications including PCFs were analyzed. Results: The incidence rate of PCF was lower in the flap group (7.7%) than that in the non-flap group (30.1%). No carotid ruptures were observed in the flap group (0%) as contrasted with patients in the non-flap group (7.7%). [ABSTRACT FROM AUTHOR]

Conclusion: A stellate ganglion block (SGB) based on the goal of improving internal ear circulatory disturbance appears to be beneficial for the treatment of sudden hearing loss. Objectives: To evaluate the effectiveness of SGB for sudden hearing loss. Methods: This retrospective study reviewed the medical records of 49 patients who received SGBs and 496 patients who received only conservative therapy, primarily with systemic steroids, for treatment of sudden hearing loss. Propensity scores were used in pairwise matching of these patients to avoid selection biases between the two treatment modalities. Results: Propensity score matching yielded 48 pairs. The mean therapeutic effect of the SGB was calculated to be 0.40 ± 0.20 (mean ± standard error, p == 0.051). [ABSTRACT FROM AUTHOR]

Conclusion. Middle ear pressure treatment by the tympanic membrane massage (TMM) device as well as the Meniett device is effective and provides minimally invasive options for intractable vertigo in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH). Objective: The effects of the TMM device were evaluated according to the criteria of the Japan Society for Equilibrium Research (1995) in patients with MD and DEH and compared to those in patients treated with the Meniett device. Methods: Twelve ears of 10 patients (MD 8; DEH 2) were treated with the TMM device, while 16 ears of 15 patients (MD 11; DEH 4) were treated with the Meniett device. All the patients had failed to respond to medical treatment including diuretics before each pressure treatment, and were followed up for more than 12 months after treatment. Tympanotomy is necessary before treatment for the Meniett device, not but for the TMM device. Results: With both devices, the frequency of vertigo after treatment was significantly lower than before treatment ( p < 0.05). The time course of vestibular symptoms with the TMM device was not significantly different from that with the Meniett device ( p > 0.05). No complications were directly attributable to treatment with the TMM device. [ABSTRACT FROM AUTHOR]

Conclusion: We found no significant differences in the bacterial features of the maxillary sinuses between eosinophilic and neutrophilic chronic rhinosinusitis (CRS) with nasal polyps. Objectives: Since neutrophilic CRS is often influenced by a predisposition to bacterial infection, and eosinophilic CRS is likely to be developed by allergic antigens, differences in the microbiology between the two pathologies of CRS can be expected. The present study was designed to investigate the bacterial findings from the maxillary sinus in eosinophilic and neutrophilic CRS. Methods: Seventy patients with CRS with nasal polyps were divided into eosinophilic and neutrophilic types based on histopathological observations of the nasal polyps. The specimens for bacterial culture were obtained from the maxillary sinus during endoscopic sinus surgery. Results: In all, 29 and 41 patients were classified as having eosinophilic and neutrophilic CRS with nasal polyps, respectively. The isolation rate of bacteria showed no significant difference between eosinophilic (90%) and neutrophilic CRS (98%). Aerobic bacteria were found in 25 patients (86%) with eosinophilic CRS, which was not significantly different from that in neutrophilic CRS (40 patients, 98%). The isolation rate for aerobic and anaerobic bacteria showed no significant differences. [ABSTRACT FROM AUTHOR]

Conclusion: Similarly to almost all delayed endolymphatic hydrops (DEH) cases with both precedent sudden deafness and mumps deafness, two-thirds of DEH cases with precedent deafness of unknown cause with onset in early childhood developed DEH symptoms within 40 years after the precedent deafness. In spite of the diagnosis of precedent deafness, viral labyrinthitis may build up the late endolymphatic hydrops in most DEH cases up to four decades. Objective: To clarify the characteristics of DEH in Japan. Methods: Clinical information on 198 DEH cases was collected by nationwide, multicenter surveys conducted by the Peripheral Vestibular Disorders Research Committee of Japan. Results: The incidence of the ipsilateral type of DEH was 47.5%, which was almost equal to that of the contralateral type. In both types of DEH, the most common diagnosis of precedent deafness was deafness of unknown cause with onset in early childhood: 43.9% in both types of DEH. Sudden deafness and mumps deafness were the subsequent diagnoses of precedent deafness. The distribution of time delay of the onset between precedent deafness of unknown cause with onset in early childhood and DEH was different from that between precedent sudden and mumps deafness and DEH. [ABSTRACT FROM AUTHOR]

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