Search

We report two cases of tortuous internal carotid artery, both involving 81-year-old women. Case 1 had an abnormal sensation in the pharynx on swallowing, while case 2 had difficulty and mild pain on swallowing. MRA was useful for diagnosis. A pulsating mass was located in the lateral lymphatic band in case 2. She was advised to undergo a biopsy at another clinic, but this would have carried a risk of bleeding.Previously reported patients with tortuous internal carotid artery have presented with an abnormal sensation in the pharynx, so it is necessary to consider the possibility of tortuous internal carotid artery in elderly patients with this symptom. Tonsillectomy is occasionally performed in elderly patients. There is a possibility of tortuosity of the internal carotid artery, even if a pulsating mass is not seen in the pharynx, and it is important to palpate the palatine tonsil before and during surgery.

We examined how smoking influenced the bacillus detected from acute and chronic sinusitis cases and the pH of nasal discharge.There was no significant difference in the bacillus detected in sinusitis due to the presence of smoking.The pH of nasal discharge temporarily falls during smoking.The decreased pH of nasal discharge may decrease the bacillus growth inhibition of the normal flora.

We reviewed the treatment of 86 patients with peritonsillar abscesses.We examined by m. a. whether the otolaryngological procedure and the antibiotics (cephems, penicillin, other f3-Ractums and clindamycin) used influenced the treatment period.We found that otolaryngological therapy is the best treatment for peritonsillar abscesses, especially incision and drainage. When aspiration is done, it is necessary to administer penicillin.Any intravenous antibiotics are effective for peritonsillar abscess after incision and drainage except for clindamycin alone.It is necessary to avoid clindamycin monotherapy, and to use clindamycin together with penicillin after aspiration.

With the development of new antimicrobial agents, the incidence of peritonsillar abscess (PTA) is on the decline. PTA is still often encountered in general practice, however, where it requires immediate diagnosis and treatment. Because the internal carotid artery runs medially to the medial parapharyngeal space, damage to nearby vascular or other structures is a surgical risk of PTA. We used contrast computed tomography (CT) from PTA patients to investigate the anatomical relationship between the abscess and parapharyngeal space, and to determine safe surgical sites. We observed 31 patients with PTA--19 men and 12 women--between February 1997 and April 1999, all examined by contrast CT and undergoing drainage or incision. The average age was 30.7 years (range: 12-54 years). The abscess was on the right side in 20 cases and on the left side in 11. We determined the sites of the abscess and carotid artery, internal jugular vein, and surrounding soft tissue density area including nerves in the parapharyngeal space based on the angle and distance from recognizable anatomical structures in CT scans. The anterior margin of the parapharyngeal space was 29 +/- 5 mm posterior from the upper posterior alveolar margin. The medial margin of that space was at 15 +/- 2 degrees laterally from the midline of the incisors, and 24 +/- 4 mm laterally from the midline sagittal plane. The internal carotid artery was located medially to the parapharyngeal space, running on the sagittal plane containing the upper posterior alveolar margin. The distance from the anterior margin of the parapharyngeal space to the posterior wall of the PTA was 9 +/- 4 mm, and the distance to the anterior wall of the abscess (including the pharyngeal mucosa) was 31 +/- 5 cm. The relationship between the upper posterior alveolar margin and midline sagittal plane was useful for determining the site of the parapharyngeal space. Because the internal carotid artery is located on the same sagittal plane as the upper posterior alveolar margin, when conducting drainage or incision of PTA, we should advance sagittaLly from the point of incision to a depth of no more than 20 mm. If the tip of the instrument is kept medial to the sagittal plane of the upper posterior alveolar margin, effective treatment should be achievable without the risk of vascular damage.

Postnasal drip is one of the symptoms of chronic sinusitis, and is often refractory. However, sinusitis is not the only cause, and among other conditions, Tornwaldt's disease can also cause postnasal drip.We report a case of Tornwaldt's disease with postnasal drip that was improved by surgery. Cyst opening was sufficient to treat the postnasal drip in this case. However, since there is a risk of cyst relapse, long-term follow-up is necessary.

We analyzed the relationship between postnasal drip and the state of the nasal middle meatus in 394 patients with sinusitis.There was a weak relationship between postnasal drip and the type of paranasal sinuses. Many of the patients with postnasal drip had bilateral contraction and obstruction of the meatus.

We encountered an infant with a peritonsillar abscess due to pharyngeal injury by a chopstick. Careful follow-up of such injuries is necessary in infants with upper respiratory tract infection because pharyngeal injuries can cause peritonsillar abscess, as in our patient. Only conservative treatment was performed for this patient. Computed tomography was useful for the diagnosis in this case.

We examined 944 patients who visited Tokyo Women's Medical University Daini Hospital Department of Otorhinolaryngology who had experienced abnormal sensations of the throat for three months or more, and who were able to be followed. The patients were examined between January 1993 and December 1997.1) There were many cases of non-organic disease among women in their forties.2) Numerous symptoms of mild illness were detected by the symptom classifications of nasal disease and rhinopharyngeal disease.3) Symptoms often affected the cervical spine, the esophagus, and the stomach at deglutition.4) It is insufficient to judge the presence of an organic disease only from the symptoms and the type of the symptoms.5) The pattern of manifestation of symptoms is important for judging the site of involvement.6) Endoscopic inspection is important for judging the presence of an organic disease.7) It is necessary to recommend examination while keeping in mind organic disease, which can be concealed in cases where the cause is thought to be psychological.

We examined 718 epistaxis cases who visited or were hospitalized in the Tokyo Women's Medical University Daini Hospital.1) Many of the epistaxis cases were men, and a relation to arteriosclerosis was strongly suggested.2) A relation to changes in the diastolic pressure was strongly suggested by the number of epistaxis patients with hypertension.3) The bleeding area, excluding the Kiesselbach area, increased with aging.

A total of 122 patients who visited our Hospital with untreated acute sinusitis with pain, were studied.1) Detailed anamnesis could locate the sinus with lesions considered to be the cause of pain.2) Maxillary sinusitis produced pain in the cheek.3) Ethmoid sinusitis often produced ocular pain.

Among the patients whose first visit with nasal complaints to the Tokyo Women's Medical College Daini Hospital occurred between January 1993 and December 1995, cysts were detected by CT in the postoperative paranasal sinuses of 95 patients.These patients were compared to 42 patients without cysts in postoperative paranasal sinuses.1) The presence of nasal discharge and ocular symptoms was of diagnostic value in cases of postoperative paranasal sinus cyst.2) Nasal discharge was related primary to the presence of postoperative paranasal sinus cysts.3) The presence of nasal polyps was not related to postoperative paranasal sinus cysts.4) The presence of nasal polyps alone was of no diagnostic value in detecting postoperative paranasal sinus cyst, with the excepting of cysts located in the maxillary sinus.

This study included 614 patients who complained of a dyssensation in pharynx and larynx at their first visit to the Department of Otorhinolaryngology, Tokyo Women's Medical College Daini Hospital between January 1993 and December 1995.1) The number of female patients having organic disease was not significantly different from that of the male patients.2) The number of female patients not having organic disease was twice that of the male patients.3) Irrespective of the presence or absence of organic disease, the frequency of complaints of a sensation of “something in the throat” was greatest among the patients between 40 and 50 years of age.4) Of the male and female patients who chiefly complained of feeling “something in the throat, ” 60% and 50%, respectively, had organic disease.5) Many patients having disease of the esophagus or cervical spine had symptoms involving swallowing.6) The organic diseases encountered most frequently involved the oropharynx.7) The organic diseases were largely inflammatory in nature.8) Patients complaining of a sensation of a foreign body in the throat when swallowing a solid substance required a complete medical examination of the hypopharynx and esophagus.9) Patients complaining of a lump sensation in the throat on swallowing and no other local specific symtoms required an endoscopic examination.

Data were collected and analyzed from 348 patients who presented with untreated nasal allergies at the Tokyo Women's Medical College Daini Hospital and the following results were obtaind:1) The most common symptom was nasal obstruction in patients having perennial nasal allergies, and nasal discharge in patients with seasonal allergies.2) Testing for HD mites showed a higher positivity rate in patients with perennial allergies or allergies in the autumn and winter.3) Testing for Japanese cedar pollen showed a higher positivity rate in patients showing allergic symptoms in the spring, spring and summer, or spring and autumn.4) The BAST scores correctly determined whether allergy was seasonal or non-seasonal in 77.1 of patients.5) However, RAST scores could not distinguish winter allergies from any other types of seasonal allergies.6) Despite this, RAST scores determined the type of seasonal allergy correctly in 56.7% of patients after excluding those with winter allergies.7) HD mite, Japanese cedar, and hogweed antigens are useful for determining the type of seasonal allergy.8) Testing with allergens characteristic of summer and winter, but not spring and autumn is indispensable for determining the type of seasonal allergy.

We performed image processings on pictures obtained from patients with esophageal diseases by using an electronic endoscope TV-Endoscope TGI-70D (Toshiba Co., Ltd.) and a digital endoscopic image processor EIP-70A (Toshiba Co., Ltd.).By using the EIP-70A, it becomes possible to perform a band pass filtering as structural enhancement and a histogram flattening as color enhancement in real-time. The band pass filtering clarified the fine vascular pattern of the esophago-gastric junction, the fine regenerative mucosal pattern of the reflux esophagitis and the three-dimentional structure of the advanced esophageal cancer. The histogram flattening exaggerated the redness in lesions of the advanced esophageal cancer, the O-II b typed esophageal cancer and the ectopic gastric mucosa of the upper esophagus.

Objective To identify distinct clinical features of pharyngotonsillitis or oropharyngitis associated with Epstein-Barr virus (EBV) infection from herpes simplex virus infection. Design Clinical studies by case exploration. Setting Institutional practice at a university hospital. Patients Thirty-three patients with pharyngotonsillitis and 4 patients with oropharyngitis of nonbacterial infection underwent biopsy of pharyngotonsillar lesions. Main Outcome Measure The specimens were examined by histopathology, immunohistochemistry, in situ hybridization, and polymerase chain reaction. In addition to serological testing and routine laboratory data, photographic oropharyngeal findings were collected for clinical evaluation. Results In situ hybridization to detect EBV-encoded small nuclear RNA-1 and -2 disclosed 8 cases of pharyngotonsillitis and 4 cases of oropharyngitis associated with EBV infection. Immunohistochemical analysis identified 5 cases of pharyngotonsillitis associated with herpes simplex virus infection. Serological examination showed that, among 12 cases positive by in situ hybridization, 3 cases were primary infection with infectious mononucleosis and 9 were nonprimary infection. The staining pattern of in situ hybridization was different, ie, a linear pattern in cases of nonprimary infection and a scattered pattern in cases of primary infection. The clinical manifestations of EBV pharyngotonsillitis were distinct from those of herpes simplex virus pharyngotonsillitis and were characteristic irrespective of infectious status, while those of EBV oropharyngitis were more variable. Conclusions Epstein-Barr virus–associated pharyngotonsillitis was demonstrated in patients with nonprimary infection unaccompanied by infectious mononucleosis. Epstein-Barr virus should be considered a potential causative agent of oropharyngotonsillitis even in absence of infectious mononucleosis, especially in a young adult.

We encountered a case of catecholamine-secreting carotid body tumor which has never been reported in Japan. The patient was a 20-year old man, who complained of a mass located at the right neck and hypertensive symptoms such as loss of consciousness at extension of the neck, fatigability, etc. Carotid angiography and computed tomography (CT scan) revealed a carotid body tumor. Before operation, a mild hypertension was noted, serum and urinary levels of norepinephrine showed abnormal increase, and phentolamine test was positive. After the tumor was dissected by a surgical procedure associated with carotid reconstruction, blood pressure and norepinephrine levels clearly trended to decrease and phentolamine test returned to negative.Histopathologically, the tumor was a paraganglioma with so-called " organoid " pattern. The tumor was not chrornaffin, but the presence of neurosecretory granules was confirmed under electron microscope.In one-year follow up after the operation, no sign suggestive of " latent " or newly arising paraganglioma was noted in assay of catecholamines in serum and urine, nor on adrenal CT scan.

Comparison of esophageal endoscopy using a nasopharyngolaryngo-fiberscope (ENF type LB, Olympus Co., Ltd.) and a gastrointestinal-fiberscope (GIF type P3 or P2, Olympus Co., Ltd.) have been attempted. After a diagnosis of esophageal ulcer was made by a GIF in case 1, the ulcer was followed by an ENF, and an easier practice by ENF has been demonstrated in this case. In case 2, reflux esophagitis of the lower esophagus could be observed by an ENF, but the esophageal hiatus hernia in the distal portion was not found by an ENF and it was found by a GIF. In case 3, right recurrent nerve paralysis and cancer infiltration into the trachea could be detected by an ENF, but cancer located near the upper end of the esophagus could be only found by a GIF. In case 4, the ectopic gastric mucosa around the upper end of the esophagus could be found by an ENF when air was sent. Case 5 was a 2-year-old girl who visited us under suspicion of swallowing a plastic foreign body into the trachea, bronchi or into the esophagus. No foreign body could be found in the trachea, bronchi, stomach and esophagus by an ENF under local anesthesia.

It is very difficult to observe the postcricoid area of the hypopharynx and the upper end of the esophagus with a fiberscope because their lumens are usually closed. When the gastrointestinal fiberscope (GIF type P2, Olympus Co. Ltd.) and nasopharyngo-laryngofiberscope (ENF type LB, Olympus Co. Ltd.) were used in a case of hypopharyngeal (postcricoid) cancer for comparison, the ENF-LB is too slender to keep a favorable position for observation and insufficient to extend the postcricoid lumen. Therefore, it is not suitable for observation on these regions as compared with the GIF-P2. A small erosion in the postcricoid area of the hypopharynx after passage of fish bones could be diagnosed by mounting the hood on the GIF-P3. When the ENF-LB was simultaneously inserted through the nose while the gastrointestinal fiberscope (GIF type XQ10, Olympus Co. Ltd.) was being orally inserted, the pyriform sinus could be favorably observed because the hypopharynx cavity had been extended by the GIF.From the above-mentioned experiences, the balloon (Top Co. Ltd.) which had been used in the sclerotherapy of the esophageal varix was mounted on the end of the GIF-XQ10 in order to obtain an enough visual field by extending the lumen of the hypopharynx and the upper end of the esophagus. It was used successfully in diagnosing and treating the ectopic gastric mucosa and foreign body in the esophagus.

A 56 year old male patient had tracheostenosis caused by a tracheotomy carried out during a heart operation. Our Department of Otolaryngology after removing scar tissues of the tracheostenosis section, morioplastry was attempted by means of Dacron-made artificial aoetic graft, but was unsuccessful. Subsequently a skin plantation was performed on the defective section, and the resulting trachoplasty was successful. The experience of this single case is herein reported.

A successfully operated case by CO2 laser for stenotic granulation scar in the trachea was reported in this paper.A 42-year-old woman who complained of dyspnea because of stenosis in the subglottic space due to Wegener's granulomatosis had been treated with tracheal cannulation.The treatment of subglottic granulation was required before removal of tracheal cannula after an effective systemic therapy for granulomatosis.The patient was successfully treated with CO2 laser operation for stenotic lesion.