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For decades, no clear consensus existed on the standard treatment option for malignant tumors of the external auditory canal, an extremely rare disease. Here we report the case of a 55-year-old female patient with secretory carcinoma that originated from the left external auditory canal. Magnetic resonance imaging (MRI) at baseline showed that the tumor had extended to the medulla oblongata despite surgical and radiation treatments for more than 20 years from the initial diagnosis. Based on the results of a next-generation sequencing test of a formalin-fixed paraffin-embedded surgical specimen indicating that the tumor harbored ETV6–NTRK3 fusion, the patient was enrolled in a global basket study of larotrectinib, an oral selective tropomyosin receptor kinase (TRK) inhibitor. Three weeks after the start of larotrectinib treatment, MRI showed only small remnants of the tumor in the medulla oblongata and the patient’s headache before the treatment had disappeared. Subsequent MRI after 12 weeks of treatment confirmed the complete disappearance of the tumor. The patient repeated grade 2 flu-like symptoms related to treatment, but did not experience any other grade 2 or worse treatment-related adverse events. TRK inhibitors, such as larotrectinib, exert potent antitumor activity against neurotrophic tyrosine receptor kinase (NTRK) fusion-positive tumors in a tumor-agnostic manner. To the best of our knowledge, this is the first report on NTRK fusion-positive secretory carcinoma of the external auditory canal, and this report provides a valuable insight into the management of the extremely rare but now treatable malignancy.

Hemangiopericytomas (HPCs) are uncommon vascular tumors originating from extracapillary cells called pericytes, and rarely occur in the nose or paranasal sinuses. We treated a 57-year-old man with nasal HPC who presented with nasal obstruction and hemorrhage. Nasal endoscopy showed a readily bleeding mass between the right nasal septum and inferior turbinate. Enhanced CT revealed a heterogeneous mass lesion with an enhancement effect that filled the right nasal cavity. A biopsy specimen was proved to exhibit a HPC histopathology. Recombinant interleukin-2 (rIL-2) was administered with a measurement of natural killer cell (NK cell) activity. Afterwards, wide excision with an extranasal approach was performed. The use of rIL-2 caused not only increased NK cell activity but also a reduction in the tumor size. With a combination of rIL-2 and wide excision with extranasal approaches, no local recurrence or metastasis has occurred over the last 4 years.

There are some simplified devices for screening SAS. However, they have some problems as to a way to operate and disconnection of oro-nasal sensors in children. The simplified device that had used the multipoint pressure sensor seat (SD-101) recently was developed in Japan. For adults, the utility of SD-101 is reported. This study was performed to clarify the usefulness of SD-101 in detecting SAS in children. The infant (0–12 years old) from whom they consulted Sleep Disorders Center or otorhinolaryngology at Aichi Medical University hospital and SAS had been doubted was targeted between October 2005 and November 2009. The inspection was executed using PSG together with SD-101 under hospitalization and using another simplified device (LS-300) with SD-101 at house. The analysis of SD-101 was done by using software for adults and added to the manual correction. SD-101 judged apnea-hypopnea when the respiratory pressure changes decrease. The correlation was admitted in AHI of 31 examples that used PSG together with SD-101 (R2 = 0.87). The cases who had used LS-300 together with SD-101 were 75 examples. AHI could not be obtained in the remaining 21 children with LS-300, but was obtained in all children with SD-101. AHI of SD-101 tended to go out to a low value compared with other methods. The high utility of SD-101 became clear. However, as there was a problem in the mode of analysis as well, it will be necessary to develop analytical software with the infant in the future.

We retrospectively analyzed postoperative adenoid tissue proliferation after adenotomy in 41 cases of pediatric sleep-related breathing disorder. Subjects were 35 boys and 6 girls with an average age of 4 years and 8 months. Adenoid size was evaluated by lateral X-ray pre-and postoperatively every 6 months. Complete surgical adenoid resection was done in 27 cases (66%) and incomplete resection in 14 (34%), although residual adenoid size was very small and did not disturb nasal breathing postoperatively. Of the 41 cases, 11 (27%) showed postoperative adenoid tissue growth. 11 cases emerged after 6 months postoperatively. None showed reproliferation more than 18 months postoperatively. We found reproliferation in 6 of 27 complete excisions. At 3 years old. 5 of 6 cases showed the reproliferation despite successful adenoid resection. Healthcare professionals should thus monitor the postoperative adenoid proliferation in younger children.

周術期予防的抗菌薬投与方法について耳鼻咽喉科領域では未だEBMに基づいた詳細な考察がなされていない。当院では2003年よりSSI（術後創部感染）防止サーベイランスを随時行っているが，今回は投与期間を短縮した新たな試みを報告する。対象は当院手術室で手術を受けた298名，例外症例を除き術当日で抗菌薬投与を終了しSSI発生の差を比較した。結果，全体のSSI発生率は1.7%，術当日のみの抗菌薬使用群では1.2%であった。研究当初より比較するとSSI発生率は徐々に改善を認めており，この為耳鼻咽喉科領域での予防的抗菌薬使用量は大多数の症例が手術日当日のみの使用で十分であることが考えられた。

These findings indicate that application of 4-16-fold diluted Omniscan could have depressant effects on the frog vestibular end organs. Based on cochlear studies on cytotoxicity using 8-fold diluted Omniscan, 16-fold diluted Omniscan is optimal for the inner ear and its application could be useful for visualization of endolymphatic hydrops as well as the control of vertiginous attacks in Meniere's disease.Endolymphatic hydrops could be visualized recently by intratympanic injection of Omniscan diluted 8- or 16-fold with saline using three-dimensional fluid attenuated inversion recovery (3-D FLAIR) MRI. However, the effects of the Omniscan on vestibular end organs are not clearly understood. The purpose of this study was to investigate the effects of Omniscan on vestibular end organs both morphologically and physiologically.Vestibular hair cells isolated from bullfrogs were loaded with 4-32-fold diluted Omniscan (gadolinium hydrate) and morphological changes were observed. Moreover, compound action potentials of posterior semicircular canals were also observed after application of Omniscan.Application of 4-16-fold diluted Omniscan caused morphological damage of isolated vestibular hair cells and decreased action potentials of the posterior semicircular canal. After application of 32-fold diluted Omniscan, no apparent changes were noted even after 20 min, both morphologically and physiologically.

Our findings indicate that oxidative stress induces morphological changes in vestibular hair cells and subsequently leads to cell death after 2.5 h.The aim of this study was to confirm the direct effects of oxidative stress on vestibular hair cells.Vestibular hair cells isolated from guinea pigs were loaded with 1 or 10 mM H2O2, and morphological changes were observed. In addition, in a viability/cytotoxicity assay system, the numbers of dead cells in isolated cristae ampullares were counted 1, 3, and 5 h after loading with H2O2 or artificial perilymph (control).Reactive oxygen, in the form of H2O2, directly affects the cell membrane of isolated vestibular hair cells and causes swelling of the cell body, bleb formation, and shortening of the neck region. Morphological changes occur within 30 min after loading with H2O2, but a significant increase in the number of dead cells is noted only after 3 h.

Objective The maxillofacial characteristics of patients with obstructive sleep apnea syndrome (OSAS) have previously been analyzed using standard cephalometric analysis. Malocclusion influences the occurrence of sleep apnea, but the pathology of malocclusion in OSAS has not yet been fully investigated. Therefore, we investigated malocclusion in patients with OSAS using cephalometric and dental analysis. Methods Cephalometric and dental analyses were performed to evaluate malocclusion in 97 male patients with OSAS (49.7±11.7 years). The number of apnea and hypopnea episodes per hour (apnea-hypopnea index: AHI) was determined by standard polysomnography. Results The overall prevalence of severe overjet (the horizontal distance between the upper and lower incisors of ≥6 mm) was 43.3%. AHI was significantly correlated with body mass index (BMI) in obese OSAS patients (r=0.385, p=0.010), whereas it was significantly correlated with overjet in non-obese OSAS patients (BMI

A 40-year-old male patient had a vertigo attack with vomiting; however, there was no hearing loss, headache, or palsy of arms or legs. On admission, the CT examination did not show any tumors, or infarctions of the brain, brain stem or cerebrum. Neurotological findings of an electro-nystagmography and caloric test did not show any abnormalities, except a platform test showed positive. Two days after admission, MRI examination showed a small mass (15 mm) in the left cerebellar peduncle. Previously, cavernous anginoma was considered rare, but the increasing use of MRI has demonstrated numerous cases. Typically, epileptic or other convulsive symptoms appear initially, but in our case, pathology was indicated by vertigo without other cranial nerve symptoms.

It has been known that psychological factors are one cause of dizziness. We report a patient with dizziness with specific psychological causes. The patient was a 26-year-old woman who had previously been examined at several hospitals for a complaint of dizziness. A detailed examination at our hospital revealed no organic or functional abnormalities. She participated in group psychotherapy on the supposition that her dizziness had strong psychological causes, but communication with the doctor and other patients was difficult and psychotherapy had no effect. We then introduced a clinical psychotherapist, who said the patient had a borderline personality disorder. The patient become hostile to treatment when administration of drugs either by drip infusion or orally was also ineffective, making further treatment virtually impossible. Mistakes in the care of patients with borderline personality disorders can aggravate the symptoms or even lead to self-mutilation or suicidal behavior. Moreover, commonly used simple psychological tests do not always detect this disorder. Consequently, accurate diagnosis and treatment of borderline personality disorder is difficult for the otorhinolaryngologist. If this disorder is suspected, the best course for the otorhinolar-yngologist is to introduce a specialist in psychiatric diagnosis at an early stage.

We previously reported that a loss of contraction in the mucosal tissue of the palate arch is effectively induced by ethanol injections of moderate concentration and dosage. The present study was performed to obtain more information on how such ethanol injections induce contraction loss in mucosa tissue. Guinea pigs of both sexes were used in this study. The left arch of the palate mucosa was injected with 2 microliters of 70% ethanol and used as the experimental group. The right arch of the palate mucosa of the same animal was injected with saline and used as a control. One, three, five, eight, 10, 30, 50, and 90 days after injection, the mucosal tissues that received the injection were resected under anesthesia and processed for light microscopy using standard procedures. One day after the ethanol injection, severe coagulative degeneration of the mucosal tissue of the palate was seen. However, the damaged area was strictly restricted to the arch of the palate. Coagulative degeneration of the tissue peaked three days after the injection. Thereafter, the mucosal epithelial and mucosal connective tissues regenerated, and the damaged mucosal tissue quickly began to repair. An apparent cicatricial contraction loss was observed 10 days after the ethanol injection, along with the progression of fibrotic changes in the submucosal connective tissue of the arch of the palate. The regenerative action of the mucosal arch of the palate abated 30 days after the ethanol injection, and the reduced mucosal tissue appeared to have become denser as a result of an increase in dense fibrous connective tissue in the submucosal layer. No cell malignancies were seen throughout the entire 90-day observation period. In conclusion, cicatricial contraction loss of the mucosal arch of the palate resulting from the injection of an appropriate concentration and dosage of ethanol leads to the regeneration of the mucosal epithelium and fibrotic changes in the submucosa. The ethanol injection described here seems to be extremely safe, since it exerted no malignant effects on the cells and tissues either morphologically or functionally.

Down-beat nystagmus is often observed in dizzy patients with a central lesion focus; however, up-beat nystagmus has rarely been noted. A 57-year-old man who com-plained of dizziness was diagnosed as having Wernicke encephalopathy on the basis of neurological findings, an MRI and the past history given at first visit to Aichi Medical University. Up-beat nystagmus was observed under an infrared camera and recorded by electronystagmography (ENG). An eye-tracking test for optokinetic nystagmus showed saccades and ataxia. Vitamin B1 50 mg per day was administered immediately. Although symptoms such as cerebellar ataxia had improved by the third day after administration and were almost absent by the 19th day, saccades and ataxia, recorded by ENG, and up-beating nystagmus remained for more than 4 months.

現代医学的治接療が難渋した老人性耳鳴の四症例に対して, 中医学的鍼治療を施行した結果, 興味深い臨床知見が得られたので報告する。初診時, 純音オージオグラムでは全症例とも高音漸傾型の感音難聴を呈し, また標準耳鳴検査法においては, 各症例それぞれに最高14dBから6dBまでの耳鳴ラウドネスが検出されていた。さらに語音聴力検査やSISIテストにて, 症例1と症例2はいわゆる迷路型, 症例3は混合型, そして症例4は後迷路型の聴覚障害であると判明した。その一方で, 中医学的弁証論では, 全症例の病因病機はいずれも, 耳や脳の基本栄養物質である腎精気の加齢による衰退, すなわち「腎精虚損証」に深く関与しているものと診断された。これより, いわゆる「補腎益気・養耳健脳」という治療原則を導き出し, それに基づいて週1回, 連続10週間, 合計10回の鍼治療を行った。その結果, 明らかな迷路性障害が存在した症例1・2・3は, ほぼ毎回鍼治療後, 約半日から数日間に亘って, 程度差があるものの確実な耳鳴の軽減効果が見られた。特に3回目の治療以降は, それぞれの症例における自覚的耳鳴の大きさや耳鳴のラウドネスは, 常時治療前の1/2～1/3のレベルにまで低下するとほぼ満足の行く臨床効果が示された。しかしながら, 症例4に関しては今回の鍼治療の期間中には, 耳鳴ラウドネスの多少の変動が見られたものの, 全般的に病状の明らかな緩解までには至らなかった。結論として, 中医学的鍼治療は老人性耳鳴に対して一定の軽減作用を有するものであろうが, その中でも後迷路性のものに比べ, とりわけ迷路性または混合性の耳鳴には, より適した治療方法ではないかと考えられる。今後, そのさらなる臨床応用が期待される。

Recently Coblation Technology has been used to enlarge the pharyngeal space in sleep disordered breathing patients. However, the indications are unclear. In this study, we evaluated Coblation Technology with the epworth sleepiness scale (ESS), visual analogue scale (VAS) for snoring, and apnea hypopnea index (AHI) in 17 sleep-disordered breathing patients. ESS (89%) and VAS (100%) were improved in most cases after surgeries. Of the 17 patients with AHI, 88% had a reduced AHI of more than 50% after Coblation Technology. All of the patients with an AuI under 40 improved remarkably after treatment; however, several patients with an AHI over 40 did not improve as much. Coblation Technology is an effective treatment for sleepiness and snoring in sleep-disordered breathing patients, however, the physician must be careful using it for patients with an AHI above 40.

Severe snoring is thought by many to be an early stage of obstructive sleep apnea syndrome (OSAS), but the anatomical relation between snoring and OSAS, if any, has remained unclear. To compare the morphology of the airway between snorers and OSAS patients for possible similarities, we conducted a cephalometric analysis of Japanese OSAS patients (n=10), habitual snorers (n=10), and non-snoring controls (n=50). There was no significant difference in SNB (the angle formed by the sella, nasion and point B) between OSAS patients and the control subjects. Obstructive sleep apnea syndrome patients tended to have an anteriorly positioned maxilla, and an anteroposterior misalignment between the maxilla and mandible. There was also a tendency toward skeletal openbite. Both OSAS patients and snorers had large tongues and large soft palates, thus causing constriction of the airway with resultant smaller airway diameter and smaller airway surface area. Significant differences between OSAS patients and snorers were found in thickness and length of soft palate surface area, and thickness, length, and position of the hyoid bone. These results suggest that cephalographic measurements may be of considerable use in determining the seriousness of a patient's condition.

Although the interrelations between dizziness and various psychological factors have been well reported, the effectiveness of various therapies in reducing dizziness has received much less attention. In a previous study, we reported that group psychotherapy was effective in improving the condition of patients suffering from dizziness. In this study, we investigated the environmental factors which may have caused the dizziness of eighty-six patients. Probable causes for their dizziness included a dysfunctional family (30%), work- or job-related stress (31%), and mental illness (23%). Difficulty with human relations and anxiety were the most common factors exacerbating symptoms of dizziness. Group psychotherapy was found to be effective in helping these patients reduce their dizziness.

This study was designed to compare large dose steroid therapy and lipo-PGE1therapy in 22 previously untreated patients with Bell's palsy accompanied by diabetes mellitus. Thirteen patients were treated with large dose steroid therapy, while the remaining 9 were treated with Lipo-PGE1 therapy. No significant differences in patient backgrounds, such as age, sex, and the side of palsy, were present between the two treatment groups. Furthermore, no significant differences in the mean palsy score at the time of presentation or at the time of aggravation were present between the two groups. Cumulative recovery rates after treatment did not differ significantly at 4 weeks or at 2 and 6 months between the two groups, nor were there any differences in the therapeutic outcomes between the groups. Fasting blood glucose levels during the period of treatment were elevated in all 13 patients receiving steroids, but not in the lipo-PGE1 group. Diabetes mellitus was also aggravated in the steroid group, but not in the lipo-PGE1 group. These findings indicate that lipoPGE1 therapy improves the blood flow to facial nerves, promoting recovery from Bell's palsy. Furthermore, lipoPGE1, therapy is useful for the treatment of Bell's palsy accompanied by diabetes mellitus because it has the same recovery rate as that of large dose steroid therapy, but it does not aggravate diabetes mellitus.

The morphology and immunohistochemistry of inducible nitric oxide synthase (iNOS) and nuclear factor-kappa B (NF-kappa B) were studied on the spiral and vestibular ganglion of young and old ddy mice. The significant decrease in the number of the spiral ganglion cells and a significant expression of iNOS and NF-kappa B were observed in old mice. In contrast, in the vestibular ganglion of all animals examined, decrease in the number of the ganglion cells or expression of iNOS and NF-kappa B were not observed. Although the relevance of enzymatic systems for the protection of vestibular ganglion cells in old individuals from harmful oxidative stress increased with aging should be further clarified, lack of harmful stress due to nitric oxide (NO) may be one of the plausible reasons for that the vestibular ganglion cells were not decreased in number with aging, since iNOS was not detected in the vestibular ganglion cells in the animals tested in the present study.

This report describes a successful conservative treatment of cervical esophageal perforation due to a flexible fiberscopy. The cervical esophagus of a 38-year-old man was perforated during upper gastrointestinal endoscopy using a flexible fiberscopy. Oral intake was withheld and high-dose antibiotics were administered through the central venous system. Body temperature, WBC and CRP were monitored to locate early signs of infection. Surgery was not attempted since the only symptoms seen were an elevated WBC and CRP within 48 hours after the injury, with no further serious infection or abscess. Oral intake was restarted on the 11th day and the patient was discharged on the 13th day. He has shown no subsequent adverse symptoms and has returned to work.

Localization of iNOS and NF-κB in the cochlear tissues of ddy-strain mice was studied immunohistochemically with reference to ageing. Severe structural disorders with a decrease in the number of cells were found, especially in the organ of Corti and in the spiral ganglion of older mice. Throughout all age-spans studied, iNOS-like immunoreactivity was found in the cells of Hensen, Claudius and the outer spiral sulcus epithelium, and it increased dramatically with age. A very small number of cells in the stroma of the spiral ligament and spiral limbus of younger mice up to 12 months of age showed weak iNOS immunoreactivity, while the spiral ganglion cells of the younger mice were almost negative. In mice after 18 months of age, however, strong iNOS immunoreactive cells remarkably increased in the spiral ligament and spiral limbus. Moreover, spiral ganglion neurons that survived from age-related cell death also showed strong reactivity. The immunohistochemical localization of NF-κB and its change with age were nearly the same as those of iNOS. The possible roles of iNOS and NF-κB in the changes of mouse cochlear tissues with advancing age were discussed.