Akimitsu Kawai

A case of bilateral eosinophilic granuloma in the temporal bone

We present a case of bilateral eosinophilic granuloma in the temporal bone in a 47-year-old woman, who visited our hospital with a headache and a feeling of occlusion in her left ear. Her left tympanic membrane was slightly turbid and pure tone audiometry revealed mild left sensorineural deafness. CT disclosed a shadow of soft tissue in the left mastoid antrum and mastoid cells, which was indicative of marked destruction of the bone. Because MRI findings led us to suspect otitis media cholesteatoma, a mastoidectomy was performed. The mastoid antrum and mastoid cells were filled with easily bleeding granulation, and there was a wide range of bone deficit in the posterior cranial fossa. Histopathologically, the granulation tissue was an eosinophilic granuloma. Her postoperative clinical progress was good and she was discharged. However 2 months after discharge, she had a feeling of occlusion in the right ear and CT revealed a shadow in the right mastoid antrum and cells. Therefore, right tympanoplasty was performed and the same findings as in the left ear were obtained. A histopathological diagnosis of eosinophilic granuloma was made again. To date, there has been no recurrence.

Congenital Cytomegalovirus Infection and Sensorineural Hearing Loss

Cytomegalovirus (CMV) is the most common cause of congenital viral infection with a reported incidence of 0.29-0.42% of live births. Bilateral and unilateral sensorineural hearing loss of varying degrees has been reported in children with symotomatic and asymptomatic congenital CMV infections. In this paper, case studies from three infants with hearing impairments diagnosed by pediatricians as symptomatic congenital CMV infections are reported. The follow-up hearing assessments were performed by ABR and pure tone audiography. According to their ABR thresholds, the three cases had severe, severe and moderate bilateral sensorineural hearing impairment, respectively. We administered acyclovir and anti-CMV r-globlin, and the ABR thresholds of all three cases improved. However, in two cases, delayed progressive hearing loss and vestibular impairment were found.

A Case of Intrabronchial Foreign Body Presenting as Mold in the Bronchus

We report an unusual case of a 1-year-old child with an intrabronchial foreign body. He had been coughing very hard and his face was cyanotic. Chest X-ray showed atelectasis in the left lower lung field and pulmonary emphysema in the right lung field. A diagnosis of suspected left intrabron chial foreign body was made. Bronchoscopy was performed immediately and a foreign body was extracted from the left main bronchus. The foreign body looked like mold in the bronchus.

A Case of Fatal Tongue Cancer with Multiple Complications

General complications are sometimes associated with the treatment of head and neck tumor. We review a case of fatal tongue cancer with multiple complications. A 57-year-old female complained of tongue swelling. She had a 5 x 3 x 2 cm well differentiated squamous cell carcinoma (T3N2M0) on the right side of the tongue. Complications before treatment included diabetes mellitus, a pre-cirrhotic liver and renal dysfunction. We performed surgery after chemotherapy by intraarterial injection. Following surgery, she developed fatal complications ; severe hypoalbuminemia, lung edema, severe Pseudomonas aeruginosa infection, septic shock, disseminated intravascular coagulation (DIC) and peritonitis cartinomatosa. Twenty-four days after surgery, she died of multiple organ failure. Paying attention to pre-, intra-, and postoperative general conditions while treating head and neck malignancies is important.