Atsushi Shinkawa

Immunological and virological study of sudden deafness.

Thirty-three patients with sudden deafness and 11 controls were selected from the patients admitted to the Department of Otolaryngology, Tokai University Hospital from November 1990 to October 1991. Viral titers were measured for mumps, adenovirus, rubella, measles, herpes simplex virus (HSV), varicella zoster virus (VZV), rhinosyncytial virus, cytomegalo-virus (CMV), and mycoplasma pneumoniae in 33 sudden deafness patients and 11 controls at a 2-week interval. In 20 of 33 sudden deafness patients and 5 of 11 controls, autoantibodies of rheumatoid factor (RF), anti-mitochondrial antibody (AMA), anti-nuclear antibody (ANA), anti-parietal cell antibody (APA), anti-smooth muscle antibody (ASA), and anti-type II collagen antibody were studied. Viral titer study did not reveal any significant change either in the patients or in the controls, whereas autoantibody study revealed a relatively high incidence for ASA in the patients as compared with the controls. The relatively high incidence for ASA suggests that immune-mediated processes may be involved in the etiology of sudden deafness.

Cochlear implant after reconstruction of the external bony canal wall and tympanic cavity in radically mastoidectomized patients with cholesteatoma

One of the postoperative complications of cochlear implants in patients, who previously received radical mastoidectomy, is an exposure of electrode by breakdown of thin epithelium in the open mastoid cavity. To avoid such complications, in the first stage, radical mastoidectomy with the reconstruction of the posterior bony canal wall and mastoid obliteration with bone chips and plates and the creation of the new tympanic cavity, were performed. One or 3 years later, implantation of a 22-channel cochlear implant, as the second stage procedure, was successfully performed in three patients with profound sensorineural hearing loss, due to cholesteatoma in the side of the ear in which cochlear implantation was indicated. The advantages of this technique are as follows: (1) Electrode is protected from the cavity problems, such as chronic infection or erosion of the epithelium in the open mastoid cavity; and (2) reconstruction of the new tympanic cavity and tympanic membrane is beneficial for avoidance of electrode exposure in the mastoid and tympanic cavity.

Klippel-Feil Syndrome with Conductive Deafness and Histological Findings of Removed Stapes

The Klippel-Feil syndrome is usually associated with sensorineural hearing impairment, but rarely is it associated with conductive or mixed deafness. A 22-year-old female presented with fusion of the cervical vertebrae, torticollis, scoliosis, pterygium colli, the Sprengel deformity with an omovertebral bone, concavity of the thorax and conductive hearing impairment of the right ear. Tympanotomy disclosed an atrophic long process of incus and a fixation of the stapes footplate, and stapedectomy was performed with immediate postoperative improvement of hearing. However, she developed a sudden hearing loss with dizziness soon after she had physical exercise on the 15th postoperative day, and revision surgery revealed a perilymph fistula of the oval window. Histological investigations of the removed stapes showed no specific osseous changes but hyperostosis of the posterior edge of the footplate. The literature is reviewed and the etiology of the conductive deafness and the perilymph fistula is discussed.

Tympanoplasty Type IV Using a Y-shaped Ceramic with Unintentionally Mobilized Footplate during Surgery for Otosclerosis

Sixty-six cases diagnosed with otosclerosis underwent small fenestra stapedotomy in our clinic. During surgery, the stapes footplate became mobile in 6 cases, so-called “floating stapes”. Considering the risk of sensorineural hearing loss, we chose tympanoplasty type IV placing a Y-shaped ceramic between the incus and the footplate, rather than stapedectomy.Improvement of the hearing level was evaluated by the standard of the Otological Society of Japan as the improvement of the hearing level. The success rates of hearing improvement were 100%. There were no cases showing progressive sensorinual hearing loss. Postoperative vertigo occurred in only one case and was very mild.The stapes is fractured not infrequently or becomes mobile during surgery for otosclerosis in Japan. In order to avoid the risk of sensorineural hearing loss due to perilymph leakage following stapedectomy, the method that we used in the present series was considered one of the good options under these circumstances, However we consider that recurrence of hearing loss due to refixation of the stapes is possible in the future.

S229 – One-Stage Tympanoplasty with or without Mastoid Obliteration

Objectives To confirm the efficacy of one-stage tympanoplasty with mastoid obliteration and a tymapanoplasty by transcanal approach using ceramic prosthesis. Methods Our surgical procedure was performed on 163 patients with cholesteatoma and 545 patients with chronic otitis media in Shinkawa Clinic. The operative method was classified into 2 groups. We use one-stage tympanoplasty with mastoid obliteration, a canal wall down procedure for chronic otitis media with cholesteatoma and chronic otomastoiditis. On the other hand, we use a tympanoplasty by an endaural approach for chronic otitis media without chronic otomastoiditis. The ossicular chain was reconstructed using the ceramic ossicular prosthesis (P-type and T-type). We performed modified Type III tympanoplasty using the P-type ceramic when the superstructure of the stapes could be utilized, while we performed modified Type IV tympanoplasty using the T-type ceramic when the superstructure of the stapes could not be used. Results In chronic otitis media with cholesteatoma or chronic otomastoiditis, the success rate of modified Type III tympanoplasty using ceramic P type was 77.8%; on the contrary, that of modified Type IV tympanoplasty using ceramic T type was 70.6%. In chronic otitis media without chronic otomastoiditis, the success rate of modified Type III tympanoplasty using ceramic P-Type was 69.8%, while that of modified Type IV tympanoplasty using ceramic T was 69.1%. Conclusions Our results show that there are no significant differences of success rate between these 2 procedures. We confirmed that the use of ceramic implant was satisfactory for both one-stage tympanoplasty with mastoid obliteration and a tympanoplasty by an endaural approach.

THE EFFICACY OF ONE-STAGE TYMPANOPLASTY WITH MASTOID OBLITERATION AND TYMPANOPLASTY BY TRANSCANAL APPROACH

Purpose: To confirm the effect of one-staged tympanoplasty with mastoid obliteration and tympanoplasty by transcanal approach using ceramic prosthesis. Materials and Methods: A retrospective chart review was performed on 516 patients undergoing ossicular chain reconstruction between June 2001 and December 2005. We use one-stage tympanoplasty with mastoid obliteration, a modified canal wall down procedure for chronic otitis media with aeration trouble in mastoid. On the other hand, we use a tympanoplasty by transcanal approach for chronic otitis media without aeration trouble in mastoid. Results: In modified canal wall down, mean ABG for partial ossicular replacement prostheses was 29.5 Db postoperatively. Mean ABG for total ossicular replacement prostheses was 38.1 Db. Mean hearing gain in the P-type ceramic group was 10.3 dB. Mean hearing gain for patients following placement of T-type ceramic group was 9.3 dB. On the contrary, in tympanoplasty by transcanal approach, postoperative mean ABG for partial ossicular replacement prostheses was 40.4 dB. Mean ABG for total ossicular replacement prostheses was 42.7 dB. Mean hearing gain in the P-type ceramic was 7.8 dB. Mean hearing gain for patients following placement of T-type ceramic was 6.2 dB. A modified canal wall down group using ceramic P-type and ceramic a T-type group had 33.3% and 67% success rates. A tympanoplasty by transcanal approach using ceramic P-type and ceramic T-type had 10% and 20% success rates.

Clinical Efficacy of Oxatomide on Japanese Cedar Pollinosis. Results of Kanagawa Multicenter Study for 3 Years.

Atsushi Shinkawa, Hirosato Miyake and Makoto Sakai (Tokai University), Isamu Takeyama (St. Marianna University School of Medicine), Tetsuya Shitara (Kitazato University), Hirokuni Otsuka and Yasuo Hattori (Nippon Medical School, Dai-ni Hospital), Yoichi Ishizuka (Teikyo University School of Medicine, Mizonokuchi Hospital), Tetsuaki Kubota (Showa University School of Medicine, Fujigaoka Hospital), Hiroyuki Zusho (Kanto Rosai Hospital)

Drug Therapy for Dizziness Associated with Autonomic Imbalance.

Alprazolam, a minor tranquilizer used to treat idiopathic dizziness was studied clinically. Thirty-one patients with dizziness who had no spontaneous nystagmus were administered Alprazolam orally at 1.2mg/day, divided into three fractions for more than 4 weeks. TMI (Toho Medical Index) was examined before the treatment in 30 patients.Clinical efficacy was excellent in 10, good in 7, fair in 9 and not useful in 5. The overall efficacy rate was 54.9%. In 12 patients who scored grade III and IV on TMI which showed the degree of autonomic imbalance, the efficacy rate was 75.0%. However, in 18 patients who scored grade I and II on TMI which showed no or minimal autonomic imbalance, the efficacy rate was 38.9%. No adverse effects were observed except for one case of sleepiness.These results suggest that Alprazolam is a useful minor tranquilizer for the treatment of dizziness associated with autonomic imbalance.

Pharmacokinetic and clinical studies of T-3761 in otorhinolaryngeal infections.

T-3761 is a new oral quinolone antibacterial agent with a broad spectrum and potent activity against Gram-positive and Gram-negative bacteria.[1] The pharmacokinetics ofT-3761 are characterised by high peak concentrations and a short half-life (about 2 hours) in plasma, and high urinary excretion.[2] This study examined the penetration of T-3761 into otorhinolaryngea1 tissues, and investigated the clinical and bacteriological efficacy of this agent in patients with otorhino1aryngeal infections. In the pharmacokinetic study, high pressure liquid chromatography was used to determine the concentrations of T-3761 in plasma and otorhinolaryngeal tissue [middle ear granulation (n = 8 patients), maxillary sinus mucosa (n = 3), nasal polyp (n = 1), tonsil (n = 1)] after oral administration of 200mg to 13 patients who underwent otorhino1aryngeal surgery. In the clinical study, 61 patients with otorhinolaryngeal infections were treated with T3761 at a daily dose of 300 to 600mg in 2 or 3 divided doses. Clinical efficacy was evaluated in 48 patients (13 patients were excluded, or dropped out) with acute otitis media (n = 4), chronic otitis media (n = 8), acute otitis extern a (n = 2), acute paranasal sinusitis (n = 13), chronic paranasal sinusitis (n = 1), tonsillitis (n = 16), or pharyngolaryngitis (n = 4). Tolerability was evaluated in 59 patients. A total of 57 strains comprising 38 strains of Gram-positive bacteria (including 14 strains of Staphylococcus au reus ), 10 strains of Gram-negati ve bacteria (including 2 strains of Pseudomonas aeruginosa) and 9 strains of anaerobic bacteria were isolated from these patients before treatment and examined for susceptibility to T-3761, ofloxacin, ciprofloxacin, norfloxacin and tosufloxacin. As shown in figure 1, at 2 to 8 hours after administration the concentrations of T-3761 in plasma were as follows: 0.14 to 2.10 mg/L (mean 0.71 mg/L) in plasma; 0.16 to 1.30 mg/kg in middle ear granulation; and 0.16 to 1.16 mg/kg in sinus mucosa. In nasal polyp tissue the concentration of T-3761 was 0.28 mg/kg at 7.5 hours after administration and, in tonsil, it was 1.28 mg/kg at

Tomographic Diagnosis of Gholesteatoma of the Middle Ear

Tomographic study coupled with information obtained from otoscopic observation of the ear drum, middle ear and audiometry provide otologists with a complete picture of cholesteatomatous involvement of the temporal bone. Tomographic studies were performed in our clinic preoperatively using a Hitachi Polytome. The ear was sectioned at consecutive levels 2.5mm apart with 4 cuts for lateral projection and 5 for frontal. Diagnosis of cholesteatoma was made when there were tomographic findings of widening over 3mm of spur interval (distance between the lateral aspect of the head of malleus and the lateral attic wall), destruction of the anterior tympanic spine and an excessively blurred attic.In the retrospective review of tomograms of the surgically treated patients, we found changes compatible with cholesteatoma in 89% of 46 patients with surgically confirmed cholesteatoma. Tomographically we were able to determine the size and extent of cholesteatoma as well as the involvement of the ossicles, dural plate, facial canal, lateral sinus and lateral semicircular canal. Forty-six cases of cholesteatoma were classified according to the site and the extent of cholesteatoma into three types: the attic type (13 ears), the tympanic type (15) and the advanced type (18).Thus the usefullness and accuracy of preoperative tomographic examinations in cholesteatoma cases have been well demonstrated.