Harumi Arao

Relevance and characteristics of gastroesophageal reflux in adult patients with otitis media with effusion

OBJECTIVE To investigate relevance and characteristics of gastroesophageal reflux (GER) in adult patients with otitis media with effusion (OME) of unknown etiology who attended private clinics. MATERIALS AND METHODS A total of 186 adults with OME of unknown etiology (OME group) and 156 adults without OME (control group) were asked to answer a questionnaire specific for the diagnosis of GER disease. Pepsinogen (PG) levels in the middle-ear effusions (MEEs) of the OME group were measured using a chemiluminescence enzyme immunoassay kit. Distributions of PG concentrations by age or body mass index (BMI) in the OME group were analyzed. Patients with high PG levels received proton pump inhibitors (PPIs) and their responses were evaluated. RESULTS Symptoms of GER were reported by significantly more patients in the OME group than in the control group (43.0% vs. 12.8%). Patients with GER symptoms tended to have higher MEE PG concentrations than those without symptoms. PG levels did not show a significant difference by age. However, high PG levels were less found in patients over 60 years old with high BMI >25. This tendency was not observed in patients under 60 years old. PG levels decreased in seven out of ten patients with high PG concentrations after PPI therapy, corresponding with palliation of GER-related symptoms. Two patients had high MEE bilirubin concentration, and OME resolved in these patients after instruction about lifestyle factors related to GER, including sleeping position. CONCLUSIONS GER symptoms were more prevalent than expected in patients with OME of unknown etiology. BMI might affect GER-related OME, especially in elderly patients. Instruction about lifestyle factors related to GER, especially in patients who do not respond to PPI therapy, may be effective for patients with intractable OME.

Computed tomographic evaluation of multiple mucocoeles of paranasal sinuses

There are some cases in which mucocoeles of the paranasal sinuses are multiple and their structures are complicated. When the mucocoeles are multiple, pre-operative evaluation is especially important for correct surgical management. We describe the usefulness of computed tomography for the evaluation of multiple mucocoeles of the paranasal sinuses.

Exploratory findings of audiometry in adult patients with otitis media with high pepsinogen concentrations: A preliminary study

Abstract Conclusions: The present study showed that elevation of bone-conduction (BC) thresholds at low frequencies might be a characteristic audiometric finding in cases with otitis media with effusion (OME) with high pepsinogen (PG) concentrations. Objective: The objective of this study was to investigate whether there is any characteristic audiometric finding in adult cases with otitis media with high PG compared to those with low PG. Methods: Twenty-four adult patients with unilateral OME of undetermined etiology and high PG concentrations (> 500 ng/ml) in their middle ear effusions (high PG group) were selected. The air-conduction and BC thresholds of pure tone audiometry were compared between the affected and healthy ears. Results were compared to those in 23 patients with low PG concentrations (< 50 ng/ml; low PG group). Results: The average BC difference in the threshold at 0.25 kHz between the affected ear and the healthy ear was significantly higher in the high PG group than in the low PG group, with a significantly higher proportion of patients in the high PG group having BC thresholds at 0.25 kHz in the affected ear that were ≥ 15 dB higher than in the healthy ear.

Auditory Screening System for 6-month-old Infants

1-3次検診で構成された, 6カ月児を対象とした聴覚検診システムを試行した。1次検診はアンケート方式で, 3・4カ月健康診査受診時に神経芽細胞腫ろ紙とともに配布し, 6カ月時に回答, 回収, その中から2次検診の対象児を選別した。2次検診はワーブルトーンとリングベルや紙もみ音を用いたBOA, 3次検診はCOR・ABRを施行した。約18,000人の中から感音難聴4例を検出し, 本システムの有効性を確認できた。しかし, 6カ月時の本システムだけですべての難聴を検出することは困難である。今回の試行では3例の感音難聴が検出できなかった。今後の課題は6カ月時で高度・中等度の難聴, 1歳6カ月時で中等度・軽度難聴の検出, 3歳時で最終チェックという体制を整備していくことである。

Adenotomy in Cases with Velopharyngeal Incompetence.

We encountered two cases with transnasal leakage of fluid and hypernasality after adenotomy. One case was diagnosed as paralysis of the soft palate and the other as submucosal cleft palate. It was thought that adenotomy exacerbated the velopharyngeal incompetence in these two cases. In order to determine the preoperative status of velopharyngeal incompetence more precisely, we studied retrospectively 35 cases of submucosal cleft palate and congenital velopharyngeal incompetence.It was found that the correct diagnosis was not immediately determined in these cases. Moreover, it became clear that otitis media with effusion coexisted in about 60% of the cases. We concluded that it is important to perform a comprehensive diagnosis including a detailed history of birth and development, visual inspection and palpation of the palate, blowing examination and XP study.

Sensorineural Hearing Loss in Congenital Cytomegalovirus Infection.

Cytomegalovirus (CMV) in the most frequent cause of congenital infections in humans. The neurodevelopmental outcome of infected neonates is well documented and includes a significant risk of sensorineural hearing loss (SNHL).We studied five SNHL subjects with congenital CMV infection. All 5 infected subjects were found to have bilateral progressive SNHL and the deterionation to profound occurred during the first two years of life.Transient evoked otoacoustic emissions (TEOAEs) were recorded in 2 subjects and the TEOAEs of all 4 ears were abnormal. These effects confirmed that hearing loss associated with congenital CMV infection was due to cochlear dysfunction at least, as literature on the histopathology had indicated.One of the five subjects was asymptomatic. The etiology of hearing loss in children often is not identified and we concluded that SNHL in some children was caused by congenital CMV infection.Because the majority of infants with congenital CMV infection are asymptomatic at birth, routine screening of all newborns for congenital CMV infection should be carried out and the management of infected children should include periodic assessments. As the therapy for congenital CMV infection is not effective, CMV vaccination for women of child bearing age should be considered. In the future, vaccination will significantly reduce the prevalence of hearing loss in children.