Hiroko Monobe

Factors Associated with Poor Outcome in Children with Acute Otitis Media

Objective --To identify factors determining poor outcome in children with acute otitis media (AOM). Material and Methods --We considered the following factors in children with AOM: age; gender; the presence of group nursing; the presence of siblings; the duration of breastfeeding; and the type of bacteria isolated from the middle ear fluid (MEF) or nasopharynx. The 73 pediatric patients studied included 61 examined in outpatient clinics and 12 seen at a childrens home. Results --Of the 61 children examined in outpatient clinics, 32 (52%) had persistent MEF (fluid accumulation in the middle ear persisting for up to 1 month after treatment); 14 (23%) had early recurrence of AOM (within 1 month following an initial improvement); and 14 (23%) developed recurrent AOM (> 3 recurrences during 6 months of follow-up). Using univariate and multivariate analyses, age < 2 years was found to be significantly related to the development of recurrent AOM and an absence of group nursing was found to be significantly related to the development of early recurrence. Persistent MEF was significantly related to the development of recurrent AOM. There was no difference between bacterial species isolated from the MEF or nasopharynx in terms of clinical outcome. Conclusion --These findings indicate that particularly close long-term follow-up is necessary for children aged < 2 years and children with a middle ear effusion that persists for up to 1 month after treatment.

The site of lesion in “vestibular neuritis”: Study by galvanic VEMP

Vestibular neuritis (VN) is characterized by isolated vertigo without other neurologic signs or symptoms.1 Patients show unilateral peripheral vestibular dysfunction mainly in the superior vestibular nerve region,2 although some patients also have dysfunction in the inferior vestibular nerve region.1,3⇓ Although VN supposedly involves the vestibular nerve, insufficient evidence is available concerning the VN lesion site. It is known that some patients with VN have benign paroxysmal positional vertigo (BPPV) following severe vertigo attacks.1 These patients would be expected to have some lesions in the labyrinth because BPPV is caused by floating debris in the semicircular canal.4 Recently, it was reported that short-duration galvanic stimulation could evoke vestibulocollic reflexes in the sternocleidomastoid muscle (SCM)5-7⇓⇓ (galvanic vestibular evoked myogenic potentials [VEMP]). It has also been reported that these reflexes are useful for differentiating labyrinthine lesions from nerve lesions in patients with an absence of VEMP by click (click VEMP).6 We postulated that galvanic VEMP could indicate the site …

Role of respiratory viruses in children with acute otitis media

OBJECTIVE The role of viral infection in acute otitis media (AOM) has not been fully elucidated. We determined the presence of various respiratory viruses in middle ear fluid (MEF) specimens from children with AOM in order to determine whether viral infection or combined effects of viral and bacterial infection enhance or prolong the inflammation in the middle ear, thus worsening clinical outcome. METHODS Multiplex nested reverse transcription-polymerase chain reactions was carried out to detect influenza A and B viruses, respiratory syncytial virus (RSV) types A and B, parainfluenza virus types 1, 2, and 3; rhinovirus; and adenovirus in 93 MEF specimens from 79 children with AOM. And we examined whether viral infection with or without an identifiable bacterial infection affect clinical outcomes in AOM. We considered persistent MEF (fluid accumulation in the middle ear persisting up to 1 month after treatment), early recurrence of AOM (within 1 month after initial improvement), and recurrent AOM (more than three recurrences during 6 months of follow up) as indicators for evaluating clinical outcomes. RESULTS One or more respiratory viruses were detected in 39 specimens (42%); a total of 42 viral infections identified (three specimens were infected by two viruses). Of the 42 infections, RSV type A was detected in 29, adenovirus in eight, rhinovirus in three, and influenza virus in two. RSV accounted for 73% of viral detections. In children younger than 2 years, RSV infection combined with Streptococcus pneumoniae or Hemophilus influenzae infection carried a higher risk for persistent middle ear effusion than infection with RSV infection alone or those bacterial infection alone. CONCLUSIONS Accordingly, vaccination of young children against RSV as well as S. pneumoniae and H. influenzae is important in improving the prognosis in AOM.

The outcome of the canalith repositioning procedure for benign paroxysmal positional vertigo: are there any characteristic features of treatment failure cases?

To demonstrate the success rate of the canalith repositioning procedure (CRP) in our clinic and to establish any characteristic features of cases of treatment failure, we reviewed clinical records of 62 patients who were diagnosed with posterior semicircular canal-benign paroxysmal positional vertigo (BPPV) and treated with the CRP. The basic strategy of the CRP was to rotate the involved canal slowly in the plane of gravity so that free-floating materials could migrate into the utricle only once. After the procedure we instructed patients to keep their heads upright for 10 h and not to sleep on the affected ear for 2 weeks. After the initial treatment, successful results were obtained in 51 of the 62 patients (82.2%). After the second treatment, 56 patients (90.3%) experienced success. Six patients (9.7%) did not obtain resolution even after the second treatment. While 46 patients were diagnosed with idiopathic BPPV, in 16 patients a different diagnosis was determined (head injury in 7 patients, Ménières disease in 2, vestibular neuritis in 2 and unilateral sensorineural hearing loss in 5). We categorized these 16 patients as having secondary BPPV. Patients with idiopathic BPPV showed a significantly higher success rate with CRP than those with secondary BPPV. Patients with secondary BPPV may have quantitatively or qualitatively different lesions than those with idiopathic BPPV.To demonstrate the success rate of the canalith repositioning procedure (CRP) in our clinic and to establish any characteristic features of cases of treatment failure, we reviewed clinical records of 62 patients who were diagnosed with posterior semicircular canal-benign paroxysmal positional vertigo (BPPV) and treated with the CRP. The basic strategy of the CRP was to rotate the involved canal slowly in the plane of gravity so that free-floating materials could migrate into the utricle only once. After the procedure we instructed patients to keep their heads upright for 10 h and not to sleep on the affected ear for 2 weeks. After the initial treatment, successful results were obtained in 51 of the 62 patients (82.2%). After the second treatment, 56 patients (90.3%) experienced success. Six patients (9.7%) did not obtain resolution even after the second treatment. While 46 patients were diagnosed with idiopathic BPPV, in 16 patients a different diagnosis was determined (head injury in 7 patients, Ménières disease in 2, vestibular neuritis in 2 and unilateral sensorineural hearing loss in 5). We categorized these 16 patients as having secondary BPPV. Patients with idiopathic BPPV showed a significantly higher success rate with CRP than those with secondary BPPV. Patients with secondary BPPV may have quantitatively or qualitatively different lesions than those with idiopathic BPPV.

Multiplex Nested Reverse Transcription-Polymerase Chain Reaction for Respiratory Viruses in Acute Otitis Media

Because respiratory viruses play an important role in the causation and pathogenesis of acute otitis media (AOM), determining which virus has infected a child is important with respect to vaccines and antiviral drugs. In some instances, this information might be used to prevent the occurrence of AOM. We used a rapid, economical, and sensitive diagnostic system involving a multiplex nested reverse transcription–polymerase chain reaction (RT-PCR) assay to detect various respiratory viruses in clinical specimens of middle ear fluid (MEF) from children with AOM in our hospital. Multiplex RT-PCR was completed on 40 MEF samples from 28 infants and children less than 6 years old with AOM. Viral RNA was detected in 17 MEF samples (43%). Respiratory syncytial virus type A was present in 12 samples, adenovirus in 3, rhinovirus in 2, and influenza A (H3N2) in 1. The multiplex RT-PCR assay is recommended to clinical laboratories that are considering adoption of a molecular technique for viral diagnosis.

Nonsyndromic isolated unilateral cochlear nerve aplasia without narrow internal auditory meatus : A previously overlooked cause of unilateral profound deafness in childhood

Objectives: Juvenile or adolescent unilateral profound sensorineural deafness (worldwide prevalence, 0.1% to 0.2%) has been attributed to postnatal viral infection, sudden deafness, prenatal and perinatal problems including maternal rubella and viral infections, congenital inner ear anomalies, and other factors. Herein, 2 cases are reported and another potentially important cause of unilateral profound hearing loss is proposed. Methods: Two nonsyndromic cases of a presently “very rare” cause of pediatric unilateral deafness are presented as a retrospective case study. Results: The 2 patients showed isolated aplasia of the cochlear nerve; other branches of the eighth cranial nerve, the seventh nerve, and the inner ear were spared, and there was no anomaly of the internal auditory meatus. Both functional and imaging studies confirmed the isolated lesion (absence) of the cochlear nerve. Conclusions: Because of the absence of bony abnormalities, such cases may have been overlooked. The authors would like to advocate this isolated anomaly of the cochlear nerve as an important cause of juvenile or adolescent unilateral profound deafness.

Infratemporal Fossa Gas Gangrene with Sepsis: A Case Report

A case of non-clostridial gas gangrene in the Infratemporal fossa with sepsis is described. A 49-year-old woman with no history of diabetes presented with persistent fever, left facial puffiness, and trismus. Her physical examination and laboratory tests indicated that she had SIRS (systemic inflammatory response syndrome). CT (computed tomography) scan demonstrated a gas-forming abscess in the left infratemporal fossa that was attributable to a caries tooth in the mandible. Surgical drainage was performed via the subtemporal-preauricular approach combined with the intraoral approach, and antibiotics TAZ 2g/day, CLDM 1.8g/day and γ-globulin 5g/day were given. Thirteen days post operatively, the inflammatory response subsided and she was discharged. Bacterial culture isolated Streptococcus constellatus, Peptostreptococcus micros, and Prevotella intermedia.Gas gangrene in head and neck lesions is usually caused by a non-clostridial organism, and most lesions are not due to a traumatic wound but to infections such as periodontitis, peritonsillitis, and pharingitis. For abscess formation, surgical drainage in the early stage is needed, and for Infratemporal fossa lesions, the subtemporal-preauricular approach, intraoral approach and transmaxillary approach have been reported. In this case, surgery was successful via the subtemporal-preauricular approach combined with the intraoral approach.Infratemporal fossa gangrene is a potentially dangerous complication of odontogenic infection, and knowledge of the relevant anatomy and pathway of the spread will facilitate effective diagnosis and treatment of these infections.

A Case of Ossifying Fibroma of the Maxillary Bone

We report a rare case of ossifying fibroma of the maxillary bone. This patient was a 48-year-old female with pain and swelling on the left root of the nose. CT scan demonstrated a broken appearance of the anterior wall of the maxillary sinus and a ground-glass appearance of the maxillary bone. We performed Caldwell-Luc procedure under general anesthesia to rule out malignant neoplasm. The pathological diagnosis was ossifying fibroma of the maxillary bone. Ossifying fibroma is a benign neoplasm, but classification of this tumor is under discussion. We describe the diagnosis and classification of this tumor with reference to the literature.