Hitoshi Hentona

Pleomorphic adenoma of the external auditory canal : a case report and review of the literature

Pleomorphic adenoma arising in the external auditory canal is rare. We report the case of a 38-year-old man. To better grasp the clinical features and natural history of this uncommon tumour, we also reviewed the worldwide literature and found 24 similar cases, which we analysed together with our own.

Usefulness of Auditory Brainstem Responses at High Stimulus Rates in the Diagnosis of Acoustic Neuroma

The effects of the stimulus rate on the auditory brainstem responses (ABRs) of acoustic neuroma (AN) patients were studied. Ninety-decibel click stimuli at a normal hearing level were delivered at stimulus rates of 9.5, 20, 40 and 90 Hz, and ABRs were recorded of 40 AN patients (40 ears) at each stimulus rate. Subjects with normal hearing (42 ears) and patients with sensorineural hearing loss (30 ears) were also studied to obtain normative data. The following two parameters were examined: the interpeak latency difference between wave I and wave V (IPL I-V) at each stimulus rate, and the increase in IPL I-V (delta IPL I-V) when the stimulus rate was increased from 9.5 Hz. AN patients showed significantly larger values for both parameters at all stimulus rates compared to those of the control groups. Among 6 AN patients with normal ABRs at 9.5 Hz, 5 showed abnormal IPL I-V or abnormal delta IPL I-V at 90 Hz, when the upper normal limits of both parameters were defined as the mean plus 2 SD of the group with normal hearing. These results suggest that recording ABR at high stimulus rates provides valuable information for detecting AN patients with normal ABRs.

Schwannoma of the posterior pharyngeal wall : a case report

Schwannoma arising in the posterior pharyngeal wall is rare. We report on a 60-year-old man who complained of discomfort in his pharynx, from whom a tumour was excised via an intraoral approach. No recurrence was seen after an 11-year follow-up. The nerve origin of the tumour is most likely to be the peripharyngeal plexus. This is the third such case reported.

Intraoperative Measurements of Auditory-Evoked Potentials in Three Patients with Acoustic Neuroma

Auditory brainstem responses (ABRs), electrocochleograms and the evoked potentials from the internal auditory canal were recorded simultaneously in 3 acoustic neuroma (AN) patients. The neural conduction in the internal auditory canal was examined by recording the compound action potentials of the cochlear nerve. In an AN patient with wave I only in the ABR, the neural conduction of the excitement in the cochlear nerve was blocked within the internal auditory canal. In 2 AN patients with elongated interpeak latency differences between waves I and V in ABRs, the neural conduction velocity of the cochlear nerve was lower than that of normal subjects. These results provide neurophysiological evidence that low neural conduction velocity in the cochlear nerve results in the abnormal ABR.

Ethyl Loflazepate in the Treatment of Tinnitus

Ethyl loflazepate (Meilax®) was administered orally to 91 patients suffering from tinnitus, 58 with tinnitus and sensorineural hearing loss, 27 with tinnitus without hearing loss, and 6 with tinnitus accompanied by sudden deafness. The clinical severity of tinnitus was evaluated every two weeks in terms of loudness, continuity and annoyance. Medication was rate of as effective in 27.5%, moderately effevtive in 33%, slightly effective in 17.6% and not effective in 21.8% at the end of treatment. Effectiveness depend on the duration of treatment. Patients treated for a relatively long period showed greater clinical improvement. Two patients complained of sleepiness as a side effect. It was concluded that ethyl loflazepate is effective in reducing severity of tinnitus.

A New Treatment for Severe Epistaxis.

Patients with severe bleeding from the upper and posterior portions of the nasal cavity are generally treated by Bellocq tamponade, balloon tamponade or surgery, i, e, embolization or ligation of the artery. These procedures cause local pain, headache and nasal obstruction. We tried a new method of treatment in 31 patients with severe epistaxis using oxy-cellulose cotton. The bleeding was controlled adequately in 29 patients, some of whom had been treated by Bellocq tamponade in other hospitals and pleased to be free of the discomfort of their previous experiences.This new method is summarized as follows:1) It is mandatory to recognize the bleeding point, because oxy-cellulose cotton is to be packed at only one bleeding point in the nasal cavity. 2) Oxy-cellulose cotton is divided into small fragments, because the space around the bleeding point is usually narrow and deep within the nose. A piece of the divided contton is dipped in epinephrine or lidocaine solution before use because dry cotton sticks easily to normal nasal mucosa.3) Referred pain is felt in the ear when the cotton is packed on the lateral wall of the inferior meatus, and in the forehead when it is packed in the meatus olfactorius. 4) This treatment never interferes with other treatments for severe epistaxis, and combined procedures with ribbon gauze, Bellocq tamponade, balloon tamponade, etc, can be used when needed.5) Inserted cotton does not need to be removed, because it is absorbed in a few days.

Parapharyngeal Cyst; A Case Report.

A rare case of parapharyngeal cyst arising from the second branchial cleft is reported.Radiologic imaging, especially CT and MRI, were useful in locating the cyst and showing that it extended from the lateral wall of the oropharynx to the base of the skull.A fenestration was made at the bottom of the cyst producing a communication between it and the oropharynx, since it was impossible to remove the cyst completely.Two years later there is no sign of recurrence of the cyst.

Availability of the Esophagoscopy as the Otolaryngological Routine Examination

To make an early diagnosis of hypopharyngeal and esophageal cancers among patients complaining of abnormal sensation of the throat, esophagoscopy is one of the most important examinations. We reviewed 121 patients who underwent esophagoscopy at the department of otolaryngology of the Saitama Cancer Center Hospital, from April 1983 to January 1985. Of the 121 patients, 103 complained of the abnormal sensation of the throat, 4 complained of hematosputum, 6 had metastatic cervical lymph node with unknown primary lesion, 3 had unilateral vocal cord paralysis and 5 others. Among 121 patients, abnormal findings were seen in 14 patients (11.6%), including one hypopharyngeal cancer (PCC T2 N0M0) and three esophageal cancers (Iu Stage 0, Im Stage O, Im Stage 4). In all these four cases with cancers, ordinary laryngo-fiberscopy could not have revealed any abnormal finding. It is generally accepted that not only hypopharyngeal cancers but also esophageal and stomach cancers may cause the abnormal sensation of the throat. Esophagoscopy is useful way for otolaryngologists to find these malignant tumors in early stage.