Hitoshi Tanimoto

Self-treatment for benign paroxysmal positional vertigo of the posterior semicircular canal

The authors compared the efficacy of the Epley procedure with and without self-treatment in 80 patients with benign paroxysmal positional vertigo of the posterior semicircular canal. The self-treatment group (88%) had better results than the Epley-alone group (69%) based on both symptoms and nystagmus (p = 0.048). Complications occurred in 2.6% of the Epley-alone group and in 7.5% of the self-treatment group (p = 0.62).

Increased Inner Ear Susceptibility to Noise Injury in Mice With Streptozotocin-Induced Diabetes

We aimed to investigate the pathophysiology of diabetes-associated hearing impairment in type 1 diabetes using mice with streptozotocin-induced diabetes (C57BL/6J; male). Hearing function was evaluated 1, 3, and 5 months after induction of diabetes (five diabetic and five control animals per time point) using auditory-evoked brain stem responses (ABRs). Mice (four diabetic and four control) were exposed to loud noise (105 dB) 5 months after induction of diabetes. ABRs were measured before and after noise exposure. Cochlear blood flows were measured by laser-Doppler flowmeter. Spiral ganglion cells (SGCs) were counted. Vessel endothelial cells were observed by CD31 immunostaining. Chronologic changes in the ABR threshold shift were not significantly different between the diabetic and control groups. However, vessel walls in the modiolus of the cochleae were significantly thicker in the diabetic group than the control group. Additionally, recovery from noise-induced injury was significantly impaired in diabetic mice. Reduced cochlea blood flows and SGC loss were observed in diabetic mice cochleae after noise exposure. Our data suggest that diabetic cochleae are more susceptible than controls to loud noise exposure, and decreased cochlear blood flow due to sclerosis of the vessels and consequent loss of SGCs are possible mechanisms of hearing impairment in diabetic patients.

A Paranasal Tumor Associated With Tumor-Induced Osteomalacia

Background: Tumor‐induced osteomalacia (TIO) is an extremely rare paraneoplastic syndrome associated with mesenchymal tumors in the craniofacial region.

Vestibular dysfunction and compensation after removal of acoustic neuroma

OBJECTIVE To evaluate vestibular function after unilateral acoustic neuroma surgery via a retrosigmoid approach. METHODS Thirty-eight patients were tested using caloric irrigation, static posturography, and the Dizziness Handicap Inventory (DHI) before, and one week to nine months after surgery. RESULTS Twenty-six patients were categorized as a response group and 12 as a no-response group on the basis of preoperative caloric irrigation findings. The posturographic parameters and DHI scores at one week after surgery showed significant deterioration in the response group, but not in the no-response group. However, they recovered to the preoperative baseline at 3 months after surgery. The posturographic parameters and DHI scores for older patients tended to be worse than those for younger patients at 6 and 9 months after surgery. CONCLUSION Patients in whom caloric responses are retained preoperatively show a temporary disturbance of balance after removal of acoustic neuroma. Disequilibrium after surgery ameliorates to the preoperative baseline within three months due to vestibular compensation, regardless of preoperative vestibular function. It is possible that poorer vestibular compensation may facilitate incomplete recovery in older patients after surgery.

A novel mitochondrial mutation, 1556C --> T, in a Japanese patient with streptomycin-induced tinnitus.

Objective Aminoglycoside antibiotics are associated with ototoxicity. The 1555A→G mutation in the 12S ribosomal RNA gene of mitochondrial DNA has been considered to be associated with susceptibility to aminoglycoside antibiotics. In this study we examined a 79-year-old Japanese patient with a 45-year history of streptomycin-induced tinnitus in an attempt to find a mitochondrial mutation. Materials and Methods DNA was extracted from the patients leukocytes. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) screening for the 1555A→G mutation was done in order to detect a mitochondrial mutation and then nucleotide sequencing analysis was performed to identify the mutation. Results PCR-RFLP screening detected the presence of a mitochondrial mutation in the patient. However, the nucleotide sequencing analysis showed that the mutation was not the 1555A→G mutation but a novel mutation, 1556C→T. The mutation was not found in 112 unrelated Japanese control subjects, suggesting that the mutation was specific to our patient. Conclusions The 1556C→T mutation may be a genetic risk factor for aminoglycoside-induced hearing impairment. Our result also suggests that patients with the 1556C→T mutation exist among those expected to have the 1555A→G mutation as a result of PCR-RFLP analysis.

Near-infrared spectroscopy of orbitofrontal cortex during odorant stimulation.

Background For olfaction, several studies have reported near-infrared spectroscopy (NIRS) signal changes in the orbitofrontal cortex (OFC) during odor stimulation. However, the roles of human OFC in olfactory cognition are less well understood. This study was designed to better understand the roles of OFC for olfaction. Methods Hemodynamic responses for phenyl ethyl alcohol or citral in the OFCs were measured with NIRS. After the experiment, participants were asked to describe the characteristics of the odor and to rate odor intensity and hedonic valence. Results Statistical analysis of all participants’ data showed significant changes in the concentration of total hemoglobin in the left OFC during the trial (p = 0.04). The total hemoglobin signal increased significantly in the right OFC (p = 0.0008) of the participants who successfully identified the odorant stimulus. Conclusion Our findings showed that NIRS combined with a questionnaire is a useful method for studying the functional neuroanatomy of OFC in terms of olfaction.

Synovial Sarcoma of the Neck

Background: Synovial sarcoma is a soft tissue sarcoma rarely seen in the head and neck. Due to its rarity and morphologic variations, diagnosis is difficult in most cases. Method: A case of synovial sarcoma arising in the upper neck is presented. The detection of the specific chromosomal translocation t(X;18)(p11.2;q11.2) is also described. Result: A specific chimeric gene, the SSX-SYT fusion gene, was identified in the formalin-fixed paraffin-embedded surgical specimen using the reverse-transcription polymerase chain reaction (RT-PCR) technique. Conclusion: Synovial sarcoma contains a characteristic chromosomal translocation, which serves as a useful diagnostic tool. RT-PCR technique has enabled to detect this specific translocation not only in fresh tissues but also in archival paraffin-embedded specimens.

Blowing ratio as an evaluation tool for velopharyngeal function after oral and oropharyngeal cancer resection

Our objective was to evaluate the value of the blowing test to measure the speech and swallowing function after resection of oral or oropharyngeal cancer.

Microscopic polyangiitis histologically confirmed by biopsy from nasal cavity and paranasal sinuses: a case report

Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis affecting small vessels without necrotizing granulomatous inflammation and is commonly associated with necrotizing glomerulonephritis. Diagnosis is based on typical clinical features, the presence of antimyeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA), and histopathologic findings. Cases of pathologically proven small-vessel vasculitis in nasal biopsy specimens are sparse. Here we report a patient with MPA that was histopathologically confirmed by nasal and paranasal biopsy. A 67-year-old man presented with fever and general fatigue. Laboratory examinations showed severe inflammation and acute progressive renal failure. The serum MPO-ANCA level was elevated. The patient also had nasal polyps that seemed to be nonspecific chronic sinusitis. To obtain a pathologic diagnosis, bilateral ethmoidectomy and nasal polypectomy were performed. Pathological findings revealed vasculitis of small vessels in the mucosal surface. MPA was diagnosed on the basis of clinical symptoms, elevated MPO-ANCA and the pathological findings of the nasal and paranasal surgical specimen.

Book Reviews / Erratum

The updated fourth edition of the Color Atlas of ENT Diagnosis is an illustrated first introduction examination, diagnosis and therapy of the most frequent ear, nose and throat diseases. The more than 500 good-to-excellent color pictures are of great help to the beginner to become familiar with the conditions typically seen in the ENT field. The text is divided into five main sections: examination; ear; nose and face; pharynx and larynx; head and neck. As the stated purpose of this small pocket book is not to be a textbook but a pictorial survey, the majority of the book is reserved for the excellent pictures. Although most of the color photographs are self-explanatory every illustration is accompanied by a short descriptive text. Moreover, small paragraphs introduce special issues like laryngectomy or audiologic examination. I suggest a reference list for additional reading. All in all this small pocket atlas will be of great help to medical students, ENT trainees and general practitioners seeking a quick reference during daily practice. Elmar Oestreicher, Munich Maria Sanna, Hiroshi Sunose, Fernando Mancini, Alessandra Russo, Abdelkader Taibeh