Kazuya Ishida

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.

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.

Inner Ear Disorders Caused by Barotrauma in Guinea Pigs

To determine the mechanism of hair cell damage caused by barotrauma to the inner ear, we investigated morphological changes in the organ of Corti and stria vascularis using transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Fractures of the stereocilia with minimal intracellular changes were observed immediately after trauma. One day later, there was marked degeneration of outer hair cells and expansion of supporting cells. The damage to stereocilia clearly preceded morphological alterations within the hair cell bodies. Most outer hair cells eventually disappeared and were replaced by supporting cells. Inner hair cells degenerated slowly: some were almost intact 1 month after the trauma despite the disappearance of stereocilia. The continuity of reticular lamina was maintained throughout the period of hair cell degeneration, preventing leakage of endolymph into the organ of Corti. Reversible dendritic swelling of inner hair cells occurred immediately after trauma. No change in the stria vascularis was observed over time. Our results suggest that the mechanism of hair cell damage caused by inner ear barotrauma is related to a deformity of the organ of Corti caused by a pressure discrepancy between the perilymph and endolymph, resulting in injury to stereocilia.

Factors Affecting Improvement of Hearing After Stapes Surgery

Presently, stapedectomy and stapedotomy are common techniques for improving hearing defects secondary to otosclerosis. Ninety-two consecutive cases with otosclerosis were analyzed on the postoperative hearing gain. The degree of postoperative hearing gain was affected by many factors, such as sex, age, preoperative bone conduction at high frequencies, and preoperative A-B gap at speech frequencies. The age of patients did not affect the postoperative hearing gain, while sex, preoperative bone conduction, and preoperative A-B gap at speech frequencies influenced postoperative hearing gain.

Improvement in Hearing and Incidence of Complications Following Three Types of Stapes Surgery

We reviewed the records of 80 patients who had undergone stapes surgery over the past 10 years and who had been followed for more than 6 months at Nagoya University Hospital. They were divided into three groups: those who received total stapedectomy using a wire loop (29), those who received a large fenestra stapedotomy using a 0.6 mm Teflon wire piston (39), and those who received a small fenestra stapedotomy using a 0.3 mm Teflon piston (12). The decline in the air conduction threshold and closure of the air-bone (A-B) gap were used as indices of postoperative improvement in hearing. The postoperative elevation of bone conduction threshold at 4 and 8 kHz was used as an index of inner ear damage caused by the surgery. The postoperative hearing improvement at four speech frequencies between the three types of stapes surgery did not differ significantly. At 4 and 8 kHz, postoperative bone conduction was elevated significantly in the patients who received total stapedectomy as compared with those who underwent a large or small fenestra stapedotomy.

Tonsilar metastasis of gallbladder adenocarcinoma - A case report.

A 67-year-old female patient visited Nagoya Univcrsity Hospital complaining of bloody sputum and swelling of the right side of the neck three years after she had had a three lobe and caudal lobe resection of the liver and pancreato-duodenal resection for advanced gall bladder carcinoma. Inspection revealed a right tonsilar mass and ipsilateral lymphadenopathy of the neck.Biopsy showed a moderately well-differentiated adenocarcinoma. A diagnosis of metastatic tumor of the tonsil was made as this histological picture corresponded with that of the primary tumor of the gallbladder. Management consisted of surgical resection of the tumor mass and right radical neck dissection with reconstruction by an MC flap. The postoperative recovery was uneventful, and the patient has had no signs of recurrence or evidence of metastatic deposits elsewhere, six months following Surgery.