Ken Ishijima

Functional anatomy of levator veli palatini muscle and tensor veli palatini muscle in association with eustachian tube cartilage.

The anatomic relationships among the levator veli palatini muscle (LVPM), the tensor veli palatini muscle (TVPM), and the eustachian tube (ET) cartilage were investigated by computer-aided 3-dimensional reconstruction and measurement methods. The study used 13 normal temporal bone–ET specimens obtained from 13 individuals (range of age at death, 3 months to 88 years). This study revealed several anatomic features of the anterior cartilaginous portion of the ET First, the LVPM is always located inferolateral to the inferior margin of the medial lamina (ML) of the ET cartilage. Second, the LVPM has a large cross-sectional area throughout the extent of the anterior cartilaginous portion of the ET. Third, although the LVPM lies close to the ML of the ET cartilage (0.44 ± 0.16 mm in children and 1.02 ± 0.58 mm in adults), there is no region of attachment. Finally, the TVPM is not attached to the lateral lamina (LL) of the ET cartilage of the anterior quarter of the cartilaginous portion. Accordingly, it could be assumed that the most anterior cartilaginous portion of the ET is opened primarily by the contraction of the LVPM, which causes a superior-medial rotation of the ML. Furthermore, since the contraction time of the LVPM is reported to be longer than that of the TVPM, the anterior cartilaginous portions of the ET may remain open, even after the middle to posterior cartilaginous portions are closed after relaxation of the TVPM. This process would produce a pumping action of the ET in the direction from the middle ear to the pharyngeal side. The pumping function may be beneficial to clearance of the middle ear.

Postnatal Development of Static Volume of the Eustachian Tube Lumen A Computer-Aided Three-Dimensional Reconstruction and Measurement Study

Eleven human temporal bone-eustachian tube (ET) specimens obtained from 11 individuals (ages, 3 months to 88 years) were studied to investigate the static volume of the ET lumen. The volumes were measured by computer-aided 3-dimensional reconstruction and measurement methods. Four of the 11 individuals were children, and the remaining 7 were adults. The total volume of the ET lumen was significantly larger in the adults than in the children (p < .01). This difference was produced by significant growth of the volume of the cartilaginous and junctional portions (p < .01). The lumen of the bony portion, by contrast, did not change with age. Increased volume of the ET lumen, especially of the cartilaginous and junctional portions, would be expected to increase both ventilation and clearance. Therefore, the small volume of ET lumen of the cartilaginous and junctional portions in children may be a predisposing factor for otitis media.

Pathophysiological and therapeutic considerations of otitis media with effusion from viewpoint of middle ear ventilation

Using nitrous oxide, we examined the gas exchange function through the middle ear mucosa in ears with otitis media with effusion (OME) in children, and found the function to be impaired in 50% of them. The size of the mastoid was significantly smaller in ears with negative gas exchange function than those with positive function, and the presence or absence of the function was even more significantly correlated with the presence or absence of aeration in the middle ear. Furthermore, the presence or absence of aeration in ears with OME was found to be significantly correlated with their prognosis (response of OME to antibiotics treatment) and also with the presence or absence of eardrum mobility examined by a pneumatic otoscope. Finally, after myringotomy and removal of effusion, the gas exchange function recovered in most of the ears with impaired function. These results indicate that the eardrum mobility test may serve as an appropriate indicator for the surgical treatment for OME.

Bilateral vocal fold paralysis caused by polyarteritis nodosa.

Polyarteritis nodosa (PAN) causes necrotizing angitis mainly in medium-sized muscular arteries throughout the body, and various clinical signs and symptoms such as fever, malaise, weight loss, skin necrosis, renal failure, cerebral nervous system disorder, heart failure, and myalgia develop in affected patients. However, otolaryngologists rarely encounter patients with polyarteritis nodosa, except those with hearing-impairment or facial paralysis.1-6 A patient with PAN whose first symptom was submandibular swelling, with subsequent necrosis over a wide area of the neck and bilateral vocal fold paralysis, is presented.

A Case of Sick-House Syndrome

Sick-house syndrome is characterized by diverse physical disorders caused by a variety of indoor environmental factors. A 27-year-old female with a history of atopic dermatitis visited our clinic complaining of chemical hypersensitivity of the upper respiratory tract. Exposure to tobacco smoke or perfume made her feel headache, nausea and pain in the throat. She was suspected of having sick-house syndrome because indefinite complaints such as headache and nausea appeared soon after the move to her new house. Blood examination showed no manifestations of allergic diseases or significant elevation of IgE for particular chemical substances. The level of formaldehyde in her house turned out to exceed the concentration recommended by the Ministry of Health, Labor and Welfare of Japan. Ventilating her house for twenty-four hours diminished her complaints immediately. Sick-house syndrome may have some correlation with allergy, for among her family no one except her had a history of allergic disease or of complaints like hers.

A Case of Eosinophilic Otitis Media Aggravated by Lung Cancer

A 35-year-old male had been treated with prednisolone for 7 years under a diagnosis of bilateral eosinophilic otitis media. Middle ear granulation was intractable despite intensive local and systemic steroid treatment and granulation extended to the inner ear, resulting in bilateral profound sensorineural hearing loss. Systemic examinations demonstrated a solitary lung adenocarcinoma accompanied by severe eosinophil infiltration, subsequently causing elevation of the serum IL-5 level. Cytokines induced by the eosinophils infiltrating the lung cancer may also account for the exacerbation of middle ear inflammation.

Mondini Dysplasia Causing Recurrent Meningitis: A Case Report

A 5-year-old girl with unilateral total deafness suffered from recurring meningitis. High-resolution computed tomography of the temporal bone revealed dysplasia of the bony labyrinth and enlarged fundus of the internal auditory canal (Mondini dysplasia). In the operation, anomaly of the stapes and leakage of cerebrospinal fluid were found. Intralabyrinthine obliteration with the temporal muscle fascia and auricular cartilaginous chip was performed after removal of the stapes. No sign of meningitis has occurred after the operation.

Sleep Apnea Syndrome with Consciousness Disorder; A Case Report.

A 55-year-old male suffering from general edema with dyspnea visited our hospital. The results of cardiac catheterization and monitoring SpO2 suggested congestive heart failure occurring with sleep apnea syndrome (SAS) with pulmonary hypertension. A polysomnography confirmed severe obstructive sleep (apnea index; 37.1). Although we strongly recommended the use of nasal CPAP or a surgical treatment (uvulopalatopharyngoplasty; UPPP), the patient refused therapy. Six months later, his respiratory status had deteriorated and he was readmitted to our hospital. He had marked hypoxia (PaO2 61.7mmHg) with hypercapnia (PaCO2 101.9mmHg) on admission. Since his consciousness level deteriorated after admission, he underwent endtracheal intubation and tracheostomy. After these treatments sufficiently improved pulmonary hypertension and congestive heart failure, he underwent further UPPP to make closure of the tracheostoma possible. Even after the closure, he showed no sign of dyspnea or congestive heart failure. We discuss the clinical course in this patient with referrence to the literature.

Burkitt's Lymphoma of the Parapharyngeal Space. A Case Report.

Although most tumors in the parapharyngeal space are benign, a few malignant tumors have been reported. Malignant lymphomas are very rare, and Burkitts lymphoma in the parapharyngeal space has been reported only once in the world literature. Here we describe a patient with Burkitts lymphoma of the parapharyngeal space.A 63-year-old male visited us because of a rapidly increasing mass at the angle of his mandible. MRI showed a large tumor occupying the parapharyngeal space. The FNA report was probable malignant tumor but perhaps not malignant lymphoma. We suspected carcinoma of the parapharyngeal space and resected it through a neck incision. Histological examination showed Burkitts lymphoma, and the patient was referred to the department of hematology in our hospital.

Focal Myositis in the Temporal Muscle; A Case Report.

Focal myositis is an inflammatory pseudotumor of the skeletal muscle that often mimics a growing neoplasm.We report the tenth case of focal myositis in the head and neck region; the first in the temporal muscle.A 42-year-old man was referred to our hospital with a subcutaneous mass in the right temporal region. An excisional biopsy was performed under general anesthesia. The mass was localized within the right temporal muscle. The histopathological diagnosis was focal myositis.Since focal myositis is a self-limited disease which regresses spontaneously, no further treatment is required. However, careful observation is necessary to exclude localized initial symptoms of polymyositis.