Kishiko Sugiyama

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.

A case of polyradiculitis with hearing loss: analysis of auditory brain stem response.

A case of acute polyradiculoneuritis accompanied by rare complications of the VII, VIII and IX cranial nerve disorder was described. There was an elevation of the rubella virus antibody titer, which suggested the case had been infected before. Thirty-eight year-old woman complained of bilateral tinnitus and was proven audiometrically to have sensori-neural hearing loss. Electroacoustical examination disclosed that all the waves were suppressed and that wave I and V were barely detected, while wave II, III and IV were absent. The neurological and audiological disorders were successfully treated with corticosteroid, and the patient had neither sequelae nor recurrence.

Case of Perforation of the Tympanic Membrane with Inner Ear Impediment

We report four case of the perforation of the tympanic membrane with inner ear impediment caused by direct trauma of earpick, which were suspected perilymph fistula. Two patients showed improvement by conservation therapy. In the other two, perilymph fistula was observed and repaired. After the operation, hearing in one patient returned to normal except the high register but the other showed little improvement. From the present findings, immediate operation should be considered for patients whose hearing dose not improve, or these in whom number of perilymph fistula dose not decrease.

Roentgenologically Observation of Tube Intubation

Tube intubation was performed in 105 ears with refractory infantile exudative otitis media and the process was observed roentgenologically. Most patients with adenoid vegetation underwent adenoidectomy and there was no difference in the process of otitis media with respect to the size of the adenoid. The healing rate was higher in patients with no shadow in the paranasal sinus than in those with shadow. Mastoid cells were observed by Schuller plain x-ray and the healing rate was high in the patients whose development of cells was good or in whom no shadow was found upon tube intubation. The patients whose condition of mastoid cells had improved showed a higher healing rate than those whose condition was unchanged or had worsend. A correlation was observed between the healing rate and the condition of mastoid cells.

Surgery for Chronic Ear Disease in Children

This paper describes a retrospective study of 44 children (50 ears) whose first ear operation was performed during the past four years.The most common disease was acquired cholesteatoma (27 cases), followed by 15 ears with simple chronic infection and 6 with cholesterol granulomas.On the basis of the analysis of cholesteatomas, the authors emphasize that cholesteatomas in children under the age of six years are more progressive and destructive, so early diagnosis and early operation are essential.The operative procedures for each disease and the postoperative results are discussed briefly.

The Surgical Management of Labyrinthine Fistulae in Chronic Otitis Media

Surgery was performed on 369 ears with inflammatory diseases; labyrinthine fistula was present in 22 of them. All 22 had cholesteatoma. Fourteen were true fistulae and 8 were only blue lines. In 21 of the 22 ears the cholesteatoma matrix was removed. In one case in which the only hearing ear was on the affected side, the cholesteatoma matrix was left over the fistula, but in this case hearing was later destroyed by invasion of the inner ear by the cholesteatoma.In 16 ears bone conduction hearing was retained postoperatively, and in 8 ears it improved. In cases of labyrinthine fistula, we recommend removal of the cholesteatoma matrix covering the fistula.

A Case Report of Harada's Disease with Equilibrium Disorder

Haradas disease is well known as a systemic disorder of pigment cells especially in the uveal tract, retina and meninges. Signs of integumentary (vitiligo, poliosis and alopecia) and auditory involvement (dysacousia, tinnitus and vertigo) are common.The authors report a case of Haradas disease with equilibrium disorder.The patient was a 36-year-old man, who complained of hyperemia of his eye balls and deterioration of his visual acuity and was admitted to the department of ophthalmology of our hospital. A diagnosis of Haradas disease was made, and he was treated with steroid therapy. His visual acuity improved, but he suffered from a sudden onset of vertigo 13 days after admission.Several neuro-otological findings and some therapeutic features are discussed.