Kyosuke Kurata

Refractory otitis media with effusion from viewpoints of eustachian tube dysfunction and nasal sinusitis

INTRODUCTION Most children with otitis media with effusion (OME) recover spontaneously before adolescence. However, some children have refractory OME. This study was undertaken to evaluate eustachian tube function and concurrent upper respiratory tract inflammatory conditions in adolescents with refractory OME. METHODS A group of 83 adolescent patients with refractory OME was identified. Ages range from 10 to 20 years. A control group of 108 children with OME (ages 4 to 9) serve as the basis for comparison. All underwent both passive and active eustachian tube function testing, dye clearance studies, and a sniffing test. Upper respiratory tract inflammation was assessed by roentgenograms of the paranasal sinuses and mucosalivary function. RESULTS High-pressure tubal opening was demonstrated in 31% of patients with refractory OME. In contrast, 84% of children with routine OME had normal opening. A marked disturbance of dye clearance was noted in refractory OME cases. Active tubal function during swallowing was disturbed in both adolescent and childrens OME groups without any significant difference between them. Paranasal sinusitis was identified in 49% of adolescents with refractory OME. In contrast, 78% of children with OME had abnormality of the sinuses. CONCLUSION Approximately one half of adolescents with refractory OME have demonstrable organic abnormality of the eustachian tube. These data suggest tubal dysfunction may be more important in refractory OME than upper respiratory tract inflammation.

Descending necrotizing mediastinitis following acute epiglottitis: a case report.

Abstract. Descending necrotizing mediastinitis occurs secondary to deep neck infection, and the primary focus of infection is mostly located in the tonsil, pharynx and carious tooth. DNM following acute epiglottitis is quite rare, with only one case reported. We treated an 84-year old female with an acute epiglottitis followed by DNM. She was successfully treated by drainages with cervical surgery combined with thoracotomy and cervical surgery.

Middle Ear Pressures of Children with Otitis Media with Effusion

Middle ear (ME) pressures were measured in 30 children with chronic otitis media with effusion (OME) transtubally with the use of a catheter pressure transducer (Mikro-tip, PC-330F). They were found to range from 40 to −185 mm H2O, the average being mildly negative (–54.33 ± 59.04 mm H2O). About two thirds of these children had pulsating changes of ME pressure; the range of the pressure change was between 10 and 50 mm H2O. The ME pressure tended to be lower in ears with serous effusion than in those with mucoid effusion, but there was no significant difference between them.

Recent progress in treating patients with cleft palate.

Over the last 4 decades remarkable progress has been made in the treatment of cleft palate: the rate of attaining normal or nearly normal speech after surgery has risen from about 65% 40 years ago to nearly 90% or more nowadays. One of the main factors is intratracheal intubation anesthesia that has made the surgery much safer and easier. Improved surgical technique and speech therapy also played a great role. This paper deals with two problems: (1) Slight velopharyngeal incompetence: The combined use of fiberscopy and fluorovideoscopy can provide useful information as to: (a) the exact place of the faulty articulation, (b) the detailed pattern of inconsistent velopharyngeal function, (c) changes in articulation induced by speech therapy, and (d) the relation between velopharyngeal function and faulty articulation. All the above information greatly facilitates speech therapy for cleft palate speech. It should be done with utmost care though due to possible adverse effects of radiation. (2) Analysis of faulty articulation. It was revealed that faulty articulations such as laryngeal fricative and affricates, pharyngeal stop, and glottal stop in cleft palate speech, secondary to velopharyngeal incompetence, were produced by articulation in the larynx at various sites such as the epiglottis, arytenoids, aryepiglottic folds and vocal folds. These faulty articulation points were located lower than supposed on the basis of auditory perception.

Atlantoaxial subluxation in an adult secondary to retropharyngeal abscess

Atlantoaxial subluxation secondary to a retropharyngeal abscess is well described in children, but very rare in adults. Only two adult cases have been reported in the literature. We present a case of severe atlantoaxial subluxation in an adult secondary to retropharyngeal abscess. His atlas-dens interval was very large, up to 10 mm in flexion. We tried external fixation with a neck collar initially, but for remaining instability, surgical fusion was performed. The mechanism of subluxation is attributed to softening of the ligament allowing greater mobility at the joint. The etiology of this process is speculative.

Viscosity of effusion in the middle ear and eustachian tube in patients with otitis media with effusion.

The viscosity of middle ear effusion (MEE) in the tympanic cavity and in the bony portion of the eustachian tube (ET) was compared in 11 specimens (10 patients) with otitis media with effusion (OME). Twenty microliters of effusion from the bony portion of the ET was sampled through myringotomy on the anterosuperior quadrant of the tympanic membrane with a micro-syringe with a curved needle. MEE in the hypotympanum was also sampled by separately puncturing the posteroinferior quadrant of the tympanic membrane. Using the microviscometer developed by one of the authors, the relative viscosity of these effusions were measured, and their natural logarithmic values were compared between the two sites mentioned above in each patient by obtaining their ratios (ET/ME). Effusion was found to have a significantly higher viscosity in the bony portion of the ET than in the hypotympanum (paired t-test: t = 3.859, p less than 0.01). In two patients with OME (serous mastoiditis) due to radiation to the temporal region, the ratios of the viscosity were comparatively small. On the other hand, excluding these two patients with serous mastoiditis mentioned above, the ratios were highest in two patients with a history of more than 60 days of hearing loss. These results were considered to be a clue to the possibility that viscous effusion aggravates ET function as a result of OME.

The beginning of Meniere's disease

Sudden deafness and low-tone hearing loss were treated by steroid therapy. Of the 106 cases of sudden deafness, 23 (21.7%) showed complete recovery, 36 (34.0%) remarkable improvement and 13 (12.3%) no change, while the results for the 56 cases of low-tone hearing loss were 32 (57.1%), 1 (1.8%), 16 (28.6%) and 7 (12.5%), respectively. Of all patients, 37 had onset of vertigo within 2 to 24 months after steroid therapy, and 17 patients, including 4 with horizontal type, 2 with deaf type and 11 with low-tone hearing loss, were diagnosed with Menières disease. The final hearing gain for 4 cases of horizontal type and 2 cases of deaf type sudden deafness was very great. The 17 patients diagnosed with Menières disease had hydrops of the inner ear.

A new microviscometer for determining the viscosity of middle ear effusion

A new microviscometer has been developed based on the capillary viscometer method. The device uses a glass sensor tube for aspirating 15-microliter samples. The relative viscosity of the samples was estimated from the negative pressure required for aspiration of the fluid. These pressures ranged widely from 1 centipoise (cp) to 10,000 cp. Measurement of the viscosity of middle ear effusions in 119 samples from 110 otitis media with effusion patients using this device revealed a close relation between their values and their gross appearance (serous less than seromucoid less than mucoid). The microviscometer is useful to determine the relative viscosity of a very small amount of fluid such as middle ear effusion.

Adenoid and otitis media with effusion—mini review

Abstract Although favorable effect of adenoidectomy on otitis media with effusion (OME) has been already established by several randomized clinical trials, the mechanism how OME is improved by adenoidectomy has not yet been fully clarified. In this paper, the mechanism was discussed from the viewpoints of Eustachian tube function (ETF) and sinusitis by reviewing our clinical studies carried out over 15 years. Comparison of ETFs between children with and without adenoid hypertrophy revealed no significant differences. Passive opening pressure (POP) of the Eustachian tube (ET) showed no significant improvement immediately after adenoidectomy compared to that before surgery. Comparison of ETFs between adenoidectomized and non-adenoidectomized children revealed significant improvement only in the active ventilatory function in adenoidectomized group 6 months after surgery. Improvement of sinusitis was observed more frequently in adenoidectomized children than in non-adenoidectomized children 6 months after surgery. ETF (active ventilatory function) was significantly better in those whose sinusitis was improved by adenoidectomy than in those whose sinusitis was not improved. These results indicated that OME might be improved after adenoidectomy as the inflammatory environment in the nasopharynx is improved owing to elimination of an infectious focus.

Effects of endolymphatic mastoid shunt operation for patients with Meniere's disease

During the past 10 years, the endolymphatic mastoid shunt operation was carried out on 108 patients with Menieres disease: 54 men and 54 women between 22 and 72 years old. According to criteria AAOO proposed in 1972, 86 cases (79.6%) belonged to class A, 19 cases (17.7%) to class B and 3 cases (2.7%) to class C. Forty patients took the body sway test before and after the operation. Four of the 40 patients were found to have Menieres disease on the contralateral side within 12 months after the operation and one patient was found to have a complicating psychogenic disease. The abnormal body sway had recovered 2 to 9 months after the operation, but the medical treatment could not be stopped during this period. The average hearing gain after the operation was 21.3 +/- 14.4 dB; that for the patients with a short period of illness (within 23 months of the first onset to the operation) was 25.2 +/- 14.5 dB and that for the patients with a longer period of illness (over 24 months) was only 13.8 +/- 10.6 dB.