Manabu Komori

Comparison between endoscopic and microscopic stapes surgery.

To investigate whether endoscopic stapes surgery is safer and less invasive than conventional stapes surgery using an operating microscope.

Traumatic perilymphatic fistula with the luxation of the stapes into the vestibule.

Traumatic perilymphatic fistula due to luxation of the stapes into the vestibule caused by an earpick is an extremely rare situation. In order to treat such an injury, it is necessary to evaluate the extent of the damage and the actual condition of the middle and inner ear. However, it is difficult to obtain such precise information about the condition of the stapes prior to performing surgery. We report on a case of a traumatic perilymphatic fistula with luxation of the stapes into the vestibule that was diagnosed using multislice CT (MSCT). MSCT clearly demonstrated the presence of air in the vestibule (pneumolabyrinth), which indicated the presence of a perilymphatic fistula and the deep depression of the stapes into the vestibule. In order to seal the perilymphatic fistula and prevent middle and inner ear infection, surgery was performed on the portion of the stapes that remained in the vestibule. The patient has been free from vertigo and has exhibited some recovery of his hearing. We discuss the diagnosis along with other therapeutic problems that have been presented in the literature for traumatic perilymphatic fistula.

Risk factors for recurrent epistaxis: Importance of initial treatment

OBJECTIVE A retrospective study of risk factors for recurrent epistaxis and initial treatment for refractory posterior bleeding was performed. Based on the results, proposals for appropriate initial treatment for epistaxis by otolaryngologists are presented. METHODS The data of 299 patients with idiopathic epistaxis treated during 2008-2009 were analyzed by multivariate logistic regression analysis. Treatment data for 101 cases of posterior bleeding were analyzed using the chi-square test. RESULTS Recurrent epistaxis occurred in 32 cases (10.7%). Unidentified bleeding point (adjusted odds ratio (OR) 5.67, 95% confidence interval (CI) 1.83-17.55, p=0.003) was predictive of an increased risk of recurrent epistaxis, and electrocautery (adjusted odds ratio (OR) 0.07, 95% confidence interval (CI) 0.03-0.17, p=0.000) was predictive of a decreased risk of recurrent epistaxis. In terms of initial treatment for posterior bleeding, the rate of recurrent epistaxis was significantly lower for patients who underwent electrocautery as initial treatment compared with those who did not (6.4% vs. 40.7%, p<0.01), and it was significantly higher for those who underwent endoscopic gauze packing compared with those who did not (39.5% vs. 15.9%, p<0.01). CONCLUSION In the present study, the risk factors for recurrent epistaxis were unidentified bleeding point. Thus, it is important to identify and cauterize a bleeding point to prevent recurrent epistaxis. The present results also suggest the effectiveness of electrocautery and the higher rate of recurrent epistaxis for patients who underwent gauze packing as initial treatment for posterior bleeding. Electrocautery should be the first-choice treatment of otolaryngologists for all bleeding points of epistaxis, and painful gauze packing may be inadvisable for posterior bleeding. More cases of posterior bleeding are needed for future studies involving multivariate analyses and appropriate analyses of factors related to hospitalization, surgery, and embolization.

Staging and classification criteria for middle ear cholesteatoma proposed by the Japan Otological Society

In order to provide a basis for meaningful exchange of information among those treating cholesteatoma, the Committee on Nomenclature of the Japan Otological Society (JOS) was appointed in 2004 to create a cholesteatoma staging system as simple as possible to use in clinical practice in Japan. Following the announcement of preliminary criteria for the staging of pars flaccida (attic) cholesteatoma in 2008, we proposed the 2010 JOS staging system for two major types of retraction pocket cholesteatoma, pars flaccida and pars tensa cholesteatoma. Since then, the JOS staging system has been widely used in clinical studies of cholesteatoma in Japan, allowing standardization in reporting of surgical outcomes based on the respective stages of cholesteatoma. We have recently expanded the range of cholesteatoma by adding cholesteatoma secondary to a tensa perforation and congenital cholesteatoma as the 2015 JOS staging system for middle ear cholesteatoma. Although further revisions may be required for universal acceptance of these criteria, we hope our staging system will open the way for international consensus on staging and classification of middle ear cholesteatoma in the near future.

Primary localized amyloidosis of the nose

Two rare cases of primary localized amyloidosis of the nose are described. A 14-year-old woman presented with anosmia, facial pain, and recurrent episodes of bilateral epistaxis persisting for 2 years. Endoscopic sinus surgery was performed and amyloidosis was diagnosed. Amyloid was also found in the trachea. A 27-year-old woman presented with decreased bilateral hearing and recurrent episodes of bilateral epistaxis. Tympanostomy tube placement was performed and observation continued. The optimum treatment of amyloidosis of the nose has not yet established. We consider that the treatment should depend on the extent of the amyloidosis.

Cochlin-tomoprotein test and hearing outcomes in surgically treated true idiopathic perilymph fistula.

Abstract Conclusion: Approximately 50% of patients with sPLF based on the clinical diagnosis criteria were definitively diagnosed with CTP-positive sPLF. These results suggest that early surgery within 7 days of the disease onset contributes to improvements in the therapeutic response of hearing loss. Objectives/Hypothesis: Idiopathic spontaneous perilymph fistula (sPLF) cannot be diagnosed reliably. It is speculated that this condition occurs in patients with vertigo-accompanied acute sensorineural hearing loss that progresses rapidly in spite of steroid therapy. This study herein evaluated cochlin-tomoprotein (CTP) test results in patients with sPLF who underwent exploratory tympanotomy and considered surgical outcomes with true sPLF. Study design: Retrospective study. Methods: Twenty-three patients diagnosed with sPLF based on the clinical diagnosis criteria who underwent exploratory tympanotomy were included. Results: CTP test results were positive in 11 cases. In CTP-positive cases, the mean hearing level was 66.5 dB pre-operatively and 42.3 dB post-operatively. The hearing level post-operatively completely recovered in four cases, markedly recovered in three cases, slightly recovered in one case and showed no response in three cases. Hearing level improvements were significantly better in CTP-positive patients who underwent surgery within 7 days of the disease onset than in those treated 8 or more days after the disease onset.

Bilateral Deafness as a Complication of the Vaccination-A Case Report

The vaccination has much profit for an infectious disease. On the other hand, there is little frequency, side effects may appear. It includes severe complication. We reported the case that resulted in bilateral acute profound hearing loss after mumps alone and measles and rubella (MR) vaccination. The case was a 5 years old girl. She inoculated mumps alone and MR vaccine. After 18days later, both sides profound hearing loss occurred in her. The hearing loss was not improved by the intravenous feeding of the steroid. Three months later, cochlea implantation was carried out to her right ear. She got hearing again. As for the hearing loss, mumps vaccine was considered as a cause from a latency period until the onset. The bilateral profound hearing loss that was a very rare complication was occurred by vaccination. The care of the hearing is important, but the mental care of an affected child and the parent is important, too.