Masaaki Kashiwamura

The efficacy of Burow's solution as an ear preparation for the treatment of chronic ear infections.

Objective To determine the efficacy of Burows solution as an otologic preparation for the treatment of chronic ear infection. Study Design Two studies were included: 1) a prospective clinical study and 2) a laboratory study on antibacterial and antifungal effects. Setting A private otology practice and a laboratory study. Patients Fifty-eight patients with refractory otorrhea. Intervention Diagnosis by otoscopy, audiometry, and bacteriology. Methods Burows solution was mixed in solutions with four organisms: methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, Candida albicans, and Aspergillus. Soon after Burows solution was mixed in the solutions with organisms, and 5, 10, and 20 minutes thereafter, the mixtures were cultured on agars. The numbers of the bacterial or fungal colonies were counted to evaluate the effect of Burows solution. Main Outcome Measures Changes in the clinical findings of the ears, the symptom of otorrhea, and side effects were assessed. Results Thirty-five (70%) of the 50 ears assessed were “cured” and 10 (20%) ears assessed were “improved.” No significant side effect was observed. Regarding the laboratory study, the four organisms disappeared within 20 minutes after Burows solution was mixed. Conclusion Burows solution was considered to be an effective otologic preparation.

An anti-mumps IgM antibody level in the serum of idiopathic sudden sensorineural hearing loss

PURPOSE Measurement of anti-IgM antibody for mumps enables us to diagnose silent mumps infection. From the viewpoint of prophylactic medicine, we examined the incidence of silent mumps infection in idiopathic sudden sensorineural hearing loss (ISSNHL) by measurement of anti-mumps IgM antibody. MATERIALS AND METHODS Serum level of anti-mumps IgM antibody was evaluated by EIA method in 69 ISSNHL cases. RESULTS Of the 69 serum samples examined, five samples were positive, two samples were regarded as quasi-positive and other samples were negative for anti-mumps IgM antibody. The positive rate was 7.2% (5/69). The relationship of anti-mumps IgM and IgG antibody was also described. CONCLUSIONS From the measurement of anti-IgM antibody for mumps, it was possible to diagnose silent mumps infection in ISSNHL. The positive rate of anti-IgM antibody in ISSNHL was 7.2% suggesting that the silent mumps infection could be considered as one of the causative factors of ISSNHL even though its incidence is not so high. Since mumps often occurs without clinical symptoms, it is still considered to be one of the important causes of profound hearing loss. From the viewpoint of prophylaxis of profound hearing loss and deafness, we should understand the situation of virus epidemiology and vaccination.

Effects of spontaneous otoacoustic emissions on distortion product otoacoustic emission

OBJECTIVE It has been reported that spontaneous otoacoustic emission (SOAE) can prolong the responses or increase the echo power of transiently evoked otoacoustic emission (TEOAE), yet the effects of SOAE on distortion product otoacoustic emission (DPOAE) have been studied less thoroughly. As most of the previous studies have not paid attention to the patients age, sex and hearing level, they have not reflected possible effects of those factors. We studied the effects of SOAE specifically on DPOAE in the following subjects. SUBJECTS AND METHODS The subjects were all females ranging in age from 19 to 24 (average: 21.4) and the 78 ears had a hearing threshold under 15 dB for 1.2, and 4 kHz on pure-tone hearing test. IL088 (Otodynamics) was used for measurement of SOAE and IL092 (Otodynamics) for DPOAE. SOAEs were measured by time-averaging over 100 of the responses, of which those showing a clear peak 3 dB above the noise floor and being reproducible were considered as SOAE-positive. In all the ears. DPOAE responses were measured at L1 = L2 = 70 dB, and in 42 ears also at L1 = L2 = 60 dB and L1/L2 = 60/50 dB. The subjected ears were grouped into two by the presence or the absence of SOAE, and DPOAE amplitudes of 1, 2, and 4 kHz were compared. respectively. RESULTS Of the total, 39 ears were SOAE-positive and 39 SOAE-negative. Statistically no significant difference was observed in the average hearing level between the SOAE-positive and SOAE-negative groups. The hearing levels did not significantly differ in the frequencies of 1, 2. and 4 kHz, respectively, indicating that influence of the hearing level on DPOAE could be excludable. DPOAE amplitudes at L1 = L2 = 70 dB in the frequencies of 1, 2, and 4 kHz were higher in the SOAE-positive group than in the SOAE-negative group. And DPOAE amplitudes were also higher in SOAE-positive group at L1 = L2 = 60 dB and L1/L2 = 60/50 dB in the frequency of 1.2, and 4 kHz, but significant differences were observed only in the frequencies of 4 kHz. By grouping the ears by the number of SOAE. we revealed the tendency that the larger the number of SOAE, the higher the DPOAE amplitudes. CONCLUSIONS We evidenced that SOAE has significant effects on DPOAE responses. In clinical application of DPOAE measurement, therefore, the effects should be seriously taken into account.

Low-dose Craniospinal Irradiation and Ifosfamide, Cisplatin and Etoposide for Non-metastatic Embryonal Tumors in the Central Nervous System

OBJECTIVE The current study was conducted to evaluate the effects of low-dose craniospinal irradiation (CSI) combined with chemotherapy on non-metastatic embryonal tumors in the central nervous system (CNS), including medulloblastoma and supra-tentorial primitive neuroectodermal tumors (ST-PNET). METHODS All patients were treated according to the following protocol. After surgery, the patients < or =5 years old received 18 Gy and the patients >5 years old received 24 Gy CSI. The dose to the primary tumor bed was 39.6-54 Gy. Chemotherapy consisted of ifosfamide, cisplatin and etoposide (ICE chemotherapy). RESULTS Sixteen patients aged 0.5-20.4 (median 6.1) years were enrolled and followed for 11-165 (median 112) months. Both 5-year actuarial overall survival (OAS) and progression-free survival (PFS) were 81% (95% confidence interval (CI): 62-100%) for the 16 patients. Both 5-year OAS and PFS were 82% (CI: 59-100%) for the patients with medulloblastoma and 80% (CI: 45-100%) for the patients with ST-PNET. Both 5-year OAS and PFS were 75% for the eight patients < or =5 years old and 88% for the eight patients >5 years old. Both 5-year OAS and PFS were 100% for six average-risk patients (3 years or older, total resection and posterior fossa) and 70% for 10 poor-risk patients (others). The median total intellectual quotient at the last follow-up was 85 (ranging from 48 to 103) in 12 patients who were followed for 3-145 (median 49) months. Eight patients received hormone replacement therapy. CONCLUSION Low-dose CSI and ICE chemotherapy may have a role as a treatment option for a subset of patients with non-metastatic embryonal tumors in the CNS.

Preserved otoacoustic emission in a child with a profound unilateral sensorineural hearing loss

We report a case of profound unilateral sensorineural hearing loss with good response of otoacoustic emission. The patient was a 5-year-old boy. who was diagnosed to have unilateral hearing impairment on pure tone audiometry at the first visit. The affected ear showed the absence of auditory brainstem response; however, its transiently evoked otoacoutic emission and distortion product otoacoustic emission were considered to be normal. These findings indicated that the outer hair cell of cochlea was not impaired and that the impairment should be localized between inner hair cells, primary afferent fiber or its synapses, spiral ganglion of the cochlea and acoustic fiber, or at a combination of these areas. That is, evaluation of otoacoustic emission was useful in determining the region of impairment in sensorineural hearing loss. Further follow-up will be necessary to differentiate the present case from auditory neuropathy.

Sensorineural hearing loss induced by radiation as a late effect: five cases followed by audiogram.

OBJECTIVE We studied the progression of the late radiation-induced sensorineural hearing loss (SNHL) to discuss the pathological mechanism responsible for the progression with referring to past reports. METHODS Five cases were selected among the SNHL cases diagnosed at the Department of Otolaryngology. Hokkaido University. All the cases were followed up with audiograms. RESULTS All of the five cases showed gradual progression of SNHL, which developed mostly 1 2 years after irradiation for brain tumors. Two of them showed rapid progression from time to time with sudden onset in their clinical courses. All the patients were resistant to any medication such as steroid, vitamin B12 or cerebral circulation activators. CONCLUSION Two patterns of progressions of radiation-induced hearing loss were observed. Both of them were considered to be explainable by ischemic changes of the vessels as reported earlier. Since there is no effective treatment for radiation-induced SNHL, it is most important to enlighten clinicians in general on this disease.

Optimal stimulus level conditions for measurements of distortion product otoacoustic emissions

OBJECTIVE Distortion product otoacoustic emission (DPOAE) is a tool for an objective examination of the cochlea function. While the clinical application of DPOEA test is in progress, the measurements vary depending on the stimulus conditions. We aimed to determine the most appropriate stimulus level in the clinical application of DPOAE test. METHODS Ninety-seven normal hearing ears and 80 hearing-impaired ears (total 177) were subjected to this study. Two levels of stimulations (L1 and L2) were applied as follows: L1 = L2 = 70 dB; L1 = L2 = 60 dB and L1 = 60/L2 = 50 dB, and DP level was measured at each stimulation, and compared with hearing level. RESULTS DP level was highest at L1 = L2 = 70 dB. Normal hearing ears and hearing-impaired ears were well differentiated at L1 = L2 = 60 dB. CONCLUSION In clinical application of DPOAE test, DP levels should be measured at the stimulus level most appropriate for the purposes.

Changes to spontaneous otoacoustic emissions (SOAEs) due to cisplatin administration

We investigated the influence of cisplatin on spontaneous otoacoustic emissions (SOAEs) by measuring SOAEs, before and after cisplatin administration, in 18 ears of nine patients (one female and eight males) who had received chemotherapy with cisplatin for a brain tumor. No hearing loss was observed after cisplatin administration in eight ears. Before cisplatin administration SOAE was present in four out of these eight ears, and only mild frequency fluctuation was observed even after administration. In 10 ears, sensory neural hearing loss was observed after cisplatin administration. Before cisplatin administration SOAE was present in four out of these 10 ears, and SOAE decreased or disappeared in three ears after administration. In two ears, SOAE was not present before cisplatin administration, but newly appeared after administration. It was indicated that SOAE principally disappeared at the frequencies where the region of the outer hair cells responsible for the same frequencies was injured, but new SOAEs appeared at the frequencies where the region of the outer hair cells was not injured after cisplatin administration.

A significance of navigation system in temporal bone and head and neck surgery

Abstract Objectives: Navigation surgery has allowed for advantage in nasal surgery. But the significance of this system especially in accuracy for temporal bone is considered to be still controversial. On the other hand, actual indication of navigation system for head and neck lesion is also still controversial. This study evaluated the accuracy of this system for temporal bone lesions and the significance of this system for head and neck lesions. Methods: Fifty patients with temporal bone lesions (28 cholesteatoma, 6 congenital aural atresia, 6 cochlear implant including ossified cochlea, 4 facial nerve lesion, 3 re-operative chronic otitis media, and 3 petrous apex lesions) were operated with the use of navigation system. We also applied this system for 3 trigeminal schwannoma, 3 osteoma and fibrous dysplasia, and 2 maxillary cancer cases. Results: The accuracy in our temporal bone series was 0.32 mm on an average. So, it was significantly useful to recognize and observe the target points and aimed structures accurately. Also it was useful in head and neck surgery to determine the accurate bone resection line and to recognize the target points, so we enter more straightly to the lesion. Conclusion: In conclusion, this navigation system ensures supplemental safe, accurate, and reliable surgery and also is considered to be useful for academic explanation to medical students and academic training for residents. A congenital anomaly, re-operative cases, petrous apex lesion and some head and neck lesion are regarded as a good indication.

Association of infantile cutaneous haemangioma on the face and neck with respiratory distress in infancy.

Sir, Infantile haemangioma is a fairly common vascular tumour of the skin in infancy. In contrast, infantile subglottic haemangioma is rare, accounting for about 1.5% of all congenital laryngeal anomalies (1). However, it often causes stridor in infancy and sometimes leads to life-threatening respiratory distress (2). We report here a case of infantile haemangiomas on the face, neck and chest that presented with stridor and respiratory distress caused by subglottic haemangioma.