Mitsuko Suetake

Trans-tympanic silicone plug insertion for chronic patulous Eustachian tube

Conclusion. Trans-tympanic insertion of a new silicone plug seems to be useful for controlling the distressing symptoms of patients with a chronic patulous Eustachian tube (PET). Objective. To evaluate the effectiveness of a new silicone plug for blocking the isthmus of a PET in patients whose symptoms were resistant to other therapies for > 6 months. Material and methods. The silicone plug (total length 23–25 mm; tip diameter 1.0–2.0 mm) was inserted in 44 ears of 37 patients with chronic PET. It was inserted through the tympanic orifice of the ET to obstruct the isthmus of the tube via an incision in the anterosuperior portion of the tympanic membrane. Results. Insertion of the plug was possible in all except two ears, in which it failed because of a narrow tympanic orifice of the ET. In 11 ears of 10 patients, the plug was replaced by a larger one using the same approach to improve efficacy. Of the 42 ears in which the silicone plug was successfully inserted, 30 (71.4%) achieved relief from symptoms of PET without additional treatment. In > 60% of these cases, the symptoms of PET were well controlled with an aerated middle ear. The follow-up period ranged from 6 to 68 months (mean 38.9 months).

Dynamic Behavior of the Middle Ear Based on Sweep Frequency Tympanometry

A measuring apparatus was developed; its probe tip, which exhibits flat frequency characteristics, enables this apparatus to measure the absolute sound pressure and absolute phase variations versus both sweeping frequency and external auditory canal pressure. Although it is difficult to diagnose ossicular chain separation and fixation from the commonly used tympanograms with a low probe tone frequency (e.g.f = 220 Hz), the results obtained with this apparatus enable one to clearly distinguish patients with ossicular chain disorders from normal subjects. Therefore, it seems to be highly useful in the clinical diagnosis of ossicular chain disorders.

Detection of respiratory viruses in nasopharyngeal secretions and middle ear fluid from children with acute otitis media

Conclusions. Our results suggest that various respiratory viruses contribute to the pathogenesis of acute otitis media (AOM). Objective. AOM is one of the most common complications of viral upper respiratory tract infections in children. Recently, the importance of respiratory viruses has been stressed as causative agents of AOM. Subjects and methods. A total of 1092 children ≤10 years old (average age 1.38 years) diagnosed as having AOM between 2002 and 2004 were studied. Bacterial and viral cultures of both nasopharyngeal secretions (NPS) and middle ear fluid (MEF) were performed for all 1092 children. Body temperature, changes of the tympanic membrane, and the number of days from the onset of illness were analyzed. Results. Respiratory viruses were detected in 360 of 1092 NPS specimens, including 157 isolates of respiratory syncytial virus and 88 of influenza virus. Among 1092 MEF specimens, 102 were virus-positive, including 43 for respiratory syncytial virus and 29 for influenza virus. In 75 children, respiratory viruses were only detected in MEF. The viral detection rate was higher in children with fever at an early stage of their illness. The tympanic membrane changes associated with viral infection tended to be less severe, while changes were more severe in cases with bacterial infection, especially co-infection with bacteria and viruses.

Detection of human metapneumovirus from children with acute otitis media.

Nasal and middle ear specimens collected from children with acute otitis media were subjected to viral isolation and bacteria culture. All virus-negative specimens underwent reverse transcription polymerase chain reaction to detect human metapneumovirus. Three of 126 middle ear specimens were positive by this assay.

Audiometry with nasally presented masking noise: novel diagnostic method for patulous eustachian tube.

Objective: Nasal-noise masking audiometry was developed to assess the acoustic transfer function from the nasopharyngeal cavity to the middle ear via patulous eustachian tube (ET). Study Design: Prospective. Setting: Tertiary referral center. Patients: Twenty-seven ears of 18 patients with patulous ET and 20 ears of 10 healthy subjects with no history of ear disease or complaints of aural symptoms. Main Outcome Measures: Audiometric measurement was conducted with and without masking noise presented in the nasal cavity. Results: The masking effect of nasally presented noise caused elevation of the threshold for the tone presented in the external auditory canal. This threshold elevation was significantly greater, particularly in the lower-frequency region, in ears with patulous ET and was decreased to the normal range after obstructive treatment of the patulous ET. Conclusion: Nasal-noise masking audiometry is a simple and effective way to identify patulous ET.

Is Change in Middle Ear Air Volume Following Ventilation Tube Insertion a Reliable Prognostic Indicator

Ninety ears (52 patients, aged 3-11 years) affected by secretory otitis media (SOM) were treated by insertion of a ventilation tube (VT). Following VT insertion, the middle ear air volume of these ears was estimated by using an impedance audiometer, at 1, 3, and 6 months postoperatively, and every 6 months thereafter. The middle ear air volume, expressed as the compliance value, increased rapidly for the first 3 months, followed by a gradual increase thereafter. A great difference was observed among the compliance values of ears, ranging from over 10 cc to below 1.5 cc at 6 months, postoperatively. Twelve percent of the ears had compliance values of less than 1.5 cc, and in this group, CT showed opacified and poorly developed mastoid cells. Although the association of upper respiratory disorders such as chronic sinusitis, nasal allergies and cleft palate were found to be more frequent in cases of ears with smaller compliance values, this was not statistically significant. Small compliance values (middle ear air volume) were correlated with the early onset of acute or secretory otitis media, repeated otorrhea after VT insertion and high recurrence rates after the extrusion of the VT.

Metastasis of gastric adenocarcinoma to the parotid gland.

A 72-year-old-man had had total gastrectomy in 1983 for stage III gastric adenocarcinoma. In October, 1986 dull pain in the right parotid area and facial weakness were noted. Three months later, he was found to have a hard mass approximately 20mm in diameter in the parotid region. Partial parotidectomy was performed Febrary 16, 1987. Histological examination revealed a well-differentiated adenocarcinoma which was identical to the pattern of the gastric cancer.The clinical features and differential diagnosis of metastatic lesions to the parotid gland are discussed with a review of the literature.